The scientific polymath has a special talent for live imaging of microscopic organisms — among a multitude of skills.
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Sitting down with the new L.A. Police Commission president, USC’s Erroll Southers
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https://priceschool.usc.edu/news/la-police-commission-erroll-southers/
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Headline: A Q&A with Erroll Southers, the new L.A. Police Commission president
Deck: Southers, a USC Price School professor, discusses crime, community relations and other issues facing the LAPD.
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The Los Angeles Police Commission recently elected Erroll G. Southers as its next president, putting the USC professor and former FBI agent in charge of the body that oversees one of the nation’s largest police agencies.
Southers, professor of the Practice in National and Homeland Security at the USC Sol Price School of Public Policy, will now set the agenda for the civilian panel, which functions much like a board of governors for the police department. Southers also serves as associate senior vice president of Safety and Risk Assurance at USC.
We caught up with Southers to discuss his goals for LAPD and some of the complex public safety challenges facing Los Angeles, from boosting transparency to recruiting more officers.
Why did you take this job?
I have had a more than 40-year relationship with LAPD, even though I never worked for them. I’ve also had a 15-plus-year relationship with Mayor [Karen] Bass, who is a USC alum. She’s been a mentor throughout my career and I was honored when she asked me to consider an appointment to the commission.
I can’t tell you how many LAPD officers have been my students. In addition to the experience I’ve had in law enforcement, I actually know these people. I think I will have a tremendous opportunity to examine the department’s transparency and accountability, and if I am critical, officers will view it as coming from someone who understands what they do.
Where could LAPD use more transparency?
Some of the adjudication outcomes – such as officers being terminated, officers being disciplined with days off – are outcomes that cannot be shared. Because of that, the public believes nothing’s happening. I can tell you as someone who sits in those meetings, when those incidents are adjudicated, that is the furthest thing from the truth.
Use of force investigations involve tens if not hundreds of hours of investigative work consisting of interviews, statements, photographs, drawings, videos, and forensic evidence. If the public knew that’s what we’re reviewing, I believe they’d have a greater level of trust, and we need to do a better job of sharing the process with the community.
How can LAPD replenish its depleted staffing ranks?
It’s a real challenge. You’ve got people today that quite frankly may not want to be police officers. We have people who want to work remotely, on a reduced work schedule, or a hybrid work schedule. In this profession, you have to come to work.
Of course, there’s an image challenge right now after the death of George Floyd and other similar incidents, which makes it particularly difficult to recruit. We are also trying to achieve compensation parity with other agencies as it relates to pay and benefits. It’s a very competitive environment for a very selective profession.
What also makes this challenging are the standards that we set. For every 100 people who apply, we may hire less than 10. This is a profession that cannot compromise on the standards because it involves the safety and security of the community.
What are some police reforms to consider?
The toughest thing now, in terms of reform, is making sure we select the right people for the job. We are considering an applicant pool that is not comprised of perfect people. It’s called the human race. Understandably, regardless of our recruitment and vetting process, there are some candidates who may successfully complete the process but should not be police officers. If officers have to leave the profession due to misconduct, they need to leave for good. Knowing that fact should enhance public trust.
I’ve always attempted to support police officers to the extent reasonably possible. But when they’ve crossed that line, and it’s resulted in being terminated, I feel just as strongly that those individuals should move on to a new profession. They’ve broken that trust, and it’s done.
How can LAPD improve community relations?
One thing that I see as a challenge is misinformation. For example, there are people who still believe that canines, meaning our dogs, are trained to find and bite. They haven’t done that in decades.
It means being more aggressive in terms of marketing the things that the department is doing well. Almost every week I listen to reports and presentations about some tremendous programs that are going on in LAPD with the community where they’re working together, and no one ever hears about it.
How can LAPD help improve officer mental health?
We’ve had two officers take their lives recently at LAPD. It is tragic and a national challenge. Many officers believe no one likes them. No one cares about them. In addition, they see things every single day that the average person will never see in their lifetime. That takes a toll.
We have to do everything possible to ensure officers know that help is available, and tell them to seek that help. Most importantly, it’s not penalizing them for doing that. Years ago, officers were of the belief that if they seek help, they’re going to be seen as weak and not get promoted. That’s the furthest thing from the truth. Now, no one holds that against an officer when it comes time for promotions or advancement. Hopefully, if they do seek help, we can retain them throughout their career in a very healthy mental state.
Officer wellness has to be the highest priority; without them we will never accomplish the community safety goals we desire.
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Could a simple blood test detect cancer?
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Could a simple blood test detect cancer?
USC Dornsife physicist Peter Kuhn discusses his breakthrough breast cancer detection test, which could potentially upend how we diagnose many types of cancer.
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Clinicians agree that cancer screenings, such as mammograms, offer the best hope of finding cancer before it’s out of hand. Unfortunately, screening is often uncomfortable and can require invasive techniques. It also generally involves several days of anxious waiting before results are available.
Replacing these sorts of screenings with a simple blood draw, one which could provide instantaneous results, has been a tantalizing yet unrealized dream among researchers for decades. (It was also the failed promise underpinning the Theranos scandal, which rocked Silicon Valley in recent years.) USC Dornsife College of Letters, Arts and Sciences Dean’s Professor of Biological Sciences Peter Kuhn says such screening technology isn’t just a pipe dream, however.
He and his team are developing a new method they’ve dubbed “the Pink Test” to detect breast cancer by looking at a patient’s bloodstream rather than imaging tissue. It could revolutionize cancer screening and treatment monitoring for many types of cancer.
Kuhn, a founding member of the Michelson Center for Convergent Biosciences at USC and part of the Biden Administration’s Cancer Moonshot, which is aiming to significantly reduce cancer deaths in America, recently sat down for a Dornsife Dialogues with retired cancer researcher Amy Ross ’86 to discuss his work.
Why it matters: Mammograms, the current standard screening for breast cancer, have a number of flaws.
They’re uncomfortable and invasive, which means many women avoid them.
Results can take days to come back.
If a mammography does detect a tumor, patients must often undergo painful follow-up biopsies.
Screening mammography is only about 85% accurate today, says Kuhn: “You have about a 10% chance that it comes back as a false positive. The other problem is that 10% of all breast cancers are actually being overlooked or getting detected too late.”
What’s new: Kuhn and his team are at work on the Pink Test, a simple blood test that could replace mammograms and biopsies and better monitor patients with breast cancer diagnoses.
In a recent study, the Pink Test was roughly 99% accurate, reducing false alarms and missed cancers.
It also proved better at detecting lobular carcinoma, the second most common breast cancer, which is typically harder to detect and is often only caught in later stages using mammography.
What else? Other solid-tumor cancers, such as lung or colon cancer, could potentially be detected using this sort of screening.
It’s personal: Kuhn’s focus on breast cancer arises from personal experience. His mother was diagnosed with breast cancer when he was a child. Although she survived, her friend undergoing treatment at the same time did not. Kuhn knows that this test could potentially save millions of lives.
“There are 70 million women in the United States alone who are eligible for breast cancer screening,” says Kuhn. “Every day that we are late in bringing this test to the clinic, there are 200,000 women potentially missing out.”
Next steps: Kuhn and his team are working on verifying the results of the initial study, as well as scaling up into larger studies with different population groups.
He’s hoping to get approval from the Food and Drug Administration within the next few years so the test can become available to everyone.
Game changer: The Michelson Center for Convergent Bioscience brings together researchers and students from USC Dornsife and across the university — and the world — to work on important scientific challenges.
“I am not a medical doctor. I have actual no training in medicine whatsoever. I’m merely a physicist,” says Kuhn. “I am approaching cancer through a very different lens than a clinician would. In isolation I can’t make any progress, but together in this context of convergent science, I really think we can make progress in very different ways.”
Get involved: To learn more about the Pink Test, including how you can get involved, visit the research website at kuhn.usc.edu/usc-intercept/.
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Is green hydrogen the fuel of the future?
As the world seeks alternatives to fossil fuels, scientists are looking to hydrogen as a promising source of clean fuel. Unlike gasoline, which releases carbon dioxide when burned, hydrogen combustion produces only water vapor, making it a clean and environmentally friendly alternative. More often, hydrogen is converted to water and electricity in a fuel cell, as in the Toyota Mirai. It is already being used in this way to fuel zero-emission fuel cell electric vehicles (FCEVs) and has long been used by NASA to send rockets into space.
As the most abundant element on Earth, hydrogen has the potential to transform many of the sectors that power our world, from transportation and utilities to biofuels, fertilizers and environmentally benign chemicals. However, the high cost and logistical complexity of physically transporting hydrogen present cost barriers that we all have to pay for in the cost of our electricity, fuels and foods.
Travis Williams, a chemist at the USC Loker Hydrocarbon Research Institute, is tackling this challenge head-on by developing a “hydrogen on-demand” reactor that promises to simplify and cost-effectively revolutionize the transportation of hydrogen. In 2022, the U.S. Department of Energy recognized Williams’ groundbreaking technology as one of five pivotal achievements in recent hydrogen research history.
“The current cost of hydrogen is mostly driven by the expense of compressing and delivering it. Our reactor essentially delivers high-pressure hydrogen when and where you need it, allowing users to convert it into energy or other products without producing any pollution,” said Williams, who is also a professor of chemistry at the USC Dornsife College of Letters, Arts and Sciences. “Our goal is to make hydrogen more accessible and economical as a clean energy source, and this technology is a major step forward.”
(Story continues below video)
Harnessing the power of green hydrogen
Green hydrogen refers to hydrogen gas produced through a process that uses renewable energy sources, such as wind, solar or hydropower, to extract hydrogen from water or other sustainable feedstocks. This production method is considered “green” because it generates minimal or no greenhouse gas emissions, making it an eco-friendly alternative to conventional hydrogen production methods, which often rely on fossil fuels.
The cleanest process for producing green hydrogen is called electrolysis, in which an electric current is passed through water to split it into its constituent elements, hydrogen and oxygen. The electricity used in this process can come from renewable sources, ensuring that the overall carbon footprint of the hydrogen production is very low or even zero.
In addition to being 100% sustainable, green hydrogen is easy to store and incredibly versatile. It can effectively supplement intermittent energy sources such as solar and wind, addressing the gaps in their reliability. The U.S. Department of Energy expects that green hydrogen, generated from these sources, will eventually displace natural gas-based hydrogen, generated by methane steam reforming, ultimately to eliminate the carbon footprint of the hydrogen industry.
Hydrogen’s uses are vast. In addition to applications in transportation, hydrogen is a key ingredient in a range of industrial processes including petroleum refining, metal treatment, fertilizer production and food processing.
However, due to hydrogen’s high reactivity and flammability, regulatory authorities have established stringent pressure and purity standards. Meeting these standards can be particularly challenging, especially when producing hydrogen for use in vehicles.
“To meet specs for vehicle filling, you have to compress the gas to a certain pressure. The cost of running the compressor ends up being almost equal to the cost of the hydrogen itself for cars, which contributes to some of the affordability problems we’re seeing in hydrogen production today,” said Williams.
“Our reactor is designed to operate effectively at high pressure, and the chemical reaction generates sufficient energy for self-pressurization, eliminating the need for expensive compressors,” he added.
The reactor also transports hydrogen in a more affordable liquid form known as formic acid, which can then be transported to the desired location and converted back into hydrogen. This transformative technology allows for the seamless mobility of hydrogen, ensuring it can be readily converted into a usable form wherever and whenever it is needed.
In California, hydrogen is taking off and USC tech can help bring it to market
While electric cars powered by lithium-ion batteries dominate the landscape of zero-emission vehicles, hydrogen FCEVs are on the road, too — especially in California. In recent years, the Golden State has doubled down on its investment in hydrogen infrastructure. California currently hosts 57 of the 58 hydrogen fueling stations nationwide, with the only exception in Hawaii.
“For a long time, there has been a debate about the ideal role of electric vehicles, particularly in urban areas like L.A. The aim has always been to reduce gas vehicle usage due to emissions, and hydrogen vehicles were seen as a solution if we could establish the necessary refueling infrastructure,” Williams said.
“If you combine lithium-ion batteries with a liquid or gaseous hydrogen carrier, you can significantly enhance fuel range. Our reactor can help make that happen,” Williams said, adding that the chemistry of these carriers can store much more energy compared to solid-state batteries.
While FCEVs are important, most hydrogen is used for liquid fuels and fine chemicals. California is also taking on sustainable aviation and, last year, marked a major milestone with the announcement of a $2 billion expansion project at the World Energy sustainable aviation fuel facility in Paramount, Calif. This adds to the facility’s current capacity to refine renewable diesel fuel. The facility is the largest of its kind in North America and is poised to become a global hub for hydrogen-powered diesel and jet fuel production as well, so long as it can get enough hydrogen. Renewable fuels manufacturing is emerging as one of the largest uses for on-demand hydrogen generation. This is an opportunity where Williams sees important impact potential for emerging USC technology.
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Why isn’t crowdfunding of social impact initiatives more effective?
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https://www.marshall.usc.edu/posts/crowdfunding-is-a-boon-for-many-projects-but-why-doesnt-it-work-as-well-for-social-impact-initiatives
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Crowdfunding is a Boon for Many Projects, but Why Doesn’t it Work as Well for Social Impact Initiatives?
New Research from USC Marshall’s Jill Kickul identifies key strategies to leverage contributor dollars for systematic change.
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You’ve seen it online: crowdfunding for just about any purpose you can imagine. From artists trying to fund a project to individuals trying to pay a difficult healthcare bill, thousands have used sites like Go Fund Me to reach a financial goal. Globally, crowdfunding is $1.1 billion dollar market, with average campaigns reaching $8K USD. In the case of social entrepreneurs, however, crowdfunding projects that address a social issue take longer to reach their financial target.
In new research, published in Entrepreneurship & Regional Development, the team, including USC Marshall School of Business Professor Jill Kickul, identified strategies to incentivize individuals to more readily contribute to social impact projects through crowdfunding. As part of this work, the team sought to better understand what motivates individuals to contribute to social impact work in the first place. Key: promoting natural rewards such as joy, honor or prestige. “Natural rewards help contributors achieve a positive emotional state,” Kickul, who is also holds the Narayan Research Directorship in Social Entrepreneurship at the USC Brittingham Social Enterprise Lab, said.
…the more empathetic a person feels, the more likely they are to contribute to the well-being or benefit of others…
Studies have shown that material rewards and incentives–such as money, perks or gifts–might not work for activities such as donating or volunteering for charitable causes. But the emotional state achieved by contributing to a project that helps others is paramount. As important is a state of mind called prosocial motivation–essentially the more empathetic a person feels, the more likely they are to contribute to the well-being or benefit of others, the researchers said.
So how do you appeal to such motivations and internal rewards in a broad audience? Kickul and her team say communication and marketing should focus on prosocial narratives, emotional tones and speech that affirms a positive emotional state. For example, say you are want to encourage your target audience to donate to preservation wildlife habitat preservation. Offering a free gift with a donation is less likely to produce a response than telling the story of one elephant named Marnie who lost her home and struggled to find food and shelter as she wandered for new spaces.
While material rewards won’t be a primary motivator in these situations, the researchers say inexpensive rewards like thank you gifts that align with a social or environmental cause (e.g. a bio-degradable pouch) could be valued by specific contributors. Other types of material rewards might repel those who find the rewards as unaligned in values or too expensive to come from a charitable donation.
Overall, crowdfunding is an excellent source of funds, but strategies for social and environmental impact projects need to target the emotional elements and tap into the internal motivation of contributors to support a solution. In short, if crowdfunding is going to have as much of an impact for social change initiatives as it does for other types of projects, organizers of those campaigns need to make target audiences care–and feel something.
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Can Crowdfunding Be Better Leveraged for Good? New research from USC Marshall offers insights into why people are slower to donate to social impact initiatives, and how we can change that.
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Fixing palliative care’s image problem could boost its use
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Candace Pearson
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Fixing Palliative Care’s Image Problem Can Boost its Use
Often confused with hospice, palliative care has a champion in USC gerontologist Susan Enguidanos, who has dedicated herself to expanding access to this beneficial resource.
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On a sunny day in early July 2022, just two weeks short of her 94th birthday, Lydia Sloan could be found in her favorite place–the flourishing garden of her Palo Alto home, pruning bushes and picking tomatoes for the dinner she would make that night.
She had lived here for more than six decades with her husband, Charles, until his passing several years earlier. Together, they raised three children in the town in which she grew up and graduated from Stanford University, where they met.
Strong-minded and determined to make it on her own, Sloan regularly exercised her passions for reading, gardening and family. But that independent life was about to change.
Suddenly, she lost her balance and fell. She hit the ground hard, breaking multiple bones, including her clavicle and her femur in four places. It took two hours, pushing herself on her back, to return to her house to call 911.
Over the coming few months, Sloan was in increasing back pain. At first, doctors suspected her injuries and long-standing scoliosis of the spine. After four visits to the emergency room, she finally got a diagnosis: uterine cancer.
“My mother had enjoyed the gift of health her whole life,” says her eldest daughter, Margaret (Blue) Tierney. “She wasn’t prepared for this. Neither were we.”
The family would soon learn a new phrase–palliative care. Though unfamiliar, it would wrap a compassionate, useful embrace around them all when they needed it most.
Discovering a Valuable Resource
Palliative care is a largely misunderstood and under-utilized resource often confused with its better-known cousin, hospice care. “It’s considered an extra layer of support–at any stage for any age,” says Susan Enguidanos, Associate Professor of Gerontology at the USC Leonard Davis School of Gerontology.
Widely renowned in the field of palliative care, she has spent decades studying its effectiveness and benefits–and trying to remove barriers to its usage.
Palliative care flies under the radar of many patients who could benefit from it and even a majority of physicians. If you search online for “palliative care,” what often comes up is “hospice” or “end-of-life care.” Neither is accurate. “One of the things we know from research is that a lot of people conflate the terms,” says Enguidanos.
In California, and elsewhere, many hospice organizations also provide palliative services, compounding the confusion. Television medical dramas don’t help.
“Many people get their healthcare information from TV,” says Deborah Fui-Yuen Hoe, an instructional assistant professor for Gerontology who collaborates in the Enguidanos Lab. “Very few medical series mention palliative care and those that do often get it wrong.”
What Palliative Care Is & Isn’t
At its most basic, palliative care is support for people with serious chronic or complicated illnesses. It can start as early as the day of diagnosis. Hospice care comes in when a patient has a terminal illness with six months or less to live.
Patients must forego curative care in hospice, while palliative care can be provided alongside other medical treatments. Whether or not a cure is anticipated, palliative’s focus is on pain relief and other physical, psychosocial and spiritual support for patients and families.
In palliative’s home-based interdisciplinary approach, each team includes a physician, nurse, social worker, chaplain and home health aide. Enguidanos developed and tested this home-based palliative care model in two pivotal research studies published in 2002 and 2007 and conducted in Kaiser Permanente HMOs in California, Colorado and Hawaii.
The 2007 clinical trial enrolled more than 300 seriously ill patients. Its findings: patients receiving home-based palliative care had fewer emergency department visits, inpatient hospital days, skilled nursing days and physician office visits than patients on usual medical care.
With more home visits than typical, home-based palliative care patients experienced a far lower cost of care– 37% to 45% below standard care. And they were more likely to die at home, a place most people prefer to be at end of life.
Quick Learning Curve Required
Blue Tierney didn’t know these statistics in the summer of 2022. She only knew she had to act quickly. Independent even now, her mother still wanted a place of her own. So, Tierney and her husband, Phil, moved her to an assisted living facility close to their home in Placerville in the Sierra Foothills.
The Tierneys had one advantage: they come from a medical family, with a son who is a head and neck surgeon, one daughter-in-law an endocrinologist and another in residency in emergency medicine. Their son gave them his prescription for his grandmother, “She needs palliative care.”
The Tierneys weren’t sure what that was. They went to Sloan’s primary care doctor, but he couldn’t make any referrals.
Phil Tierney set to work. “First, I looked for palliative care doctors or doctors with it in their portfolio. I identified three in our area–it seemed pretty sparse,” he says. In an amazing synchronicity, the Tierneys found what they needed in a nonprofit organization they and Sloan had supported as donors–Snowline in El Dorado County.
“We didn’t realize Snowline provided palliative care,” says Blue Tierney. “Everyone here thinks of it as hospice.”
Palliative care’s identity problem is why Snowline has stopped using “hospice” in its name and why its medical director, Jeanine Ellinwood, prefers to call it “supportive” care.
Ellinwood began working in hospice in 1998, “before palliative care had branched into its own entity,” she says. Then, in 2010, a landmark study published in the New England Journal of Medicine, showed that for patients with metastatic non-small-cell lung cancer, early palliative care led to significant improvements in quality of life, as well as longer survival. “That got attention from the medical profession.”
Ellinwood and Enguidanos have collaborated on palliative care studies that focus on expanding access to care and understanding challenges in accessing care from multiple perspectives.
360 Degrees of Support
Palliative care can provide a wide range of services and supports, including expert pain management, medication reminders, wound and oxygen care or help with medical equipment, insurance paperwork, care planning, food and housing support, everyday chores, like trash collection, that have become difficult to manage–even spiritual issues.
Ellingwood recalls one patient in her mid-50s with lung cancer whose primary care doctor had labeled “non-compliant.” Her Snowline palliative care team discovered she was worried about eviction because her medical equipment blocked her apartment building’s hallway and about her 14-year-son’s reaction to her illness.
The team nurse spoke to the landlord about allowing the equipment, while the social worker arranged for additional school support. Now the patient could focus on healing. “We walk alongside each patient whatever their goals,” says Ellinwood.
She believes acceptance of palliative care has grown in the last several years. “Physicians are starting to have a better understanding. Things are changing but slowly.”
For Enguidanos, that progress has been too slow.
Unlike hospice, home-based palliative care is still not a Medicare benefit and “not broadly provided across the country,” she says. In 2018, the State of California enacted Senate Bill 1004, which mandates that providers of Medi-Cal (the state’s Medicaid health care program) offer team-based, coordinated palliative care to eligible patients with serious illnesses.
But, in a 2020 study, Enguidanos, Hoe and others characterized the response from primary care physicians to the expanded coverage as “underwhelming.” In the two years following enactment of SB 1004, fewer than 1% of all Medi-Cal patients were enrolled in home- and community-based palliative care programs. Most doctors surveyed had not even heard of the coverage.
Also discouraging: Anecdotal reports suggest that of the Medi-Cal patients who were referred to home-based palliative care, less than half enrolled.
What prevents physicians and patients from signing up for services that have been proven to increase comfort and quality of life? In multiple studies, Enguidanos’s team has analyzed possible barriers from every angle–providers, patients and caregivers.
Discomfort, Worry & Resistance
One explanation: Many people shy away from conversations about illness, dying and end of life–“and that includes physicians,” says Hoe. “Our surveys have found many doctors are not comfortable talking about the issue or they wait for patients to bring it up.”
Often, physicians aren’t sure how to explain palliative care. Some interpret it as a failure of their own treatment plans.
Patients have their own uncertainties. “They oftentimes don’t know what palliative care is or feel they are not sick enough,” says Enguidanos. “Or they are already so overwhelmed by their health issues and related appointments, they don’t understand the value of having another team of providers managing their care.”
In addition, some patients don’t want strangers in their homes or, depending on their immigration status, may worry about “authorities” stepping in.
Complicating this picture are cultural differences. In some languages, there is no direct translation for “palliative care” or the term carries negative connotations. In Mandarin, for example, palliative translates as “last-minute care” or “waiting for death.”
For patients struggling with financial, food and/or housing instability having palliative care’s “extra level of support,” even if covered by insurance, may not be the highest priority. “They are dealing with 101 other things and may not know how to ask for help or even what to ask for,” says Enguidanos. In a 2022 study, her team evaluated ways to increase palliative care to low-income patients in California, concluding culturally sensitive education is essential.
A Team Takes Charge
Sloan’s cancer spread to her abdomen and she opted for chemotherapy. The first round had little effect and she decided to try a second. She became so dizzy, she couldn’t get out of bed and suffered another bad fall. At that point, “there were just too many people involved in her care,” says Tierney. “We needed help. We needed structure.”
The Snowline team stepped in, assisting with insurance paperwork and care decisions. Nurse practitioner Deborah Cheever took the lead in adjusting Sloan’s pain meds. “Sometimes, families don’t know what to ask for. We help them navigate and identify their goals,” says Cheever.
Lydia Sloan and her family, including daughter Catherine and son David, knew what they wanted–guidance. Sloan was able to call Snowline with her own questions. “I also had someone I could talk to anytime,” says Tierney. “With so much knowledge on the team, there is information and emotional support.”
When the time came for Sloan to enter hospice care, that transition was easier. On June 8, she passed quietly in her sleep.
Going forward, Enguidanos and her team are looking at the impact of race on access to palliative care, along with the effectiveness of video as an educational tool. Another line of inquiry is whether enrollment would grow if physicians and nurses provide patients with a “warm handoff” to a palliative care social worker instead of a less personal referral.
There are positive developments on the horizon. Hawaii is close to following California’s example and approving Medicaid reimbursements for palliative care. A growing number of insurers, health plans and medical groups offer the care, and home-based palliative care is gaining ground. “It’s exciting to see some of our early work adapted into standard practice after all this time,” says Enguidanos. “Especially considering the extensive evidence of the value of this service to patients and their family members.”
One caregiver emphatically agrees. As Tierney says: “Palliative care is a public health necessity.”
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USC Mann study unlocks the potential of neurosteroids
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Susan Wampler
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USC Mann Study Unlocks the Potential of Neurosteroids
Findings published in The Journal of Biological Chemistry reveal how the brain produces pregnenolone, the “mother hormone” that is the progenitor of all neurosteroids.
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While the brain’s abilities include the capacity to answer innumerable questions, the organ itself still holds countless mysteries. Dean Vassilios Papadopoulos and postdoctoral research scholar Yiqi Christina Lin have solved one of those riddles by revealing how the brain produces pregnenolone–the “mother hormone” that is the progenitor of all neurosteroids.
Neurosteroids are formed by the brain to modulate nervous system function, and changes in their levels have been implicated in neurological conditions such as Alzheimer’s disease as well as in psychiatric and mood disorders. Therefore, neurosteroids represent a vital new frontier in biomedicine. Yet their therapeutic possibilities have barely been tapped. For example, the first approval for a neurosteroid drug did not come until 2019, when the Food and Drug Administration authorized brexanolone for postpartum depression.
“It wasn’t until the late 1980s that we learned the brain can make its own steroids,” Papadopoulos notes. “But questions remained about how this occurs because nobody had spotted the first enzyme responsible for manufacturing those steroids. We could find it in mice but not in the human brain.”
The breakthrough arose from Papadopoulos and Lin’s realization that, although cholesterol remains as the “father” of steroids, the “mother” neurosteroid pregnenolone is made by a different enzyme in the brain than in other organs. Under Papadopoulos’ direction, Lin used multiple approaches to find evidence that the enzyme metabolizing cholesterol to give birth to steroids in organs such as the gonads and adrenals hadn’t been found in the human brain because it wasn’t there.
“I spent my whole thesis proving that,” says Lin, who earned her PhD as a scientist in the Papadopoulos laboratory before continuing there as a postdoc. But then, having shown that a different enzyme must be responsible, the researchers had to determine which one that was.
Building on their previous investigations and Papadopoulos’ decades of work in steroid exploration, the scientists screened hundreds of enzymes. With the use of bioinformatics, they narrowed down their search to a handful, on which they performed drug inhibition and knockdown experiments. They ultimately identified the enzyme CYP1B1 as being involved in pregnenolone synthesis in the nervous system.
These findings, published in The Journal of Biological Chemistry in August 2023 are important since pregnenolone, as well as the neurosteroid dehydroepiandrosterone (DHEA), has been found to be elevated in Alzheimer’s patients. On the other hand, the levels of pregnenolone sulfate–a product of pregnenolone–and other neurosteroids are generally lower in patients with major depression, bipolar disorder and other mood-related conditions.
Understanding the mechanisms that drive pregnenolone production opens potential avenues to devising more effective treatments for neurological diseases and mood disorders.
The next direction to take, Lin says, “is to look at the enzyme kinetics” of CYP1B1 to form pregenolone. “Because nobody has ever studied this, we want to see the rate at which this enzyme can make these steroids.”
“It will take time,” Papadopoulos adds. “But discovering this physiological process is the link to the understanding needed to develop new treatments.”
In addition to Papadopoulos and Lin, the paper’s other authors are USC Mann PhD candidates Garett Cheung and Zeyu Zhang.
The work was supported by funds from the USC Mann School of Pharmacy and Pharmaceutical Sciences and the John Stauffer Dean’s Chair in Pharmaceutical Sciences at USC.
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New #USCMann research, published in @JBioChem, reveals how the brain produces pregnenolone–the “mother hormone” that is the progenitor of all neurosteroids.
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A new study, published in The Journal of Biological Chemistry in August 2023, reveals how the brain produces pregnenolone–the “mother hormone” that is the progenitor of all neurosteroids.
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Ed Carreon
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Liquid biopsies provide breakthrough in diagnosing retinoblastoma
8541 Melinda A. Smith, PhD
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https://keck.usc.edu/looking-ahead-a-new-frontier-in-retinoblastoma/
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Looking Ahead: A New Frontier in Retinoblastoma
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How to biopsy the unbiopsy-able: Retinoblastoma research study to go international.
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Just a handful of years ago, retinoblastoma had the medical field stumped. This aggressive eye cancer affects babies and young children and can lead to loss of vision. Unfortunately, the only way to diagnose the disease is through a doctor’s exam. Unlike with most cancers, oncologists can’t directly sample or biopsy the cancer.
Enter Jesse Berry, MD, Associate Professor of Ophthalmology and Dermatology (Clinical Scholar) at the USC Roski Eye Institute, and the Director of Ocular Oncology and the Retinoblastoma Program at Children’s Hospital Los Angeles. Dr. Berry was a full-time clinician who turned to research in hopes of finding a better way to diagnose this pediatric cancer. She decided to examine the aqueous humor, which is the fluid inside the eye. What began as a question–can we arrive at a diagnosis using the aqueous humor?–grew into a full research program.
It turns out that these liquid biopsies contain more than a yes or no diagnosis of retinoblastoma.
“We use a tiny amount of fluid,” says Dr. Berry. “It’s only 100 microliters, about half the size of a pea. But we get a trove of information, things that were impossible to see before. We can see genetic mutations, chromosomal abnormalities. We can diagnose retinoblastoma at a molecular level.” This arms oncologists with a very specific map of each child’s disease.
The results have been so promising that Dr. Berry is taking her research to the next level. She has received funding from the National Cancer Institute of the National Institutes of Health (NIH) to oversee an international study on liquid biopsies for retinoblastoma. “Our studies have shown that some markers in the aqueous humor might mean a more severe disease,” she says. “Now we have a chance to really study this in a much, much larger patient population.”
Set to begin this summer, the study involves 18 sites internationally, including the largest retinoblastoma center in Canada. All study samples will be sent to and processed by Dr. Berry’s team and the Center for Personalized Medicine. The study is the first of its kind.
Children will be followed for a minimum of two years, so researchers can examine samples for possible cancer recurrence. Because tumors return in approximately 50% of retinoblastoma patients, this information can be lifesaving.
“We know that detecting a cancer as early as possible gives a child the best chance,” says Dr. Berry. “In continuing to take biopsies from these children, we can treat any recurrences early on, even before they’re visible to a clinician upon examination.”
Innovation in Under a Decade
To put into perspective how quickly and exponentially this research has grown, one need only to look at Dr. Berry’s NIH awards. A mere five years ago, she proposed to study the aqueous humor for liquid biopsy. Now, as her five-year grant comes to a close, much has changed, thanks to Dr. Berry’s determination and the work of CHLA’s Center for Personalized Medicine. “We now have a test in-house, where we can sample a patient’s aqueous humor, and within days we know whether or not the child has retinoblastoma, and the exact mutations and molecular profile of their cancer.”
What’s next?
The results of Dr. Berry’s forthcoming study will help shape the next phase of her research. “Right now, we’re in this position where we see very strong data,” she says, “and we need to ensure that what we’re seeing is also represented in the international population.” Then, says Dr. Berry, the team has plans to develop a clinical trial to evolve the standard of care for diagnosing and treating retinoblastoma–and link specific treatments to the information identified in the liquid biopsy.
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This story originally appeared on the website of Children’s Hospital Los Angeles and has been reprinted with their permission.
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COVID-19, flu and respiratory syncytial virus (RSV) vaccines — what you need to know
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https://news.keckmedicine.org/covid-19-flu-and-rsv-vaccines–what-you-need-to-know/preview/9110734b9c29bac78beb3d3a77833f99a72ef2a1
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COVID-19, Flu and RSV vaccines — what you need to know
Keck Medicine of USC experts discuss new recommendations for staying healthy and safe during the respiratory virus season
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LOS ANGELES — Over the last few years, the nation has been through multiple rounds of COVID-19 vaccinations. This fall, the COVID-19 vaccine will be offered annually. The flu shot will also be recommended, as well as a newly approved vaccine for respiratory syncytial virus (RSV), a virus that is especially harmful to infants and older adults.
What can we expect from the vaccines, how important are they and can you get them at the same time? Keck Medicine of USC experts have the answers.
How COVID-19 vaccinations are changing this fall
The updated COVID-19 vaccine is designed as a single annual dose that will target the Omicron subvariant XBB.1.5, which is responsible for the majority of cases today. This formula should also offer protection against the new XBB substrains that have recently emerged.
The vaccine will be offered by Pfizer, Moderna and a newcomer, Novavax.
We are still awaiting final approval and recommendations for the vaccine from the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). At that time, health officials will also make recommendations about who is eligible for the vaccine.
The U.S. Government COVID-19 Vaccine Distribution Program, which provided free vaccinations, will end. However, insurance should pick up the cost for COVID-19 vaccines, and for those uninsured or underinsured, the CDC is launching the Bridge Access Program for COVID-19 vaccines. The CDC will partner with state and local programs to provide and distribute the free vaccines.
— Edward Jones-Lopez, MD, MS, is an infectious disease expert with Keck Medicine of USC. He is available for interviews in English and Spanish.
Why COVID-19 vaccines are still needed
Research shows about 75% of Americans have retained at least some immunity from a prior infection of the virus. However, immunity fades over time and the individual risk of getting COVID-19, despite some immunity, is varied and inconsistent. The protection offered by vaccines also fades over time.
Despite advances in treating COVID-19, it still can be a difficult and deadly disease that can lead to hospitalization, long-term symptoms or death. The side effects of the vaccine have proven to be minimal, so it is recommended that everyone who is eligible gets vaccinated, especially as we are coming off a summer surge and there may be future outbreaks over the holidays.
If you have any concerns about the vaccine due to a health condition, consult your health care provider. Additionally, while most people can wait until the new COVID-19 vaccine is released rather than getting the still-available 2022 vaccine, if you feel your health requires a vaccination now, you should also talk to your health care provider.
— Earl Strum, MD, is the medical director of Employee Health Services for Keck Medicine of USC and clinical professor of population and public health science with the Keck School of Medicine of USC.
Timing your vaccines safely and effectively
It is recommended that everyone six months or older be vaccinated against influenza every year. The best time to get the flu shot is September or October, so you will be inoculated in plenty of time before the high-flu season of the holidays.
It is safe to get the flu shot at the same time as your COVID-19 vaccine. For some people, one or both vaccines may result in mild flu-like symptoms that should pass within a few days. For those concerned about soreness at the site of the jab, consider getting one shot in one arm and one in the other arm to avoid overtaxing one limb. Also, if a local reaction does occur, you will know which vaccine was responsible. If not insured, you can find a free flu shot at a local health clinic, pharmacy or even grocery store.
RSV is a highly contagious virus that causes infections of the lungs and breathing passages, particularly among the young and old. The CDC recommends adults 60 years and older receive a single dose of the RSV vaccine in consultation with their health care provider. Additionally, the FDA just approved the RSV vaccine for use in pregnant individuals to protect infants from the virus.
Clinical trials have shown that there are minimal side effects of the vaccine, and any mild symptoms far offset the possible serious complications RSV can cause. Talk to your health care provider should you have any questions or concerns about this new vaccine, including payment/insurance options.
While co-administration of the RSV vaccine with other vaccines is in accordance with general best practice guidelines for immunization, recommendations have not yet been made whether or not this vaccine should be taken at the same time as the COVID-19 and flu vaccines.
— Krist Azizian, PharmD, MHA, is the chief pharmacy officer for Keck Medicine of USC.
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Alzheimer’s gene associated with increased fertility in Amazonian women
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Alzheimer’s gene associated with increased fertility in Amazonian women
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Alzheimer’s gene associated with increased fertility in Amazonian women
Allele associated with increased risks for dementia and heart disease is linked to earlier age of first birth as well as shorter intervals between births in a Bolivian indigenous community.
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gust 18, 2023 | Print
In a quest to determine how a gene associated with increased Alzheimer’s risk is surviving natural selection, a group of researchers from multiple universities including USC have discovered that the APOE-?4 allele is associated with increased fertility in women.
Previous research revealed that the Apolipoprotein-?4 (APOE-?4) allele increases the risk for a variety of diseases in aging populations, specifically Alzheimer’s and cardiovascular disease. And yet, despite its negative effects, this allele remains prevalent in approximately 20% of the human population.
In the new paper, the authors worked alongside the Tsimane (Chi-mahn-eh) community in Bolivia, a forager-horticultural society, to look at the effects of the allele through an evolutionary, anthropological lens. To do so, lead author Benjamin Trumble, an associate professor of evolutionary anthropology at Arizona State University, headed to the Bolivian Amazon lowlands where the Tsimane live.
The Tsimane Health and Life History Project (co-directed by Trumble, Hillard Kaplan of Chapman University, Michael Gurven of UC Santa Barbara, and Jonathan Stieglitz of the Institute for Advanced Study in Toulouse, France) has a longstanding relationship with the Tsimane to collect demographic and biomedical data and help provide medical care — a relationship that has been in effect for over 20 years. With over 17,000 people living across 90 villages, their hunter-farmer lifestyle is more similar to human life prior to the Industrial Revolution than modern cities, offering a unique glimpse into health and aging without modern-day influences.
Several researchers at USC have been involved with the Tsimane Health and Life History Project (THLHP), including University Professor and ARCO/William F. Kieschnick Chair in the Neurobiology of Aging Caleb Finch, a corresponding author of the new study. Finch has researched APOE alleles and their associations with health risks for more than 30 years; in a 2017 study, he and his colleagues discovered that APOE-?4 was associated with higher fertility in women exposed to high pathogen levels in rural Ghana.
“APOE-?4 was first recognized in the 1980s for its association with high blood cholesterol and more heart attacks,” Finch said. “That set many of us to thinking that maybe there was a reproductive advantage to having high lipids during pregnancy.”
For this particular study, the researchers collected data from 795 Tsimane women, ranging in age from 13 to 90 years old. The team of researchers not only retrieved genetic data to determine which alleles are present for each individual, but also information about their fertility, including age of first birth, how long between births and total number of live births.
When looking at the data, the researchers found that Tsimane women with the presence of one APOE-?4 allele had an increase of 0.5 births, compared with those without the APOE-?4 allele. The number of live births increased even more when there was the presence of two copies of the APOE-?4 allele. These women had an average increase of two live births compared with those without this specific allele.
“What we found in this population was that women began reproducing almost a year earlier if they had the APOE-?4 allele, and they had shorter interbirth intervals. Those two things combined allow them to have about half an additional kid if they have one copy or two additional kids if they have two copies,” Trumble explained.
This advantageous effect on fertility could help to explain how an allele that has such a negative impact in one’s later life through the increased chances of developing Alzheimer’s or cardiovascular disease has not been weeded out by natural selection — the advantages take place in one’s early to mid-life years, and therefore are passed along to their offspring.
“Genes that are associated with diseases that occur after the age of reproduction, or after reproduction has already started, are in ‘selection’s shadow.’ There have been a lot of arguments about the APOE-?4 allele — that it may be an example of selection’s shadow, that you don’t develop Alzheimer’s until after you’ve already had all your kids,” Trumble said.
Other smaller studies have shown other advantageous aspects of the APOE-?4 allele, including that children in Brazil are able to handle environmental pathogens and parasites, such as Giardia, better than those without the allele, which resulted in better cognitive functions and higher growth rates.
Even with these benefits of the APOE-?4 allele that have been discovered, there is still the major deleterious effect of the increased risk of Alzheimer’s and cardiovascular disease in the later stages of life. Interestingly, this negative effect of the allele is mostly seen in Westernized nations. The Tsimane, for instance, have the lowest rates of dementia and Alzheimer’s in the world, despite having the same 20% prevalence of the APOE-?4 allele in their population.
What can this mean for understanding and treating the negative effects of the allele in areas affected the most?
“We need to better understand global variation, and in particular, we need to kind of think outside the box and move beyond our focus on ‘this allele causes X disease’ and that’s just how it is,” Trumble said. “Instead, we need to take a step back and say, ‘What about in different environments? What about in the environments in which humans evolved?’ Because that actually opens up a whole other possibility for prevention or treatment by being able to mimic some of the aspects of that lifestyle. If we aren’t seeing the same associations between APOE-?4 and some outcome, then maybe (we need to) kind of take a step back and say, ‘OK, what are the differences?'”
Further research into the APOE alleles will also include the study of their “gene neighbors,” separated genes that modify the activity of the different alleles, which may shed more light on how APOE-?4 improves fertility, Finch said.
“This is a deep, robust study that shows APOE-?4 has a major set of benefits to reproduction,” Finch said. “The next phase of the work with the Tsimane is to look at these other genes to see how they interact or modify the effects of APOE-?3 and APOE-?4.”
“Apolipoprotein-?4 is associated with higher fecundity in a natural fertility population” was released August 9, 2023 in Science Advances. In addition to Trumble, Gurven, Finch, Kaplan, and Stieglitz, coauthors included Mia Charifson of New York University; Tom Kraft of the University of Utah; Angela R. Garcia, Stephanie V. Koebele, and Kenneth Buetow of Arizona State University; Daniel K. Cummings and Paul Hooper of Chapman University; Amanda J. Lea of the Canadian Institute for Advanced Research; Daniel Eid Rodriguez of the Universidad de San Simon, Bolivia; Bret Beheim and Riana Minocher of the Max Planck Institute for Evolutionary Anthropology, Germany; Maguin Gutierrez of the Tsimane Gran Consejo, Bolivia; Gregory S. Thomas of UC Irvine; and Margaret Gatz of USC.
The Tsimane Health and Life History Project is a large interdisciplinary team effort, combining anthropologists, cardiologists, neurologists and gerontologists, as well Bolivian physicians and Tsimane anthropologists. The project was funded by the National Institutes of Health, National Institute on Aging (R01AG054442). Other funders of this study included the National Science Foundation (1748282) and Agence Nationale de la Recherche (ANR-17-EURE-0010).
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