Anatomy

ABC/Brian Bowen Smith; ABC/Ed Herrera; ABC/Image Group LAABC/Brian Bowen SmithViola DavisWith How to Get Away With Murder coming to an end later this year, its time for Viola to hop onto another Shondaland show ASAP. Plus, shes already guest-starred on Scandal, so shes done a crossover episode before. We need to see Annalise Keating interact with Meredith Grey!ABC/Ed HerreraDax ShepardDax is currently on another ABC show, Bless This Mess, but we could definitely see him playing a patient on Greys and maybe falling in love with one of the doctors. Since Justin Chambers, aka Alex Karev, is leaving the show for good, Dax could be a new love interest for Jo! InstagramSophia BushA few of her fellow One Tree Hill co-stars have already guest-starred on the show Bethany Joy Lenz and Hilarie Burton so now its time for Sophia to join the Grey's family! We could definitely see her playing a new doctor on the scene.ABC/Richard CartwrightLisa KudrowLisa would be great at playing a visiting doctor from another accomplished hospital who comes in for a few episodes to stir stuff up. Not to mention, her appearance would be so fun for Friends fans.ABC/Kelsey McNealOliver HudsonOlivers ABC show, Splitting Up Together, was canceled last year, so they should keep the funny man in the ABC family and bring him over to Grey Sloan Memorial. Hes charming and sweet, which would make him a great patient.InstagramZendayaNot only is Zendaya a Greys fan herself, her Euphoria costar, Eric Dane, was on the show for many seasons. We could see the actress taking on an interesting patient storyline.ABC/Image Group LATaylor SwiftTaylors such a big Greys Anatomy fan, she even named her cat after Meredith Grey. She also gave acting a shot this year in Cats, so it could be another opportunity to show her abilities.ABCDiane KeatonGreys has a history of bringing in older, accomplished actresses Geena Davis, Faye Dunaway, and June Squibb, just to name a few and Diane would be a great addition to the list. We could definitely see her playing somebodys mother or grandmother. Maybe she could play Merediths aunt? So many possibilities!

Over the course of the past 16 seasons, Greys Anatomy has featured an incredible amount of guest stars. From Oscar-nominated actresses playing visiting doctors to up-and-coming stars showing their range as patients, the show has truly seen it all.

Now that were nearing the end of another season, its time to start thinking about the actors we want to see on the show in the future. Whether its a fellow ABC network alum or an iconic film star, check out the gallery above to see the actors we want to guest star in the future.

Grey's Anatomy, Thursdays, 9/8c, ABC

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8 Stars We Need to Guest on 'Grey's Anatomy' ASAP (PHOTOS) - TVInsider

Anatomy

The Anatomy of the Fiscal Year 2020 Budget – TheJambar.com

January 19, 2020 medical

By Amanda Joerndt

Youngstown State Universitys Fiscal Year 2020 Operating Budget showcases an overall 2.1% increase, $3,785,228, from the previous fiscal years budget.

Neal McNally, vice president of finance and business operations, said the budget is handled with the universitys overall financial health in mind at a YSU Board of Trustees meeting Dec. 4.

We think in order for the trustees to exercise their responsibility, we need to manage the overall finances of the university in such a way to ensure a balanced budget, McNally said.

YSU student wages and faculty labor agreements per the Ohio Education Association are two categories that fall under Provost Brien Smiths budget.

McNally said funds are assigned accordingly when departments request various actions in the budget.

The department chairs will bring requests to the deans, the deans would take the budget requests to the provost and typically those requests want to increase the number of faculty or they may have a retirement in one department, he said.

McNally said a portion of the provosts budget is almost exclusively tied to the labor agreements, particularly for faculty, resulting in a total of $693,147 allocated dollars for Ohio Education Association labor agreements, according to the Fiscal Year 2020 Operating Budget.

We have a three-year labor agreement for the faculty union, which is the Ohio Education Association, and their salary went up about 2.5% this year, McNally said. If weve hired somebody, were committed to covering their salary and benefits.

John Jakubek, a YSU Board of Trustees member, said some smaller variations in the budget dont always have to get approved through the board.

We dont have to approve each and every one of them, but the actual budget every year we do, he said.

Jakubek said having a shared governance is the most important step when having open communication with different departments.

I think when you look at the strategic plan thats being put together and so forth, we have to align the strategy, what we need to accomplish and the dollars that we have and how we can best use those dollars to achieve those goals. Shared governance plays a big part in that, Jakubek said.

Additionally, the Ohio minimum wage increased from $8.55 to $8.70 in January 2020, and according to McNally, the university plans to adjust to the increase through hiring fewer students or having students work fewer hours to manage the budget.

Appendix C of the Fiscal Year 2020 Operating Budget states graduate assistants that work for the STEM department receive a stipend of $10,000 and graduate assistants in all other departments at the university receive a $7,500 stipend.

According to McNally, there was a need to create a differential to respond to the market.

Thats pertinent for STEM because I guess theres a lot more opportunities in places like the Youngstown Business Incubator and America Makes that could really benefit from some of our graduate engineering students, McNally said.

Nico Lucarelli, adjunct STEM faculty member, said although student wages may be differential, he believes the compensation for STEM graduate assistants is fairly balanced.

Graduate assistants, like other student employees, are allowed to work a maximum of 20 hours on teaching assistant-related jobs, Lucarelli said. Balancing coursework, research, thesis writing and a full 20 hours of grading a week can be quite difficult.

According to Lucarelli, his time as a graduate assistant was focused on engaging with students and performing engineering experiments.

I was also able to serve as an instructor for a few labs, which went a long way in developing public speaking skills as well as getting more familiar with laboratory equipment and practices, Lucarelli said. STEM GAs [graduate assistants] definitely earn the stipend they receive with the workload and responsibilities they have.

According to McNally, the operating budget has not seen any kind of wiggle room in the last 20 years.

This is not uncommon in a public university, McNally said. Since were public, were not really expected to have a big margin or profit. You typically will see break-even budgets with public entities and our revenues are just about right at our expenses.

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Anatomy

15 ‘Grey’s Anatomy’ Exits Ranked From Most to Least Climactic (PHOTOS) – TVInsider

January 19, 2020 medical

ABCDerek Shepherd (Patrick Dempsey)We may never know the full story over Dempseys fallout with Greys, but at least Shonda & Co. had the good sense to know that only death would do Derek part from Meredith (Ellen Pompeo). And so, in Season 11, Derek died of medical incompetence at Dillard Medical Center after he was hit by a semi.ABCStephanie Edwards (Jerrika Hinton)Hinton chose to leave the show after Season 13, and Stephanie literally went out in a blaze of glory, setting the hospital on fire to save a young girl from a sexual predator. And after narrowly escaping with her life, Steph realized that she wanted to experience life outside of a hospital for once.ABCGeorge OMalley (T.R. Knight)Knight exited the show after Season 5, citing disappointment with Georges storyline and a communication breakdown with Rhimes, and George died after saving a stranger from the path of an oncoming bus. An abrupt ending, yes, but a heroic one, at least.ABCCristina Yang (Sandra Oh)Oh gave a full seasons notice, specifying that Season 10 would be her last before the season even premiered. And so the Greys writers had time to give her a fitting sendoff, with her old flame Burke handing her the keys to a cutting-edge cardiothoracic research center in Switzerland.ABCPreston Burke (Isaiah Washington)In the wake Washingtons gay slur scandal, ABC didnt confirm his firing from Grey's until after Season 3 had already concluded, but the writers must have seen the writing on the wall. In the Season 3 finale, Burke realized that his wedding to Cristina wasnt what she wanted, and he disappeared until the aforementioned reprise in Season 10.ABCCallie Torres (Sara Ramirez)According to Rhimes, Ramirez didnt give the writers a heads-up that the Season 12 finale would be her last episode. To her credit, though, she picked an opportune time to bail: Callie was getting ready to leave for a new life in New York City in that finale.ABCMark Sloan (Eric Dane)Mark only lasted two episodes more than Lexie, succumbing to his injuriescardiac tamponade, to be specificafter being airlifted back to Seattle. It was a sad epilogue to the plane crash drama, but at least Mark regained consciousness long enough to spend quality time with his friends at the hospital.ABCAddison Montgomery (Kate Walsh)Anyone who didnt watch the premiere of Greys spinoff Private Practice missed the scene where Addison quits her job at the hospital then known as Seattle Grace, but the character made plenty of return trips to her former workplace.ABCApril Kepner (Sarah Drew)After surviving a near-death experience (and after Drew and costar Jessica Capshaw got their walking papers during Season 14), April found her happily-ever-after with ex-fiance-turned-husband Paramedic Matthew (Justin Bruening) and left the hospital to work with Seattles homeless population. Its a fitting ending for such a good-hearted character but would April really give up surgery that easily?ABCArizona Robbins (Jessica Capshaw)Once daughter Sofia started missing her NYC life, Arizona decided she and Callie should be co-parenting in the same city, and she opted to relocate to the Big Apple. Greys gets points for teasing the potential of a Calzona reunionwith Callie and Arizona flirting via text message before the movebut the show loses points for not bringing Sara Ramirez back to close out Arizonas storyline.ABC/Screencap by Home of the NuttyIzzie Stevens (Katherine Heigl)Heigls discontentment on the Greys set made national news during Season 6, but the ending fans gotIzzie fleeing Seattle after getting rejected by estranged husband Alexis not the one the writers had in mind. Fans had long held out hope of some sort of Alex-Izzie closure, but now those hopes are dashed because ofABCAlex Karev (Justin Chambers)Hours, nay, minutes after the announcement that Chambers was leaving Greys came the news that his last episode had already aired in Season 16 and there wouldnt be any sort of send-off for the character. Alex at least saved Merediths medical license in his final appearance, but fansand Jolex shippers!deserved more.ABC/Screencap by Home of the NuttyLeah Murphy (Tessa Ferrer)Leah didnt do much during her tenure at Grey Sloan besides sleeping with Arizona and inspiring a non-fraternization rule at the hospital. And when Ferrer was let go during Season 10, Greys closed out Leahs storyline, with Richard (James Pickens Jr.) firing her from the hospital for being a better doctor than surgeon. But then the writers brought Leah back for a handful of Season 13 episodes, and for all we know, shes still there? Somewhere?ABC/Screencap by Home of the Nutty

The doctors are out. The abrupt departure of Justin Chambers from Greys Anatomy is just the latest in a long succession of cast member exits from the ABC drama, which has bid farewell to a dozen and a half series regulars in its 16-season run so far.

Some of these outgoing characters got carefully-crafted swan songs while others exits were just mentioned in passing on the show or just ignored entirely.

Flip through the slides above to see which of 15 former Greys stars went out with a bang and who went out with a whimper or less. (Warning: Spoilers for all seasons herein!)

Greys Anatomy, Season 16 Returns, Thursday, January 23, 9/8c, ABC

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Anatomy

Anatomy of Protest Music in Assam during the time of CAA Protests – A Humming Heart

January 19, 2020 medical

When Dr Bhupen Hazarika sang the song Biswa Bijoyee Na-Jowan (youngsters who won the world) in the 1939 film Indramalati, he probably would not have thought that the youth of Assam would resonate with the same song as they lead the protest against the Citizen Amendment Act, some 80 years later.

Music has been a very integral part of the Assamese society and even at the most distressing time, songs have been the adjuvant that ensured the mobilisation of the Assamese sentiments.

It is important to go back to the days of Assam Agitation (1979-85) to see the importance of music as a form of protest is the state, to see how Hazarikas work has managed to strike a chord amongst the Assamese nationalists.

Hazarikas songs united a frustrated Assamese diaspora and reflected the helplessness faced by the state since 1947. Assams troubled relationship with New Delhi found a rich and resounding depiction in his lyrics and songs.

The 1983 Assam elections were brutal. At the peak of the agitation, Dr Hazarika wrote a ballad which described a little brother who was killed. The song, Juye Pura Tirasir was dedicated to a young martyr, and its lyrics translated to: My little brother disappeared that year. Do you have any news about him? He wanted to build his country and to secure a happy future for those who live in Assam. He did not want to become a stranger in his own land.

Today, the fight remains the same. The Assamese do not want to become strangers in their own land. So, when 17-year-old Sam Stafford and 20-year-old Dipanjal Das lost their lives due to the brutal open firing by police during the anti-CAA protests in Guwahati; what Dr Bhupen Hazarika wrote about came rushing back.

Protest songs have a very deep-rooted hold within the Assamese society. Even before the current anti-CAA protest intensified, there was a trend which showed the mobilisation of the Assamese youth towards fighting the age-old issue of illegal immigration and the negligence from the Central Government through music. The anti-CAA protests established music as one of the foremost weapons for this generation to show dissent. New-age and independent artists populate the domain of protest music in Assam currently.

Hip-hop has become the voice of the youth and is actively used today as a means to express opinions. In 2018, Guwahati-based rapper Minimi released his composition titled Bangladeshi. The song talks about the Assamese fighting for their rights and how they feel betrayed by the government and its system. The song has the feel of a war cry asking the youth to join this fight and save the land from the infiltration of the illegal immigrants.

The track, however, has garnered criticism for being overtly xenophobic. The lyrics can be considered inflammatory and be interpreted as a catalyst for inciting violence. A part of the song translates to: Foreigners maybe brought and filled up in Assam. If we pick up our hengdang (sword), the Bangladeshi will run lifting their legs, leaving their lungi. Another part translates to, The guest is godlike for us. But beat-up the foreigner repeatedly. We will cut them into half if the question arises of the existence of motherland. Every house has a sword. It is sharp. Whoever dares to die, come out, you brave Asomiyas, Let us make the Luit red.

The shift in tone and themes between the songs Hazarika composed, and what is being rendered today indicates the mindset which has set in within the Assamese society. The current wave of protest in Assam saw the use of the slogan, Aah Aah Ulai Aah. It calls everyone to come out and join the movement. This slogan also originates from a Bhupen Hazarika song with the same name.

While Bhupen Hazarikas songs are a call to sacrifice, Minimis track is a call to arms. Also, notably, Hazarikas song had the phrase, Xogaj Jonota which translates to well-informed public. At a time, when the nation is battling misinformation, an age-old song showcases its timelessness yet again.

Another young singer from the state, Shankuraj Knowar collaborated with a few upcoming musicians to compose a song called Odhikaar. The song was released on December 10, 2019, at the peak of the anti-CAA protests in Assam with a statement which read:

The Assamese speaking population feels they will be outnumbered within their own state by the Citizenship Amendment Bill, 2019, (CAB), due to the threat and pattern of illegal Bangladeshi immigrantsAt the macro level, the whole of India will not suffer what Assam will suffer in micro-levelsAll protests should be in the spirit of the constitution of India by peaceful means and by respecting everyone elses views. Violence and atrocities of any kind should be avoided. However, we stand here to stand against the implementation of the CAB in its current way. The state has to be protected like you would protect your homes and then welcome guests.

Odhikaar is a beautiful composition which criticizes the state government for sacrificing the interest of their land for those of the central government. The song reminds everyone of the sacrifices made by the martyrs and asks everyone to come out and oppose what is wrong. The themes here are similar to the ones composed by Hazarika. The tone is calm, yet it evokes the spirit of Assamese nationalism. It doesnt call for aggression but requests people to fight for what is right by being well informed.

Rahul Rajkhowa has written an English rap highlighting the atrocities of the government and the impact of the decisions made by those in power. In one of his earlier compositions, Rajkhowa has also sung about the vulnerability of immigrants being perceived as the ones responsible for a spectrum of Assams problems that range from economy to ecology. That song garnered some criticism for it giving impetus to discrimination and marginalisation.

Along with them, there are other upcoming, independent artists composing music who are contributing to the movement. Their composition, delivery and lyrics are indicative of the influence of the underground culture as well as Indian hip-hop scene that has become even more popular since the release of Gully Boy(2019). A perfect example is rapper AS Wonderland. He uploaded a song called Jai Shri Ram (which was originally composed by Gangtok-based rapper UNB). Similar to AS Wonderland, Rapper Im D composed an Assamese song which again invokes sentiments similar to Minmi, We are Assamese, we are ready to die and kill for our motherland.

In Assam, celebrities from the field of art and entertainment are leading the protests against the Citizen Amendment Bill (CAB) and now the Citizen Amendment Act (CAA), although very few commercial singers have sung or composed anti-establishment music. One of the most famous figures leading the anti-CAA protest is Zubeen Garg, who incidentally sang the campaign song of the ruling Bharatiya Janta Party (BJP) in the 2016 elections. He, however, has apologised, just like Simanta Shekar who sang it in the previous elections. But neither of the two has so far composed or sang anything for the movement.

It is only Manas Robin, popular commercial Assamese singer, who has composed a protest song, Bodone Aanile Maan Oi. The undertone is anti-Bengali and openly asks people to fight the issue of illegal Bangladeshis, be it Hindu or Muslim.

The culture of protest music is vibrant and deep-rooted in Assamese society. The current protest is led by musicians and artists and is based on the songs written by legendary Dr Bhupen Hazarika. One can estimate how big a visionary the singer, writer and composer was, given his songs still hold relevance to the utmost optimum level. Ironically, Hazarika fought the 2004 Lok Sabha elections on a BJP ticket. Today, as the state fights against the BJP majority government, it is his songs which lead the masses.

Assamese protest music witnesses a transition, but overall still embodies the values set by the notable names in the past. There has been a paradigm shift, especially in the aggressive approach, and protest music is an essential indicator of it. However, the Assamese community is known to be a peace-loving one, and Dr Bhupen Hazarikas songs reflected the same ethos that the society holds. The fact that even today, the majority is still using his songs to lead protests and agitations, is proof of those values.

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Anatomy

Greys Anatomy Star Caterina Scorsone And Husband Welcomes Third Child. … – Union Journalism

January 19, 2020 medical

The new year has been extremely good for Greys Anatomy star Caterina Scorsone as she welcomed her third daughter with her husband, Rob Giles. The couple started the new decade on an auspicious note.

Caterina Scorsone and Rob Giles with their first two daughters

The couple announced the birth of their baby girl on Tuesday, 31 December, the last day of 2019.

Arwen is here! the actress, 38, captioned the photos she shared on Instagram. The pictures show newborn Arwen cuddling with each of her elder sisters, Eliza, 7, and Paloma, 3. Our family wishes you a happy new year, a happy new decade, and a happy heart made new by love in every exquisite moment, Scorsone added.

Scorsone, who plays the role of Amelia Shepherd on the ABC medical drama, shared the good news in November 2019 that she was expecting baby No. 3. She did so by posting a Halloween-themed photo of herself, her musician husband, and their two daughters dressed as the Addams Family along with the caption, Our Familys about to get even kookier. #pumpkinintheoven.

Similar to her real-life situation, her on-screen character announced her pregnancy in the season 16 premiere episode earlier in 2019. It could have been done to make shooting easier, drive forward the plot, and avoid any unnecessary complications during the shoot while trying to hide the baby bump.

Earlier in March, Scorsone also opened up about raising their second daughter Paloma, who has Down Syndrome.

My whole concept of what motherhood was had to shift, she said on the Motherly podcast. She shared that even though in the beginning the revelation sent her into a tailspin, Scorsone soon realized that her primary responsibility is to keep her safe and make her feel loved.

Suddenly, my understanding of my job as a mother completely distilled and opened, she continued. This also made her rethink the way she was bringing up her first daughter. Since then, things have changed a lot, and she is thankful for them.

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Immunology

The babies ‘at risk of catching deadly illnesses’ in West Sussex – Spirit FM

January 18, 2020 medical

The British Society for Immunology has urged the new government to deliver on its promise to develop the UKs first vaccine strategy to protect communities against nasty diseases.

Young children should get the so-called six-in-one jab, which protects against six serious infections including polio, whooping cough and diphtheria, in the first few months of their lives.

Public Health England data shows that 231 children in West Sussex who had their first birthday in the six months to September missed out on the vaccination.

But 94.8% of one year olds did have it, meaning the area was only just short of the 95% rate recommended by the World Health Organisation to prevent outbreaks.

The uptake rate for the South East over the period was 93.2%, while the figure across England stood at 92.1%.

Across England, the figure stood at 92.1%.

The British Society for Immunology said the uptake rate across England for the six-in-one vaccine among one year olds has averaged around 92% over the past year.

"Low levels of vaccination coverage matter as it means these diseases have the potential to spread within our communities, infecting unvaccinated people, with young babies and people with compromised immune systems particularly at risk.

"We urge the new government to deliver on its promise to develop the UKs first vaccine strategy and to fully fund immunisation services to ensure our communities are protected against these preventable diseases."

Dr Doug Brown, chief executive, The British Society for Immunology

But he also urged parents to make sure their children get the jabs.

"If you are worried your child hasnt received all the doses of the six-in-one vaccine, do make an appointment at your GP surgery.

"Its much better to get your child vaccinated than risk them catching one of these nasty diseases."

Babies should have three rounds of the six-in-one vaccination at eight, 12 and 16 weeks of age.

It helps them develop a strong immunity to diphtheria, hepatitis B, haemophilus influenza type b, polio, tetanus and whopping cough all described by the NHS as serious childhood diseases.

"Every child must be vaccinated against dangerous and potentially fatal diseases.

"Vaccine uptake is very high, at around 90%, for most childhood vaccines, but we are determined to drive rates up even further.

"Our new vaccination strategy, published in the new year, will consider a range of approaches to improve uptake."

Health minister, Nicola Blackwood

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Immunology

Chemosensory Cells in the Nose Play a Role in Allergic Reactions – The Scientist

January 18, 2020 medical

There are a lot of unknowns when it comes to understanding how the mammalian respiratory tract responds to allergens, but a study published today (January 17) in Science Immunology, offers new insight. Researchers identified a group of epithelial cells in the mouse nose that are capable of responding to allergens directly and also to ATP released in response to allergens. When exposed to allergens, these so-called brush cells secrete cysteinyl leukotrienes, proinflammatory lipids that have been previously shown to come mostly from immune cells and have been linked to asthma and allergies.

We have been interested in how allergens are recognized by the airway epithelium and how they drive immune responses that are biased towards allergic inflammation, says coauthor Lora Bankova of Harvard Medical School.

Previous research had shown that tuft cells, a solitary chemosensory cell type found in the intestine, are responsible for orchestrating immunity to parasitic worms in the gut, which trigger the same type of immune response as allergens. To determine whether there might be cells playing the same role in the airway epithelium, she and her colleagues investigated a similar cell type in the mouse trachea: brush cells. In work published in 2018, they analyzed the gene expression profile of brush cells and found that brush cell activation was important for airway inflammation.

In the trachea, brush cells are only about half of a percent of the total number of cells. These small numbers made it hard to do in vitro or ex vivo cultures in which it would be possible to directly stimulate them and see what happens, Bankova explains. So the research team looked for these cells elsewhere in the airway. In the current study they found that there are solitary chemosensory cells with similar transcriptional profiles to the tracheal brush cells present in much larger numbers in the mouse nose, where they contribute 48 percent of the total cells.

Because theyre so abundant we were actually able to isolate them and study them directly to see what activates them, what can they produce in response to stimulation, Bankova tells The Scientist.The researchers isolated nasal brush cells from mice and incubated them with ATP, which functions as a cellular stress or damage signal, or with allergens from dust mites or mold.

In response, the brush cells released proinflammatory cysteinyl leukotrienes at amounts comparable to or exceeding what immune cells produced when the research team stimulated them. Brush cell production of these lipids, and the lower levels generated by other cell types, indicate that the epithelial cells are likely the dominant source of cysteinyl leukotrienes in the nose. The researchers also showed that mice without brush cells had a reduced amount of allergic inflammation in response to an allergen.

Allergen activates them, and theyre important for generating the cysteinyl leukotrienes and allergic inflammation in that setting, says Bankova. She explains that its likely that theyre also responding to other sorts of damage in the airway epithelium because they release cysteinyl leukotrienes in response to ATP as well.

That ATP serves as a ligand for brush cells is the most surprising finding, says Christoph Schneider, a biologist at the University of Zurich who did not participate in the study. He adds that open questions include whether or not brush cells are the sole target of ATP and sole source of cysteinyl leukotrienes and whether this is true only for these airway brush cells or whether the same ATP effect is also observed in other situations, in other organs, et cetera.

To develop an asthma-like syndromeespecially if its allergic in natureyou have to have sensitization and then a subsequent response to challenge, so this is providing a mechanism by which the epithelium by itself is critical for sensitization, says Teal Hallstrand, a pulmonary physician at the University of Washington who was not involved in the work. Id be very excited to learn about whether or not people with asthma have an alteration in the number of these cells in their airways and what specific physiological effect that has.

S. Ualiyeva et al., Airway brush cells generate cysteinyl leukotrienes through the ATP sensor P2Y2, Science Immunology, doi:10.1126/sciimmunol.aax7224, 2020.

Abby Olena is a freelance journalist based in Alabama. Find her on Twitter@abbyolena.

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Immunology

Emerging Biologic Treatments for Allergies and Asthma – Pulmonology Advisor

January 18, 2020 medical

A great deal of research into allergic diseases has yielded many new observations that have immediate implications for treatment.1-3 Epidemiologic studies in several countries have indicated that the prevalence of allergies and asthma has been steadily increasing during the past 2 decades.2 At the same time, recent investigations have identified multiple pathogenic entities and several distinct allergic diseases with specific phenotypic characteristics and treatment response profiles, including allergic rhinitis, atopic dermatitis (AD), angioedema, and asthma.2

These findings have all contributed to a game-changing evolution in the treatment of allergic disease that is rapidly moving forward. In 2018, Dagmar Simon, MD, from Bern University Hospital, Switzerland, observed in the first of 2 annual reviews, With the development of novel therapies, of which some have already been approved, we face a new era of disease management and, with that, probably a modification of the expected course of diseases. 2

Targeting Immune Mechanisms for Therapy

Many large-scale studies have expanded the understanding of the important role of the immune system in homeostasis and host defense, which has led to the exploration of small molecule and biologic therapies that target immune mechanisms in allergic diseases. 1-3 The pathogenesis of allergies is determined by a complex of overlapping mechanisms that produce different patterns of inflammatory symptoms, as immune cells distributed throughout the body respond to individual and environmental triggers, mediated by lipids, growth factors, chemokines, cytokines, and endothelial barriers.

This multifaceted etiology of allergic diseases, including asthma, makes it difficult to identify a single target for therapy, so novel biological agents are designed to influence particular segments of the pathogenic pathways. Several types of immunologic therapies, including IgE and interleukin-4 (IL-4), IL-13, and IL-5 therapies that target eosinophils and alarmins, have already been approved, based on efficacy in clinical trials against specific subtypes of allergies.

Omalizumab is a monoclonal antibody with a high binding affinity for IgE that has demonstrated good efficacy against asthma and allergic conditions such as AD, reducing the frequency, severity, and chronicity of symptoms by inhibiting the T2 inflammatory action of IgE.3 Omalizumab is considered an appropriate add-on therapy for patients with uncontrolled allergic asthma, as well as those with chronic urticaria.

The IL-4 and IL-13 pathways have been implicated in the production of inflammatory eosinophils in allergic diseases; IL-4 cytokines contribute to IgE mechanisms and hepatic proliferation, whereas IL-13 has effects that are limited mostly to barrier dysfunction and biological disturbances of the skin.3 Dupilumab is a monoclonal antibody that works as a dual inhibitor of IL-4 and IL-13 signaling. It has been approved for the add-on treatment of uncontrolled eosinophilic asthma, AD, and chronic rhinosinusitis with nasal polyps.

Expression of eosinophils has a particularly strong association to asthma by contributing to inflammatory obstruction.4 The protein granules in eosinophils can also cause irritation to the airway structure and trigger bronchial spasm.4 Cytokines such as IL-5 produced by eosinophils may also stimulate new eosinophil formation to promote an ongoing cycle of airway dysfunction.4

Monoclonal antibodies (mAbs) that target the IL-5 pathway, including mepolizumab, reslizumab, and benralizumab, have demonstrated rapid reduction of eosinophil levels in patients with severe, uncontrolled asthma.3,4 All 3 drugs have been shown to reduce asthma exacerbations by about 50%.4 The challenges to IL-5 mAbs are that only about 50% of patients with severe asthma respond to these therapies, and the improvement in exacerbations may not be accompanied by improved lung function and quality of life.3 In addition, the benefits to IL-5 mAbs are lost with discontinuation of therapy, which may even produce rebound eosinophilia.3

Key mediators of homeostasis are cytokines such as thymic stromal lymphopoietin and IL-25 and IL-33, known as alarmins, as they initiate inflammation in response to damage or insult to the body. Tezepelumab is undergoing clinical trials as a first-in-class human mAb designed to block thymic stromal lymphopoietin, whereas antibodies to IL-33 and IL-25 are in the early stages of development. 3

Next Steps for Biologic Therapies

A multitude of dynamic internal and environmental factors have a continuing effect on the status of the immune system, eliminating the possibility of a single therapeutic target for many patients with resistant types of allergic diseases, particularly asthma. And although several biologic therapies have shown great promise, researchers are as-yet unable to identify the patients who are most likely to respond to these interventions. A 2020 review by Agache et al3 reported that achieving selective immune modulation without altering the healthy immune response and with a long-lasting disease modifying effect is still not reached. The immediate goals in biologic therapies for allergies and asthma are to develop biomarkers to identify patients who are most likely to respond to these therapies and to monitor disease severity. As experience with biological therapies continues to grow, they are expected move from their current position as add-on therapies for severe allergic disease to play a more prominent role in treatment strategies for many more allergy patients.

References

1. Simon D. Recent advances in clinical allergy and immunology 2019. Int Arch Allergy Immunol. 2019;180:291-305.

2. Simon D. Recent advances in clinical allergy and immunology. Int Arch Allergy Immunol. 2018;177:324-333.

3. Agache IO, Catalina C, Laculiceanu A, Rogozea L. Critical points on the use of biologicals in allergic diseases and asthma. Allergy Asthma Immunol Res. 2020;12:24-41.

4. Busse W. Biologic treatments for severe asthma: a major advance in asthma care. Allergol Int. 2019;68:158-166.

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Emerging Biologic Treatments for Allergies and Asthma - Pulmonology Advisor

Immunology

The Week Ahead: Abbott Laboratories and Johnson & Johnson Due – Morningstar.com

January 18, 2020 medical

Earnings season continues next week with a medley of narrow- and wide-moat companies announcing earnings.

Johnson & Johnson (JNJ) and Abbott Laboratories (ABT) will both release earnings on Wednesday.

Johnson & Johnson has had steady growth for the past several years, and we expect this trend to continue with its fourth-quarter earnings. The company is expected to beat fourth-quarter earning estimates despite a recent onslaught of lawsuits. It is currently fighting over 16,000 asbestos-related lawsuits connected to its talcum powder products. Last October, Johnson & Johnson was also ordered to pay out $8 billion in a Risperdal (an anti-psychotic drug) product liability case.

Our director of equity analysis for North America, Damien Conover, stated that while we expect the quarters results to be under some pressure from patent losses in the firms oncology and immunology divisions, we expect the full-year 2019 earnings growth to be close to 6%. While patent pressures will likely continue into 2020, Johnson & Johnsons diversified platform should enable the firm to offset generic competition. Expected updates on the firms robotic device platforms should also help reinvigorate growth in the companys device segment. However, overall, from a valuation perspective, we view the company as slightly overvalued with some concerns on the firms late-stage pipeline weighing on our fair value estimate.

Abbott Laboratories is changing up its leadership this year with its senior vice president of finance and controller, Robert Funck Jr., becoming CFO and its president and operating chief, Robert Ford, becoming CEO this March. Miles White, the companys current CEO since 1999, will stay on as the executive chairman. Abbott Laboratories is currently waiting upon FDA approval for its new glucose monitor, Freestyle Libre 2.

Overall, the healthcare sector has increased 22% as of the end of 2019, which, while solid performance, underperformed the broader equity market performance of 31%. Concerns around potential healthcare policy change in the United States have increased uncertainty in the sector and have affected performance.According to Conover, although U.S. policy reform is probable, it is unlikely that a major overhaul will occur that will affect drug pricing power, which is expected to remain steady. Additionally, while the sector is slightly overvalued, with the most overvalued stocks in the device and diagnostics industries, there are some pockets of undervalued stocks in the drug and biotech industries.

On Tuesday, IBM (IBM), Netflix (NFLX), Capital One Financial (COF), UBS (UBS), Progressive (PGR), and TD Ameritrade (AMTD) will all be reporting earnings.

Thursday brings another round of earnings announcements, with Microsoft (MSFT), Procter & Gamble (PG), Intel (INTC), Comcast (CMCSA), and Discover Financial (DFS) reporting.

Microsoft has done well in recent months, earning a coveted $10 billion contract with the Joint Enterprise Defense Infrastructure Contract in October. The company has been focusing on the proliferation of its Azure platform and customer adoption of hybrid cloud environments on said platform.

In other economic news, Wednesday also brings with it the FHFA Housing Price Index for January, the Existing Home Sales report for December, and the EIA Crude Oil Inventories for Jan. 18.

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The Week Ahead: Abbott Laboratories and Johnson & Johnson Due - Morningstar.com

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Greys Anatomy Star Caterina Scorsone And Husband Welcomes Third Child. … – Union Journalism

The babies ‘at risk of catching deadly illnesses’ in West Sussex – Spirit FM

Chemosensory Cells in the Nose Play a Role in Allergic Reactions – The Scientist

Emerging Biologic Treatments for Allergies and Asthma – Pulmonology Advisor

The Week Ahead: Abbott Laboratories and Johnson & Johnson Due – Morningstar.com