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Perceived Preparedness of Internal Medicine Interns for Residency and the Value of Transition to Residency Courses – Cureus

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Perceived Preparedness of Internal Medicine Interns for Residency and the Value of Transition to Residency Courses - Cureus

Remembering Vice Adm. Michael Cowan, the 34th Surgeon General of Navy Medicine (2001-2004) – American Military News

On December 10, 2023, Vice Adm. Michael L. Cowan, the 34th Surgeon General of the Navy died. He was 78.

Vice Adm. Cowan served in a wide-variety of clinical, operational, staff and leadership positions over the course of his 33-year career. His career culminated in 2001 with his selection as the 34th Surgeon General of the U.S. Navy and Chief of the Bureau of Medicine and Surgery (BUMED).

Cowans career legacy includes pioneering the concept of Force Health Protection, redefining deployable medicine in the 21st century, and serving as the Navy Surgeon General during the attacks on September 11th, 2001, and the start of the wars in Iraq and Afghanistan.

It could be stated that medicine was always in the sights of the Fort Morgan, Colorado native. Following pre-med at the University of Colorado at Boulder and after attending medical school at the Washington University School of Medicine, Cowan went to Temple University to study internal medicine and hematology under his mentor Dr. Sol Sherry (1907-1983). Sherry was already a medical giant whose research led to the development of clot-dissolving drugs to treat heart attacks. Cowan envisioned following in Sherrys footsteps and spending his career in academic medicine, but all that would change in 1971 when he was drafted into service.

At the time I was a free spirit, related Cowan. My hair was too long, and I could have put it into a ponytail. I had the attitude that most people had in 1971 about the militaryI was very anti-war, anti-military. I really knew nothing about the military, and everything I thought I knew was wrong.

Although he entered the Navy, as he later jokingly remarked, kicking and screaming, he was soon hooked. While serving as a general medical officer at Naval Hospital Camp Lejeune, N.C., Cowan learned the important role the Navy played in supporting the Marines. I particularly took pride that I was taking care of these young men and women who were serving their country, said Cowan. And it felt good as a physician to know that I didnt have to worry about their insurance. The phrase I always used was, I didnt have to ask them how sick they could afford to be. My job was just to take care of them to the best of my ability, and my paycheck didnt depend on anything else.

Camp Lejeune would remain a special place for Cowan throughout his career. Just over twenty years after entering the Navy, while serving as the Commanding Officer of Naval Hospital Camp Lejeune (1993-1996), he was selected for flag rank.

In 1972, Cowan continued his residency in internal medicine followed by a hematology/oncology fellowship at the National Naval Medical Center (NNMC) in Bethesda, Maryland. It was at Bethesda that his love for Navy Medicine was born, and his decision to stay in the Navy was made.

I was at a change of command ceremony at Bethesda, and as the band started playing the march, as the flags came in, I got a tingle, recalled Cowan. As we were standing at attention in front of the flags about to witness this time-honored, old military ceremony, the hair on the back of my neck went up and I thought, Okay, thats it, thats the answer to my friends question as to why I stay in. The hair on the back of my neck goes up and Im reminded of what this is all about.

Over the ensuing years, Cowans love for the Navy and his role as, he described it, a physician-leader continued to grow. He served as Chief, Internal Medicine, at Naval Hospital Rota, Spain (1975-1976), and Chief of Clinical Investigations for the Navy Malaria Vaccine Research Program at the Naval Medical Research Institute (forerunner of todays Naval Medical Research Command) (1979-1982).

In 1982, Cowan was selected by Dr. Jay Sanford (1928-1996), president of the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, Maryland, to serve as the schools Deputy Director of Operational and Emergency Medicine in the Department of Military Medicine. In this position, Cowan taught the military medicine course and led fourth-year medical students through the Bushmaster exercise. It was a role that would leave an indelible mark on hundreds of future military physicians.

In Bushmaster, we wanted to push people to their limits in a controlled way, explained Cowan. It was a leadership lab that tested what people are really made of when they are really tired and frustrated and just dont think they can do it anymore. Over time we learned how to push people to grow, but in the early days we didnt know how far to push.

On one of his earliest Bushmasters, Cowan, Dr. Sanford, and his team of instructors, started a drill at eleven oclock at night after the students had had a long day. We simulated an attack on the camp with boomers and machinegun fire, recalled Cowan. They were supposed to respond, but they didnt come out.

Cowans team then threw several tear gas canisters around the tent. But still no response. Dr. Sanford slowly walked over, picked up the tent flap, kicked a tear gas canister under the tent flap and walked to the observation area. Still nothing. Cowan and Sanford then turned to each other and at that point knew they had overworked the students and called it a day. The students had just had it, so they had put their gas masks on, pulled their sleeping bags up over themselves the best they could, and just stayed there, recalled Cowan. They slept in their gas masks.

One of his students forever impacted by Cowan and the Bushmaster was Vice Adm. (ret.) C. Forrest Faison III, the 38th Surgeon General of the Navy and a USUHS graduate.

I dreaded this course all four years [at USUHS], recalled Faison. Over the next two weeks we started running back-to-back mass casualty, and combat scenarios. Youre doing this around the clock, and youre exhausted. Then comes the main event, which is a main mass casualty drill where they wrap it all together, and were so sleep deprived. Its hot, its muddy, and its just nasty. And we get through the scenario and were doing a hot wash, and Admiral Cowan gets up there and he goes, Youre cold, youre wet, youre tired, youre hungry. So why do you do it? You do it because that guy on the stretcher is depending on you to do it. And his family back home are depending on you to do it. And its the right thing to do.

Cowans time leading the Bushmaster would follow him throughout his career, even to distant places around the globe. While serving as Task Force Surgeon, Operation Restore Hope in Mogadishu, Somalia (1992-1993), Cowan recalled that many of his former students were serving as medical officers in Marine units and as command surgeons. I was able to delegate far more and had far more confidence in the abilities of these folks than I ever would have if they never had that field experience.

It was in Somalia that Cowan also recognized the unique values of each service, a piece of knowledge that would later serve him well as Joint Staff Surgeon (1997-1999); Chief of Staff, Office of Assistant Secretary of Defense for Health Affairs, The Pentagon (1999-2000); and Deputy Director and Chief Operating Officer, TRICARE Management Activity (2000-2001).

Cowan took the helm as the 34th Surgeon General of the Navy in August 2001. He was on the job for just 30 days when the attacks on September 11th occurred. Instantly, the world had changed, and Navy Medicines course would forever be altered to meet the new challenges ahead. He recalled, On September 11th, I walked to my desk about 10:30 in the morning and threw [my priorities] in the trash can. Priorities had just changed.

Within 24-hours of the attack Cowan updated the Navy Medicines motto from Standing by to assist to Steaming to assist and deployed the hospital ship USNS Comfort to New York City where it served as a relief valve for the rescue workers.

Primary care and physical therapy and messmen and general duty hospital corpsmen boarded he Comfort, and they steamed up to New York, related Cowan. While there they provided up to 1,000 people a day [with] hot meals, a shower, a berth, and laundry service. So, youd go aboard, theyd take your dirty laundry, feed you, put you to bed, give you a shower, wake you up, give you your clean clothes back, or new clothes, and send you back to work. We took criticism for that. There were people who thought that that was an undignified mission for a war ship of the United States Navy and I shouldnt have done that.

Yet, it had a positive impact.

A year later, while attending a reception for exercise BALTIC OPERATIONS (BALTOPS 22), he walked over to a group of Navy messman to congratulate them on doing a nice job. As we were talking and laughing, I said, By the way, how many of you were on the Comfort last year? And most of the hands went up, said Cowan. And this one kid, a 22-year old, kept trying to put his hand up and the others kept slapping him down, good naturedly. He said, I was on the Comfort in New York, but I wasnt crew. I was a New York City fireman. After seeing what the Navy did in New York I was so impressed that I joined the Navy under the condition that I become a messman assigned to the Comfort.

Admiral Cowan was a soft-spoken, caring, and impactful leader who always saw the bigger picture and thought outside the box, said Rear Adm. Darin Via, the 40th Navy Surgeon General. He was way ahead of his time and Navy Medicine is stronger because if him.

One of Vice Adm. Cowans greatest legacies was a humble leadership and his trust of others. This is captured when describing his philosophy of service:

I think a big part of my philosophy was formed by a phrase my dad used to use that I really glommed onto. He said, Your life finds you far more often than you find your life, stated Cowan. Had I not been drafted I never would have come into the military. I would have been an academic, probably stayed at Temple [University] . . . That would have been my life, and I would have been very happy. But this detour happened, and it became a better life, one that I would have never sought after and the direction of that detour I would have never sought out. My whole life found me almost against my will.

So, when people, young officers in particular, ask me, Can you give me some career advice? I say, I will, but its not going to be very good. What Im going to tell you youve got to take with a grain of salt. I tell them, Just dont worry about it. The one thing you must do in life is to do your job. No matter what job youve got, do the hell out of it and then position yourself to try to get jobs you enjoy doing. If you enjoy a job, youll do it well; if you dont enjoy your work, then life isnt worth living.

Admiral Cowan was predeceased by his wife of 60 years, Linda, and son Dr. Mark Cowan, both passing earlier this year.

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Remembering Vice Adm. Michael Cowan, the 34th Surgeon General of Navy Medicine (2001-2004) - American Military News

Enhancing the Comprehensive Integration of General Medicine Education in Rural Japan: A Thematic Analysis – Cureus

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Please choose I'm not a medical professional. Allergy and Immunology Anatomy Anesthesiology Cardiac/Thoracic/Vascular Surgery Cardiology Critical Care Dentistry Dermatology Diabetes and Endocrinology Emergency Medicine Epidemiology and Public Health Family Medicine Forensic Medicine Gastroenterology General Practice Genetics Geriatrics Health Policy Hematology HIV/AIDS Hospital-based Medicine I'm not a medical professional. Infectious Disease Integrative/Complementary Medicine Internal Medicine Internal Medicine-Pediatrics Medical Education and Simulation Medical Physics Medical Student Nephrology Neurological Surgery Neurology Nuclear Medicine Nutrition Obstetrics and Gynecology Occupational Health Oncology Ophthalmology Optometry Oral Medicine Orthopaedics Osteopathic Medicine Otolaryngology Pain Management Palliative Care Pathology Pediatrics Pediatric Surgery Physical Medicine and Rehabilitation Plastic Surgery Podiatry Preventive Medicine Psychiatry Psychology Pulmonology Radiation Oncology Radiology Rheumatology Substance Use and Addiction Surgery Therapeutics Trauma Urology Miscellaneous

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Enhancing the Comprehensive Integration of General Medicine Education in Rural Japan: A Thematic Analysis - Cureus

James Murray named head doctor at Confluence Health – Source ONE News

WENATCHEE Confluence Health has officially named Dr. James Murray as its new Chief Medical Officer (CMO), marking a significant leadership transition for the healthcare system. This decision follows a thorough evaluation by the Confluence Health Board.

Previously holding the position of interim CMO since July 2023, Dr. Murray steps into the permanent role, succeeding Dr. Jason Lake. His extensive background in medical practice and healthcare leadership positions him as a key figure in advancing Confluence Health's mission of delivering exemplary local healthcare.

"Dr. Murray brings many years of experience to this position, not only in medicine and healthcare leadership, but in understanding our community and its needs," said Dr. Jennifer Jorgensen, president of the Wenatchee Valley Medical Group, the largest physician group affiliated with Confluence Health.

Dr. Murray's medical credentials are robust. He is board certified by the American Board of Internal Medicine and joined Confluence Health in 2005. His academic foundation includes a medical degree from Loyola University and a residency in internal medicine at Grand Rapids Medical Education and Research. Dr. Murray's career at Confluence Health has been marked by his roles in critical care and medical education, including serving as the medical director for inpatient medicine and for specialty and ancillary medicine.

"I am in full support of the Confluence Health Boards selection and know that Dr. Murrays years of leadership experience and the respect he has earned among his colleagues will make him an excellent CMO," Dr. Andrew Jones, CEO of Confluence Health, commented. He praised Dr. Murray's adept handling of the interim CMO responsibilities, emphasizing his rapid adaptation to the challenges and opportunities within the healthcare system.

Confluence Health's medical networth covers a vast region of over 12,000 square miles across Okanogan, Grant, Douglas, and Chelan counties.

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James Murray named head doctor at Confluence Health - Source ONE News

The Analysis of Job Satisfaction of Health Practitioners in Saudi Arabia: Determinants and Strategic Recommendations … – Cureus

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Please choose I'm not a medical professional. Allergy and Immunology Anatomy Anesthesiology Cardiac/Thoracic/Vascular Surgery Cardiology Critical Care Dentistry Dermatology Diabetes and Endocrinology Emergency Medicine Epidemiology and Public Health Family Medicine Forensic Medicine Gastroenterology General Practice Genetics Geriatrics Health Policy Hematology HIV/AIDS Hospital-based Medicine I'm not a medical professional. Infectious Disease Integrative/Complementary Medicine Internal Medicine Internal Medicine-Pediatrics Medical Education and Simulation Medical Physics Medical Student Nephrology Neurological Surgery Neurology Nuclear Medicine Nutrition Obstetrics and Gynecology Occupational Health Oncology Ophthalmology Optometry Oral Medicine Orthopaedics Osteopathic Medicine Otolaryngology Pain Management Palliative Care Pathology Pediatrics Pediatric Surgery Physical Medicine and Rehabilitation Plastic Surgery Podiatry Preventive Medicine Psychiatry Psychology Pulmonology Radiation Oncology Radiology Rheumatology Substance Use and Addiction Surgery Therapeutics Trauma Urology Miscellaneous

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The Analysis of Job Satisfaction of Health Practitioners in Saudi Arabia: Determinants and Strategic Recommendations ... - Cureus

Top docs of 2023and what it takes to be one – MD Linx

It takes grit and determination to become one of the best doctors in the US, as well as fierce dedication to compassionate patient care. Some common themes of being named the "best of the best" include taking advantage of opportunities, strong working relationships with nurses and other HCPs, speaking out for the safety of patients and staff, practicing self-care, and maintaining a knowledge base.[]

Here are some of the years best US physicians according to those who rank them, including what it takes to garner a coveted spot on a year-end, best-of list.

Castle Connolly

With more than 30 years in the game, Castle Connolly has raised the bar as a credible source of top doc data.[]

These doctors represent the top 7% of physicians in the country, as rated by their peers. Here are a few doctors who made the cut this year.

Dr. Manjeet S. Chawla, Chicago, IL, medical oncologist, Thorek Memorial Hospital, Saint Anthony Hospital, Chicago

Dr. Lucy M. McBride, Washington, DC, internal medicine, Foxhall Internists

Dr. Jeffrey R. Leonard, Columbus, OH, neurosurgeon, Nationwide Children's Hospital, The Ohio State University Wexner Medical Center

Dr. Holly Salzman, San Diego, CA, family medicine, UC San Diego Medical Center, Rady Children's Hospital

Castle Connolly collects data from the National Provider Identifier Registry (NPI), and collaborates directly with hospitals and physicians to come up with names for their Top Doctors list. The sites dedicated physician portal allows doctors to update their profile to have the best chance of being considered for the year-end list.

Top doctors are nominated by their peers and vetted by the Castle Connolly research team based on professional qualifications, hospital and faculty appointments, education, research leadership, professional reputation, interpersonal skills, disciplinary history, and outcomes data.

Castle Connollys focus on diversity

Castle Connolly recently debuted Top LGBTQ+ Doctors 2023, which recognizes exceptional physicians in the LGBTQ+ community who have exhibited outstanding expertise, patient care, and contributions in the field of medicine.

The 64 names on this list include physicians from 22 states across 34 specialties.[]

Being an LGBTQ+ physician adds a powerful dimension to their ability to serve patients because LGBTQ+ doctors embody visibility and representation, inspiring hope and confidence in their patients, says Alex Sheldon, Executive Director of GLMA (which partnered with Castle Connolly to produce the list). Having health professionals who understand the unique health needs of LGBTQ+ communities first hand is invaluable for fostering trust and achieving better health outcomes."

"Their visible presence challenges societal norms, breaks down barriers, and inspires future generations of LGBTQ+ physicians, creating a transformative ripple effect within the medical field."

Alex Sheldon, executive director of GLMA

The new distinction is part of Castle Connollys Diversity Equity and Inclusion (DEI) Initiative designed to celebrate physicians from diverse backgrounds and walks of life. To come up with the list of winners, Castle Connolly mined their current Top Doctors list. These doctors voluntarily shared information about their race/ethnicity, gender identity, and sexual orientation.

Other 2023 DEI initiatives include Top Black Doctors, Exceptional Women in Medicine, Top AAPI Doctors (Asian American and Pacific Islanders), and Top Hispanic/Latin Doctors.

The American Health Council

The American Health Council issues an annual Best in Medicine list of those who master the key roles that drive patient careadvocate, collaborator, communicator, decision maker, expert, manager, scholar.[]

The awards come in two flavors. First, the Leader in Medicine award is for physicians who have demonstrated exemplary conduct in their field and includes medical educators and clinicians who lead by example and inspire change.[]

The following are some Leader in Medicine winners:

James Kennedy, MD, MPH, FACEP, emergency physician, Quest Care/OU Medical Center

Dr. Keith A. Perry, medical director of Precision Pain Treatment Clinic in Smithfield, RI

Lawrence S. Miller, MD, Chief and Chairman of the Department of Orthopaedic Surgery at Cooper University Hospital and the Cooper Medical School of Rowan University

M. Scott Lucia, MD, associate professor and Chief of Genitourinary and Renal Pathology at the University of Colorado School of Medicine, Denver, CO

Here are some Award of Excellence winners:

Mohamad Jaafar, MD, professor and Chief of Ophthalmology, Childrens National Health System

Richard Nugent, MD, Clinician, CenseoHealth

Joshua Meyerson, MD, MPH, medical director, Health Department of NW Michigan

Nicholas Smyrnios, MD, ICU medical director, UMass Mememorial Medical Center

These physicians are recognized for their admirable character, selfless dedication, and outstanding effort. Perpetually raising the bar for all, they help establish a higher standard quality of care, per the American Health Council website.

What this means for you

To be honored as a top physician of the year is a remarkable achievement. Physicians who garner such accolades typically represent the full package: They not only help their patients but also their peers and community, leading by example with complete dedication to their craft.

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Top docs of 2023and what it takes to be one - MD Linx

Another Medical Society Turns Up the Heat on MOC – Medpage Today

The Infectious Diseases Society of America (IDSA) urged the American Board of Internal Medicine (ABIM) to make substantial changes to its maintenance of certification (MOC) requirements in a letter published Thursday.

"We assert the current ABIM MOC program is not a good metric for measuring ongoing competence in the field, and it should be reexamined and modified to meet the current demands of the workforce," IDSA president Steven Schmitt, MD, of the Cleveland Clinic, wrote in the letter to ABIM President and CEO Richard Baron, MD.

"We strongly request that corrective action be taken and substantive changes be made to the program that address the important concerns of the ID community," Schmitt wrote in the letter, which was published in Clinical Infectious Diseases.

IDSA asked ABIM for several reforms, including a reduction in MOC fees, changes in the Longitudinal Knowledge Assessment questions (an alternative to the 10-year board exam), and eliminating redundant continuing medical education (CME) requirements.

In September, IDSA conducted a member survey about MOC requirements that garnered more than 800 responses. Overall, it revealed that the "majority of physician respondents reported the MOC program adds no clinical value, does not positively impact clinical practice, and contributes to burnout," Schmidt wrote.

In the survey responses, over 80% agreed with the following statements about MOC: "time required is a burden," "annual cost is a burden," and "points and assessment are a burden." Nearly 70% disagreed that MOC "positively impacts my clinical practice."

The IDSA's letter comes amid wider criticism of and pushback against MOC. Four cardiology societies announced in September that they planned to break away from ABIM and create a new, separate board for cardiovascular medicine.

Oncologists have also been questioning MOC, with the American Society of Clinical Oncology launching a member survey earlier this year to better understand their membership's feelings about certification. The American Society of Hematology also sent a letter to Baron, urging "immediate action" to establish a new and improved MOC program.

Baron announced earlier this year that he plans to retire in September 2024.

Critics have argued that there is limited evidence that MOC improves physician performance and patient outcomes. Previous MedPage Today reporting has shown that some specialty boards can be lucrative businesses, complete with highly paid executives and luxury trips.

Among IDSA's criticisms of the MOC program were its clinical relevance and the time and cost burden of the MOC exams and points system.

Infectious disease in particular has become increasingly more specialized, with a focus on certain diseases or populations, the letter stated. "Rather than issue a standardized, one-size-fits-all set of assessment questions and activities, it would be more relevant to allow physicians to be self-directed in their learning, requiring instead that they partake in a specific number of hours or credits in their medical educational training of choice," it said.

Cost, too, can be a problem, the letter noted. "ID physicians are among the lowest paid physicians in the United States, and the current MOC fees are cost-prohibitive for our members overall -- and particularly so for those early in their careers."

In general, to maintain board certification for internal medicine and infectious disease, physicians must take either a long assessment every 10 years, or a shorter test of 120 questions each year, and earn 100 MOC points every 5 years through CME activities, among others. These are requirements that can take anywhere from 25 to 62 hours per year, the letter stated.

In the specialty, physicians may have to maintain both internal medicine and infectious disease board certification, which can total as much as $4,100, according to the letter. Physicians are also responsible for costs associated with CME courses.

Though board certification is not always needed to practice, employment for many physicians is contingent on this credential, which many hospitals and insurers require.

Sophie Putka is an enterprise and investigative writer for MedPage Today. Her work has appeared in the Wall Street Journal, Discover, Business Insider, Inverse, Cannabis Wire, and more. She joined MedPage Today in August of 2021. Follow

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Another Medical Society Turns Up the Heat on MOC - Medpage Today

The future of mRNA biology and AI convergence – Drug Target Review

In the rapidly evolving landscape of mRNA biology and artificial intelligence (AI), Anima Biotech stands at the forefront, a unique approach that reshapes our understanding of diseases and transforms the drug discovery process. mRNA biology holds immense potential with RNAi drugs in the market and mRNA vaccines showing promise, particularly in cancer trials.

mRNA biology has become widely recognised as a new drug mine. RNAi drugs are in the market and mRNA vaccines, initially developed for Covid-19, are already in trials for cancer. mRNA is an intermediate form that codes the instructions for making proteins but the biology around its regulation is not well understood and is still an uncracked code. Complex regulatory pathways move mRNAs through their life cycles and control when, where, and how much of each individual protein is made. Examples of such mechanisms include RBPs, splicing, and relocalisation of mRNAs among many others. All of these are novel targets to be explored in small molecule drug discovery as well as for improving the efficacy of mRNA vaccines.

However, our inability to understand that biology is what stands in the way of further progress. And really, this comes to the biggest question of all: what is the underlying mechanism of a given disease? There must be something different in those diseased cells, some dysregulated pathway that is causing that disease phenotype. And since mRNA biology is like the highway of cell biology, it would likely be visible there. And this is exactly where AI can provide us with an extremely powerful new strategy. The elucidation, or decoding of complex biology is becoming possible with AIs ability to process large amounts of visual data and recognize patterns in images. We could use it to identify the underlying disease mechanism, the dysregulated pathway, or as we call it at Anima, the disease signature.

AI has become very capable in both understanding and generating images. So, you could capture images of live mRNA biology from millions of diseased and healthy cells and have an AI neural network trained to recognize the differences. It would see in the images the pathway that tells the diseased cells apart from the healthy ones, essentially elucidating the disease mechanism. You could then use large language models to research all available knowledge around that pathway and novel drug targets. This is where I see things going: using AI to process vast amounts of data coming through images taken from live biology of a disease model, identify what is causing the disease, the disease signature, and then have AI suggest targets along that pathway. You can then screen molecule libraries to find modulators of the underlying disease biology. So, as you can see, AI has the potential to completely transform the process by visualising and decoding disease biology.

What we are doing at Anima is applying our proprietary mRNA biology visualization technologies to generate millions of images of mRNA regulatory pathways in disease models. We feed them to our AI mRNA Image Neural Network which has been trained on over 2 billion such images, proprietary data that came from our projects across a decade. We pinpoint the disease mechanism and then apply our mRNA knowledge graph and our mRNA biology LLM, an augmented large language model that we built around mRNA knowledge. This elucidation of underlying disease biology is now happening at the beginning of a drug discovery process, rather than being tried at the end of it. For a very long time, companies had to choose between two very different approaches to drug discovery. The first approach is to come up with a proposed target and screen against that protein. The problem here is that you are betting on the target to have an effect on disease phenotype.

When drugs fail in the clinic it is mainly because we do not understand the disease mechanism. The target that was chosen is the secret switch to turn off the disease phenotype. So, this betting on a target is a real problem and for many diseases, we are still in the dark with regards to what is the real cause and do not understand the full biology. An alternative approach is phenotypic screening and there, you basically screen many molecules and look for those that reverse the phenotype. You dont know the target and you are not betting on one. So, this approach has the advantage of being completely unbiased but its big downside is that you dont have any prior understanding of the biology and even after you find some active molecules, it is still very hard to elucidate their mechanism of action and molecular targets.

Our mRNA Lightning platform represents a game changer that solves this fundamental problem. It retains the advantages of phenotypic screening, but it starts with an elucidation of disease biology. The process starts with an analysis of the disease in our mRNA knowledge graph, suggesting pathways that are most relevant to the disease. These become proposed disease mechanisms, pathways regulating mRNA biology. We then go into actual cells that are disease models. We take millions of images in a fully automated lab, and we give them as training data to our AI image neural network. It looks at the images of these proposed pathways and finds the one that shows the biggest change. That becomes the pathway that we will be targeting.

Notice that it will give you this pathway not from a couple of publications and a handful of experiments It will look at the results of millions of single-cell experiments running in parallel and will recognize the common pattern. It will suggest a few alternatives by ranking possible pathways. Now we have a specific biological pathway to go after. We proceed with drug discovery by screening against actual disease mechanisms, the disease signature. We are looking for molecules that modify the image of the pathway in diseased cells, so they now look like the images coming from healthy cells. We are seeing that the exact pathway that we confirmed is the difference, so we have a preconceived notion of the MOA already. The molecules that are coming out of the screen as active compounds now can go through a rapid iterative process where biologists work with other major elements of the AI in our platform, namely the mRNA biology LLM and the Lightning copilot working together in our MOAi technology. It looks at the results and suggests confirmatory experiments to identify the molecular targets of compounds and this typically converges at a fraction of the time that it typically takes to identify the MOA of drugs. It is because we have identified the disease mechanism at the beginning of the process rather than attempting to elucidate it in the end.

The technology that got us started was the ability to visualize the translation of mRNAs into proteins. This was TranslationLight, enabling for the first time to see in images where, when, and how much of the mRNA is translated. In version 1.0 we were leveraging this technology in order to identify molecules that modulate mRNA translation. We would basically look for compounds that affect the light. Molecules that were decreasing the light were inhibiting translation. If they increase the light, they increase translation. It was a very different readout that enabled us to run what seemed like a phenotypic screening but instead of being run in the dark it was running in the light because we were watching an actual major biological process, the translation of mRNAs. We are talking 2013 here so that was a decade ago. Since then, we have generated over a billion of such images from many disease models and cell types. We also built our first automated mRNA biology lab that was running those millions of experiments in cells and taking all these images, uploading them to the cloud for analysis. We built a lot of computational biology stuff to analyse them in order to identify active ones.

Our lead program in lung fibrosis emerged as a strong showcase of how all this worked. All this encouraged us to develop additional visualisation technologies and led to TranscriptLight, over a dozen visualisation technologies that enabled us to see mRNA transcripts, being it single or multiple. Now with this, we have expanded our capabilities to identify compounds that affect anything along the life cycle of mRNA, mRNA biology modulators. We would screen our libraries and see in images the effect of hit molecules on the mRNA, across its life cycle. By doing that we again expanded our image dataset, reaching nearly 2 billion images, the worlds largest dataset of mRNA biology visualisations. We also developed dozens of MOA assays that basically were the other side of these visualisations, experiments that would enable us to look at what a compound is doing and compare it to those known behaviours.

We expanded our automation in our tera-scale lab. Consider that all this was in 2020 and AI was still on the side lines as an experiment. But it became clear to us that we are generating a very large dataset of mRNA biology images, the only one in the world in fact and that has tremendous value. We started to consider how we could use AI to make sense of that data. In Lightning 2.0, we introduced MOAi, a technology that used AI to elucidate the mechanism of action of AI. In Lightning 2.0, we introduced MOAi, a technology that used AI to elucidate the mechanism of action of AI. The idea was that AI would take all evidence collected from the screen and advise biologists on the sequence of experiments to rapidly discover how compounds work. This was a big thing because we leveraged AI to tackle the biggest problem of phenotypic screening, to identify the MOA of hit compounds.

We would actually start doing that very early, right after the hit stage of the screening and it would run along the project by leveraging all the data. But it wasnt until 18 months ago that the full power of AI could be brought into the platform in a way that is a game changer. And that came in Lightning 3.0 with the development of PathwayLight, the ability to visualise mRNA biology regulatory pathways. That was a turning point in the development of the platform. We could for the first time visualise disease mechanisms. We turned back to the dataset of the images we had, and we saw that for a given disease, we could train a neural network on images of diseased and healthy cells, use PathwayLight to see all different pathways, and identify the one that is dysregulated in the disease. The AI image network proved to be very effective in identifying these disease signatures. We then looked back at the vast amount of knowledge that we have collected over a decade around mRNA biology.

We decided to create the worlds first mRNA biology knowledge graph and apply LLM technology to interact with it. Earlier this year we incorporated into the platform the first generation of these technologies. So, with Lightning 3.0 what you are basically seeing is AI everywhere: there is AI on the imaging side, used to identify disease signatures, enabling us to screen against disease-relevant biological pathways. Then there is the mRNA knowledge graph and the LLM that is used to query that, and the Lightning co-pilot is a chat interface across the whole system that biologists can use to interact with all that data. It all comes together in Lightning 3.0 in the form of three applications: target discovery, drug discovery, and MOA discovery. Going forward we will continue to expand and integrate these three major applications.

Understanding the mechanism of action of drugs is a decades-long problem. There are many drugs for which the MOA has never been elucidated. Some companies have recently applied high-scale imaging and AI analysis technologies. They are looking for compounds that modify the image of diseased cells to look more like the healthy ones, but you are left with that problem. This seems much like what we have been talking about here but in fact, is different in a fundamental way. Cell morphology images do not provide any immediate biological meaning in the context of disease biology. What we are doing is very different. We are visualising the pathways in mRNA biology and not cell morphology. We identify the disease signature and find compounds that directly modulate that pathway. So, when we turn to the challenge of figuring out how these compounds are working, their MOAs, we already have a pretty good understanding and an inherent rationale for that. If they show that then the image of the disease signature is modified from an image of diseased cells to healthy ones, and the mechanism of action and molecular targets must be around that pathway.

This fact is changing the game because now we have a pathway that we can study. You have a compound, and you have a hypothesis for the pathway it is working through. What you really need now is to figure out which experiments you must run to quickly understand which protein along the pathway could be the molecular target. You have a much small number of candidates, but it could still be hundreds of experiments in trial and error. They generate a lot of information and understanding all of these results and figuring out what to do next is still a big challenge. So, this is the 3rd place where AI is applied in the platform. MOAi takes the pathway and goes back to the knowledge graph. It then devises a strategy that is basically to decide on the sequence of experiments to conduct in order to move the MOA elucidation process forward. At each step, an experiment is conducted, and the results are brought back into the system. The information is brought back into the knowledge graph, expanding the original knowledge with actual results. This in turn makes the model look at all the data and suggest the next experiment. But doesnt do this by itself or alone. We figured that LLMs are still highly experimental when it comes to their understanding of biology, so we created an architecture where MOAi is working through the Lightning co-pilot in a biologist-in-the-loop model. This means that biologists can ask the system for its suggestions for targets and experiments but can also suggest their own ideas and the system will evaluate them. The different MOAs are continuously ranked by considering the results from all experiments and you have like a compass visually gravitating to the north, which is the MOA. This is an iterative, creative process where biologists work with AI to elucidate the underlying mechanism of action but at the same time, it increases our understanding of the biology of the disease.

Our partnerships with Lilly, Takeda, and AbbVie, coupled with our 20 active drug discovery programs indeed validate our technology and our overall approach in mRNA biology drug discovery. What these companies have recognized right away is that our unique ability to visualize mRNA biology gives them a whole new strategy in the discovery of drugs against many hard targets. You are actually seeing the disease mechanisms and how they play out to differentiate healthy and diseased cells. They then realised that we are also capable to analyse all that information and decode this mRNA biology. It is a fundamentally different approach from the ones that all the other players in small molecule mRNA drugs are taking. No one can visualise and decode mRNA biology. We are also the only company in the space that has built a platform that brings AI to mRNA biology.

I like to call what we do mRNA biology AI and I believe that this approach can significantly impact the entire landscape of mRNA biology research and applications. It provides major new insights into underlying disease biology. AI neural networks that recognize disease mechanisms and can identify the pathway that has become dysregulated, the disease signature is a huge step forward in our understanding of what is causing a given disease. This has the power to us discover treatments for so many diseases. This is the most important thing. Regarding applications, our platform really covers the whole process from target discovery, through drug discovery to MOA discovery, bringing the superpower of AI to transform the drug discovery process. There are companies out there using AI to analyse publications. Thats computational and it is valuable, but I believe that the ability to visualize actual mRNA biology in disease cells and to be able to decode that biology is key because you are now bringing all this experimental data from the real world and again you are using the power of AI LLM with a knowledge graph to make sense of all of that data.

We were talking mostly about small molecule drugs but really the approach and the platform are applicable across any research into mRNA biology. We are seeing now mRNA vaccine companies coming to us as they want to use these capabilities to better understand the biology around synthetic mRNAs and how they interact with the regulatory mechanisms. By understanding this they can improve the efficacy of those vaccines. So, its really all about that fundamental thing, bringing the superpower of AI to mRNA biology, visualising disease mechanism and really decoding that underlying biology. It is applicable to the discovery of novel targets and new drugs and to the understanding of how they work. We are just in the beginning of using AI across computational and experimental and there is tremendous potential here. I think that this is going to be transformational to our understanding of diseases and to the development of new treatments.

About the author

Yochi Slonim

Co-Founder & CEO, Anima Biotech

A serial entrepreneur in software and biotech, Yochi Slonim has built multiple companies as a founder and CEO through all phases of growth all the way to IPOs and large M&A exits. As a Co-founder and CEO of Anima Biotech, he is driving the companys strategy and business development at the intersection of mRNA biology and AI.

Prior to Anima, Yochi was a co-founder of Mercury Interactive. As CTO and VP R&D from the companys early days, he created product vision and strategy and led a multi-product organisation of 200 developers.

In 2000, Yochi was founder and CEO of Identify. Yochi founded ffwd.me, a unique startup acceleration program where he led a team that worked with over 25 startups in diverse areas and technologies, developing strategy, products and go to market operations while raising multiple rounds of financing from VCs and private investors.

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The future of mRNA biology and AI convergence - Drug Target Review

The future of artificial breast milk, according to one lab – Quartz

Some 15 or so years ago, Leila Strickland was mother to a newborn struggling to breastfeed her weeks-old son, and quickly realized how difficult breastfeeding can be. Today, Strickland and her biotech company, Biomilq, are working to make the benefits of breast milk more accessible to mothers and their infantsby engineering it in a lab.

Breast milk has long been considered the highest standard for infant nutrition, linked to a myriad of benefits for both babies and nursing parents. Yet it remains difficult or unfeasible for many to breastfeed: at six months old, less than a quarter of US infants are breastfeeding as recommended.

When she gave birth to her son, Strickland was completing postdoc research in cell biology at Stanford University, and decided to focus on mammary cells, where little work had been done. By 2020, she hit a first-of-its-kind breakthrough: lab-grown mammary cells that were able to produce some of the nutrients found in human milk. Together with food scientist Michelle Egger she co-founded Durham, N.C.-based Biomilq to develop and scale the discovery.

Stricklands advance was made possible with the help of hundreds of volunteers who donated samples of their breast milk. She also landed $3.5 million in seed money from Breakthrough Energy Ventures, an investment firm founded by Bill Gates to fund innovations focused on climate change. It was a natural fit, given that infant formula made from cow milk is hardly sustainable: it uses an enormous amount of water and produces up to 5,700 metric tons of CO2 each year to feed just one baby.

Investment interest in Biomilq ratcheted up in 2022 when infant formula brands were recalled over safety concerns, sparking worldwide shortages. For her part, Strickland cautions that fully lab-grown milk will not be able to replace baby formula anytime soon. She and Biomilq have recently moved away from her original goal of creating milk individually tailored to one persons breast cells. Thats unrealistic because milk is incredibly complex, she says; its complex enough that there isnt even an agreed-on definition for it. Were now focused on developing certain key nutrients found in breast milk.

Biomilq plans to partner with manufacturers that can include its nutrients in their formula products, and Strickland says she expects to make a major announcement early in 2024. Shes hopeful, she adds, that Biomilq will have its first commercial product in three to five years.

This story is part of Quartzs Innovators List 2023, a series that spotlights the people deploying bold technologies and reimagining the way we do business for good across the globe. Find the full list here.

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The future of artificial breast milk, according to one lab - Quartz

Shedding new light on the hidden organization of the cytoplasm – News-Medical.Net

Back in 2018, the lab of Christine Mayr, MD, PhD, at Memorial Sloan Kettering Cancer Center (MSK) introduced the world to a key cellular component that had been hiding in plain sight.

Now the lab is back with important results that build on that discovery. New findings published in Molecular Cell provide details about the hidden organization of the cytoplasm -; the soup of liquid, organelles, proteins, and other molecules inside a cell. The research shows it makes a big difference where in that cellular broth that messenger RNA (mRNA) get translated into proteins.

"You know the old real estate saying, 'location, location, location.' It turns out it applies to how proteins get made inside of cells, too," says Dr. Mayr, a molecular and cell biologist at the Sloan Kettering Institute, a hub for basic and translational research within MSK. "If it's translated over here, you get twice as much protein as if it's translated over there."

This first-of-its-kind study highlights the degree to which the cytoplasm is "beautifully organized," rather than being just a big jumble of stuff, she says.

Not only do the findings shed new light on fundamental cellular biology, but the knowledge also holds promise for increasing or altering the production of proteins in mRNA vaccines and therapies, the researchers note.

The study was led by former lab member Ellen Horste, PhD, whom Mayr tapped for the daunting but exciting project when she joined the lab several years ago. Dr. Horste received her doctorate from the Gerstner Sloan Kettering Graduate School in June and now works for a gene therapy company.

When we started, we had a hard time getting funding for this project. Everyone thought isolating the individual components would be totally impossible. This was really Ellen's project from her first day in the lab to her last day. It was quite challenging, and I couldn't be more proud of her."

Dr. Christine Mayr, MD, PhD, at Memorial Sloan Kettering Cancer Center

Adapting an approach commonly used by immunologists, the team was able to color-code individual particles within cells using antibodies and then sort them by color. They used RNA sequencing to identify which RNAs were associated with which particles.

"And it was really striking to see that in each of these intracellular neighborhoods, very different types of mRNAs were being translated," Dr. Mayr says.

Most of the well-known components inside a cell have a defined shape and come wrapped in an exterior membrane: the nucleus, mitochondria, lysosomes, the Golgi apparatus.

Two of the key components at the heart of the Mayr team's study don't have membranes -; which is what has made them so hard to find in the first place, and a challenge to isolate and study in the lab.

A quick biology review: Cells build proteins using instructions encoded in DNA. Those DNA sequences are transcribed into mRNA inside the cell nucleus. These messenger RNA then move out into the cytoplasm where they are translated into a useful protein.

The new study demonstrated that where in the cytoplasm this translation step happens isn't random, and that there's an underlying logic or "code" that directs mRNAs to specific neighborhoods within the cell.

"The whole cytoplasm is nicely compartmentalized," Dr. Mayr says. "We were able to demonstrate there is a code at work that's based on the mRNA's biophysical features -; their size and shape -; and the particular RNA-binding proteins they partner with. This code directs the mRNAs to different locations for translation."

Through a painstaking series of experiments, the research team was able to show that mRNAs of different lengths and shapes tend to gravitate to specific neighborhoods. And that if you intervene to redirect them to a different location, it can have a profound impact on the amount of protein that gets produced and on the protein's function.

The researchers looked at mRNAs that locate to the surface of the endoplasmic reticulum (an organelle involved in protein synthesis and other cellular functions). It's well established that proteins associated with cellular membranes and those that get secreted by the cell for use elsewhere are translated there. The research revealed that nearly 15% of mRNAs that encode non-membrane proteins are also translated at the ER -; and they encode large and highly expressed proteins.

Meanwhile, the mRNAs that get translated in the cytosol (the liquid part of the cytoplasm) tend to be very small proteins.

And mRNAs that locate to TIS granules tend to be transcription factors (proteins that regulate the transcription of genes). TIS granules are a membrane-less cellular component Mayr's lab discovered in 2018. They form a network of interconnected proteins and mRNAs, and are closely allied with the endoplasmic reticulum, forming a distinct space where mRNA and proteins can collect and interact.

A fluorescent microscopy image of a cell, with TIS granules shown in red and the endoplasmic reticulum is shown in green. The central black area is the cell's nucleus.

Cracking the code for how mRNA localize to different locations revealed some surprising findings.

After discovering the TIS granule network five years ago, the lab had turned its attention to understanding which of the many thousands of mRNAs in a cell localize there, and whether they have shared characteristics.

The team homed in on one part of the mRNA that doesn't usually get much attention -; the tail. It's separate from the middle part of the mRNA, which contains the instructions for building the protein. Scientists call the tail the three prime untranslated region (3 UTR), and it turns out to be critical for the localization process.

"The tail usually contains a longer sequence than the part of the RNA that's actually used to make the protein," Dr. Mayr says. "But for a long time, people didn't pay that much attention to the tail regions since you can still make the protein without them." (They're also important in other ways, as Dr. Mayr outlined in a 2019 review article.)

It turns out that the tail is essential for partnering with RNA-binding proteins so that, together, the mRNA goes to the correct translation region within the cell. (RNA-binding proteins are a type of protein that attaches to RNA molecules and can modulate various aspects of their activity.)

At first the team thought it was primarily these RNA-binding proteins that directed the action -; guiding the mRNAs to neighborhood one, neighborhood two, and so forth, Dr. Mayr says.

"But the really surprising finding was that the RNA-binding proteins actually play a secondary role rather than a primary role in the process," she says.

The default sorting of mRNA to a location, the researchers found, is based on the overall size and shape of the mRNAs. But being in partnership with a binding protein can override this default and redirect them.

"Our data show that if you translate an mRNA in the TIS granules, the resulting protein will perform one function, and if you translate it outside of the TIS granules, it will perform a different function," she says. "And this is how, in higher organisms like us, one protein can have more than one function."

One specific protein the team examined during the study is MYC. The MYC gene is one of the more famous oncogenes, and mutations in MYC underlie the development of many cancers.

"We observed that several MYC protein complexes were only formed when MYC mRNA was translated in the granules and not when it was translated in the cytosol," Dr. Mayr says. "Our results show there's an important biological relevance to these neighborhoods, even when only about 20% of mRNAs get translated in the TIS granules."

Together, these insights suggest that mRNA could be targeted to achieve different functions, as well as to vary the amount of a protein that gets produced, she adds.

"So, we hope that in the future we can make smarter medicines by making more or less of a particular factor, and also by manipulating its function," Dr. Mayr says. "This probably won't happen in the next five years, but it's something we are paving the way to do."

Source:

Journal reference:

Horste, E. L., et al. (2023) Subcytoplasmic location of translation controls protein output. Molecular Cell. doi.org/10.1016/j.molcel.2023.11.025.

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