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[World Report] Brazilian scientists reject national award

Sa, 20/11/2021 - 00:00
21 scientists have rejected one of Brazil's highest scientific honours, after President Bolsonaro vetoed two recipients. Lise Alves reports from São Paulo.

[World Report] Legal challenges threaten Biden's COVID-19 vaccine rule

Sa, 20/11/2021 - 00:00
Critics want to block a safety rule requiring employees of large companies to get vaccinated or be tested weekly for COVID-19 and wear masks. Susan Jaffe reports from Washington, DC.

[World Report] mRNA discoveries earn the 2021 Prince Mahidol Award

Sa, 20/11/2021 - 00:00
Katalin Karikó, Drew Weissman, and Pieter Cullis have been recognised for their work that led to the development of COVID-19 vaccines. Talha Burki reports.

[Perspectives] Helen Milroy: pioneer in Indigenous and child mental health

Sa, 20/11/2021 - 00:00
In 1983, Helen Milroy became Australia's first Indigenous doctor to qualify medicine—a pivotal moment in the country's history. She never envisioned being a trailblazer, but her list of firsts in Australia includes being the first Indigenous psychiatrist and the first Indigenous Commissioner to the Australian Football League. Reflecting today as the Stan Perron Chair of Child and Adolescent Psychiatry at Perth Children's Hospital and the University of Western Australia (UWA) and the Co-Director of Embrace at Telethon Kids Institute, she says: “My passion is to make sure we get the best wellbeing and mental health outcomes for our kids right across Australia.” Pat Dudgeon, Professor of Indigenous Psychology at UWA, recognises her contribution to strengthening support services for children's mental health, and comments: “Helen has created a bridge between Aboriginal and mainstream mental health and understandings.

[Perspectives] Readiness for mammography and artificial intelligence

Sa, 20/11/2021 - 00:00
One area that has attracted great attention for the use of deep learning artificial intelligence (AI) in health care is medical imaging, especially mammography. Many initial AI studies proclaimed remarkable improvement in accuracy over the performance of radiologists, but a recent systematic review highlighted there is insufficient scientific evidence to support such findings. The UK National Screening Committee commissioned Freeman and colleagues to review the quality and results of studies that assessed the accuracy of AI algorithms, alone or in combination with radiologists, to detect cancer in digital mammograms; 34 of 36 AI systems evaluated were less accurate than a single radiologist, and all were less accurate than the consensus of two or more radiologists.

[Perspectives] Medicine, magic, and online performance

Sa, 20/11/2021 - 00:00
COVID-19 has transformed clinical practice; online consultation has become a daily reality for many doctors and clinicians have had to rethink what it means to perform. Patient-centred consulting requires the integration of knowledge, technical skill, and expert communication. This integration is partly achieved through performance. Yet clinical work is seldom framed in such terms within mainstream clinical curriculums. As part of the Royal College of Music–Imperial College London Centre for Performance Science, UK, our interdisciplinary research group investigates how skilled performers from diverse fields meet the complex challenges of their work, and what they can learn from one another.

[Obituary] Mortimer Mishkin

Sa, 20/11/2021 - 00:00
Pioneer neuroscientist who researched neurobiological mechanisms of perception and memory. He was born in Fitchburg, MA, USA, on Dec 13, 1926, and died in Bethesda, MD, USA, on Oct 2, 2021, aged 94 years.

[Correspondence] COVID-19: stigmatising the unvaccinated is not justified

Sa, 20/11/2021 - 00:00
In the USA and Germany, high-level officials have used the term pandemic of the unvaccinated, suggesting that people who have been vaccinated are not relevant in the epidemiology of COVID-19. Officials’ use of this phrase might have encouraged one scientist to claim that “the unvaccinated threaten the vaccinated for COVID-19”.1 But this view is far too simple.

[Correspondence] Long-term effects on survivors with COVID-19

Sa, 20/11/2021 - 00:00
Lixue Huang and colleagues1 reported that patients discharged from hospital with COVID-19 showed good physical and functional recovery 1 year after symptom onset. Because of several concerns with the methods, we contend that the findings should be interpreted cautiously.

[Correspondence] Long-term effects on survivors with COVID-19

Sa, 20/11/2021 - 00:00
The conditions that linger after recovery from COVID-19 are commonly referred to as the long-term effects of COVID-19 (long COVID). The risk for sequelae varies according to the severity of the initial acute SARS-CoV-2 infection.1

[Correspondence] Long-term effects on survivors with COVID-19 – Authors' reply

Sa, 20/11/2021 - 00:00
Yan-Jie Zhao and colleagues and Chengliang Yang and colleagues all recommend specific questionnaires to evaluate depression and anxiety symptoms in hospital survivors with COVID-19 1 year after onset.1 We agree that the professional questionnaires could provide the actual prevalence of psychiatric symptoms. However, these questionnaires are somewhat complex and time-consuming. It is challenging to integrate all these assessments into our follow-up study.1 The EuroQol five-dimension five-level (EQ-5D-5L) questionnaire is commonly used to assess the quality of life from five domains in clinical studies.

[Correspondence] CoronaVac efficacy data from Turkey

Sa, 20/11/2021 - 00:00
Mine Tanriover and colleagues1 report that the efficacy of CoronaVac against laboratory-confirmed symptomatic COVID-19 in a trial in Turkey is 83·5% (95% CI 65·4–92·1). By contrast, the efficacy of CoronaVac against symptomatic COVID-19 has been estimated at 50·7% (36·0–62·0) in a Brazilian trial and at 65·3% (20·0–85·1) in an Indonesian trial.2,3 Noting that post-vaccination neutralising antibody titres are quite strongly associated with vaccine efficacy against symptomatic infection,4,5 the efficacy estimated from the Turkish dataset is much higher than we would expect given the modest post-vaccination neutralising antibody titres after the second dose of CoronaVac.

[Correspondence] CoronaVac efficacy data from Turkey – Authors' reply

Sa, 20/11/2021 - 00:00
We thank Martina McMenamin and Benjamin Cowling for raising important issues on vaccine trials in the context of our Article.1 The work they refer to by Palacios and colleagues2 has not been published in a peer reviewed journal; thus we cannot comment on the accuracy or the comparability of its methods. The Indonesian trial data have been published,3 and although the main method of this study was similar to ours, the case definition of COVID-19 and the methods used for active surveillance were different.

[Department of Error] Department of Error

Sa, 20/11/2021 - 00:00
Sun J-M, Shen L, Shah MA, et al. Pembrolizumab plus chemotherapy versus chemotherapy alone for first-line treatment of advanced oesophageal cancer (KEYNOTE-590): a randomised, placebo-controlled, phase 3 study. Lancet 2021; 398: 759–71—The appendix of this Article has been corrected as of Nov 18, 2021.

[Clinical Picture] Hydroxychloroquine-induced cardiomyopathy accelerated after gastric banding

Sa, 20/11/2021 - 00:00
A 51-year-old woman was admitted to our hospital for investigation of blackouts occurring in the context of worsening breathlessness (New York Heart Association [NYHA] class IV) and swelling of her legs. 14 months earlier she had a gastric banding operation.

[World Report] Reaching net zero carbon emissions in health systems

Gi, 18/11/2021 - 00:30
14 countries have now pledged to develop a carbon-neutral health system. The question now is: how will they do it? Emma Wilkinson reports.

[Comment] Improving gastric balloons to treat obesity

Ma, 16/11/2021 - 00:30
The understanding of the causes, implications, and available treatments for obesity is increasing rapidly. This knowledge gain has been partly driven by the increasing proportion of people affected.1 Addressing the obesity epidemic is complex, requiring population-based approaches as well as effective treatments to prevent or manage the effect of obesity on an individual level.

[Articles] Adjustable intragastric balloon for treatment of obesity: a multicentre, open-label, randomised clinical trial

Ma, 16/11/2021 - 00:30
When aIGB was combined with lifestyle modification, significant weight loss was achieved and maintained for 6 months following removal. Balloon volume adjustability permitted individualised therapy, maximising weight loss and tolerance.

[Comment] A novel risk score for contrast-associated acute kidney injury: the heart of the matter

Lu, 15/11/2021 - 14:24
Given the hundreds of thousands of contrast medium doses that are injected every day, contrast-associated acute kidney injury is an important issue. However, it is fraught with controversy. The first reports of acute kidney injury after contrast administration date from the 1950s, but who is at risk and the risk itself are still being debated. Identifying kidney injury caused by contrast media is a challenge because it is not characterised by specific symptoms; contrast-associated acute kidney injury is an indirect, biochemical diagnosis based on absolute or relative increases in serum creatinine within a few days after contrast medium administration.

[Articles] A contemporary simple risk score for prediction of contrast-associated acute kidney injury after percutaneous coronary intervention: derivation and validation from an observational registry

Lu, 15/11/2021 - 14:24
A contemporary simple risk score based on readily available variables from patients undergoing PCI can accurately discriminate the risk of contrast-associated acute kidney injury, the occurrence of which is strongly associated with subsequent death.