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Preference: Statistics, epidemiology and research design

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[Comment] Mass trapping of malaria vector mosquitoes

Every field of research needs a few pleasant surprises every now and then to challenge the limitations imposed by existing paradigms, and stretch the ambitions of those of us who accepted them for too long. In The Lancet, Tobias Homan and colleagues1 show that population-wide installation of solar-powered odour-baited mosquito traps beside houses in Rusinga Island (Lake Victoria, western Kenya, Africa) can reduce malaria infection prevalence by suppressing populations of Anopheles funestus, the most efficient mosquito vector in Africa.

Billions start flowing for medical research

Almost $1.3 billion of funds stripped from the Health portfolio have been funnelled to the Medical Research Future Fund as the Federal Government makes good on its controversial plan to divert billions of dollars from other areas of health to support research.

Late last month the Government, with little fanfare, transferred $1.277 billion to the MRFF’s Special Account, the first instalment of what is expected to be $20 billion injected into the Fund in coming years.

Prime Minister Malcolm Turnbull is persisting with the Medicare rebate freeze, reduced public hospital funding and cuts to bulk billing incentives in pathology and diagnostic imaging, with a share of the savings being directed to the MRFF.

The plan, unveiled in the 2014 Budget, was heavily criticised at the time by the AMA, which argued that although increased investment in medical research was welcome, it should not come at the expense of medical services and other areas of health.

But the $1.2 billion transfer is the clearest demonstration yet that the Government has no intention to abandon or scale back its plan, which has the backing of parts of the medical research community.

The Research Australia alliance, which claims to have 160 members and supporters, welcomed the initial investment as a “significant step to secure Australia’s health and medical research future”.

Research Australia Chief Executive Officer Nadia Levin said the transfer of the money to the MRFF Special Account was “words in action”.

“This is Prime Minister Turnbull and Health Minister Ley doing exactly what they said they would do – build our health system and build an innovation nation,” Ms Levin said. “This is not just words. It’s action and it’s money, and it is going to make an enormous difference to the health of Australians and the health of the economy.”

Following months of consultation, the MRFF is developing a document setting out the strategy and principles which will guide its investment in research projects.

Initially, the Fund intends to direct $61 million toward health and medical research project this financial year.

Under the Government’s plan, the Fund will expand rapidly in the next few years to reach $20 billion in the early 2020s, enabling it to invest around $1 billion a year in research.

Adrian Rollins

[Series] Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees

The prison setting presents not only challenges, but also opportunities, for the prevention and treatment of HIV, viral hepatitis, and tuberculosis. We did a comprehensive literature search of data published between 2005 and 2015 to understand the global epidemiology of HIV, hepatitis C virus (HCV), hepatitis B virus (HBV), and tuberculosis in prisoners. We further modelled the contribution of imprisonment and the potential impact of prevention interventions on HIV transmission in this population.

News briefs

Anti-Zika drugs on the way

Compounds that suppress Zika virus replication or prevent the death of cells infected by the virus have been reported online in Nature Medicine. Similar to dengue virus and chikungunya virus, Zika virus can cause flu-like symptoms in some individuals. Unlike dengue virus and chikungunya virus, Zika virus infection can also result in the congenital defect microcephaly in developing fetuses, and in Guillain–Barre disease in adults. Researchers from the Johns Hopkins University School of Medicine screened a library of approximately 6000 compounds that included US Food and Drug Administration-approved drugs and experimental therapies currently in clinical trials, and identified two classes of compounds: one inhibits the death of cells infected by Zika virus, the other blocks Zika virus replication in infected cells. The two classes of compounds showed activity in several relevant types of brain cells — including human neural progenitor cells and astrocytes — and in 3D brain organoid cultures. The compounds also worked when given either before or after exposure to Zika virus. Finally, the two classes of compounds showed even greater benefits when used together than when given individually. Further research is needed before these compounds can be considered for human treatment, especially of pregnant women. Essential next steps include testing the efficacy and safety of these lead compounds in animal models of adult and fetal Zika virus infection.

http://dx.doi.org/10.1038/nm.4184

Night surgery doubles risk of death

New research presented at the World Congress of Anaesthesiologists in Hong Kong late last month showed that patients who had surgery during the night were twice as likely to die as patients operated on during regular working hours. Patients operated on later in the working day or in the early evening also had a higher mortality risk, concluded the researchers from McGill University Health Centre in Montreal, Canada. A retrospective review of 30-day postoperative in-hospital mortality was carried out at the Jewish General Hospital in Montreal, which is also a teaching hospital. The study evaluated all surgical procedures for the past 5 years, from 1 April 2010 to 31 March 2015. A database was constructed collecting variables about surgical interventions. All elective and emergent surgical cases were included, except ophthalmic and local anaesthesia cases. The working day was divided into three time blocks (daytime, 07:30-15:29; evening, 15:30-23:29; nighttime, 23:30-07:29). The start time of the anaesthetic recorded by the circulating nurse was used to determine in which time block the operation began. There were 41 716 elective and emergency surgeries performed on 33 942 patients in 40 044 hospitalisations. Of these, 10 480 were emergency procedures; there were 3445, 4951, and 2084 emergency procedures with anaesthesia starting during the day, evening and night respectively. There were 226, 97 and 29 deaths during day, evening and night surgery respectively (79, 95, 29 mortalities for emergency surgery in the same time periods). The researchers found that after adjustment for age and ASA scores, the patients operated on at night were 2.17 times more likely to die than those operated on during regular daytime working hours, and patients operated on late in the day were 1.43 times more likely to die than those operated on during regular daytime working hours.

https://owncloud.wellbehavedsoftware.com/index.php/s/WcTAhN1rXCXPmwX#pdfviewer

[Editorial] Launching a plan for the Cancer Moonshot

On Sept 7, the findings of the blue ribbon panel of a major presidential initiative to accelerate cancer research in the USA were presented to the country’s National Cancer Institute. The panel’s report laid out ten recommendations to double the rate of cancer progress—to achieve a decade of advances in cancer prevention, diagnosis, treatment, and care in 5 years. 8 months ago a Lancet Editorial worried that the aims of the Cancer Moonshot were nebulous and overly ambitious. Now, as the Moonshot plans unfold, we see opportunities for them to be more determined.

[Comment] Stroke and mortality after atrial fibrillation—a global struggle

Atrial fibrillation is a widely recognised health-care challenge with increasing prevalence across the world. Epidemiological observations mainly attribute this increase to an ageing population and better prognosis in distinguishing it from other cardiac disorders such as myocardial infarction.1 Research into atrial fibrillation has focused on antithrombotic management for stroke prevention and mortality, in the era of non-vitamin K antagonist oral anticoagulants.2 However, although these large, phase 3 trials enrolled patients from many centres in different countries and included broad populations, regional differences and between-centre variations in quality of treatment might have affected the results.

[Perspectives] Josiah Rich: speaking up for the incarcerated

Click on to the website of Brown University’s Center for Prisoner Health and Human Rights and you’re greeted by a shocking nugget of information. “The nation’s three largest psychiatric facilities”, it says, “are the New York, Los Angeles and Chicago jails. More than half of the incarcerated population has a mental health problem.” The Center’s Co-Director is Josiah “Jody” Rich, Professor of Medicine and Epidemiology at Brown University’s Warren Alpert Medical School in Providence, Rhode Island.

[Series] New and emerging targeted treatments in advanced non-small-cell lung cancer

Targeted therapies are substantially changing the management of lung cancers. These treatments include drugs that target driver mutations, those that target presumed important molecules in cancer cell proliferation and survival, and those that inhibit immune checkpoint molecules. This area of research progresses day by day, with novel target discoveries, novel drug development, and use of novel combination treatments. Researchers and clinicians have also extensively investigated the predictive biomarkers and the molecular mechanisms underlying inherent or acquired resistance to these targeted therapies.