Tuesday, July 18, 2023

Rice engineers’ storage technology keeps nanosurfaces clean

Containers attract, trap organic molecules that frequently foul nanosurfaces

RICE UNIVERSITY

containers that can keep volatile organic compounds from accumulating on the surfaces of stored nanomaterials — IMAGE: MECHANICAL ENGINEERS IN RICE UNIVERSITY’S PRESTON INNOVATION LABORATORY HAVE CREATED CONTAINERS THAT CAN KEEP VOLATILE ORGANIC COMPOUNDS FROM ACCUMULATING ON THE SURFACES OF STORED NANOMATERIALS. view more
CREDIT: CREDIT GUSTAVO RASKOSKY/RICE UNIVERSITY

HOUSTON – (July 17, 2023) – Rice University engineers have created containers that can keep volatile organic compounds (VOCs) from accumulating on the surfaces of stored nanomaterials.

The portable and inexpensive storage technology addresses a ubiquitous problem in nanomanufacturing and materials science laboratories and is described in a paper published this week in the American Chemical Society journal Nano Letters.

“VOCs are in the air that surrounds us every day,” said study corresponding author Daniel Preston, an assistant professor in Rice’s Department of Mechanical Engineering. “They cling to surfaces and form a coating, primarily of carbon. You can’t see these layers with the naked eye, but they form, often within minutes, on virtually any surface exposed to air.”

VOCs are carbon-based molecules that are emitted from many common products, including cleaning fluids, paints, and office and crafting supplies. They accumulate indoors in particularly high concentrations, and the thin layers of carbon gunk they deposit on surfaces can hinder industrial nanofabrication processes, limit the accuracy of microfluidic testing kits and produce confusion for scientists who conduct fundamental research on surfaces.

To address the problem, Ph.D. student and study lead author Zhen Liu, together with Preston and others from his lab, developed a new type of storage container that keeps objects clean. Experiments showed that her approach effectively prevented surface contamination for at least six weeks and could even clean VOC-deposited layers from previously contaminated surfaces.

The technology relies on an ultraclean wall inside the container. The surface of the interior wall is enhanced with tiny bumps and divots ranging in size from a few millionths to a few billionths of a meter. The microscopic and nanoscopic imperfections increase the wall’s surface area, making more of its metal atoms available to VOCs in air that’s inside the containers when they are sealed.

“The texturing allows the internal container wall to act as a ‘sacrificial’ material,” Liu said. “VOCs are pulled onto the surface of the container wall, which allows other objects stored inside to remain clean.”

She said the idea of using a large precleaned surface to accumulate pollutants was proposed 50 years ago but went largely unnoticed. She and her colleagues improved on the idea with modern methods of cleaning and nanotexturing surfaces. They showed, through a series of experiments, that their approach did a better job of preventing VOCs from coating the surfaces of stored materials than other approaches, including sealed petri dishes and state-of-the-art vacuum desiccators.

Preston’s group built on its experiments, developing a theoretical model that accurately characterized what was happening inside the containers. Preston said the model will allow them to refine their designs and optimize system performance in the future.

The research was supported by Rice’s Shared Equipment Authority, the Rice University Academy of Fellows, the United States Coast Guard Advanced Education Program and an Innovation in Buildings fellowship from the Department of Energy (DE-SC0014664).

-30-

A scanning electron microscope image (scale bar is 500 billionths of a meter in length) reveals myriad imperfections like those that Rice University engineers created on the interior walls of materials storage containers. The imperfections keep the surfaces of stored materials clean by attracting volatile organic compounds from air that gets sealed inside the containers.
CREDIT
Credit: Preston Innovation Laboratory/Rice University

Rice University Ph.D. student Zhen Liu and colleagues in the Department of Mechanical Engineering’s Preston Innovation Laboratory developed container technology that can prevent volatile organic compounds from coating the surface of stored objects for at least six weeks.
CREDIT
Credit: Gustavo Raskosky/Rice University

Peer-reviewed paper:

“Mitigating Contamination with Nanostructure-Enabled Ultraclean Storage” | Nano Letters | DOI: 10.1021/acs.nanolett.3c00626

Authors: Zhen Liu, Te Faye Yap, Anoop Rajappan, Rachel A. Shveda, Rawand M. Rasheed and Daniel J. Preston

https://doi.org/10.1021/acs.nanolett.3c00626

Image downloads:

https://news-network.rice.edu/news/files/2023/07/0717_CLEAN_GR03xc-lg.jpg
CAPTION: Mechanical engineers in Rice University’s Preston Innovation Laboratory have created containers that can keep volatile organic compounds from accumulating on the surfaces of stored nanomaterials. (Photo by Gustavo Raskosky/Rice University)

https://news-network.rice.edu/news/files/2023/07/0717_CLEAN_GR09-ZL-lg.jpg
CAPTION: Rice University Ph.D. student Zhen Liu and colleagues in the Department of Mechanical Engineering’s Preston Innovation Laboratory developed container technology that can prevent volatile organic compounds from coating the surface of stored objects for at least six weeks. (Photo by Gustavo Raskosky/Rice University)

https://news-network.rice.edu/news/files/2023/07/0717_CLEAN-sem3x2-lg.jpg
CAPTION: A scanning electron microscope image (scale bar is 500 billionths of a meter in length) reveals myriad imperfections like those that Rice University engineers created on the interior walls of materials storage containers. The imperfections keep the surfaces of stored materials clean by attracting volatile organic compounds from air that gets sealed inside the containers. (Image courtesy of Preston Innovation Laboratory/Rice University)

https://news-network.rice.edu/news/files/2023/07/0717_CLEAN_GR12-zldp-lg.jpg
CAPTION: Zhen Liu (left), a Ph.D. student in mechanical engineering at Rice University, and Daniel Preston, an assistant professor of mechanical engineering at Rice, teamed with others from Preston’s laboratory to create storage technology that can keep volatile organic compounds from accumulating on stored surfaces. (Photo by Gustavo Raskosky/Rice University)

JOURNAL

Nano Letters

DOI

10.1021/acs.nanolett.3c00626

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Mitigating Contamination with Nanostructure-Enabled Ultraclean Storage

THIRD WORLD U$A GOP COUNTIES

Rural mortality rose during year two of pandemic, despite vaccines, new study finds

BU research highlights how healthcare inequities between urban and rural areas, and vaccine skepticism, played a role in deaths related to COVID

Peer-Reviewed Publication

BOSTON UNIVERSITY

Interactive Map — IMAGE: THE RESEARCHERS CREATED AN INTERACTIVE MAP TO VISUALIZE COUNTY-LEVEL ESTIMATES OF EXCESS DEATHS MONTH-BY-MONTH. HERE, THE SNAPSHOT SHOWS THE NATIONAL VIEW IN SEPTEMBER 2021—THE DARKER THE COLOR, THE HIGHER THE EXCESS MORTALITY RATE. view more
CREDIT: COURTESY PAGLINO E, LUNDBERG DJ, ZHOU Z, WASSERMAN JA, RAQUIB R, LUCK AN, HEMPSTEAD K, BOR J, PRESTON SH, ELO IT, STOKES AC. “MONTHLY EXCESS MORTALITY ACROSS COUNTIES IN THE UNITED STATES DURING THE COVID-19 PANDEMIC, MARCH 2020 TO FEBRUARY 2022.” SCIENCE ADVANCES. 2023 JUN 23;9(25):EADF9742There was one striking difference between 2020, year one of the COVID-19 pandemic, and 2021, year two: in the second year, vaccines became readily available.

Presumably, vaccines created specifically to fight a new and deadly disease should have caused a dramatic reduction in deaths from that disease. And, according to new research from Boston University and the University of Pennsylvania, they did—but only in large, metropolitan counties. In rural counties across the United States—where vaccines were harder to obtain, where vaccine skepticism remained higher, and where access to good healthcare is often more challenging—excess deaths in year two of the pandemic actually increased, despite the presence of vaccines, according to the new study.

The study provides the first look at monthly estimates of what the researchers call “excess deaths” for every US county in the pandemic’s first two years. It says an estimated 1,179,024 excess deaths occurred during those first two years (first: 634,830; second: 544,194), a figure found by comparing mortality rates across all US counties for those years versus the years 2015–2019.

“We define excess mortality as the difference between what was observed versus what we would have expected,” says Andrew Stokes, a BU School of Public Health assistant professor of global health and corresponding author on the study.

The Brink spoke with Stokes about the new study, published this month in the journal Science Advances. Among his other studies into COVID was one looking at “hidden deaths” from the disease—where he found the actual pandemic death toll could be 20 percent higher than the formal count.

The Brink: There have been so many studies examining death rates due to COVID. Can you talk about your interest and approach for this novel study?

Stokes: Many studies have estimated the impact of COVID-19 during the first year, 2020, but as the pandemic evolved, there was less information on the coming waves and the ways they affected different regions and communities. We thought comparing data from the first year to the second year would provide insight into the evolving impact of the pandemic and how mortality rates changed across the country. This was especially valuable to do using an excess mortality metric, as official COVID-19 death surveillance likely worsened over time as testing became increasingly limited in many communities.

Right. Because the second year is when vaccines were ready, so states had to figure out how they were going to make them readily available to people.

Vaccines became available right at the end of the first year, the end of 2020. This next pandemic year, which stretches from 2021 to 2022, was an important year to understand patterns of mortality. It turns out that association with vaccines and mortality was very strong.

What jumped out at you through the data?

One major finding of the study, monitoring at the county level, is that yes, there was inequity across rural and urban lines, across the urban-rural continuum. While the pandemic slowed down after the first year in large metropolitan areas, rural areas continued to experience a significant burden of excess deaths throughout the second year of the pandemic.

Inequalities in mortality outcomes in the second year of the pandemic were fundamentally shaped by patterns of vaccine uptake at the community level. We observed increasingly divergent outcomes across states and across the urban-rural continuum as gaps in vaccine uptake widened.

So, what conclusions do you draw from that?

It’s a combination of factors. There was less vaccination happening in rural areas and that gap between urban and rural areas grew as the second year progressed. There was momentum for vaccine access in urban areas, with vaccine distribution clinics and mass vaccination sites. But those things were not widely implemented in rural America. Then there are the long-standing gaps in rural healthcare related to funding gaps and workforce shortages, making it much harder to be cared for and to get high-quality care. There was also a lack of COVID-19 testing.

So, the pandemic really hit rural America in the second year, when vaccines were available, harder than it hit urban areas.

Rural America was being affected disproportionately and had fewer safeguards to combat the whole of COVID-19. This was especially pronounced among blue-collar workers who suffered economic losses when they had to stay home, but could not work from home. The economic consequences those communities suffered shaped their responses to COVID-19 policies. The emergence of partisanship and misinformation further disadvantaged small metropolitan and rural areas during the second year of the pandemic. This partisanship even went as far as deteriorating the quality of surveillance data by affecting the certification of COVID-19 deaths, which were systematically undercounted in rural communities.

Can you talk more specifically about how different states responded to COVID and its impact on them?

The high excess death rates that burdened large cities in the Northeast and Mid-Atlantic regions in the first months of the pandemic began to shift to more rural areas in the South and West as early as August 2020, with the sharpest increases occurring during the wave of the highly contagious Delta variant in the spring and summer of 2021. In our maps, you see that these later waves of Delta and Omicron, when widespread vaccination was largely available, were much more pronounced in southern states and rural counties. If you compare Massachusetts to Tennessee, Massachusetts had very little impact from Delta, where Tennessee had a profound Delta surge. In Massachusetts, a large fraction of the population was vaccinated. But southern states like Tennessee or Mississippi, with lower vaccination rates, with many rural counties, really suffered during that second wave.

What about Florida? Republican Governor Ron DeSantis has proudly proclaimed that Florida did not shut down because of COVID and was better for it. Is he right?

What happened in Florida is quite heterogeneous. Highly affluent areas in south Florida, Democratic-leaning counties in certain parts that were highly vaccinated, did well. But rural Florida looks more like the rest of the South. It had very high excess mortality during Delta, and those were largely preventable deaths. And it occurred at a time when Florida had very few mitigation measures in place to protect their rural residents.

OK, then take a different big state: California.

Even states like California, with its more progressive public health policies, were not completely insulated from the widening chasm between rural and urban areas that became increasingly stark over the second year of the pandemic. This highlights the limits of states’ policy responses in reaching rural America. Even as large metro areas in those same states experienced declines in COVID-19-related mortality as the pandemic progressed, rural counties were heavily burdened with deaths from COVID-19.

Taking the data from a 30,000-foot view, what do you see?

The really striking finding is that despite the strong efficacy of vaccines and high uptake in many large metropolitan areas, the number of excess deaths in the second year was not substantially lower than in the first year. The many deaths in rural, nonmetropolitan areas likely contributed to the high excess mortality we saw in the second year. Many of the deaths in the second year were preventable, through wider vaccination.

For the vaccine skeptics out there—and we know there are many of them—what does your study say to them?

This study simply compares what happened to what should have happened. It’s hard to argue with excess mortality.

This interview has been edited for clarity; additional detail was also added after initial publication.

This research was supported by the Robert Wood Johnson Foundation, the National Institute on Aging, the W. K. Kellogg Foundation, the BU Center for Emerging Infectious Diseases Policy & Research, and the National Science Foundation.

JOURNAL

Science Advances

DOI

10.1126/sciadv.adf9742

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Monthly excess mortality across counties in the United States during the COVID-19 pandemic, March 2020 to February 2022

WHITE SUPREMACY

Redlining linked to higher heart failure risk among Black adults in US

Black adults living in areas historically affected by discriminatory housing practices had higher heart failure risk, according to new study published in Circulation journal

Peer-Reviewed Publication

AMERICAN HEART ASSOCIATION

Research Highlights:

An analysis of more than two million adults in the U.S. found that present day heart failure risk was higher among Black adults who lived in zip codes historically impacted by redlining compared to Black adults living in non-redlined areas.
Redlining did not have the same impact on heart failure risk among white adults living in historically redlined zip codes.
Among Black adults living in historically redlined communities, approximately half of the excess risk of heart failure appeared to be explained by higher levels of socioeconomic distress.

DALLAS, July 17, 2023 — The risk of heart failure in the present day was higher among Black adults who lived in U.S. zip codes historically impacted by redlining, according to research published today in the American Heart Association’s flagship, peer-reviewed journal Circulation. The analysis, published as part of the journal’s “Disparities in Cardiovascular Medicine Special Issue,” included more than 2.3 million adults from 2014-2019 who lived in U.S. communities with varying degrees of redlining, which began in the mid-1930s.

In 1933, the Home Owners’ Loan Corporation, a government agency created as part of President Roosevelt’s New Deal, began sponsoring low-interest mortgage loans to help people recover from the financial crisis of the Great Depression. In a process called “redlining,” the HOLC developed a color-coding system for neighborhoods across the country based on “risk for investment” criteria; it deemed red areas, which were largely Black communities, “too risky” to insure mortgages. The residents who lived in these neighborhoods were denied home loans, which lowered tax revenues in these communities and reduced investment in schools and government programs and services. This created numerous inequities for residents for multiple generations despite the practice being outlawed by the Fair Housing Act of 1968.

Previous research has found that communities exposed to redlining had higher rates of stroke, as well as increased risk of hypertension, Type 2 diabetes and early mortality due to heart disease. Heart failure is a progressive condition in which the heart is unable to pump enough blood to the body either due to the heart muscle stiffening or from it losing pumping strength. According to the American Heart Association’s 2023 Statistical Update, heart failure affects 6.7 million people in the U.S. and disproportionately impacts Black adults.

“Although discriminatory housing policies were effectively outlawed nearly a half-century ago, the relationship between historic redlining practices and people’s health today gives us unique insight into how historical policies may still be exerting their effects on the health of many communities,” said study co-senior author Shreya Rao, M.D., M.P.H., a cardiologist and assistant professor in the department of internal medicine at the University of Texas Health Science Center at San Antonio and University Hospital, both in San Antonio, Texas.

The researchers identified nearly 2.4 million adults in the Medicare Beneficiary Summary Files between 2014 and 2019 with linked residential zip codes. Study participants were 55.4% female and had a mean age of 71 years; 801,452 of participants self-identified as Black adults, and nearly 1.6 million participants self-identified as non-Hispanic white adults. Individuals of other races were excluded due to the low numbers available within the Medicare data. Participants were excluded from the analysis if they had a history of heart failure or heart attack in the preceding two years, had fewer than two years of Medicare coverage before the study start date or were younger than the age of 40.

The researchers mapped historical redlining maps onto modern day maps of 1,044 zip codes in the U.S. and sorted them into four groups ranging from zip codes that had the least amount of area impacted by redlining to zip codes with the most areas exposed to redlining.

“Ultimately, we were most interested in assessing the difference in risk of heart failure between individuals from communities with the highest level of exposure to redlining and individuals from other communities,” said first author Amgad Mentias, M.D., M.S., an interventional cardiology fellow at Cleveland Clinic in Cleveland, Ohio.

The researchers assessed the association between living in higher proportions of redlined zip codes and heart failure risk. They conducted separate analyses for Black and white adults and additional variables were considered, such as social determinants of health, which were determined at the zip-code level with Social Deprivation Index scores collected in the American Community Survey from 2011-2015. The Social Deprivation Index is a composite measure based on seven demographic characteristics collected in the American Community Survey, including poverty rate, education level, employment, access to transportation, household characteristics (single-parent households), percentage of households that rent rather than own housing, and percentage of households that are overcrowded. Heart failure was identified as hospitalization with a primary diagnosis of heart failure. Although most adults qualify for Medicare at 65 years old, the cohort also included adults younger than 65 who qualified for Medicaid due to disability.

The analysis found:

Black adults living in zip codes with the highest proportion of redlining had an 8% higher risk of developing heart failure compared to Black adults living in communities with low levels of redlining.
In contrast, white adults living in zip codes with the highest proportion of redlining did not have an increased risk of heart failure.
About half of the excess risk of heart failure among Black adults living in redlined communities was explained by higher levels of socioeconomic distress (determined by Social Deprivation Index scores) in those redlined communities.
The risk of heart failure was highest in Black adults living in redlined communities that had high scores on the Social Deprivation Index.

“These findings show us the harm that discriminatory and racist housing policies have had on generations of Black adults and suggest the long-term impact of such policies on cardiovascular health disparities,” said senior author Ambarish Pandey, M.D., M.S., a cardiologist and assistant professor in the department of internal medicine at the University of Texas Southwestern Medical Center in Dallas. “A reparative approach may be needed on the part of federal, state and local governments to intervene and drive investment in redlined communities.”

The findings also highlight the pivotal role housing plays as a social determinant of health, Pandey noted. “Aggressive enforcement of anti-discrimination laws in housing, and support for and pathways to homeownership for Black families are needed in order to begin to achieve equity in health, ” he said.

The study’s limitations include that redlining is just one facet of the impact of discrimination in the U.S. Redlining does not, alone, capture the full contribution of systemic racism on health today, the authors noted.

“Decades of discriminatory housing policies have left a lasting imprint on the cardiovascular health of Black communities. This careful and systematic analysis underscores the higher heart failure risk faced by Black adults residing in historically redlined areas, and provides evidence that social determinants of health, such as poverty, education, and access to healthy food, drive this risk,” said the American Heart Association’s Chief Clinical Science Officer Mitchell Elkind, M.D., M.S., FAHA, FAAN. “The study serves as a stark reminder of the ongoing impact of structural racism and emphasizes the urgent need for restorative actions and targeted investments to promote health equity.”

Co-authors are Mahasin S. Mujahid, Ph.D., FAHA; Andrew Sumarsono, M.D.; Robert K. Nelson, Ph.D.; Justin M. Madron, Ph.D.; Tiffany M. Powell-Wiley, M.D., M.P.H., FAHA; Utibe R. Essien, M.D., M.P.H.; Neil Keshvani, M.D.; Saket Girotra, M.D., S.M.; Alanna A. Morris, M.D., M.Sc., FAHA; Mario Sims, Ph.D., FAHA; Quinn Capers IV, M.D.; Clyde Yancy, M.D., M.Sc., FAHA; Milind Desai, M.D., M.B.A., FAHA; and Venu Menon, M.D., FAHA. Authors’ disclosures are listed in the manuscript.

The study was funded by the Haslam Family, Bailey Family and Khouri Family to the Cleveland Clinic, as well as the National Institute on Aging and the National Institute on Minority Health and Disparities, both of which are divisions of the National Institutes of Health.

The Disparities in Cardiovascular Medicine Special Issue of Circulation also includes a separate study examining historical neighborhood redlining and cardiovascular risk in patients with chronic kidney disease. In this study, researchers at Case Western Reserve University analyzed data for 1,720 participants enrolled in the Chronic Renal Insufficiency Cohort in 2003-2008. The analysis found that people with mild to moderate chronic kidney disease who lived in historically redlined neighborhoods had a two-fold higher risk of developing heart failure, independent of major risk factors for cardiovascular disease.

Additional research publishing in the special issue includes:

Historical Neighborhood Redlining and Cardiovascular Risk in Patients with Chronic Kidney Disease; Al-Kindi et al.
Associations between Maternal Sociodemographics and Hospital Mortality in Newborns with Prenatally Diagnosed Hypoplastic Left Heart Syndrome; Lopez et al.
Racial Disparities in Exposure to Ambient Air Pollution During Pregnancy and Prevalence of Congenital Heart Defects; Arogbokun Knutson et al.
Arrhythmia and Survival Outcomes among Black and White Patients with a Primary Prevention Defibrillator; Goldenberg et al.
Racial differences in quality of life in patients with heart failure treated with sodium-glucose cotransporter 2 inhibitors: A patient-level meta-analysis of the CHIEF-HF, DEFINE-HF, and PRESERVED-HF trials; Lanfear et al.
Race-based differences in ST elevation myocardial infarction (STEMI) process metrics and mortality from 2015-2021: an analysis of 178,062 patients from the American Heart Association Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) Registry; Goyal et al.
Socioeconomic disparities and mediators for recurrent atherosclerotic cardiovascular disease events after a first myocardial infarction; Ohm et al.

Statements and conclusions of studies published in the American Heart Association’s scientific journals are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. 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 and the Association’s overall financial information are available here.

Additional Resources:

Multimedia is available on right column of release link https://newsroom.heart.org/news/redlining-linked-to-higher-heart-failure-risk-among-black-adults-in-u-s?preview=298e1988abf3c097c8219ccc1529598a
After July 17, 2023, view the manuscript online.
AHA news release: Structural racism: Communities with higher redlining scores had higher rates of stroke (March 2021)
AHA presidential advisory: Call to Action: Structural Racism as a Fundamental Driver of Health Disparities (Nov. 2020)
Follow AHA/ASA news on Twitter @HeartNews
Follow news from the AHA’s flagship journal Circulation @CircAHA

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. 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.

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JOURNAL

Circulation

DOI

10.1161/CIRCULATIONAHA.123.064351

ARTICLE TITLE

Historical Redlining, Socioeconomic Distress, and Risk of Heart Failure Among Medicare Beneficiaries

Racial disparities discovered in patients with cardiac devices

Peer-Reviewed Publication

UNIVERSITY OF ROCHESTER MEDICAL CENTER

Black patients with implantable cardioverter defibrillators (ICDs) have a significantly higher burden of disease than white patients with the same device, according to a new study from University of Rochester Medical Center (URMC) cardiology researchers. Analyzing data from clinical trials conducted over a 20-year period by the Clinical Cardiovascular Research Center (CCRC) at URMC, investigators concluded that not only did Black patients with ICDs tend to be significantly younger than white patients, but they also had a higher rate of post-implant cardiac events and risk of death.

When a patient is at risk for cardiac arrest, an ICD helps to monitor their heart rhythm, and if an abnormality is detected, the device delivers a shock of electricity to reset the heartbeat to a normal rhythm. The study, published in Circulation, examines the rate of events that a patient experiences after their ICD is implanted. After three years of monitoring, the risk of ventricular arrhythmia (sustained rapid heartbeat that can lead to sudden cardiac death) was 20 percent for white patients, but 31 percent for Black patients. The other significant findings were that Black patients requiring an ICD appeared at younger ages, by five to ten years, and the risk of death for Black patients, despite having an ICD to protect them, is two times higher.

There are two types of heart failure. In one, a heart attack can leave a scar, which develops the potential for future heart failure. This is ischemic cardiomyopathy (ICM). In the other, heart failure is due to comorbidities, such as diabetes and hypertension. This is non-ischemic cardiomyopathy (NICM). An interesting note in the study shows there was virtually no difference in results for Black and white patients with ICM because the scar is essentially the same in both races, therefore they have the same issues and receive the same treatment. It’s only in patients with NICM that there are stark differences between Black and white patients.

These results beg the question: why? Principal investigator Ilan Goldenberg, MD, said they can hypothesize some reasons for the differences, but not fully draw solid conclusions. “It is possible that Black patients are not managed as well as white patients because of health care disparities, but we did not identify any significant differences in our study. We did identify that after one year, Black patients were more likely to discontinue some medications, but the reasons for that are unknown as well. The younger age of onset and the increased rate of comorbidities, such as diabetes and hypertension, among Black patients with NICM is striking and may contribute to the worse outcomes due to more advanced heart disease.”

The authors applied the Gini Index to their results. This index looks at zip codes across the country to compare its citizens wealth to areas surrounding it. For this particular study, the index scores for patients indicated that Black patients did tend to come from areas with lower socioeconomic status. “Future studies should examine closely social determinants of health, which were not captured in our clinical trials, to see why these findings occurred,” said Goldenberg.

Lead author Arwa Younis, MD, is a former research fellow from the URMC Clinical Cardiovascular Research Center who is now at the Cleveland Clinic and still holds an adjunct position with URMC. Younis knew going into the study that there were differences between racial groups with ICDs, but he was surprised by the extent of the results. “There’s nothing worse than getting a shock for a patient,” said Younis. “And it’s difficult to see a patient continue to receive shocks despite being on optimal medical therapy. In our study, we assessed patient compliance at the one-year mark and more than 85 percent of patients remained compliant. So, despite being on optimal medical therapy and having a high compliance rate, the burden of disease remained very high for Black patients.”

According to Younis, these results mean that Black patients with an ICD should receive aggressive positive treatment as early as possible. This means monitoring patients closely, referring to specialists as needed, and implanting devices earlier on. Goldenberg agrees: “We believe the main implication of this study is that because we now know that Black patients who have heart failure are more likely to have more advanced arrhythmias, they should be considered earlier for an ICD defibrillator to protect them from sudden cardiac death.” He also notes that primary prevention and treatment of comorbidities such as diabetes and hypertension may be one way to help prevent the burden of cardiac disease in Black patients.

Additional co-authors of the study from URMC include Sanah Ali, MD, Ido Goldenberg, MD, Scott McNitt, MS, Bronislava Polonsky, MS, Mehmet Aktas, MD, Valentina Kutyifa, MD, PhD, and Wojciech Zareba, MD, PhD. Co-authors from the Cleveland Clinic include Eileen Hsich, MD, and Oussama Wazni, MD, MBA.

JOURNAL

Circulation

DOI

10.1161/CIRCULATIONAHA.123.065367

METHOD OF RESEARCH

Meta-analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Arrhythmia and Survival Outcomes Among Black Patients and White Patients With a Primary Prevention Defibrillator

ARTICLE PUBLICATION DATE

18-Jul-2023

COI STATEMENT

Drs Younis, Ali, Ido Goldenberg, and Aktas, and S. McNitt and B. Polonsky, have nothing to declare. Drs Kutyifa, Wazni, Zareba, and Ilan Goldenberg report receiving grants from Boston Scientific.

UMD researchers uncover privacy risks in cellphones purchased at police auctions

Their two-year study found that 27% of the phones they successfully bid on contained personal data

Reports and Proceedings

UNIVERSITY OF MARYLAND

UMD Researchers Uncover Privacy Risks in Cellphones Purchased at Police Auctions — IMAGE: (FROM LEFT) UNIVERSITY OF MARYLAND COMPUTER SCIENCE PH.D. STUDENTS RICHARD ROBERTS AND JULIO POVEDA ARE SHOWN WITH THEIR ADVISER, ASSOCIATE PROFESSOR DAVE LEVIN. THE TRIO RECENTLY CONCLUDED A STUDY THAT UNCOVERED SIGNIFICANT PRIVACY CONCERNS WITH CELLPHONES PURCHASED FROM POLICE PROPERTY ROOM AUCTIONS view more
CREDIT: UNIVERSITY OF MARYLAND

Law enforcement agencies nationwide regularly sell items that are seized in criminal investigations or are unclaimed from lost-and-found inventories. Many of these items—vehicles, jewelry, watches and electronic devices like cellphones—end up at online auction houses.

People looking for a bargain can bid on cellphones in bulk, snatching up dozens at rock bottom prices for parts or other uses. This ultimately provides revenue for the police agencies, making for a good deal for everyone involved. Or is it?

A recent study by University of Maryland security experts found that many of the phones sold at police property auction houses are not properly wiped of personal data. The study, conducted over two years with cellphones bought from the largest police auction house in the U.S., uncovered troves of personal information from previous owners that was easily accessible.

Of the 228 phones that the UMD team successfully bid on, 61 (27%) contained personal data like social security numbers, credit card and banking information, passport data, pictures of driver’s licenses, and more.

“We were actually surprised at the level of personal information we found, and the ease by which we could access it,” said Dave Levin, an associate professor of computer science who led the UMD team.

Levin, a core faculty member in the Maryland Cybersecurity Center, first became interested in this topic through a casual conversation with a colleague. After determining there was a security breakdown—whether through police not wiping the phones, or auction houses not taking proper safeguards before shipping items to the highest bidder—Levin and several of his graduate students set out to explore the scale of the problem

The first step was to work closely with the university’s legal counsel and institutional research review board to determine the appropriate protocols needed to view any personal data.

“There were stringent guidelines in place—how each phone we received was catalogued, the processes we used to access the phones, and most importantly, what we would be legally required to do if we found any evidence of child abuse,” said Julio Poveda, a second-year computer science Ph.D. student who was part of the research team.

The UMD team did not come across any evidence of child abuse, but did uncover other information that was unsuitable for public dissemination, such as depictions of adult nudity and drug use.

Some of the phones they accessed had been used in criminal activities like identity theft, a discovery Levin found particularly troubling.

“It’s as if people that were victims of identity theft were being ‘re-victimized’ by having their personal information available again for anyone to see,” he explained.

The UMD team determined that some of the phones had been used by sex workers, with text messages between the workers and their clients still intact.

“It's important to remember that your phone does not just have your data, it has data from anyone who has communicated with you,” said Richard Roberts, a sixth-year computer science Ph.D. student and lead author of the study.

Roberts, who presented the team’s academic work at a major security conference earlier this year, said that out of the 61 phones the researchers accessed, they determined that there had been some form of digital contact with more than 7,000 people.

Levin, Poveda and Roberts are all security experts, but decided against using using any type of sophisticated digital forensics for their study. “We wanted to attempt to gain access to any cellphone data using techniques that someone on the street might use,” Roberts said.

The researchers were shocked at how easy it was. One of the phones arrived with a sticky note attached with the phone’s passcode in plain view, a leftover from the originating police agency that had already legally hacked the phone. Multiple other phones had PINs or passcode patterns that were easy to guess.

“Sadly, passcodes like 1-2-3-4 are still in common use today,” Levin said.

Last October, the researchers reached out to the auction house where they purchased the phones. The company—PropertyRoom.com, which bills itself as the largest police auction house in the U.S. working with more than 4,400 law enforcement agencies—promised to investigate the problem. Shortly after that, the company stopped selling bulk lots of phones altogether for a short period, then started again, prompting the researchers to purchase another batch.

“We found that PropertyRoom had started wiping the phones but failed to wipe the phones’ [Secure Digital] cards, which in several cases had partial backups of the phones’ contents,” Levin said.

After pinging the company again to inform it of this oversight, the UMD researchers received no further response.

A subsequent investigative report by a local television station prodded the company to publish a message on its website stating it was aware of the security concerns and was taking corrective measures.

From a security standpoint, Levin said, police agencies should avoid auctioning used cellphones. “Just destroy them,” he said. “[The police agencies] don’t get that much money in return, and the potential damage far outweighs any financial incentives.”

He also suggested that people take better precautions in the event their phone is lost or stolen and ends up being resold.

“Use your phone under the assumption that somebody else might later become its legal owner,” Levin said. “Set a passcode that is hard to guess, minimize the private information that’s easy to access, and remotely wipe your phone if it is lost or stolen. Otherwise, our study shows just how easy it is for someone to gain an incredible amount of access to your private information.”

DOI

10.1109/SP46215.2023.00167

Innovative infection prevention program reduces surgical site infections, results in hospital days reduced and $500,000 savings

Could serve as model for improving outcomes

Reports and Proceedings

AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Chicago — An innovative anesthesiologist-led infection prevention program helped reduce the number of surgical site infections (SSIs) in colorectal patients by 50%, the number of days in the hospital by 46%, and led to significant cost savings over a two-year period, according to research presented at the virtual American Society of Anesthesiologists’ Anesthesia Quality and Patient Safety Meeting.

“With the skyrocketing cost of medical care for patients and health care institutions, one area physicians can focus on is reducing SSIs,” said Austin Street, M.D., study author and anesthesiologist at UT Southwestern Medical Center, Dallas. “Many SSIs are preventable through well-designed, evidence-based interventions. We were very happy to reduce the SSIs in our colorectal patients by half, which also led to decreases in hospital bed days, saving the hospital and patients money, as well as freeing up beds for other patients and surgeries.”

Largely avoidable with proper infection control measures, SSIs occur either during or up to 30 days after a surgical procedure. SSIs often need to be treated with additional antibiotics, and may require interventional procedures or even re-operation. SSIs can lead to major complications, including death, as well as significantly increase the cost of care. The cost of a patient’s care increases by $20,000, on average, if they develop an SSI. According to the Centers for Disease Control and Prevention, the annual cost of SSIs to hospitals in the U.S. ranges between $3.2 billion to $10 billion a year. The SSI incidence rate in colorectal surgery is higher than many other procedures.

Prior to the intervention, the infection ratio at UT Southwestern had increased from .74 in 2018 to 3.08 in 2020, putting the program in the bottom quartile for infection rates in the country. The new infection prevention initiative leveraged the strength of the hospital’s Enhanced Recovery After Surgery (ERAS) program. An ERAS pathway is an evidence-based protocol that standardizes care to minimize surgical stress and postoperative pain, reduce complications, improve outcomes, decrease hospital length of stay and expedite recovery following elective procedures. Under the umbrella of the ERAS program, UT Southwestern’s infection prevention initiative implemented a number of interventions, each targeted at evidence-based causes of SSIs, including:

Giving oral antibiotics with the patient’s mechanical bowel preparation
Identifying the best antibiotic to use, as well as optimal timing and redosing for colorectal surgery, with the guidance of UT Southwestern’s antibiotic stewardship committee
Using chlorhexidine baths, a cleaning product that kills germs, prior to the surgery and wipes to the abdomen immediately prior to the operating room to decrease bacteria on the skin
Improving access to critical medications by storing the antibiotics directly in each operating room’s “pyxis” machines, which hold and distribute the anesthetic drugs
Requiring the surgical team and their assistants (scrub techs and residents) to change their gowns and gloves when the surgery was completed and they were about to close the wound, assuring no contamination from the surgical site got into the sterile areas of the wound
Actively warming patients both prior to and during the surgery, which has been shown to decrease the risk of wound infections
Increasing patient mobility as soon as possible after surgery, for example sitting up in a chair the day of surgery and walking in the hallways up to three times as soon as possible, which decreases the risk of infection

By implementing these infection control strategies, UT Southwestern met their goal of reducing colorectal SSIs by 50%. Additionally, the hospital saved an estimated $540,000 in total costs in 2021 and 2022, compared to 2020, and hospital bed days were reduced by 578 days (46%).

This program may serve as a useful model for other academic or major medical centers seeking to improve their SSI outcomes.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 56,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Like ASA on Facebook, follow ASALifeline on Twitter.

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Merck Prize boosts work on automated air sensor for pandemic pathogens

Emory University chemist Khalid Salaita leads a visionary project

Grant and Award Announcement

EMORY UNIVERSITY

Merck KGaA, Darmstadt, Germany, awarded its 2023 Future Insight Prize to Khalid Salaita, professor of chemistry at Emory University. The award comes with $540,000 to fund the next phase of research into an air sensor that can continuously monitor indoor spaces for pathogens that can cause pandemics.

“I’m extremely thankful to receive the Future Insight Prize as this enables us to continue our path toward an early-warning system for emerging threats,” Sailta says. “Our research sets the stage for fully automated detection of airborne pathogens without human intervention or sample processing.”

The Merck Future Insight Prize recognizes groundbreaking ideas to solve some of the world’s most pressing challenges in health, nutrition and energy. The Salaita lab’s sensor, a rolling micro-motor called “Rolosense,” holds the potential to help mitigate, or even prevent, a pandemic.

“The importance of being prepared is a key lesson from the COVID-19 pandemic,” says Belén Garijo, chair of the executive board and CEO of Merck, a leading science and technology company. “There are many promising collaborations to build an inclusive framework for pandemic preparedness, but we still lack an effective warning system to detect potential threats before it is too late. The pioneering work of Khalid Salaita could help fill this urgent gap in our global defenses.”

Salaita’s lab has already shown that a prototype of the sensor can detect the five variants of COVID-19 that it has tested, along with influenza type A. Theoretically, Rolosense can be programmed to simultaneously screen for a wide group of viral pathogens within a breath sample from an individual or within ambient indoor air.

Within the next five years, the researchers hope to have viable products available to provide convenient, non-invasive, rapid ways to detect airborne viral pathogens. These products may include testing kits for the home and healthcare clinics that screen for an array of viruses within a single test, delivering a result within minutes.

“Our ultimate goal is to develop automated viral air sensors that function similar to smoke detectors,” Salaita says. “These sensors could be located in busy locations like airports, hospitals and schools to continuously monitor aerosolized particles for viruses.”

Salaita is also on the faculty of the Wallace H. Coulter Department of Biomedical Engineering, a joint program of Georgia Tech and Emory.

Curiosity got the ball rolling on the project around a decade ago.

“We wondered if we could convert chemical energy into mechanical work and make something move,” Salaita recalls. “Ultimately, our goal was to mimic life at the nanoscale. We wanted to make artificial, miniscule motors that match the sophistication and functionality of proteins that move cargo around in cells and perform other functions.”

As a graduate student in the Salaita lab, Kevin Yehl had the idea of constructing a DNA-based motor using a micron-sized glass sphere as its “chassis.” Hundreds of DNA strands, or “legs,” were allowed to bind to the sphere. They were then placed on a glass slide coated with the fuel: RNA.

The result was the invention of the first rolling DNA-based motor in 2015. Dubbed the “Rolosense,” the motor was 1,000 times faster than any other synthetic DNA motor. It was so fast that a simple smart phone microscope could capture its motion through video.

Its speed and stability gave the Rolosense potential for real-world applications, such as a tool for medical diagnostics.

Emory graduate students continued to work on refinements of the technologies through the years. Alisina Bazrafshan, who has since graduated and is now a scientist at Illumina, a DNA sequencing company, enhanced the speed and persistence of the DNA-based motors.

When Selma Piranej joined the Salaita lab as a PhD candidate in 2018, she began working on a project to build computer programming logic into the Rolosense. She tapped a well-known reaction in bioengineering to perform the computation and then paired it with the motion of the Rolosense. The computer readout becomes simply “motion” or “no motion.”

These two logic gates of “motion” or “no motion” can be strung together to build more complicated operations, mimicking how regular computer programs build on the logic gates of “zero” or “one.”

Piranej took the project even further by finding a way to pack many different computer operations together and still easily read the output. She simply varied the size and materials of the microscopic spheres that form the chassis for the DNA-based rolling motors. For instance, the spheres can range from three to five microns in diameter and be made of either silica or polystyrene. Each alteration provides slightly different optical properties that can be distinguished through a cell phone microscope.

When the pandemic hit in 2020, the chemists began focusing on using the Rolosense technology to develop an indoor air sensor to detect the SARS-CoV-2 virus, the infectious agent of COVID-19.

The Salaita lab received a $883,000 grant for the project from the National Institutes of Health RADx Radical initiative, which aims to support new, non-traditional approaches for rapid-detection devices that address current gaps in testing for the presence of SARS-CoV-2, as well as potential future pandemic viruses.

Co-investigators on that grant included Gregory Melikian, a professor at Emory School of Medicine, in the Department of Pediatrics’ Division of Infectious Disease; and Yonggang Ke, assistant professor at Emory’s School of Medicine and the Coulter Department of Biomedical Engineering.

An additional key collaborator is Primordia Biosystems, a company that specializes in building microfluidic chips that can sample virus-containing aerosols in the air.

Piranej continued to work on the project along with fellow Emory PhD students. She searched through the scientific literature to find an aptamer, a piece of DNA that would bind to a universal spike protein on SARS-CoV-2, sticking to it like Velcro.

Experiments showed that this bind stalls the Rolosense motor, giving the “no motion” readout that signals the presence of SARS-CoV-2. Variants of SARS-CoV-2 share the same spike protein, so the Rolosense is able to detect a range of them.

By adding different aptamers, or binding agents, the researchers have shown they can detect other viruses as well, including influenza type A. Millions of nano-motors are deployed at once via the technology. The motors can be individually programmed so that they each respond only to one specific virus. That means multiple viruses could be simultaneously screened for within one test sample.

“Unlike conventional tests, we don’t have to treat a viral sample in any way to get a result,” Salaita says. “We can do the detection directly from a nasal swab, saliva sample or breath condensate. We don’t have to do any kind of amplification process to enhance the signal. That’s a huge advantage in terms of making the assay more assessable while also preserving ultrasensitive detection.”

The Merck award will support the researchers as they further refine and test the technology.

“Some of the world’s leading experts at testing and validating new COVID diagnostics happen to be on the Emory campus,” Salaita notes. His team will be drawing from this expertise, along with thousands of samples from human COVID-19 infections available in an NIH RADx Radical Diagnostic Core Resources center located at Emory School of Medicine. The samples are used to benchmark and validate the efficacy of a viral assay.

A key challenge in terms of a Rolosense product for home testing or use in a physician’s office is integration of the breath-collection tube with the readout device.

The development of a viral sensor to continuously monitor indoor air also must overcome many chemistry and engineering challenges.

“We’ve shown that our nano-motors can run for at least 24 hours, but we need them to run for days or weeks at a time in an automated system,” Salaita says. “We also have to engineer methods to collect air samples while filtering out enzymes in the atmosphere that chop up DNA. We need to circumvent these enzymes so that they don’t destroy the DNA nano-motors.”

While more development and clinical evaluation is needed, Salaita remains confident that the Rolosense will one day become a useful tool for public health.

“One thing is for certain,” he says. “There is a need for viral-detecting devices for public indoor air spaces as we enter an era when pandemics will likely become more common.”

Tuesday, July 18, 2023

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The Brink: There have been so many studies examining death rates due to COVID. Can you talk about your interest and approach for this novel study?

Right. Because the second year is when vaccines were ready, so states had to figure out how they were going to make them readily available to people.

What jumped out at you through the data?

So, what conclusions do you draw from that?

So, the pandemic really hit rural America in the second year, when vaccines were available, harder than it hit urban areas.

Can you talk more specifically about how different states responded to COVID and its impact on them?

What about Florida? Republican Governor Ron DeSantis has proudly proclaimed that Florida did not shut down because of COVID and was better for it. Is he right?

OK, then take a different big state: California.

Taking the data from a 30,000-foot view, what do you see?

For the vaccine skeptics out there—and we know there are many of them—what does your study say to them?

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