Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
Apply for our exciting research Prize!
Te Science-PINS Prize is a highly competitive international prize that honors sci-entists for their excellent contributions to neuromodulation research. For purposesof the Prize, neuromodulation is any form of alteration of nerve activity through thedelivery of physical (electrical, magnetic, or optical) stimulation to targeted sites ofthe nervous system with impications for translational medicine.
www.sciencemag.org/prizes/pins
For full details, judging criteria and eligibility requirements, visit:
$25, 000 Grand Prize!
Get published in Science!
SubmissionDeadline: 15 March 2021
CALL FOR PAPERS
ARTICLE PROCESSING CHARGES WAIVED UNTIL 2022
Plant Phenomics is a Science Partner Journal published in afliation with the State Key Laboratory of
Crop Genetics & Germplasm Enhancement, Nanjing Agricultural University (NAU) and distributed by
the American Association for the Advancement of Science (AAAS). Plant Phenomics publishes novel
research that advances both in Geld and indoor plant phenotyping, with focus on data acquisition
systems, data management, data interpretation into structural or functional traits, integration into
process based or machine learning basedmodels, and connects phenomics to applications and other
research domains.
Submit your research to Plant Phenomics today!
Learn more: spj.sciencemag.org/plantphenomics
The Science Partner Journals (SPJ) program was established by the American Association for the Advancement of Science(AAAS), the non-proGt publisher of the Science family of journals. The SPJ program features high-quality, online-only,Open-Access publications produced in collaboration with international research institutions, foundations, funders, andsocieties. Through these collaborations, AAAS furthers its mission to communicate science broadly and for the beneGt ofall people by providing top-tier international research organizations with the technology, visibility, and publishing expertisethat AAAS is uniquely positioned to oOer as the world’s largest general science membership society.
Learn more at spj.sciencemag.org
@SPJournals@SPJournals
PNASwww.pnas.org
The 13th annual Cozzarelli Prize recognizes
outstanding scientifc achievement, originality,
and innovation. Awarded to one PNAS article in
each of the National Academy of Sciences’six
broadly defned scientifc classifcations, the prize
celebrates the work of researchers who have
pushed the envelope of discovery in their felds
in 2020.
We invite you to nominate the top 2020 PNAS
article in your feld no later than January 4, 2021.
Learnmore at pnas.link/cozzarelli
CALL FOR NOMINATIONS
2020 PNAS
Cozzarelli Prize
TRILLIONSOF MICROBES
ONE ESSAY
Apply by 1/24/21 at www.sciencemag.org/noster
Sponsored by Noster Inc.
The NOSTER Science Microbiome
Prize is an international prize t hat
rewards innovative research by
investigators, under the age of 35,
who are working on the functional
attributes of the micro-biota. The
research can include any organism
that has potential to contribute to
our understanding of human or
veterinary health and disease, or to
guide therapeutic interventions.
The winner and /nalists will be
chosen by a committee of
independent scientists, chaired by
a senior editor at Science. The top
prize includes a complimentary
membership to AAAS, an online
subscription to Science, and
$25,000 1USD4. Submit your
research essay today.
Oliver Harrison
2020 Grand Prize Winner
Climate Change Resource ManagementArtifcial IntelligenceSustainability International S&T
InnovationPublic Engagement Infectious DiseaseTechnology Public HealthDiversity
Ecology Workforce Developtment Big Data Anthropogenic Processes Microbiome
The 2021 AAAS Annual Meeting will convene entirely online February 8-11,
with related pre-released materials available starting in late January.
The 2021 AAAS Annual Meeting program is available online.
Meeting registration will open on November 9.
JOIN THE CONVERSATION!
aaas.org/meetings
ARTICLE PROCESSING CHARGES WAIVED UNTIL JULY 2023
The Journal of Remote Sensing is an online-only Open Access Science Partner Journal published in afliation with
Aerospace Information Research Institute, Chinese Academy of Sciences (AIR-CAS) and distributed by the
AmericanAssociation for theAdvancement of Science (AAAS). Like all partners participating in theSciencePartner
Journal program, the Journal of Remote Sensing is editorially independent from the Science family of journals and
AIR-CAS is responsible for all content published in the journal. This journal coversmultiple research areas that include
theory, science, technology of remote sensing, and interdisciplinary research with earth science and information
science. Particular topics of interest within the journal include radiative transfer modeling, biogeosciences remote
sensing, remote sensing of energy, and more.
Submit your research to the Journal of Remote Sensing today!
Learn more at spj.sciencemag.org/remotesensing
The Science Partner Journal (SPJ) program was established by the American Association for the Advancement of Science (AAAS), thenonproft publisher of the Science family of journals. The SPJ program features high-quality, online-only, Open Access publications producedin collaboration with international research institutions, foundations, funders and societies. Through these collaborations, AAAS furthers itsmission to communicate science broadly and for the beneft of all people by providing top-tier international research organizations with thetechnology, visibility, and publishing expertise that AAAS is uniquely positioned to ofer as the world’s largest general science membership society.
Visit us at spj.sciencemag.org
@SPJournals@SPJournals
CALL FOR PAPERS
LIFE SCIENCE TECHNOLOGIES
731SCIENCE sciencemag.org/custom-publishing
telemedicine
Produced by the Science/AAAS Custom Publishing OfficePH
OTO
: ©
TIE
RN
EYM
J\SH
UTTER
STO
CK
.CO
M
On March 11, 2020, COVID-19 was declared a pandemic by the World Health Organization, radically changing the way medicine is practiced. In the span of a few weeks, as quarantining and social distancing became the norm, in-person medical visits plummeted, suddenly thrusting telemedicine from the wings of medical care to center stage.
ìThe pandemic created a huge public health issue, but the biggest problem wasnít that COVID-19 patients couldnít get careóit was that people without the disease couldnít access their normal care,î says Michael Okun, professor and chair of neurology at the University of Florida.
Viral outbreak = viral uptakeAmericans began delaying all kinds of health care amid fears of the virus.
The United States saw a 42% reduction in emergency department (ED) visits in April 2020 compared to the same time period in 2019 (1). The multisite Mayo Clinicówhich sees 1.2 million patients annually, making it the largest U.S. health care systemóreported a 78% drop in in-person visits from mid-March to mid-April (2).
Over the same time period, use of Mayoís digital health care services went through the roof, including a 10,880% increase in video appointments to patient homes. Before the pandemic, 300 of their providers had performed at least one video telemedicine visit in the preceding year. By the middle of July this number had increased 2,000% to more than 6,500 (2).
ìThe COVID-19 pandemic has essentially accelerated U.S. digital health by about 10 years,î says Bart Demaerschalk, medical director for synchronous services at Mayoís Center for Connected Care.
Many parts of Europe and Asia also experienced falling ED and clinic visits and a surge in digital health (3,4). ìIn the UK, telemedicine before COVID-19 was almost nonexistent. During the pandemic, in-person consultations dropped by ��������������������������������������������������������������������������professor of neurosurgery at the University of Oxford.
Many forms, many usesTelemedicine is a general term that refers to the provision of medical care
at a distance through telecommunications technology. Broadly, it falls into two categories: synchronous and asynchronous. Synchronous telemedicine is performed in real time, such as a video call between a patient and a provider. It can also occur provider-to-provider, such as when an ED doctor consults with a remote stroke expert to develop the best treatment for a patient.
Another example of synchronous telemedicine is the use of remote programming for neural therapies such as deep-brain stimulation, vagus nerve stimulation, sacral neuromodulation, and spinal cord stimulation (5). This approach has been used in China since 2014. Unlike Western device manufacturers, Chinese companies such as Beijing PINS Medical Company Limited make implanted devices that can be adjusted from afar, says Beijing Tsinghua Changgung Hospital neurosurgeon James Wang. These devices were developed to solve the problem of patients having to travel long distances due to the clinician shortage in Central and Western China.
Asynchronous telemedicine includes ìstore-and-forwardî technologies, such as online portals that allow patientñprovider or providerñprovider communications. It also includes chat bots, such as those designed to help a patient decide whether to get tested for the virus that causes COVID-19, and remote monitoring of patients through wearable or implantable devices.
Advantages aboundTelemedicine offers many advantages over the traditional face-to-face health
care provider visit. ìIn the era of COVID-19, telemedicine improves the safety of patients and providers alike,î says Judd Hollander, associate dean for strategic health initiatives at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania. ìBut independent of the pandemic, it simply offers better, more convenient care that costs less.î ���������������������������������������������������������������������
accessing it due to distance or disability. Removing the need for transportation is a huge advantage for high-risk populations, such as seniors and those with chronic medical conditions, says Hollander.������������������������������������������������������������������
patients spent an average of 2 hours at a doctorís appointment, yet
Upcoming features
cont.>
Telemedicine takes center stage in the era of COVID-19Telemedicine comes in many shapes and sizes and offers many advantages over
the traditional healthcare visit, but until recently, it was largely underutilized. The
COVID-19 pandemic quickly changed thatóonly time will tell if telemedicineís new
popularity will last. By Allison Marin
Immuno-Oncology—November 20
Telemedicine uses a wide variety of data to improve patient care.
LIFE SCIENCE TECHNOLOGIES
732 SCIENCE sciencemag.org/custom-publishing
telemedicine
Produced by the Science/AAAS Custom Publishing Office
for the duration of the COVID-19 national emergency, is that Health Insurance Portability and Accountability Act of 1996 (HIPAA)-covered providers may now use apps that are not fully HIPAA compliantósuch as FaceTime, Zoom, and Skypeóto provide telemedicine.
ìWeíre very optimistic because the pandemic has forced regulations to ��� ������������������������� �������� ���������������������������� ������������ �� ������������������������� ��������
Okun, who in addition to his role at the University of Florida, is medical director of the Parkinsonís Foundation, headquartered in Miami as well as New York City, is also excited by the recent changes (9���������������������over a decade to get telemedicine approved as a treatment for Parkinsonís. In terms of regulatory changes, the COVID-19 outbreak accomplished in 10 days what weíve been working on for 10 years,î he says.
Several other countries, such as France and China, also enacted policy changes to bolster telemedicine use during the pandemic (4).
For example, before the COVID-19 outbreak, China had no national policy on telemedicine. ìPhysicians could provide it to their patients for free, but thatís not sustainable,î says Wang. ìNow, the national health care system covers telemedicine.î
TeletechnologyAlthough one limitation of telemedicine is the inherent lack of a hands-on
approach to medicine, there is technology such as TytoCare that providers can use to augment the physical exam, explains Libby. Based in New York City, TytoCare provides patients with a device that can make recordings of the heart and lungs; perform imaging of the ear, mouth, and skin; and detect body temperature, all remotely. This information is transmitted to the physician in real time through an app.
Remote blood pressure monitoring systems that transmit measurements over Wi-Fi or Bluetooth are also available. Apple watches can measure heart rate and some models can conduct an EKG. Besides these patient-operated devices, there are a number of professional devices providers can use when conducting a remote consultation with a specialist, such as digital scopes, which provide high-quality images or sounds from a number of body parts, and the PINS Bluetooth deep-brain stimulator, which detects brain signals from deep in the brain and sends electrical impulses to block abnormal nerve signals.
Another type of technology that is beginning to play a role in telemedicine ���*���(��*+��)�++��)��������10). For example, it has been used to
only 20 minutes with the provider (6). The remaining time was spent on travel and waiting at the clinic.
ìThere is a hands-on component to medicine that is traditional and is important, but itís a small part of the whole experience of seeing a physician,î says Russell Libby, president of the primary care multisite pediatric practice Virginia Pediatric Group�����()����*������*��)���*����������)�*���*)��much less stressed when I see them via video.î
�++*)�����
��()�����*���*��)���������+�����)����������)����)�)���ìOur patient satisfaction for virtual visits is through the roof,î he says. ìIn fact, patients are 30% more likely to show up for a telemedicine visit than an in-person one.î
���*������������������*����*)�*���)(��*������)����*��� !���those who had used telemedicine had a good experience and that 78% would use it again (7).
A third major advantage of telemedicine is cost. A 2016 survey found that 93% of telemedicine users reported lower health care costs (8). ìNot only can telemedicine prevent unnecessary ED visits, there are also other expenses that *���)�*�������)���(��������������*��+*������)����"#$��%+���*�����*��&��that may not be needed and are not used during a video visit,î says Libby.
'+�����)�*+����
����������)(�)��*+��������*��)�������*��)��want to be seen in a clinic, and it affords family members scattered across the globe the opportunity to participate in their loved oneís care, says Okun.
Virtual visits can also give providers access to information they might not otherwise have, adds Libby. ìI get a glimpse into the patientís home environment, which can provide important clues about their health. Plus, on a video call, patients can just grab their prescription bottle if they canít remember what medication theyíre taking.î
However, telemedicine is about more than just replacing face-to-face visits, says Ann Mond Johnson, CEO of the American Telemedicine Association, headquartered in Arlington, Virginia. ìIn the U.S. and across the world, both in urban and rural areas, there is a huge shortage of clinicians. Wait times to see primary care providers can be weeks; for specialists it can be even longer,î she explains. ìWe can use telemedicine to reimagine medical care and provide access to more people.î
Relaxing the rulesA number of regulatory changes have occurred in the United States to facilitate
������������������������������������������������������������������������� IMA
GE
: C
OU
RT
ES
Y O
F P
INS
cont.>
Telemedicine increases health care access to patients with disabilities and those who live in rural areas.
LIFE SCIENCE TECHNOLOGIES
733SCIENCE sciencemag.org/custom-publishing
telemedicine
Produced by the Science/AAAS Custom Publishing Office
remotely predict which chronic obstructive pulmonary disease (COPD) patients are at high risk for an exacerbation of symptoms. As AI methodology evolves, it is likely to play an increasingly greater role in telemedicine.
Protecting privacy, preserving securityA major concern with telemedicine is ensuring the privacy and security of
patients, a topic on the minds of health care providers and consumers alike. ìIf you use a traditional telemedicine platform, itís totally secure,î says
&'(()������������'(��(��������������'����)(��()��'����������(��)(('����������the COVID-19 pandemic, he adds. ìAs we come out of the pandemic, we have to enforce appropriate regulations that protect patient privacy and security.î
An April 2020 international survey of physicians indicates that just under half '����'�����������(�������������������������)����'�����'��'����������������11). Mond Johnson has a message for them: ìAlthough youíre adopting quickly, donít �����'������'������)��������������)����'�������)(����������)����'���'��)���
Yanan Sui, assistant professor at Tsinghua University in Beijing, China, has developed a unique method of preserving patient privacy (12). COVID-19 has increased the number of neurology patients in China who want to use telemedicine; however, due to a shortage of clinicians, many patients must make video recordings that can be viewed later by their doctors. Existing de-��������)��'�����'���������)��(�������)��)�����!���)�����'�!����������������)��)(�movements that are critical to a neurologistís assessment of the patient, says Sui.
Instead, Sui and his collaborators have developed a method that uses AI and deepfake technology to ìswapî faces, in order to de-identify patients while still preserving facial aspects such as movements, which provide medical information.
"����)���')����)����(��)��'����)����'�������'('���#)����$�����%��'�)���kinds of telemedicine videos,î says Sui. ìBy properly protecting the patientís identity, our technology makes it much more likely that doctors and patients will consent to share their recorded video data with the larger medical and research community.î The team is currently in the process of assembling a large dataset using videos of Parkinsonís disease patients, which they hope to have ready to share with researchers in the next 2 years.
Closing the ìdigital divideîUnfortunately, it was well documented before COVID-19óbut is especially
true during the pandemicóthat structurally inequities are very pervasive in the U.S. health care system. One example of this is the ìdigital divideîólower rates of technology and broadband adoption among older adults, racial and ethnic minorities, and those of lower socioeconomic status.
ìWe became concerned that certain patients might have increased barriers to engaging in care via telemedicine and that rapid adoption of telemedicine might exacerbate existing inequities in care among the more marginalized patients,î explains Lauren Eberly, a cardiology fellow at the University of Pennsylvania in Philadelphia.
To better understand who telemedicine is reaching and who it might be leaving behind, Eberly and her colleagues looked at nearly 3,000 adult cardiology patients who were scheduled for a telemedicine visit between mid-March and mid-April 2020 to identify factors associated with a noncompleted visit (13).
ìOverall, we found that 54% of patients either canceled or did not show up for their telemedicine visit,î said Eberly. The factor that was most strongly associated with lower telemedicine use was non-English language. Non-English speakers had a greater than 50% lower usage of telemedicine than English speakers.
�������'�����'������������������������)��������)���������)����()���)���translation services into their telemedicine platform and are now working to have a more formalized outreach to contact patients in their native language.
The new normal?
As the pandemic slows, many are wondering what will happen to telemedicine down the road. ìItís unlikely that the current high utilization of telemedicine is going to persist in exactly the same way in the future, but it will almost certainly remain higher for both patients and providers than it was pre-pandemic,î says Demaerschalk.
ìThe silver lining of the COVID-19 crisis is that we hope providers, their patients, regulators, and payers can embrace and support telemedicine as an essential enhancement to providing the best care possible,î says Libby.
The extent to which telemedicine remains an integral part of health care depends largely on whether the legislative, regulatory, and payer changes that have recently occurred become permanent, says Mond Johnson. ìWe have a lot of work to do, but Iím very hopeful,î she adds.
References1. K. P. Hartnett et al., Morb. Mort. Wkly. Rep. 69, 699ñ704 (2020), https://doi.org/10.15585/mmwr.
mm6923e1.
2. B. M. Demaerschalk, R. N. Blegen, S. R. Ommen, Telemed. J. E. Health (2020),
https://doi.org/10.1089/tmj.2020.0290.
3. C.-C. F. Tam et al., Circ. Cardiovasc. Qual. Outcomes 13, e006631 (2020),
https://doi.org/10.1161/CIRCOUTCOMES.120.006631.
4. R. Ohannessian, T. A. Duong, A. Odone, JMIR Public Health Surveill. 6, e18810 (2020),
https://doi.org/10.2196/18810.
5. H. Xie et al., Epilepsy Res. 159, 106246 (2020),
https://doi.org/10.1016/j.eplepsyres.2019.106246.
6. K. N. Ray, A. V. Chari, J. Engberg, M. Bertolet, A. Mehrotra, Am. J. Manag. Care. 21, 567ñ574
(2015), available at www.ajmc.com/view/opportunity-costs-of-ambulatory-medical-care-in-the-
united-states.
7. Morning Consult (2020), available at www.bettermedicarealliance.org/wp-content/
uploads/2020/06/BMA-Memo-CT-D23.pdf.
8. HealthMine (2016), available at https://healthmine.com/wp-content/uploads/2019/07/
HealthMine_Digital_Health_Tools_Report_May_2016.pdf.
9. J. Zhang et al., Mov. Disord. 35, 909ñ910 (2020), https://doi.org/10.1002/mds.28098.
10. C. Kuziemsky et al., Yearb. Med. Inform. 28, 35ñ40 (2019),
http://dx.doi.org/10.1055/s-0039-1677897.
11. Sermo (2020), available at https://sermo-mktg.s3.amazonaws.com/instapage/
COVID+HCP+Sentiment_Updated+4.16.20.pdf.
12. B. Zhu et al., in AIES ë20: Proceedings of the AAAI/ACM Conference on AI, Ethics, and Society
(2020), 414ñ420, https://doi.org/10.1145/3375627.3375849.
13. L. A. Eberly et al., Circulation (2020), https://doi.org/10.1161/circulationaha.120.048185.
Allison Marin is a science writer and editor who specializes in
neuroscience and resides in Nashville, Tennessee.
American Telemedicine Association
www.americantelemed.org
Beijing PINS Medical Company Limited
www.pinsmedical.com
Beijing Tsinghua Changgung Hospital
www.btch.edu.cn
Mayo Clinic
www.mayoclinic.org
Parkinson’s Foundation
www.parkinson.org
Thomas Jefferson University
www.jefferson.edu
Featured participants
Tsinghua University
www.tsinghua.edu.cn
TytoCare
www.tytocare.com
University of Florida
www.ufl.edu
University of Oxford
www.ox.ac.uk
University of Pennsylvania
www.upenn.edu
Virginia Pediatric Group
www.vapg.com
READY TO
PUT THE
SPOTLIGHT
ON YOUR
RESEARCH?Submit your research:
cts.ScienceMag.org
ScienceImmunology.org
Twitter: @SciImmunology
Facebook: @ScienceImmunology
T cell
Antigen
Chimeric Antigen
Receptor (CAR) Tumor cell
��� ��� ������� ����� �� �� �� ��� ��� ����� � ����� �� ���� ������� ���� ��������� ����� ����� �� ��������
CAR-T Products & Engineering
Discover more | www.promab.com
All products are for research only
Intracellular
signaling domain
Transmembrance
domain
Co-stimulatory
domain
Co-stimulatory
domain #2
ScFv
Current CAR-T Products
CD19
CD19-FLAG
CD19-GFP
CD19-CD22
iCas-9-CD19
BCMA
EpCAM
CS1
EGFR
VEGFR2
CD20
CD22
CD24
CD33
CD38
ROR-1
c-MET
CD47
CD123
CD138
GPC3
NGFR
MCAM
PDL-1
B7H4
HER2
HER2-GFP
Mesothelin
Mesothelin-FLAG
CEA
Target cells alone T cells CAR-T cells
Custom design and development services available.
ProMab Biotechnologies has developed over 60 types of of-the-
shelf CAR-T/NK cells, target cells and generated CAR-T with several
patented innovations in the CAR construct design. ProMab can initiate
your CAR project in many ways: starting from your antibody sequence,
by developing a mouse monoclonal or humanized antibody; or even
producing a fully human single-chain variable antibody fragment (scFv)
from our existing antibody library. ProMab Biotechnologies has completed
more than 400 CAR-T projects and has developed about 5,000
hybridoma cell lines to date. Inquire today about your custom project.
50
~70%
Time (Hour)
2.5
2.0
1.5
1.0
0.5
0.0
0 10 20 30 40 50
NormalizedCellIndex
Time (Hour)
2.5
2.0
1.5
1.0
0.5
0.0
0 10 20 30 40 50
Cytotoxicity AssayCAR Expression
Norm
alizedCellIndex
Time (Hour)
Innovating Chimeric Antigen Receptors for
Research and Development
Discover more | www.promab.com
2600 Hilltop Dr, Building B, Richmond, CA 94806
1.866.339.0871 | [email protected]