Navigating a stable transition to the age of intelligence: A mental wealth perspective

In the grand narrative of technological evolution, we are transitioning from the "Age of Information" to the "Age of Intelligence." Rapid advancements in generative artificial intelligence (AI) are set to reshape society, revolutionize industries, and change the nature of work, challenging our traditional understanding of the dynamics of the economy and its relationship with human productivity and societal prosperity. As we brace for this transformative shift, promising advancements in healthcare, education, productivity, and more, there are concerns of large-scale job loss, mental health repercussions, and risks to social stability and democracy. This paper proposes the concept of Mental Wealth as an action framework that supports nations to proactively position themselves for a smooth transition to the Age of Intelligence while fostering economic and societal prosperity.

The influence of economic policies on social environments and mental health

Despite increased advocacy and investments in mental health systems globally, there has been limited progress in reducing mental disorder prevalence. In this paper, we argue that meaningful advancements in population mental health necessitate addressing the fundamental sources of shared distress. Using a systems perspective, economic structures and policies are identified as the potential cause of causes of mental ill-health. Neoliberal ideologies, prioritizing economic optimization and continuous growth, contribute to the promotion of individualism, job insecurity, increasing demands on workers, parental stress, social disconnection and a broad range of manifestations well-recognized to erode mental health. We emphasize the need for mental health researchers and advocates to increasingly engage with the economic policy discourse to draw attention to mental health and well-being implications. We call for a shift towards a well-being economy to better align commercial interests with collective well-being and social prosperity. The involvement of individuals with lived mental ill-health experiences, practitioners and researchers is needed to mobilize communities for change and influence economic policies to safeguard well-being. Additionally, we call for the establishment of national mental wealth observatories to inform coordinated health, social and economic policies and realize the transition to a more sustainable well-being economy that offers promise for progress on population mental health outcomes.

The Brain Economy: Advancing Brain Science to Better Understand the Modern Economy

The coming years are likely to be turbulent due to a myriad of factors or polycrisis, including an escalation in climate extremes, emerging public health threats, weak productivity, increases in global economic instability and further weakening in the integrity of global democracy. These formidable challenges are not exogenous to the economy but are in some cases generated by the system itself. They can be overcome, but only with far-reaching changes to global economics. Our current socio-economic paradigm is insufficient for addressing these complex challenges, let alone sustaining human development, well-being and happiness. To support the flourishing of the global population in the age of polycrisis, we need a novel, person-centred and collective paradigm. The brain economy leverages insights from neuroscience to provide a novel way of centralising the human contribution to the economy, how the economy in turn shapes our lives and positive feedbacks between the two. The brain economy is primarily based on Brain Capital, an economic asset integrating brain health and brain skills, the social, emotional, and the diversity of cognitive brain resources of individuals and communities. People with healthy brains are essential to navigate increasingly complex systems. Policies and investments that improve brain health and hence citizens' cognitive functions and boost brain performance can increase productivity, stimulate greater creativity and economic dynamism, utilise often underdeveloped intellectual resources, afford social cohesion, and create a more resilient, adaptable and sustainability-engaged population.

Adaptation, Transformation and Resilience in Healthcare Comment on "Government Actions and Their Relation to Resilience in Healthcare During the COVID-19 Pandemic in New South Wales, Australia and Ontario, Canada"

Adaptive capacity is a critical component of building resilience in healthcare (RiH). Adaptive capacity comprises the ability of a system to cope with and adapt to disturbances. However, "shocks," such as the current coronavirus disease 2019 (COVID-19) pandemic, can potentially exceed critical adaptation thresholds and lead to systemic collapse. To effectively manage healthcare systems during periods of crises, both adaptive and transformative changes are necessary. This commentary discusses adaptation and transformation as two complementary, integral components of resilience and applies them to healthcare. We treat resilience as an emergent property of complex systems that accounts for multiple, often disparately distinct regimes in which multiple processes (eg, adaptation, recovery) are subsumed and operate. We argue that Convergence Mental Health and other transdisciplinary paradigms such as Brain Capital and One Health can facilitate resilience planning and management in healthcare systems.

Investing in Late-Life Brain Capital

Within many societies and cultures around the world, older adults are too often undervalued and underappreciated. This exacerbates many key challenges that older adults may face. It also undermines the many positive aspects of late life that are of tremendous value at both an individual and societal level. We propose a new approach to elevate health and well-being in late life by optimizing late-life Brain Capital. This form of capital prioritizes brain skills and brain health in a brain economy, which the challenges and opportunities of the 21st-century demands. This approach incorporates investing in late-life Brain Capital, developing initiatives focused on building late-life Brain Capital.

Abstract P043: Extracellular matrix modulates T cell clearance of malignant cells in vitro

Introduction: Emerging evidence suggests that tumor extracellular matrix (ECM) may play a role in tumor-immune interactions. Breast tumors with high immune infiltrates have a distinct ECM profile, and T cell exclusion has been linked to specific ECM signatures. Despite this evidence suggesting a link between immune infiltrates and tumor matrix, it remains unclear whether ECM can directly affect the ultimate step in tumor clearance by the immune system, T cell mediated cytotoxicity.

Methods: We compared clearance of 4T1 mammary gland carcinoma cells (MCC) seeded on ECM arrays by T cells isolated from spleens of MHC mismatched strain of mice. Briefly, 4T1 were seeded at 10k/ml for 1 hour, cultured for 24 hours then cocultured with T cells for 2 hours before fixing and staining. For RNA sequencing, ECM proteins (Collagen 1 -Col1, Collagen 4- Col4, Fibronectin -Fn or Vitronectin- Vtn) were coated onto plates at 250ug/ml, then 4t1 were added for 24 hours, then T cells were added for 24 hours followed by RNA isolation and sequencing.

Results: We compared number of cells per spot with and without T cells across all ECM combinations and found that co-culture with T cells reduced the average number of MCCs, but this difference did not reach statistical significance. Only in the following conditions did MCC number significantly decrease: Col1 alone, Col6 alone, Fn alone, Vtn alone and Col6+ Eln (Fig 2B). In Col4 containing conditions, MCC cell number increased in the presence of T cells. Intensity of CD274 (PD-L1) and the MHC class 1 protein H2-Kd varied with substrate (p<10−19, p<10−22 respectively) with significantly higher expression of PD-L1 in Col1 and Vtn conditions vs. Col4 or Laminin, and higher H2-Kd in Vtn conditions. These findings demonstrate a defect in T cell mediated MCC clearance in some ECM conditions that is distinct from the PD-L1 checkpoint. Comparing transcriptomes across, we observed that all MCC+ T cell conditions separated from MCC alone conditions (Fig. 3B), largely due to expression of known T cell related genes (such as Ptprc, Trbc2, Sell, Itk, and Il7r). Differentially regulated gene counts between MCC+ T cells and MCC alone conditions were lowest in the Col4 condition (Fig. 3BC-E), and significance and number of genes from T cell associated ontologies were lowest in the Col4 conditions (Fig. 3E). We observed that MCC on Col4 upregulated cytokines including Ccl2, Cxcl3, Cxcl10, and Tgfβ2, compared to both Fn and Vtn conditions, suggesting that this condition could suppress immune activation through altered cytokine expression.

This work was funded by LDRD 19-SI-003 under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under contract DE-AC52-07NA27344. LLNL-ABS-8235222

Citation Format: Claire Robertson, Aimy Sebastian, Aubree Hinckley, Naiomy Rios-Arce, William Hynes, Wei He, Nicholas Hum, Elizabeth Wheeler, Gabriela Loots, Matthew Coleman, Monica Moya. Extracellular matrix modulates T cell clearance of malignant cells in vitro [abstract]. In: Abstracts: AACR Virtual Special Conference: Tumor Immunology and Immunotherapy; 2021 Oct 5-6. Philadelphia (PA): AACR; Cancer Immunol Res 2022;10(1 Suppl):Abstract nr P043.

Building brain capital

Brains are indispensable drivers of human progress. Why not invest more heavily in them? We seek to place Brain Capital at the center of a new narrative to fuel economic and societal recovery and resilience.

A Brain Capital Grand Strategy: toward economic reimagination

‘I have not found among my possessions anything which I hold more dear than, or value so much as, my knowledge of the actions of great people, acquired by long experience in contemporary affairs, and a continual study of antiquity.’ The Prince, Machiavelli

Tiered Approach to Resilience Assessment

Regulatory agencies have long adopted a three-tier framework for risk assessment. We build on this structure to propose a tiered approach for resilience assessment that can be integrated into the existing regulatory processes. Comprehensive approaches to assessing resilience at appropriate and operational scales, reconciling analytical complexity as needed with stakeholder needs and resources available, and ultimately creating actionable recommendations to enhance resilience are still lacking. Our proposed framework consists of tiers by which analysts can select resilience assessment and decision support tools to inform associated management actions relative to the scope and urgency of the risk and the capacity of resource managers to improve system resilience. The resilience management framework proposed is not intended to supplant either risk management or the many existing efforts of resilience quantification method development, but instead provide a guide to selecting tools that are appropriate for the given analytic need. The goal of this tiered approach is to intentionally parallel the tiered approach used in regulatory contexts so that resilience assessment might be more easily and quickly integrated into existing structures and with existing policies.

Intrapartum intravenous fluids for caesarean delivery and newborn weight loss: a retrospective cohort study

OBJECTIVE

To examine weight loss (WL) and excess weight loss (EWL) among newborns of caesarean delivery, comparing colloids plus crystalloids versus crystalloids only. Also, to examine different doses of intrapartum intravenous fluids on WL and EWL.

DESIGN

Comparative safety retrospective cohort study.

SETTING

University Teaching Hospital, Moncton, Canada.

PATIENTS

Mothers exposed to intravenous fluids with caesarean delivery between 2008 and 2016.

INTERVENTIONS

Exposure to colloids plus crystalloids was compared with crystalloids only, and dose-response analyses were performed for colloids, crystalloids and total intravenous fluids doses. Linear and logistic regression models were used, adjusting for potential confounders.

MAIN OUTCOME MEASURES

Infants' WL was measured at days 1, 2 and 3 post partum, and EWL defined as loss of >7% of birth weight.

RESULTS

From 801 mother-infant pairs, 176 were exposed to colloids plus crystalloids and 625 were exposed to crystalloids only (overall mean birth weight=3416 g, EWL=2%, 41.4% and 55.5% on days 1, 2 and 3, respectively). No significant difference in newborns' WL was observed on any of the days assessed. Adjusted OR (95% CI) of EWL was 1.0 (0.3 to 3.3) at 24 hours, 1.0 (0.7 to 1.5) at 48 hours and 1.4 (0.9 to 2.2) at 72 hours. No dose-response relationship was detected with type-specific and total intravenous fluids exposures.

CONCLUSIONS

The risk of EWL was similar with colloids plus crystalloids and crystalloids only, suggesting that both therapeutic options can be considered during caesarean delivery. The absence of dose-response relationships adds confirmatory evidence to the intravenous fluids safety profiles.

Health Care Infrastructure for Financially Sustainable Clinical Genomics

Next-generation sequencing has evolved technically and economically into the method of choice for interrogating the genome in cancer and inherited disorders. The introduction of procedural code sets for whole-exome and genome sequencing is a milestone toward financially sustainable clinical implementation; however, achieving reimbursement is currently a major challenge. As part of a prospective quality-improvement initiative to implement the new code sets, we adopted Agile, a development methodology originally devised in software development. We implemented eight functionally distinct modules (request review, cost estimation, preauthorization, accessioning, prebilling, testing, reporting, and reimbursement consultation) and obtained feedback via an anonymous survey. We managed 50 clinical requests (January to June 2015). The fraction of pursued-to-requested cases (n = 15/50; utilization management fraction, 0.3) aimed for a high rate of preauthorizations. In 13 of 15 patients the insurance plan required preauthorization, which we obtained in 70% and ultimately achieved reimbursement in 50%. Interoperability enabled assessment of 12 different combinations of modules that underline the importance of an adaptive workflow and policy tailoring to achieve higher yields of reimbursement. The survey confirmed a positive attitude toward self-organizing teams. We acknowledge the individuals and their interactions and termed the infrastructure: human pipeline. Nontechnical barriers currently are limiting the scope and availability of clinical genomic sequencing. The presented human pipeline is one approach toward long-term financial sustainability of clinical genomics.