COVID-19 vaccine benefits still outweigh risks, despite possible rare heart complications

Statement from the American Heart Association/American Stroke Association

AMERICAN HEART ASSOCIATION

Research News

 

DALLAS, Sunday, May 23, 2021 - Late last week, the U.S. Centers for Disease Control and Prevention (CDC) alerted health care professionals that they are monitoring the Vaccine Adverse Events Reporting System (VAERS) and the Vaccine Safety Datalink (VSD) for cases of young adults developing the rare heart-related complication myocarditis, after receiving a COVID-19 vaccine manufactured by Pfizer-BioNTech or Moderna. The COVID-19 Vaccine Safety Technical Work Group (VaST) of the CDC's Advisory Committee on Immunization Practices (ACIP) is reviewing several dozen cases of myocarditis that have been reported in adolescents and young adults: more often in males rather than females; more frequently after the second dose rather than the first dose of either the Pfizer-BioNTech or Moderna vaccine; and typically appearing within 4 days of vaccination.

The benefits of COVID-19 vaccination enormously outweigh the rare, possible risk of heart-related complications, including inflammation of the heart muscle, or myocarditis. The American Heart Association/American Stroke Association, a global force for longer, healthier lives, urges all adults and children ages 12 and older in the U.S. to receive a COVID vaccine as soon as they can.

The following statement reflects the views of the American Heart Association/American Stroke Association and its science leaders:

• President Mitchell S.V. Elkind, M.D., M.S., FAHA, FAAN,

• Immediate Past President Robert A. Harrington, M.D., FAHA,

• President-Elect Donald M. Lloyd-Jones, M.D., Sc.M., FAHA,

• Chief Science and Medical Officer Mariell Jessup, M.D., FAHA, and

• Chief Medical Officer for Prevention Eduardo Sanchez, M.D, M.P.H., FAAFP.

"We strongly urge all adults and children ages 12 and older in the U.S. to receive a COVID vaccine as soon as they can receive it, as recently approved by the U.S. Food and Drug Administration and the CDC. The evidence continues to indicate that the COVID-19 vaccines are nearly 100% effective at preventing death and hospitalization due to COVID-19 infection. According to the CDC as of May 22, 2021, over 283 million doses of COVID-19 vaccines have been administered in the U.S. since December 14, 2020, and more than 129 million Americans are fully vaccinated (i.e., they have received either two doses of the Pfizer-BioNTech or Moderna COVID-19 vaccine, or the single-dose Johnson & Johnson/Janssen COVID-19 vaccine).

"We commend the CDC's continual monitoring for adverse events related to the COVID-19 vaccines through VAERS and VSD, and the consistent meetings of ACIP's VaST Work Group, demonstrating transparent and robust attention to any and all health events possibly related to a COVID-19 vaccine. The few cases of myocarditis that have been reported after COVID-19 vaccination are being investigated. However, myocarditis is usually the result of a viral infection, and it is yet to be determined if these cases have any correlation to receiving a COVID-19 vaccine, especially since the COVID-19 vaccines authorized in the U.S. do not contain any live virus.

"We remain confident that the benefits of vaccination far exceed the very small, rare risks. The risks of vaccination are also far smaller than the risks of COVID-19 infection itself, including its potentially fatal consequences and the potential long-term health effects that are still revealing themselves, including myocarditis. The recommendation for vaccination specifically includes people with cardiovascular risk factors such as high blood pressure, obesity and type 2 diabetes, those with heart disease, and heart attack and stroke survivors, because they are at much greater risk of an adverse outcome from the COVID-19 virus than they are from the vaccine.

"We also encourage everyone to keep in touch with their primary care professionals and seek care immediately if they have any of these symptoms in the weeks after receiving the COVID-19 vaccine:

• chest pain including sudden, sharp, stabbing pains;

• difficulty breathing/shortness of breath;

• abnormal heartbeat;

• severe headache;

• blurry vision;

• fainting or loss of consciousness;

• weakness or sensory changes;

• confusion or trouble speaking;

• seizures;

• unexplained abdominal pain; or

• new leg pain or swelling.

"We will stay up to date with the CDC's recommendations regarding all potential complications related to COVID-19 vaccines, including myocarditis, pericarditis, central venous sinus thrombosis (CVST) and other blood clotting events, thrombosis thrombocytopenia syndrome (TTS), and vaccine-induced immune thrombosis thrombocytopenia (VITT).

"The American Heart Association recommends all health care professionals be aware of these very rare adverse events that may be related to a COVID-19 vaccine, including myocarditis, blood clots, low platelets, or symptoms of severe inflammation. Health care professionals should strongly consider inquiring about the timing of any recent COVID vaccination among patients presenting with these conditions, as needed, in order to provide appropriate treatment quickly. As detailed in last month's AHA/ASA statement, all suspected CVST or blood clots associated with the COVID-19 vaccine should be treated initially using non-heparin anticoagulants. Heparin products should not be administered in any dose if TTS/VITT is suspected, until appropriate testing can be done to exclude heparin-induced antibodies. In addition, health care professionals are required to report suspected vaccine-related adverse events to the Vaccine Adverse Event Reporting System, in accordance with federal regulations.

"We also support the CDC recommendations last week that loosen restrictions on mask wearing and social distancing for people who are fully vaccinated. For those who are unable to be vaccinated, we reiterate the importance of handwashing, social distancing and wearing masks, particularly for people at high risk of infection and/or severe COVID-19. These simple precautions remain crucial to protecting people who are not vaccinated from the virus that causes COVID-19.

"Individuals should refer to their local and state health departments for specific information about when and where they can get vaccinated. We implore everyone ages 12 and older to get vaccinated so we can return to being together, in person - enjoying life with little to no risk of severe COVID-19 infection, hospitalization or death."

MYOCARDITIS AND PERICARDITIS

Both myocarditis and pericarditis are most often the result of an infection and/or inflammation caused by a virus.

Myocarditis is inflammation of the middle layer of the wall of the heart muscle, and it can weaken the heart muscle and the heart's electrical system, which keeps the heart pumping regularly. Severe myocarditis can lead to heart failure, abnormal heartbeat and sudden death. Signs and symptoms of myocarditis are chest pain, abnormal heartbeat (arrhythmia) and unexpected shortness of breath. Approximately 10 to 20 per 100,000 people are diagnosed with myocarditis in the U.S. annually, and many cases resolve on their own or with treatment, leading to a full recovery.

Pericarditis is a condition often related to myocarditis, and involves swelling and inflammation of the pericardium, a sac-like structure with two thin layers of tissue that surround the heart to hold it in place and help it function properly. Pericarditis can progress and lead to severe complications, including cardiac tamponade, which results from too much fluid in the pericardium that can cause a sharp drop in blood pressure and can be fatal; and chronic constrictive pericarditis, when scar-like tissue develops in the pericardium causing it to become stiff, affecting the heart's ability to contract. Symptoms of pericarditis are sharp, stabbing chest pain that comes on suddenly; fever; weakness; and trouble breathing or shortness of breath. Approximately 45,000 people in the U.S. are hospitalized with pericarditis each year.

TYPICAL VACCINE- RELATED SYMPTOMS

According to the CDC, typical COVID-19 vaccine symptoms are tiredness, headache, muscle pain, chills, fever and nausea. Symptoms typically appear within 24 - 48 hours and usually pass within 36-48 hours after receiving the vaccine. If symptoms are severe and include difficulty breathing, seek immediate medical attention - call 911 or go to the nearest emergency room.

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For more information visit: http://www.heart.org/pandemic

Follow AHA/ASA news on Twitter @HeartNews

The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association's overall financial information is available here.

About the American Heart Association/American Stroke Association

The American Heart Association is a relentless force for a world of longer, healthier lives and includes the American Stroke Association. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public's health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

 

A natural food supplement may relieve anxiety

Mice receiving the plant-derived substance were less anxious than the controls

WEIZMANN INSTITUTE OF SCIENCE

Research News

 

A natural food supplement reduces anxiety in mice, according to a new Weizmann Institute of Science study. The plant-derived substance, beta-sitosterol, was found to produce this effect both on its own and in synergic combination with an antidepressant known under the brand name Prozac. If these findings, published today in Cell Reports Medicine, are confirmed in clinical trials, they could point the way toward the use of beta-sitosterol as a treatment for relieving anxiety in humans.

Anxiety is not always a bad thing. In fact, in evolutionary terms, feeling anxious about potential threats is critical for survival because it helps us mount an appropriate response. That's precisely why developing antianxiety drugs is so challenging. The circuits for anxiety in the brain are closely related to those responsible for memory, awareness and other functions vital for handling danger, so scientists are on the lookout for compounds that can selectively suppress anxiety without causing unwanted side effects.

The starting point for the present study was research conducted several years ago in the lab of Prof. Mike Fainzilber in Weizmann's Biomolecular Sciences Department. Dr. Nicolas Panayotis and other lab members studied the roles of proteins that shuttle cargoes into the nuclei of nerve cells, and they discovered that in stressful situations, mice lacking a shuttling protein known as importin alpha-five showed less anxiety than the control mice. The researchers then checked how these "calmer" mice differed from regular ones in terms of gene expression, and they identified a genetic signature of their "calmness": about 120 genes with a characteristic pattern of expression in the hippocampus, one of the brain regions that regulate anxiety.

In the new study, Panayotis, now a senior intern in Fainzilber's lab, together with colleagues, searched an international genomic database for existing drugs or other compounds that might mimic the same gene expression signature. He identified five candidates and tested their effects on behavior in mice. That was how the researchers zeroed in on beta-sitosterol, a plant substance sold as a dietary supplement intended mainly to reduce cholesterol levels.

In a series of behavioral experiments, mice given beta-sitosterol showed much less anxiety than the controls. They were, for example, less fearful than the controls when placed in an illuminated enclosure, daring to walk into its brightly lit center, whereas regular mice were careful to stay on the darker periphery, avoiding the stress of the bright light. Moreover, the mice receiving beta-sitosterol did not exhibit any of the side effects that might be expected from antianxiety medications - their locomotion was not impaired, and they did not refrain from exploring novel stimuli.

Next, the researchers tested the effects of beta-sitosterol on mice when given in combination with fluoxetine, a drug belonging to the class of selective serotonin reuptake inhibitors, or SSRIs, and sold under the brand name Prozac, among others. The combination had a synergistic effect: Both beta-sitosterol and fluoxetine reduced the anxiety of mice at lower doses when given together, compared with the doses needed to produce the same effect when they were administered separately.

"One of the major problems with existing antianxiety medications is that they produce side effects, so if beta-sitosterol could help cut down the dosage of such medications, it might potentially also reduce the unwanted side effects," Panayotis says.

A great advantage of beta-sitosterol is that it is naturally present in a variety of edible plants, and it is thought to be safe, as it has been marketed for years as a nutraceutical. It is found in particularly large concentrations in avocados, but also in pistachios, almonds and other nuts, in canola oil, in various grains and cereals and more.

However, this does not mean that eating avocado can induce a calming effect, since it doesn't contain enough beta-sitosterol. "You'd need to eat avocado day and night to get the right dose - and you would be more likely to develop digestive problems than relieve your anxiety," Panayotis says.

The precise mechanism of beta-sitosterol's effect on anxiety remains to be revealed, but the scientists did find that the expression of several genes known to be activated in stressful situations was reduced in mice given the supplement. They also found that these mice had changes in the levels of certain metabolites and neurotransmitters in brain areas involved in anxiety.

Since the study focused on brain regions and neural pathways that are involved in regulating anxiety in both mice and humans, it is likely that the findings will apply to humans as well. This will, however, require further clinical testing.

As Fainzilber points out: "There's a need for a clinical trial to test the use of beta-sitosterol for reducing anxiety in humans. Until then, we recommend that people consult their physicians before taking the supplement for this purpose."

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Study participants included Philip Freund and Dr. Letizia Marvaldi of the Biomolecular Sciences Department; Dr. Tali Shalit of the Nancy and Stephen Grand Israel National Center for Personalized Medicine; Dr. Alexander Brandis and Tevie Mehlman of the Life Sciences Core Facilities Department; and Dr. Michael Tsoory of the Veterinary Resources Department.

Prof. Michael Fainzilber is the incumbent of the Chaya Professorial Chair in Molecular Neuroscience

Prof. Fainzilber's research is supported by the Moross Integrated Cancer Center; the David Barton Center for Research on the Chemistry of Life; the Laraine and Alan A. Fischer Laboratory for Biological Mass Spectrometry; the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation; Miel de Botton; and the Estate of Lola Asseof for Alzheimer's Disease Research.

 

Is closing the gap working?

Indigenous welfare, health not improving - study

FLINDERS UNIVERSITY

Research News

 

Gaping policy shortfalls in the Australian Government's 'Closing the Gap' program have seen it fail to reduce disparities in Indigenous health, income, employment, child removal and incarceration, Flinders University researchers say.

Their five-year study just published in the Australian Journal of Public Administration examined why the targets of Australia's national Closing the Gap strategy to reduce or eliminate inequalities in health, education and employment outcomes between Aboriginal and Torres Strait Islander people and other Australians have mostly not been met.

"Despite talk of governments 'doing things with and not to' Indigenous Australians, we found that most strategies implemented under Closing the Gap are controlled from the top by government agencies, leaving little room for Indigenous communities to have a say," says lead author Dr Matthew Fisher, a senior researcher at the Southgate Institute for Health, Society and Equity at Flinders University.

"Indigenous leaders said consistently that Closing the Gap policy will be more successful when it supports greater community control at a local level and puts more focus on strategies to build community resources for health and wellbeing," said Dr Fisher.

The study interviewed more than 40 key individuals involved in Closing the Gap policy between 2008 and 2018, from within and outside government. More than half of the interviewees identified as Aboriginal or Torres Strait Islander.

"The Indigenous health program within the national Department of Health provides a model of good practice," said Dr Fisher. "It adopts a partnership approach to policy governance and supports a network of over 140 Aboriginal community-controlled health services."

"However, 'Closing the Gap' strategies in education and employment could learn from this good practice," he says, adding that Closing the Gap adopted a new partnership approach in 2019 aimed at improving outcomes.

'Closing the Gap' is a national strategy aiming to reduce or eliminate inequalities in health, education and employment outcomes between Aboriginal and Torres Strait Islander people and other Australians.

"Strong cultures are central to Aboriginal and Torres Strait Islander health and wellbeing, and this needs to be reflected in Closing the Gap strategies," says co-author and Waljen woman, Associate Professor Tamara Mackean, from Flinders University.

"In the 10 years studied, we identified policy incoherence between Closing the Gap policies, aiming to improve Indigenous health, and other policies in income management, child removal and incarceration, which are having the opposite effect," she says.

"Our research suggests that beliefs held by some political leaders about the superiority of 'Western' cultures over Indigenous cultures are a barrier to the policy changes needed to really close the gap in Australia," the research concludes.

"The new policies adopted in 2019 are a very positive development, but in order to succeed the Closing the Gap program should address the issues identified in this research," researchers say.

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Read the article, Stakeholder perceptions of policy implementation for Indigenous health and cultural safety: A study of Australia's 'Closing the Gap' policies (2021) by M Fisher, T Mackean, E George, S Friel and F Baum has been published in the Australian Journal of Public Administration (Wiley) DOI: 10.1111/1467-8500.12482.

Acknowledgements - The study received funding from the NHMRC Centre of Research Excellence on the Social Determinants of Health Equity, Grant/Award Number: GNT1078046

No link between milk and increased cholesterol according to new study of 2 million people

UNIVERSITY OF READING

Research News

 

Regular consumption of milk is not associated with increased levels of cholesterol, according to new research.

A study published in the International Journal of Obesity looked at three large population studies and found that people who regularly drank high amounts of milk had lower levels of both good and bad cholesterol, although their BMI levels were higher than non-milk drinkers. Further analysis of other large studies also suggests that those who regularly consumed milk had a 14% lower risk of coronary heart disease.

The team of researchers took a genetic approach to milk consumption by looking at a variation in the lactase gene associated with digestion of milk sugars known as lactose.

The study identified that having the genetic variation where people can digest lactose was a good way for identifying people who consumed higher levels of milk.

Prof Vimal Karani, Professor of Nutrigenetics and Nutrigenomics at the University of Reading said:

"We found that among participants with a genetic variation that we associated with higher milk intake, they had higher BMI, body fat, but importantly had lower levels of good and bad cholesterol. We also found that those with the genetic variation had a significantly lower risk of coronary heart disease. All of this suggests that reducing the intake of milk might not be necessary for preventing cardiovascular diseases."

The new research was conducted following several contradictory studies that have previously investigated the causal link between higher dairy intake and cardiometabolic diseases such as obesity and diabetes. To account for inconsistencies in sampling size, ethnicity and other factors, the team conducted a meta-analysis of data in up to 1.9 million people and used the genetic approach to avoid confounding.

Even though the UK biobank data showed that those with the lactase genetic variation had 11% lower risk of type 2 diabetes, the study did not suggest that there is any strong evidence for a link between higher milk intake and increased likelihood of diabetes or its related traits such as glucose and inflammatory biomarkers.

Professor Karani said:

"The study certainly shows that milk consumption is not a significant issue for cardiovascular disease risk even though there was a small rise in BMI and body fat among milk drinkers. What we do note in the study is that it remains unclear whether it is the fat content in dairy products that is contributing to the lower cholesterol levels or it is due to an unknown 'milk factor'".

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The team from the University of Reading, University of South Australia, Southern Australian Health and Medical Research Institute, University College London, and University of Auckland worked together on the study.

Peer Reviewed
Meta Analysis
Humans

New research suggests that night shift work is linked to menstrual irregularity and increased risk of developing endometriosis

EUROPEAN SOCIETY OF ENDOCRINOLOGY

Research News

 

Press release - Abstract 1394: Alterations in clock genes expression in Eutopic and Ectopic Endometrial Tissue

New research suggests that night shift work is linked to menstrual irregularity and increased chance of developing endometriosis

According to a study being presented at the 23rd European Congress of Endocrinology (e-ECE 2021), on Sunday 23 May at 19:00 CET (http://www.ece2021.org), women working night shifts may be at a greater risk of menstrual irregularity and developing endometriosis. The research found a reduction in the expression of PER-2, CRY-1 and CLOCK genes along with an increase in REV-ERBb in ectopic compared to eutopic tissues. Prior to this research, there had been no previously published studies relating to the alterations in core clock-genes and the impact on women with endometriosis.

Endometriosis is a condition where tissue similar to the lining of the womb starts to grow in other places such as ovaries and fallopian tubes. Endometriosis affects roughly 10% (190 million) of reproductive age women and girls globally. The symptoms of endometriosis can vary - some women are badly affected, while others might not have any noticeable symptoms. In severe cases, it can be very painful and can cause infertility, miscarriages and ectopic pregnancies due to the probable effects of endometriosis on the pelvic cavity, ovaries, fallopian tubes, or uterus.2 Disruption of circadian rhythm in night shift workers has been associated with menstrual irregularity, as well as an increased chance of developing endometriosis and ovarian tumours.

Dr. Narjes Nasiri-Ansari, Dr. Aggeliki Karapanagioti, and a team of colleagues under the guidance and supervision of Professor Eva Kassi from the National and Kapodistrian University of Athens, Greece, investigated the expression of the core clock related genes in paired eutopic and ectopic endometrial tissues. The study looked at 27 patients with confirmed ovarian endometriosis. Eleven (11) paired samples were collected from ovarian cysts (ectopic endometrial tissues) and normal endometrium (eutopic tissues), while further eight (8) ectopic and eight (8) eutopic endometrial tissues were collected from 16 different patients with the same diagnosis.

"The clinical evidence that circadian rhythm disruptions can be associated with endometriosis, is now confirmed at tissue level, by the altered expression of local clock genes in ectopic endometrium. Understanding the causes and effects of endometriosis will improve our ability to detect, manage or even prevent the condition. These findings provide us with a better understanding of biological rhythm disturbances," commented Professor Eva Kassi.

The results from this study demonstrate an altered expression of CLOCK, CRY1, PER-2 and Rev-ERBb in normal endometrium tissues, as compared to ectopic endometrial tissues, indicating a disturbance of biological timing. However, the causal relationship of the altered expression pattern of these genes with the development of endometriosis needs further investigation.

IBS patients' symptoms improved under COVID-19 lockdown orders

Unexpected reduction in symptoms may result from lower stress and more control over diet at home

DIGESTIVE DISEASE WEEK

Research News

 

Bethesda, MD (May 23, 2021) -- Patients' irritable bowel syndrome (IBS) symptoms unexpectedly improved when they were under COVID-19 stay-at-home orders, reaffirming the gut-brain connection in functional gastrointestinal disorders, according to research that was selected for presentation at Digestive Disease Week® (DDW) 2021.

"One of our main hypotheses was that these patients were going to be worse because of pressure and stress due to COVID-19," said Juan Pablo Stefanolo, MD, a lead author on the study and a physician with the Neurogastroenterology and Motility section, Hospital de Clínicas José de San Martín, Buenos Aires University, Argentina. "We think the results have something to do with people staying at home. They were not exposed to outside stress, and at home they were able to avoid food triggers."

Pandemic lockdown orders in Argentina created a unique opportunity for researchers to study the impact of pandemic stressors and reduced social interaction on 129 IBS patients whose pre-pandemic data had already been collected through an earlier research project. The patients were re-assessed during the lockdown with the same online survey that included multiple validated measures of IBS severity, anxiety and depression, along with questions about co-occurring illnesses, including heartburn, regurgitation, indigestion, chronic fatigue, fibromyalgia and nonmigraine headaches.

During the lockdown in Argentina -- one of the longest lockdowns in the world -- the number of patients experiencing severe IBS fell sharply from 65 to 39. The mean Irritable Bowel Syndrome Severity Scale score for the group also fell 66 points, from 278 to 212 on a 500-point scale. IBS symptoms of pain, distention, stool consistency, anxiety, somatization, fibromyalgia and chronic fatigue symptoms all improved during the lockdown.

Patients with functional gastrointestinal disorders experience symptoms even though no structural or biochemical abnormalities are present. The gut-brain connection refers to the role of stress and psychological difficulties in triggering debilitating gut-related symptoms. Headache, heartburn and regurgitation -- all outside the category of functional disorders -- became worse during the study, likely due to the increase in weight that nearly 60 percent of patients reported.

"Our results reinforce the concept that IBS, or functional gastrointestinal disorders, have a connection to psychosocial factors, as well as food and other factors," Dr. Stefanolo said. "The gut-brain axis has a lot of facets."

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DDW Presentation Details

Dr. Stefanolo will present data from the study, "Gut-brain axis and irritable bowel syndrome during SARS-CoV-2 pandemic. A survey-based study," abstract Su093, on Sunday, May 23, at 1 p.m. EDT.

For more information about featured studies, as well as a schedule of availability for featured researchers, please visit http://www.ddw.org/press.

Digestive Disease Week® (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW is a fully virtual meeting from May 21-23, 2021. The meeting showcases more than 2,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. More information can be found at http://www.ddw.org.

 

Smart toilet may soon analyze stool for health problems

Artificial intelligence tool can be used for long-term tracking and management of chronic gastrointestinal ailments

DIGESTIVE DISEASE WEEK

Research News

 

Bethesda, MD (May 22, 2021) -- An artificial intelligence tool under development at Duke University can be added to the standard toilet to help analyze patients' stool and give gastroenterologists the information they need to provide appropriate treatment, according to research that was selected for presentation at Digestive Disease Week® (DDW) 2021. The new technology could assist in managing chronic gastrointestinal issues such as inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS).

"Typically, gastroenterologists have to rely on patient self-reported information about their stool to help determine the cause of their gastrointestinal health issues, which can be very unreliable," said Deborah Fisher, MD, one of the lead authors on the study and associate professor of medicine at Duke University Durham, North Carolina. "Patients often can't remember what their stool looks like or how often they have a bowel movement, which is part of the standard monitoring process. The Smart Toilet technology will allow us to gather the long-term information needed to make a more accurate and timely diagnosis of chronic gastrointestinal problems."

The technology can be retrofitted within the pipes of an existing toilet. Once a person has a bowel movement and flushes, the toilet will take an image of the stool within the pipes. The data collected over time will provide a gastroenterologist a better understanding of a patient's stool form (i.e., loose, normal or constipated) and the presence of blood, allowing them to diagnose the patient and provide the right treatment for their condition.

To develop the artificial intelligence image analysis tool for the Smart Toilet, researchers analyzed 3,328 unique stool images found online or provided by research participants. All images were reviewed and annotated by gastroenterologists according to the Bristol Stool Scale, a common clinical tool for classifying stool. Using a computationally efficient approach to convolutional neural networks, which is a type of deep learning algorithm that can analyze images, researchers found that the algorithm accurately classified the stool form 85.1 percent of the time; gross blood detection had an accuracy of 76.3 percent.

"We are optimistic about patient willingness to use this technology because it's something that can be installed in their toilet's pipes and doesn't require the patient to do anything other than flush," said Sonia Grego, PhD, a lead researcher on the study and founding director of the Duke Smart Toilet Lab. "An IBD flare-up could be diagnosed using the Smart Toilet and the patient's response to treatment could be monitored with the technology. This could be especially useful for patients who live in long-term care facilities who may not be able to report their conditions and could help improve initial diagnosis of acute conditions."

The prototype has promising feasibility, but it is not yet available to the public. Researchers are developing additional features of the technology to include stool specimen sampling for biochemical marker analysis that will provide highly specific disease data to meet patients' and gastroenterologists' needs.

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DDW Presentation Details

Dr. Fisher will present data from the study, "Automated stool image analysis by artificial intelligence in a smart toilet," abstract Sa652, on Saturday, May 22, at 12:15 p.m. EDT. For more information about featured studies, as well as a schedule of availability for featured researchers, please visit http://www.ddw.org/press.

Digestive Disease Week® (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW is a fully virtual meeting from May 21-23, 2021. The meeting showcases more than 2,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. More information can be found at http://www.ddw.org.

 

New COVID-19 rapid test kit receives scientific seal of approval

The researchers suggest the test could be deployed in remote locations, clinics and airports due to its ease of use and portability

SIMON FRASER UNIVERSITY

Research News

 

Simon Fraser University researchers have validated a faster, cheaper COVID-19 test that could kickstart the expansion of more widespread rapid testing. Study results have been published in The Journal of Molecular Diagnostics.

"This research offers a cheaper, faster alternative to the most reliable and sensitive test currently used worldwide, without sacrificing sensitivity and reproducibility," says molecular biology and biochemistry professor Peter Unrau, who led the team evaluating the COVID-19 test kit.

The researchers suggest the test could be deployed in remote locations, clinics and airports due to its ease of use and portability.

The microchip real-time PCR test can provide accurate results in 30 minutes and requires 10 times less reagents than the tube-based RT-PCR tests approved by the Centers for Disease Control and Prevention (CDC). Supply chain shortages of reagents and test kits during the pandemic has slowed the rapid expansion of clinical testing. This new COVID-19 test kit is another tool in the toolbox that uses less of the supply constrained reagents to achieve fast and accurate results.

Unrau, along with PhD candidate Razvan Cojocaru and Master's student Iqra Yaseen, first evaluated test sensitivity in the lab.

Then the test kit was sent to a clinical team at St. Paul's Hospital in Vancouver, British Columbia, Canada to determine its ability to detect COVID-19 in patient samples. The microchip PCR COVID-19 test kit results aligned with hospital testing results - demonstrating its effectiveness.

The kit comes preloaded with COVID-19 primers and probes making it easy to use, reducing the potential for user error and improving the reliability of test results.

The COVID-19 detection kits developed by Lumex Instruments Canada and validated by Unrau's team are low power (100 watt), compact, lightweight and available internationally.

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Evacuating under dire wildfire scenarios

UNIVERSITY OF UTAH

Research News

 

IMAGE: IN 2018, THE CAMP FIRE RIPPED THROUGH THE TOWN OF PARADISE, CALIFORNIA AT AN UNPRECEDENTED RATE. MUCH OF THE TOWN WAS DESTROYED IN THE TRAGEDY. view more 

CREDIT: THE WHITE HOUSE VIA WIKICOMMONS

In 2018, the Camp Fire ripped through the town of Paradise, California at an unprecedented rate. Officials had prepared an evacuation plan that required 3 hours to get residents to safety. The fire, bigger and faster than ever before, spread to the community in only 90 minutes.

As climate change intensifies, wildfires in the West are behaving in ways that were unimaginable in the past--and the common disaster response approaches are woefully unprepared for this new reality. In a recent study, a team of researchers led by the University of Utah proposed a framework for simulating dire scenarios, which the authors define as scenarios where there is less time to evacuate an area than is required. The paper, published on April 21, 2021 in the journal Natural Hazards Review, found that minimizing losses during dire scenarios involves elements that are not represented in current simulation models, among them improvisation and altruism.

"The world is dealing with situations that exceed our worst case scenarios," said lead author Thomas Cova, professor of geography at the U. "Basically we're calling for planning for the unprecedented, which is a tough thing to do."

Most emergency officials in fire-prone regions develop evacuation plans based on the assumptions that wildfires and residents will behave predictably based on past events. However, recent devastating wildfires in Oregon, California and other western states have shown that those assumptions may no longer hold.

"Wildfires are really becoming more unpredictable due to climate change. And from a psychological perspective, we have people in the same area being evacuated multiple times in the past 10 years. So, when evacuation orders come, people think, 'Well, nothing happened the last few times. I'm staying,'" said Frank Drews, professor of psychology at the U and co-author of the study. "Given the reality of climate change, it's important to critically assess where we are and say, 'Maybe we can't count on certain assumptions like we did in the past.'"

How to predict the unprecedented

The framework allows planners to create a dire wildfire scenario--when the lead time, defined as the time before the fire reaches a community to respond, is less than the time required to evacuate. The authors developed a scoring system that categorizes each scenario as routine, dire, very dire or extremely dire based on many different factors.

One big factor affecting the direness is the ignition location, as one closer to a community offers less time than one farther away. A second major factor is the wildfire detection time. During the day, plumes of smoke can cue a quick response, but if it starts at night when everyone is asleep, it could take longer to get people moving. Officials may delay their decisions to avoid disrupting the community unnecessarily, but a last-minute evacuation order can cause traffic jams or put a strain on low-mobility households.

Alert system technologies can create dire circumstances if residents do not receive the warning in time due to poor cellphone coverage or low subscription rates to reverse 911 warning systems. If the community has many near misses with wildfire, the public's response could be to enact a wait-and-see approach before they leave their homes.

Using a dire scenario dashboard, the user assigns various factors an impediment level--low, minor or major--that can change at any point to lessen or increase a situation's direness.

"Usually when we run computer simulations, nothing ever goes wrong. But in the real world, things can get much worse half-way through an evacuation," said Cova. "So, what happens when you don't have enough time? The objective switches from getting everyone out to instead minimizing casualties. It's dark."

"More people began working remotely from home during the pandemic, which then led to them moving out of large cities into rural areas," explained assistant professor Dapeng Li of the South Dakota State University Department of Geography and Geospatial Sciences, a co-author and U alumnus who helped develop the computer simulations. "These rural communities typically have fewer resources and face challenges in rapidly evacuating a larger number of residents in this type of emergency situation."

Reducing dire scenarios

Simulating dire wildfire scenarios can improve planning and the outcomes in cases where everything goes wrong. For example, creating fire shelters and safety zones inside of a community can protect residents who can't get out, while reducing traffic congestion for others who can evacuate. During the 2018 Camp Fire, people improvised temporary refuges in parking lots and community buildings. Modeling could help city planners construct permanent safety areas ahead of time.

A common human response during wildfires are improvisations and creative thinking, which are difficult to model but can be literally lifesaving. For example, during the 2020 Creek Fire in California, a nearby military base sent a helicopter to rescue trapped campers. Another crucial component is individuals helping others, such as people giving others rides or warning neighbors who missed the official alert. During the Camp Fire, Joe Kennedy used his bulldozer to singlehandedly clear abandoned cars that were blocking traffic.

"It is very common for families and neighbors to assume a first responder role and help each other during disasters," said Laura Siebeneck, associate professor of emergency management and disaster science at the University of North Texas and co-author of the study. "Many times, individuals and groups come together, cooperate, and improvise solutions as needed. Though it is difficult to capture improvisation and altruism in the modeling environment, better understanding human behavior during dire events can potentially lead to better protective actions and preparedness to dire wildfire events."

Studying and modeling dire scenarios is necessary to improve the outcomes of unprecedented changes in fire occurrence and behavior. This study is the first attempt to develop a simulation framework for these scenarios, and more research is needed to incorporate the unpredictable elements that create increasingly catastrophic wildfires.

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UBCO researchers examine how pandemics impact the homeless

Forgotten population becomes more so during time of crises and disease

UNIVERSITY OF BRITISH COLUMBIA OKANAGAN CAMPUS

Research News

 

A team of UBC Okanagan researchers is looking at strategies that could help the homeless during a pandemic.

John Graham, director of UBC Okanagan's School of Social Work, says while many populations have been targeted with guidelines to keep them safe, homeless people have been mostly overlooked.

While this research project began a few years ago, Graham says his team quickly turned their attention to the impact of COVID-19. His team looked at peer-reviewed publications, dating back to 1984, that examined how homeless populations were impacted by other highly contagious or communicable illnesses such as tuberculous, H1NI and Severe Acute Respiratory Syndrome (SARS).

"Those experiencing homelessness do not fare well in terms of general health and this risk rises during public health outbreaks," says Graham. "Research findings have shown that homeless people under the age of 65 have a mortality rate five to 10 times higher compared to the general population."

Before this research, Graham, who is principal investigator of the Kelowna Homelessness Research Initiative, says no one really knew how pandemics historically impacted services for the homeless sector.

"It's important to remember that when public health officials make recommendations and response to a community they don't necessarily take into account all populations," he says. "Some of the methods of response are not easily transferable to the homeless populations -- that's partially because of their transient nature. But it is not unusual for homeless individuals to have a number of underlying illnesses, which could leave them more susceptible to virus obtainment, transmission and mortality."

Postdoctoral researcher Jordan Babando says they looked at a range of journal articles from across the world and identified six key themes that particularly affect the homeless: education and outreach, structure of services provided, screening and contact tracing, transmission and prevention strategies, shelter protocols and finally treatment, adherence and vaccination.

"Those experiencing homelessness often live in low?capacity shelters or transient locations that likely have no access to hygienic resources. This places them at increased risk of obtaining and spreading viruses in comparison to the general population," says Babando.

Shelter overcrowding, poor ventilation and an accumulation of clients with predispositions to infection increase the risk factors for virus and also complicate detection and tracing procedure, he explains.

"These concerns provide extraordinary considerations for developing and implementing pandemic and outbreak response planning and protocols," says Babando. "Trying to get the homeless population to come into the clinic for a vaccine and adhere to stay at home or social distancing regulations is difficult."

The goal of this research paper, says Graham, is to help public health agencies and homelessness sectors formulate a pandemic response to homeless populations.

"We need to move the needle as quickly as possible when it comes to our homeless situation," he says. "COVID-19 is extraordinarily significant for all of us, but most especially our vulnerable people. We hope these findings will contribute further to the dialogue help to end homelessness."

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The paper, published recently in Health and Social Care, was funded by the Social Sciences and Humanities Research Council.