The findings, reported Sept. 1 at the European Society of Cardiology meeting and published in the Journal of the American College of Cardiology, provide inconclusive data about whether atrial fibrillation screening lowers stroke rates. The COVID pandemic led to an early halt of the study before fully enrolling, so it did not have enough participants to establish definitive results about stroke.

“Atrial fibrillation is often undiagnosed and can increase the risk of ischemic stroke, which is largely reversible by oral anticoagulation,” said lead author Renato Lopes, M.D., Ph.D., a professor of medicine and member of the Duke Clinical Research institute.

“We still need definitive evidence that diagnosis of atrial fibrillation through systematic screening can lead to subsequent treatment with oral anticoagulation and therefore, lower stroke risk,” Lopes said.

The study enrolled approximately 12,000 patients in the U.S. who were at least 70 years old with no history of atrial fibrillation. Roughly half the patients were randomly assigned to receive a long-term (14 days) continuous monitoring device, and the other half usual care.

Over a median of 15 months of follow-up, the study reported a 52% increase in the number of cases of atrial fibrillation diagnosed among the device-wearers compared to those in usual care. There was no increase in rates of hospitalization for bleeding, and no significant reduction in the rate of hospitalizations for all stroke compared with usual care.

The study was originally designed to enroll 52,000 patients, which would have given it the power to determine whether screening reduces the numbers of strokes. A large study population is needed because strokes occur in a subset of patients with atrial fibrillation.

“Despite the inconclusive results, we have a lot of lessons learned that might inform future studies” Lopes said. He said the study’s design, which enabled patients to be enrolled and screened online in a virtual format with self-applied patch devices in their homes with only remote support, could be duplicated in future studies.

In addition to Lopes, study authors include Steven J. Atlas, Alan S. Go, teven A. Lubitz, David D. McManus, Rowena J. Dolor, Ranee Chatterjee, Michael B. Rothberg, David R. Rushlow, Lori A. Crosson, Ronald S. Aronson, Michael Patlakh, Dianne Gallup, Donna J. Mills, Emily C. O’Brien, and Daniel E. Singer.

The study received funding support from the Bristol-Myers Squibb/Pfizer Alliance.

Precisely howbutterflies are able to generate the vibrant patterns and colors on their wings has fascinated biologists for centuries. The genetic code contained within the cells of developing butterfly wings dictates the specific arrangement of the color on the wing’s scales — the microscopic tiles that form wing patterns — similar to the arrangement of colored pixels to form a digital image. Cracking this code is fundamental to understanding how our own genes build our anatomy. In the lab, researchers can manipulate that code in butterflies with gene-editing tools and observe the effect on visible traits, such as coloration on a wing.

Scientists have long known that protein-coding genes are crucial to these processes. These types of genes create proteins that can dictate when and where a specific scale should generate a particular pigment. When it comes to black pigments, researchers thought this process would be no different, and initially implicated a protein-coding gene. The new research, however, paints a different picture.

The team discovered a gene that produces an RNA molecule — not a protein — controls where dark pigments are made during butterfly metamorphosis. Using the genome-editing technique CRISPR, the researchers demonstrated that when you remove the gene that produces the RNA molecule, butterflies completely lose their black pigmented scales, showing a clear link between RNA activity and dark pigment development.

“What we found was astonishing,” said Livraghi, a postdoctoral scientist at GW. “This RNA molecule directly influences where the black pigment appears on the wings, shaping the butterfly’s color patterns in a way we hadn’t anticipated.”

The researchers further explored how the RNA molecule functions during wing development. By examining its activity, they observed a perfect correlation between where the RNA is expressed and where black scales form.

“We were amazed that this gene is turned on where the black scales will eventually develop on the wing, with exquisite precision” said Arnaud Martin, associate professor of biology at GW. “It is truly an evolutionary paintbrush in this sense, and a creative one, judging by its effects in several species.”

The researchers examined the newly discovered RNA in several other butterflies whose evolutionary history diverged around 80 million years ago. They found that in each of these species, the RNA had evolved to control new placements in the patterns of dark pigments.

“The consistent result obtained from CRISPR mutants in several species really demonstrate that this RNA gene is not a recent invention, but a key ancestral mechanism to control wing pattern diversity,” said Riccardo Papa, professor of biology at the University of Puerto Rico — Río Piedras.

“We and others have now looked at this genetic trait in many different butterfly species, and remarkably we are finding that this same RNA is used again and again, from longwing butterflies, to monarchs and painted lady butterflies,” said Joe Hanly, a postdoctoral scientist and visiting fellow at GW. “It’s clearly a crucial gene for the evolution of wing patterns. I wonder what other, similar phenomena biologists might have been missing because they weren’t paying attention to the dark matter of the genome.”

The findings not only challenge long-standing assumptions about genetic regulation but also open up new avenues for studying how visible traits evolve in animals.

“Improvements in MI management and data from observational studies have led physicians to question whether continuing beta-blockers after 1 year post-MI is needed since unnecessary treatment may result in side effects.^2-5 We conducted the ABYSS trial to provide conclusive randomised data on the effects of beta-blocker interruption vs. continuation on cardiovascular events and quality of life, but we were unable to show safety preservation in terms of clinical events nor any benefit on quality of life with beta-blocker interruption,” said Principal Investigator, Professor Johanne Silvain of the Sorbonne University, Paris, France.

The open-label, non-inferiority, randomised ABYSS trial, conducted by the ACTION Group, included patients with a prior MI taking long-term beta-blockers, with a left ventricular ejection fraction of at least 40% and no cardiovascular events in the previous 6 months. Participants were randomised (1:1) to interrupting or continuing their β-blocker medication.

The primary endpoint was a composite of death, non-fatal MI, non-fatal stroke or hospitalisation for cardiovascular reasons at the longest follow-up (minimum, 1 year), according to an analysis of non-inferiority (defined as a between-group absolute difference of <3 percentage points for the upper boundary of the two-sided 95% confidence interval [CI]). The main secondary endpoint was the change in quality of life as measured by the European Quality of Life-5 Dimensions questionnaire.

In total 3,698 patients were randomised from 49 sites in France. The mean age was 64 years and 17% were female. The median time between last MI and randomisation was 2.9 years (interquartile range 1.2-6.4 years).

Over median follow-up of 3 years, interruption of long-term beta-blocker treatment was not shown to be non-inferior to beta-blocker continuation. A primary-outcome event occurred in 23.8% of patients in the interruption group and in 21.1% in the continuation group (risk difference 2.8 percentage points; 95% CI <0.1-5.5), with a hazard ratio of 1.16 (95% CI 1.01-1.33; p=0.44 for non-inferiority).

Death occurred in 4.1% in the interruption group and 4.0% in the continuation group, while MI occurred in 2.5% and 2.4%, respectively. Of note, hospitalisation for cardiovascular causes occurred in 18.9% in the interruption group and 16.6% in the continuation group. Beta-blocker interruption was also associated with increases in systolic and diastolic blood pressure and heart rate at 6 months (all p<0.001 vs. beta-blocker continuation) and during the study follow up. Beta-blocker interruption did not improve the patients’ quality of life.

Summing up the evidence from the ABYSS trial, Professor Silvain concluded: “Differences between the groups with respect to hospitalisation for cardiovascular reasons and the negative effect on blood pressure levels, together with the absence of quality-of-life improvement do not support interruption of a chronic beta-blocker treatment in post-MI patients. These results must be put into context with recent findings from the open-label REDUCE-MI⁶ trial and ongoing trials to provide additional evidence on the optimal use of beta-blockers after MI.”

1 ‘Beta blocker interruption in patients with prior myocardial infarction: results of the ABYSS trial and effect on blood pressure and heart rate control’ will be discussed during Hot Line 1 on Friday 30 August in room London.

2 Holt A, Blanche P, Zareini B, et al. Effect of long-term beta-blocker treatment following myocardial infarction among stable, optimally treated patients without heart failure in the reperfusion era: a Danish, nationwide cohort study. Eur Heart J. 2021;42:907-914.

3 Park CS, Yang H-M, Ki Y-J, et al. Left ventricular ejection fraction 1 year after acute myocardial infarction identifies the benefits of the long-term use of beta-blockers: analysis of data from the KAMIR-NIH Registry. Circ Cardiovasc Interv. 2021;14:e010159.

4 Puymirat E, Riant E, Aissaoui N, et al. β Blockers and mortality after myocardial infarction in patients without heart failure: multicentre prospective cohort study. BMJ. 2016;354:i4801.

5 Kim J, Kang D, Park H, et al. Long-term β-blocker therapy and clinical outcomes after acute myocardial infarction in patients without heart failure: nationwide cohort study. Eur Heart J. 2020;41:3521-3529.

6 Yndigegn T, Lindahl B, Mars K, et al. Beta-blockers after myocardial infarction and preserved ejection fraction. N Engl J Med. 2024;390:1372-1381.

Mindfulness refers to the ability of an individual to focus attention on the present, in a way that is open, curious and not judgmental. Essentially, the ability to be fully in the moment.

“There’s a lot of discussion about the benefits of mindfulness, but it poses two challenges when you’re going through periods of stress,” says Tom Zagenczyk, co-author of a paper on the work and a professor of management in North Carolina State University’s Poole College of Management. “First, it’s hard to be mindful when you’re experiencing stress. Second, if it’s a truly difficult time, you don’t necessarily want to dwell too much on the experience you’re going through.

“Because hope is inherently forward looking, while mindfulness is about appreciating your current circumstances, we wanted to see how each of these two mindsets influenced people’s well-being and professional attitudes during difficult times,” Zagenczyk says. “The COVID pandemic presented us with an unfortunate, but useful, opportunity to explore this topic. And we chose to focus on the performing arts since that sector was particularly hard hit by the pandemic.”

For the study, researchers recruited 247 professional musicians from the organization MusiCares to take two surveys, one month apart. The first survey was given in September 2021. In addition to collecting broad demographic data, study participants were asked about their thoughts and experiences at the beginning of the pandemic — March to August 2020. They were also asked questions aimed at capturing how hopeful and mindful they were from September 2020 through March 2021.

The second survey was given in October 2021 and asked study participants questions aimed at capturing work engagement, work tensions, how positive their emotions were, and the extent to which they were experiencing distress.

The researchers then used statistical techniques to identify relationships between hope, mindfulness, and outcomes related to their personal well-being and attitudes toward work.

“Fundamentally, our findings tell us that hope was associated with people being happy, and mindfulness was not,” says Kristin Scott, study co-author and a professor of management at Clemson University. “And when people are hopeful — and happy — they experience less distress, are more engaged with their work, and feel less tension related to their professional lives.”

“Being mindful can be tremendously valuable — there are certainly advantages to living in the moment,” says Sharon Sheridan, study co-author and an assistant professor of management at Clemson. “But it’s important to maintain a hopeful outlook — particularly during periods of prolonged stress. People should be hopeful while being mindful — hold on to the idea that there’s a light at the end of the tunnel.”

While the study focused on musicians during an extreme set of circumstances, the researchers think there is a takeaway message that is relevant across industry sectors.

“Whenever we have high levels of job stress, it’s important to be hopeful and forward looking,” says Emily Ferrise, study co-author and a Ph.D. student at Clemson. “And to the extent possible, there is real value for any organization to incorporate hope and forward thinking into their corporate culture — through job conditions, organizational communications, etc.”

“Every work sector experiences periods of high stress,” says Zagenczyk. “And every company should be invested in having happy employees who are engaged with their work.”