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Published31 October 2023Shareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesBy Sean SeddonBBC NewsAt the centre of the UK’s response to Covid-19 was a small cast of politicians and officials tasked with steering the country through the crisis.But private messages aired during the public inquiry into the government’s handling of the pandemic have laid bare the strained relations between key players – and in some instances, the contempt and animosity. Here are some of the most eye-catching exchanges we’ve seen.This article contains language some readers may find offensive.’He thinks it’ll be like swine flu’ The inquiry has heard in recent days how then-Prime Minister Boris Johnson and other key figures inside Downing Street grappled with the size of the challenge facing the government between January and March 2020.On 2 March, Mr Johnson chaired his first meeting of the Cobra emergency committee to discuss how the government would respond to the rapid spread of Covid-19.But a day later, Dominic Cummings – the PM’s then chief of staff – said he still didn’t think Mr Johnson was convinced of the severity of the situation.In a message to No 10 communications director Lee Cain, he said Mr Johnson “doesn’t think it’s a big deal” and “it’ll be like swine flu”, another virus which spread across the world in 2009, killing more than 450 people in the UK but not prompting a major public health crisis.”His focus is elsewhere,” the PM’s closest aide said of his boss the day after that Cobra meeting.’He’s back to Jaws mode’On 19 March 2020, Mr Cummings was in a meeting with Mr Johnson and then-Chancellor Rishi Sunak. During it, he messaged his frustrations to Mr Cain.The exchange – which took place four days before the first UK-wide lockdown was announced – lays bare the vitriol Mr Johnson’s closest advisers were privately sharing at the time.Mr Cummings described the PM as “melting down” during a discussion about how government debt would be financed during the pandemic. The PM is in “Jaws mode”, Mr Cummings says – a reference to a joke Mr Johnson had previously made about his political hero being the mayor from the film Jaws, who keeps the beaches open despite warnings about shark attacks.Both say they are “exhausted” with him. They then discuss a tweet from Times journalist Steven Swinford, saying Mr Johnson had sent a “confusing message” at a press conference.Mr Cummings adds: “It’s only a matter of time before [Mr Johnson’s] babbling exposes fact he doesn’t know what to say.”‘I’ll personally handcuff her’The inquiry was shown expletive-laden messages Mr Cummings wrote about Helen MacNamara, who was deputy cabinet secretary at the time.On 21 August 2020, he said her propriety and ethics “bullshit” was “designed to waste huge amounts of my time”, and said she should be moved from her job.Mr Cummings said “I’ll personally handcuff her and escort her from the building”, and – using a highly offensive term – refers to dealing with her questions as “dodging stilettos”. He told the inquiry his language was “appalling” but denied being a misogynist, saying he had been just as brutal about male colleagues, and worked well with other women in government.Scottish government accused of withholding Covid WhatsApps,

Published31 October 2023Shareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesBy Nick TriggleHealth correspondent@nicktriggleBefore the pandemic, Sally enjoyed regular trips abroad and played golf three or four times a week, socialising with the other members at her club.Now in her mid-70s, she enjoys good health. But despite having been vaccinated against Covid, Sally says the virus has changed her approach to life.”I’ve not been on a plane since the pandemic started,” she says. “I just don’t think it is worth the risk. “I still play lots of golf – and in the summer, I enjoy having a drink on the terrace. But I don’t really do any socialising inside. I skip the Christmas parties and other events when the weather turns.”Sally is not alone, with research suggesting anxiety over Covid continues. And in recent weeks, it appears to have intensified, with internet searches for Covid having shot up with news of a new variant and a rise in hospital admissions.But there is plenty of evidence to suggest the virus is on its way to becoming just another respiratory bug to contend with, alongside flu and others maybe lesser known, such as respiratory syncytial virus (RSV), rhinorvirus and adenovirus.All carry risks – particularly to those with certain health conditions and compromised immune systems, who are advised to take precautions, including getting the available vaccinations and limiting contact with people with symptoms. Last winter there were estimated to be more flu deaths than Covid ones, in England – just over 14,000 compared with 10,000 – according to the UK Health Security Agency.That comes as no surprise to Prof Paul Hunter, an infectious-diseases expert at the University of East Anglia. The immunity to serious illness built up from vaccination and infection means the death rate per Covid infection is now well below that of flu, he says.Although there was a lot more Covid around in 2022, with a series of peaks over the 12 months, rather than it being largely confined to the winter months like other respiratory viruses – so for the year as a whole, the Covid death toll would outstrip that of flu.But, crucially, that trend has not been repeated in 2023. Instead, there is a much more seasonal pattern to the virus, with a long lull during spring and summer.Covid is “well on the way” to becoming seasonal, Prof Hunter says, with flu likely to cause more deaths from now on. And eventually, Covid will become “just another cause of the common cold”, like the other coronaviruses that circulate.Prof Adam Kucharski, who advised the government during the pandemic, agrees there are positive signs but remains a little more cautious.”With flu, we see a lot of pre-existing immunity,” Prof Kucharski says, “which makes it difficult to spread outside of winter.”The colder months tip the balance, he says, because of more indoor mixing and lower temperatures, which affect susceptibility to infection as well as allowing the virus to survive for longer outside.”The question with Covid is whether it can evolve enough to escape the immunity built up and cause problems outside of winter,” Prof Kucharski says.”We are seeing hints of seasonality but I wouldn’t say we’re definitely there.”What to do if you have CovidWho can get another Covid jab this autumn?But people can find it difficult to put Covid in context, Prof Kucharski says, pointing out there is still much more data on Covid than other respiratory viruses. “Data is good for scientists but it can cause alarm when interpreted wrongly,” Prof Kucharski says. “With recent new variants, we’ve sometimes seen people exaggerate the level of risk – that’s not helpful.”Prof Mike Tildesley, a modeller in infectious diseases, at the University of Warwick, is also encouraged by changes in Covid but says it could still end up causing more deaths than flu this winter. “There was quite a rebound for flu last year,” he says, “partly because immunity was down following a few years of not much flu circulating – so we may see the picture change this winter.”It is also hard to judge to what extent Covid deaths are coming on top – or instead – of flu. Combined, the number of Covid and flu deaths last winter was on a par with the worst two winters of the past decade.The changing nature of Covid also poses an interesting question about testing – is there any point to it?The era of free Covid tests may be over but plenty of people still test when they feel ill. Although, the experts have their doubts about whether this is entirely necessary.Image source, Getty Images”If you have symptoms,” Prof Tildesley says, “the question you have to ask yourself is whether you would do anything different if you tested and it wasn’t Covid. “If there is one thing we have learnt from the pandemic, it is the importance of trying to stay away from people if you are ill with a respiratory virus. That is as true for flu and other respiratory viruses as it is for Covid.”Prof Hunter agrees: “”The only situation where [Covid testing] is useful is if you are vulnerable with a condition* that would benefit from antivirals.”Image source, Getty ImagesSo what continues to hold some people back?Dr Martyn Quigley, a psychologist from Swansea University, says: “Covid had a huge impact on our lives – unlike anything we have lived through, for most – and for some, uncertainty and worry persist even though the risks have changed.”There are still lots of social cues – hand sanitiser, signs and screens in shops – that remind us of what happened. “It is similar with data. It is that unique history that is associated with Covid that induces worry and concern. It will take a long time for that to go for those affected in this way.”Update 31st October: We have added a paragraph referring to the risk from respiratory bugs for vulnerable groups and the precautions they are advised to take. Separately, on the 16th October Professor Hunter’s quote was edited at his request to use the word ‘condition’ instead of ‘lung condition’.More on this storyWarning that Covid will ‘continue to surprise us’Published2 October 2023New Covid and flu dashboard launched for EnglandPublished26 September 2023Who can get another Covid jab this winter?Published20 December 2023

A new study from researchers at the University of British Columbia’s Faculty of Medicine reveals a direct link between high insulin levels, common among patients with obesity and Type 2 diabetes, and pancreatic cancer.
The study, published in Cell Metabolism, provides the first detailed explanation of why people with obesity and Type 2 diabetes are at an increased risk of pancreatic cancer. The research demonstrates that excessive insulin levels overstimulate pancreatic acinar cells, which produce digestive juices. This overstimulation leads to inflammation that converts these cells into precancerous cells.
“Alongside the rapid increase in both obesity and Type 2 diabetes, we’re seeing an alarming rise in pancreatic cancer rates,” said co-senior author Dr. James Johnson, a professor in the department of cellular and physiological sciences and interim director of the Life Sciences Institute at UBC. “These findings help us understand how this is happening, and highlights the importance of keeping insulin levels within a healthy range, which can be accomplished with diet, exercise and in some cases medications.”
The study focused on pancreatic ductal adenocarcinoma (PDAC), the most prevalent pancreatic cancer, and one that is highly aggressive with a five-year survival rate of less than 10 per cent. The incidence of pancreatic cancer is on the rise. By 2030, PDAC is expected to become the second leading cause of cancer-related deaths.
While obesity and Type 2 diabetes had previously been established as risk factors for pancreatic cancer, the exact mechanisms by which this occurred remained unclear. This new study sheds light on the role of insulin and its receptors in this process.
“We found that hyperinsulinemia directly contributes to pancreatic cancer initiation through insulin receptors in acinar cells,” said Dr. Anni Zhang, the study’s first author who recently graduated with their PhD from UBC. “The mechanism involves increased production of digestive enzymes, leading to heightened pancreatic inflammation.”
While insulin is widely recognized for its role in regulating blood sugar levels, the study underscores its importance in pancreatic acinar cells. The findings show that insulin supports the physiological function of these cells in producing digestive enzymes that break down fat-rich foods, but at high levels, its increased action can inadvertently foster pancreatic inflammation and the development of precancerous cells.

Nearly 200 million people around the globe have coronary heart disease, which accounts for about one in every six deaths, according to the British Heart Foundation. That’s why the recent and rapid rise in wearable electronic health-monitoring devices with heart rate-measuring electrocardiograms (ECG) represents a significant step forward. By detecting cardiovascular ailments and helping assess overall cardiac health, wearable ECGs save lives, not to mention exorbitant hospital care costs.
In Applied Physics Reviews, by AIP Publishing, a group of researchers from Australia and India advanced the positive momentum with a study that presents a novel wearable ECG patch for enhanced point-of-care diagnostics.
“We did a deep dive into the world of wearable ECG devices,” said author Peter Francis Mathew Elango. “We focused on a critical aspect, how the design and materials of the electrodes impact their performance, and the findings were quite illuminating.”
Typically, Ag/AgCl electrodes, also known as “wet” electrodes, are used in devices to measure ECG signals and include a conductive gel to enhance electrical signaling. But these are known to be uncomfortable, irritating to the skin, and prone to drying out.
Instead, the study focused on the advantages of using active dry electrodes for ECG signaling and ultimately demonstrated an effective and promising prototype.
“Dry electrodes offer some significant advantages,” said Elango. “They prioritize user comfort, remain durable over time, and reduce the likelihood of skin irritation. These attributes make them ideal for continuous monitoring, a crucial feature for wearable ECG devices.”
The research included considerations of how the performance of dry electrode sensors is affected by the contact area, conductivity, and stability of the electrical contact. The team investigated various tight space geometry-based dry electrodes and different electrode geometries, studying their various influences on ECG sensing. They also examined how different body parts influence ECG measurements.
After extensive experimentation, they created a compact, lightweight, gel-free hexagonal-shaped ECG patch ideally suited for point-of-care diagnostics. The configuration was then integrated with wireless Bluetooth communication for remote sensing capabilities.
“The potential applications are where it gets really exciting,” said Elango. “These portable ECG patches could revolutionize remote and ambulatory healthcare, and perhaps even preventive medicine. They’re light, they can wirelessly transmit data, and they’re adept at discerning various states of rest or activity. Whether used in a clinical setting, seamlessly integrated into everyday attire, or worn as wearable devices, they could redefine how we monitor cardiac health.”

Drugs to treat common infections in children and babies are no longer effective in large parts of the world, due to high rates of antibiotic resistance.
The University of Sydney led study found many antibiotics recommended by the World Health Organization (WHO) had less than 50 percent effectiveness in treating childhood infections such as pneumonia, sepsis (bloodstream infections) and meningitis. The findings show global guidelines on antibiotic use are outdated and need updates.
The most seriously affected regions are in South-East Asia and the Pacific, including neighbouring Indonesia and the Philippines, where thousands of unnecessary deaths in children resulting from antibiotic resistance occur each year.
The WHO has declared antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity. In newborns, an estimated three million cases of sepsis occur globally each year, with up to 570,000 deaths: many of these are due to lack of effective antibiotics to treat resistant bacteria.
The findings, published in Lancet South East Asia, adds to mounting evidence that common bacteria responsible for sepsis and meningitis in children are often resistant to prescribed antibiotics.
The research reveals the urgent need for global antibiotic guidelines to be updated, to reflect the rapidly evolving rates of AMR. The most recent guideline from The World Health Organization was published in 2013.
The study found one antibiotic in particular, ceftriaxone, was likely to be effective in treating only one in three cases of sepsis or meningitis in newborn babies. Ceftriaxone is also widely used in Australia to treat many infections in children, such as pneumonia and urinary tract infections.

The main transmission routes identified initially for the novel coronavirus infection were droplet and contact transmission. Airborne transmission by aerosol particles was eventually identified as one of the most likely transmission routes. Especially with the relaxation of behavioral restrictions, infections continued to prevail, making prevention and risk reduction during public transportation a major challenge.
In this study, researchers identified the risk of virus exposure by visualizing and measuring the flow field of aerosol particles derived from exhaled air (jet stream) during face-to-face encounters using a mobile full-scale mannequin and a particle-tracking velocimetry system. Subsequently, the researchers compared the differences between aerodynamic characteristics with and without ventilation and their effects on the risk of virus exposure.
The researchers found that, with or without ventilation, the number of aerosol particles peaked within 5 seconds after face-to-face encounters and then declined rapidly. This was observed during walking, jogging, running, and sprinting activities. The higher the transit velocity, the smaller this peak became, which may be due to the increase in the relative velocity between exhaled air and ambient air that facilitated particle diffusion. Furthermore, the number of aerosol particles in ventilated conditions was significantly lower than that in nonventilated conditions.
The results indicate that, to reduce the risk of viral infection during face-to-face encounters, measures such as interrupting inhalation, maintaining a physical distance of at least 1 m, and positioning oneself upwind, are effective within 5 seconds of face-to-face encounters. These findings can help in the management of exposure risk to airborne viruses in general.
This work was supported by JSPS KAKENHI Grant Numbers JP21K19695.

A pioneering study at Umeå University, Sweden, has unveiled that the 3D organization of DNA can influence the progression of the aggressive brain tumour known as glioblastoma. Having identified the factors that glioblastoma uses to respond to neurons by growing and spreading, this discovery paves the way for further research into new treatments for brain tumours.
“We have now identified the most important factors behind how the tumour responds to nerve cells, thus becoming more dangerous. These findings offer hope in our long-term battle against this difficult-to-treat cancer, for which the prognosis has not improved in decades,” comments Silvia Remeseiro, Wallenberg fellow at WCMM, Assistant Professor at Umeå University, and lead author of the study.
Glioblastoma is the most fatal type of brain tumour among adults and there is currently no curative treatment. Glioblastoma patients typically face a survival of roughly one year post-diagnosis. Even following current treatment regimes, which include surgery, radiotherapy and chemotherapy, a mere four per cent of patients are still alive five years after diagnosis.
One possible way to understand and tackle this form of cancer is through DNA. It is already known that changes, mutations, in parts of DNA that do not contain genes can increase the risk of cancer and affect how genes function. This is because DNA contains so-called enhancers, “switches” that ensure that the right genes are turned-on in the right cells at the right time. A tight control of genes is crucial. If there are errors in these “switches” or abnormalities on how they contact the genes, changes in gene expression occur, which can eventually lead to cancer. A further step forward was taken when researchers discovered synaptic connections between nerve cells and brain tumours. Nerve cells can send electrical signals to brain tumour cells that make the tumour grow and spread.
This recent study by Umeå researchers highlights that alterations in DNA structure and in enhancers, which in turn affect how genes are expressed, are crucial for the communication between neurons and tumour cells. It offers insights into how glioblastoma cells become more dangerous in response to the signals from the nerve cells. Using cells from glioblastoma patients and advanced techniques to analyse DNA structure and epigenetics, the researchers identified the key players central to this neuron-to-tumour communication, named SMAD3 and PITX1. These two proteins bind to and control the DNA switches that regulate gene expression. In experiments on both cell cultures and mice, it was possible to see how SMAD3 inhibition, together with the signals from the nerve cells, potentiates the tumour’s ability to grow and spread.
“We are optimistic that our discovery can guide efforts to attack glioblastoma by controlling how nerve cells and brain tumours interact. This would enable the development of new treatment strategies targeting this critical communication, which could hopefully improve the prognosis of glioblastoma patients,” concludes Silvia Remeseiro.

Current osteoarthritis treatment manages symptoms rather than addressing the underlying disease, but a new University of Adelaide study has shown the condition may be treatable and reversible.
Osteoarthritis is the degeneration of cartilage and other tissues in joints and is the most common form of arthritis in Australia, with one in five people over the age of 45 having the condition.
It is a long-term and progressive condition which affects people’s mobility and has historically had no cure. Its treatment cost the Australian health system an estimated $3.9 billion in 2019-20.
Often described as a ‘wear and tear’ condition, factors such as ageing, obesity, injury and family history contribute to the progression of osteoarthritis.
University of Adelaide researchers discovered a novel population of stem cells — marked by the Gremlin 1 gene — responsible for the progression of osteoarthritis.
Treatment with fibroblast growth factor 18 (FGF18) stimulated the proliferation of Gremlin 1 cells in joint cartilage in mice, leading to significant recovery of cartilage thickness and reduced osteoarthritis.
Gremlin 1 cells present opportunities for cartilage regeneration and their discovery will have relevance to other forms of cartilage injury and disease, which are notoriously challenging to repair and treat.

If anesthesiologists had a rigorous means to manage dosing, they could deliver less medicine, maintaining exactly the right depth of unconsciousness while reducing postoperative cognitive side effects in vulnerable groups like the elderly. But with myriad responsibilities for keeping anesthetized patients alive and stable, as well as maintaining their profoundly unconscious state, anesthesiologists don’t have the time without the technology.
To solve the problem, researchers at The Picower Institute for Learning and Memory at MIT and Massachusetts General Hospital have invented a closed-loop system based on brain state monitoring that accurately controls unconsciousness by automating doses of the anesthetic drug propofol every 20 seconds.
The scientists detail the new system and its performance in animal testing in a new study in the journal PNAS Nexus.
“One of the ways to improve anesthesia care is to give just the right amount of drug that’s needed,” said corresponding author Emery N. Brown, Edward Hood Taplin Professor of Medical Engineering and Computational Neuroscience at MIT and an anesthesiologist at MGH. “This opens up the opportunity to do that in a really controlled way.”
In the operating room, Brown monitors the brain state of his patients using electroencephalograms (EEGs). He frequently adjusts dosing based on that feedback, which can cut the amount of drug he uses by as much as half compared to if he just picks a constant infusion rate and sticks with that. Nevertheless, the practice of maintaining dose rather than consciousness level is common because most anesthesiologists are not trained to track brain states and often don’t take time in the operating room to precisely manage dosing.
The new system is not the first closed-loop anesthesia delivery (CLAD) system, Brown said, but it advances the young field in critical ways. Some prior systems merely automate a single, stable infusion rate based on general patient characteristics like height, weight and age but gather no feedback about the actual effect on unconsciousness, said Brown, who is also a member of the Institute for Medical Engineering and Science at MIT and the Warren Zapol Professor in Harvard Medical School. Others use a proprietary control system that maintains “black box” markers of unconsciousness to vary within a wide range.
The new CLAD system, developed by Brown and his team at the MIT and MGH Brain Arousal State Control Innovation Center (BASCIC), enables very precise management of unconsciousness by making a customized estimate of how doses will affect the subject and by measuring unconsciousness based on brain state. The system uses those measures as feedback to constantly adjust the drug dose.

At what age does an adolescent start thinking as an adult? A new study published this week in Nature Communications presents some of the first definitive evidence that executive function — a set of cognitive skills underlying the ability to plan, seamlessly switch from task to task, resist tempting distractions and focus on a task at hand — usually matures by the time an individual turns 18 years old.
The study collected and analyzed nearly two dozen laboratory measures of executive functions in over 10,000 participants across four unique datasets, presenting a first-of-its-kind large scale chart of cognitive development in teens. The findings have significant implications not only for psychiatrists and neuroscientists, but also for parents, educators, and potentially the judicial system in defining the boundaries of the adolescent period.
“When I talk with parents, a lot of them say, ‘There is no way that my 18-year-old is a fully formed adult!'” said senior author Beatriz Luna, Ph.D., professor of psychiatry at the University of Pittsburgh School of Medicine and an expert on neurocognitive development. “Other important behavioral factors that complement executive function, such as the ability to control one’s own emotions, can change with age. The ability to use executive function reliably improves with age and, at least in a laboratory setting, matures by 18 years of age.”
Unlike the meticulously mapped out milestones of childhood, the timeline of adolescence remained less formally defined, primarily due to the complexity of developmental processes set into motion with the onset of puberty. High variability among individuals and a lack of tools for analyzing complex datasets also limited the confidence of previous attempts to build a roadmap of brain development in teens.
“In our study, we wanted to present a consensus and not just a hunch,” said lead author Brenden Tervo-Clemmens, Ph.D., assistant professor of psychiatry and behavioral sciences at the University of Minnesota.
“This is developmental science meets big data. We are using tools that were not available to researchers studying cognitive and brain development until several years ago. A study of this scale was made possible only by open data-sharing and collaborators who graciously gave access to their datasets without asking anything in return,” added Tervo-Clemmens, who began this research as a graduate student in Luna’s lab at Pitt.
The study collected 23 distinct measures of executive function from over 10,000 participants from 8 to 35 years old. Scientists then analyzed those metrics by tracking their change over time and checking whether performance across different tests fit a single trajectory that could be described with a mathematical model.
The resulting analysis showed a common dynamic of executive function maturation that was shared between both sexes: a rapid burst of executive function development in late childhood to mid-adolescence (10-15 years old), followed by small but significant changes through mid-adolescence (15-18) that stabilized to adult-level performance by late adolescence (18-20).
By presenting reproducible growth charts across tasks and datasets, this roadmap could allow researchers to track how therapeutic and drug interventions might affect developmental milestones. For instance, adolescence is the time when many mental illnesses, which also have problems in executive function, such as schizophrenia, emerge. Charting the neurotypical brain development timeline will then allow researchers to better track any subtle shifts from the “norm” and possibly improve early diagnosis.
This research was supported by the National Institutes of Health (grants R03MH113090 and R01MH067924) and the Staunton Farm Foundation.