Wisdom, loneliness and your intestinal multitude

It may take guts -- or more precisely, a diverse gut microbiome -- to achieve wisdom and fend off loneliness. Or perhaps it's the other way around, report UC San Diego researchers

UNIVERSITY OF CALIFORNIA - SAN DIEGO

Research News

IMAGE: GREATER DIVERSITY OF GUT MICROBES MAY BE ASSOCIATED WITH GREATER WISDOM OR VICE VERSA; SIMILARLY LESS DIVERSITY MIGHT MEAN HIGHER LIKELIHOOD OF BEING LONELY. view more 

CREDIT: UC SAN DIEGO HEALTH SCIENCES

The evolving science of wisdom rests on the idea that wisdom's defined traits correspond to distinct regions of the brain, and that greater wisdom translates into greater happiness and life satisfaction while being less wise results in opposite, negative consequences.

Scientists have found in multiple studies that persons deemed to be wiser are less prone to feel lonely while those who are lonelier also tend to be less wise. In a new study, published in the March 25, 2021 issue of the journal Frontiers in Psychiatry, researchers at University of California San Diego School of Medicine take the connection between wisdom, loneliness and biology further, reporting that wisdom and loneliness appear to influence -- and/or be influenced by -- microbial diversity of the gut.

The human gut microbiota is comprised of trillions of microbes -- bacteria, viruses, fungi -- that reside within the digestive tract. Researchers have known for a while about the "gut-brain axis," which is a complex network that links intestinal function to the emotional and cognitive centers of the brain.

This two-way communication system is regulated by neural activity, hormones and the immune system; alterations can result in disruptions to stress response and behaviors, said the authors, from emotional arousal to higher-order cognitive abilities, such as decision-making.

Past studies have associated gut microbiota with mental health disorders including depression, bipolar disorder and schizophrenia, as well as personality and psychological traits regarded as key, biologically based components of wisdom. Recent research has connected the gut microbiome to social behavior, including findings that people with larger social networks tend to have more diverse gut microbiotas.

The new Frontiers in Psychiatry study involved 187 participants, ages 28 to 97, who completed validated self-report-based measures of loneliness, wisdom, compassion, social support and social engagement. The gut microbiota was analyzed using fecal samples. Microbial gut diversity was measured in two ways: alpha-diversity, referring to the ecological richness of microbial species within each individual and beta-diversity, referring to the differences in the microbial community composition between individuals.

"We found that lower levels of loneliness and higher levels of wisdom, compassion, social support and engagement were associated with greater phylogenetic richness and diversity of the gut microbiome," said first author Tanya T. Nguyen, PhD, assistant professor of psychiatry at UC San Diego School of Medicine.

The authors said that the mechanisms that may link loneliness, compassion and wisdom with gut microbial diversity are not known, but observed that reduced microbial diversity typically represents worse physical and mental health, and is associated with a variety of diseases, including obesity, inflammatory bowel disease and major depressive disorder.

A more diverse gut microbiota may be less susceptible to invasion by outside pathogens, which could contribute to and help promote better resilience and stability of the community.

"It is possible that loneliness may result in decreased stability of the gut microbiome and, consequently, reduced resistance and resilience to stress-related disruptions, leading to downstream physiological effects, such as systemic inflammation," the authors wrote.

"Bacterial communities with low alpha-diversity may not manifest overt disease, but they may be less than optimal for preventing disease. Thus, lonely people may be more susceptible to developing different diseases."

The relationship between loneliness and microbial diversity was particularly strong in older adults, suggesting that older adults may be especially vulnerable to health-related consequences of loneliness, which is consistent with prior research.

Conversely, the researchers said that social support, compassion and wisdom might confer protection against loneliness-related instability of the gut microbiome. Healthy, diverse gut microflora may buffer the negative effects of chronic stress or help shape social behaviors that promote either wisdom or loneliness. They noted that animal studies suggest that gut microbiota may influence social behaviors and interactions, though the hypothesis has not been tested in humans.

The complexity of the topic and study limitations, such as the absence of data about individuals' social networks, diet and degree of objective social isolation versus subjective reports of loneliness, argue for larger, longer studies, wrote the authors.

"Loneliness may lead to changes in the gut microbiome or, reciprocally, alterations of the gut milieu may predispose an individual to become lonely," said Dilip V. Jeste, MD, Distinguished Professor of Psychiatry and Neurosciences at UC San Diego School of Medicine and senior author of the paper. "We need to investigate much more thoroughly to better understand the phenomenon of the gut-brain axis."

###

Co-authors include: Xinlian Zhang, Tsung-Chin Wu, Jinyuan Liu, Collin Le, Xin M. Tu and Rob Knight, all at UC San Diego.

New discoveries of deep brain stimulation put it on par with therapeutics

Possibly speeding the process and allowing personalized treatment

UNIVERSITY OF HOUSTON

Research News

 

IMAGE: NURI INCE, ASSOCIATE PROFESSOR OF BIOMEDICAL ENGINEERING, IS REPORTING THAT ELECTRICAL STIMULATION OF THE BRAIN AT HIGHER FREQUENCIES (ABOVE 100HZ) INDUCES RESONATING WAVEFORMS WHICH CAN SUCCESSFULLY RECALIBRATE DYSFUNCTIONAL CIRCUITS CAUSING... view more 

CREDIT: UNIVERSITY OF HOUSTON

Despite having remarkable utility in treating movement disorders such as Parkinson's disease, deep brain stimulation (DBS) has confounded researchers, with a general lack of understanding of why it works at some frequencies and does not at others. Now a University of Houston biomedical engineer is presenting evidence in Nature Communications Biology that electrical stimulation of the brain at higher frequencies (>100Hz) induces resonating waveforms which can successfully recalibrate dysfunctional circuits causing movement symptoms.

"We investigated the modulations in local ?eld potentials induced by electrical stimulation of the subthalamic nucleus (STN) at therapeutic and non-therapeutic frequencies in Parkinson's disease patients undergoing DBS surgery. We ?nd that therapeutic high-frequency stimulation (130-180 Hz) induces high-frequency oscillations (~300 Hz, HFO) similar to those observed with pharmacological treatment," reports Nuri Ince, associate professor of biomedical engineering.

For the past couple of decades, deep brain stimulation (DBS) has been the most important therapeutic advancement in the treatment of Parkinson's disease, a progressive nervous system disorder that affects movement in 10 million people worldwide. In DBS, electrodes are surgically implanted in the deep brain and electrical pulses are delivered at certain rates to control tremors and other disabling motor signs associated with the disease.

Until now, the process to find the correct frequency has been time consuming, with it taking sometimes months to implant devices and test their abilities in patients, in a largely back and forth process. Ince's method may speed the time to almost immediate for the programming of devices at correct frequencies.

"For the first time, we stimulated the brain and while doing that we recorded the response of the brain waves at the same time, and this has been a limitation over the past years. When you stimulate with electrical pulses, they generate large amplitude artifacts, masking the neural response. With our signal processing methods, we were able to get rid of the noise and clean it up," said Ince. "If you know why certain frequencies are working, then you can adjust the stimulation frequencies on a subject-specific basis, making therapy more personalized."

###

DBS is also being explored for the treatment of many other neurological and psychiatric indications, including Obsessive-Compulsive Disorder.

Additional authors of the article are Ince's doctoral student Musa Ozturk; and Ashwin Viswanathan and Sameer Sheth, Baylor College of Medicine.

Narcissism driven by insecurity, not grandiose sense of self

NEW YORK UNIVERSITY

Research News

 

Narcissism is driven by insecurity, and not an inflated sense of self, finds a new study by a team of psychology researchers. Its research, which offers a more detailed understanding of this long-examined phenomenon, may also explain what motivates the self-focused nature of social media activity.

"For a long time, it was unclear why narcissists engage in unpleasant behaviors, such as self-congratulation, as it actually makes others think less of them," explains Pascal Wallisch, a clinical associate professor in New York University's Department of Psychology and the senior author of the paper, which appears in the journal Personality and Individual Differences. "This has become quite prevalent in the age of social media--a behavior that's been coined 'flexing'.

"Our work reveals that these narcissists are not grandiose, but rather insecure, and this is how they seem to cope with their insecurities."

"More specifically, the results suggest that narcissism is better understood as a compensatory adaptation to overcome and cover up low self-worth," adds Mary Kowalchyk, the paper's lead author and an NYU graduate student at the time of the study. "Narcissists are insecure, and they cope with these insecurities by flexing. This makes others like them less in the long run, thus further aggravating their insecurities, which then leads to a vicious cycle of flexing behaviors."

The survey's nearly 300 participants--approximately 60 percent female and 40 percent male--had a median age of 20 and answered 151 questions via computer.

The researchers examined Narcissistic Personality Disorder (NPD), conceptualized as excessive self-love and consisting of two subtypes, known as grandiose and vulnerable narcissism. A related affliction, psychopathy, is also characterized by a grandiose sense of self. They sought to refine the understanding of how these conditions relate.

To do so, they designed a novel measure, called PRISN (Performative Refinement to soothe Insecurities about SophisticatioN), which produced FLEX (perFormative seLf-Elevation indeX). FLEX captures insecurity-driven self-conceptualizations that are manifested as impression management, leading to self-elevating tendencies.

The PRISN scale includes commonly used measures to investigate social desirability ("No matter who I am talking to I am a good listener"), self-esteem ("On the whole, I am satisfied with myself"), and psychopathy ("I tend to lack remorse"). FLEX was shown to be made up of four components: impression management ("I am likely to show off if I get the chance"), the need for social validation ("It matters that I am seen at important events''), self-elevation ("I have exquisite taste"), and social dominance ("I like knowing more than other people").

Overall, the results showed high correlations between FLEX and narcissism--but not with psychopathy. For example, the need for social validation (a FLEX metric) correlated with the reported tendency to engage in performative self-elevation (a characteristic of vulnerable narcissism). By contrast, measures of psychopathy, such as elevated levels of self-esteem, showed low correlation levels with vulnerable narcissism, implying a lack of insecurity. These findings suggest that genuine narcissists are insecure and are best described by the vulnerable narcissism subtype, whereas grandiose narcissism might be better understood as a manifestation of psychopathy.

###

The paper's other authors were Helena Palmieri, an NYU psychology doctoral student at the time of the study, and Elena Conte, an NYU psychology undergraduate student.

DOI: 10.1016/j.paid.2021.110780

The 'great leveler' revisited: Why the Corona pandemic might boost inequality in society

UTRECHT UNIVERSITY

Research News

 

How will Covid-19 affect inequality in countries worldwide? The current pandemic is sometimes marked as 'great equalizer', but scientists from Utrecht and Wageningen University show why the opposite might be true. A study by prof. Bas van Bavel and prof. Marten Scheffer shows that throughout history, most disasters and pandemics have boosted inequality instead of levelling it. Whether such disastrous events function as levellers or not, depends on the distribution of economic wealth and political leverage within a society at the moment of crisis. Their findings on the historical effects of crises on equality in societies are now published open access in Nature HSS Communications.

It is often thought that the main levellers of inequality in societies were natural disasters such as epidemics or earthquakes, and social turmoil such as wars and revolutions. The most salient example is the Black Death of 1347-1352, a large-scale pandemic that killed up to half of the Eurasian population. In several European societies, wealth disparities seem to have been reduced afterwards. The suggested logic behind that equitable effect is the decimation of people while capital remained intact, thereby shifting the economic balance in favour of labour. Crises as windows of opportunity In most cases throughout history, the opposite is true. Bas van Bavel: "In spite of the marked differences in character and direct impact of the shocks we studied, most historical disasters were followed by a widening of wealth gaps." In their article, historian Bas van Bavel (Utrecht University) and ecologist Marten Scheffer (Wageningen University) critically review evidence of the effects of catastrophes such as the plague on inequality, from medieval times till the present. Van Bavel and Scheffer used empirical data to study the long term effects of shocks on inequality.

Their research shows a twofold effect. First, the wealth distribution and institutional outlay of these societies at the moment of the shock to a large extent shaped the impact. Subsequently, the distribution of political leverage in society came into play in determining the institutional responses. Van Bavel explains: "Upon a crisis, rules tend to be rewritten. Social groups and organizations with the greatest leverage can therefore use that window of opportunity to adapt institutional rules, thereby shaping long-term wealth distribution. As most societies were historically unequal, in most cases the result was a further widening of disparities."

Power to the people: the importance of bottom-up organisations Over the centuries, exceptions have occurred in situations where the ordinary people had strong leverage in shaping the response to the crisis - through organizations such as guilds, fraternities, trade unions, cooperatives, and political movements. Scheffer: "Our results provide empirical support for the view that in nations where such leverage of ordinary people is weak, the responses to novel crises such as the COVID-19 pandemic may increase inequality instead of diminishing it. Furthermore, when explaining the effects of a disaster on equality, we need to distinguish between the immediate impact, the medium-term effects of the institutional measures taken in response to the disaster, and the indirect outcomes in the long run."

What history suggests about the current pandemic Their insights also hold relevance when thinking about the effects of the COVID 19-crisis. Van Bavel: "The direct impact and long term effects are likely to enlarge material inequalities. The social and economic context at present is much more similar to that during the 2008 crisis than to the context during the twentieth-century disasters - when societies were more equitable both in wealth distribution and societal leverage than at present."

###

The article 'Historical effects of shocks on inequality: the great leveler revisited' is published open access and is now available online: http://www.nature.com/articles/s41599-021-00763-4.

When synthetic evolution rhymes with natural diversity

GMI - GREGOR MENDEL INSTITUTE OF MOLECULAR PLANT BIOLOGY OF THE AUSTRIAN ACADEMY OF SCIENCES

Research News

 

IMAGE: THE MOTILITY OF PLANT-COLONIZING BACTERIA IS LARGELY DEPENDENT ON FLAGELLIN. IN A. THALIANA, A SHORT ANTIGENIC COMPONENT FROM FLAGELLIN, TERMED FLG22, IS SUFFICIENT TO INDUCE A PLANT IMMUNE RESPONSE THROUGH... view more 

CREDIT: PARYS/GMI/UNC-CHAPEL HILL

Researchers at GMI - Gregor Mendel Institute of Molecular Plant Biology of the Austrian Academy of Sciences, the University of North Carolina at Chapel Hill and The Howard Hughes Medical Institute (HHMI) use two complementary approaches to unveil a co-evolutionary mechanism between bacteria and plants and also explain complex immune response patterns observed in the wild. Together the papers change the way scientists have been thinking about the relationship of a bacterial antigenic component with its plant immune receptor. The two papers are published back to back in the journal Cell Host & Microbe.

Immune responses have developed in virtually all organisms over evolutionary time scales to protect them from foreign invaders. A central aspect of the immune response of higher organisms, i.e., plants and animals, is the use of sensory systems that detect and respond to "non-self" molecular signals. These molecular signals generally determine the survival chances of the pathogen, a factor that prevents them from being eliminated by natural selection as a means to evade host recognition. Their evolutionary conservation is thus due to the functionality of these molecular signals to the foreign invader. However, the negative evolutionary pressure to maintain this functionality is counterbalanced by the positive evolutionary pressure to mediate the pathogen's immune evasion. The dissection of these co-evolutionary forces through synthetic and reverse evolutionary methods is one of the two research approaches that researchers from the Belkhadir lab at GMI and the Dangl lab at UNC- Chapel Hill team up to investigate. In an orthogonal approach, they also inquire into the natural diversity of molecular antigenic determinants (epitopes) in plant-colonizing bacterial communities (commensal communities) and map the complex immune response patterns they trigger in the plants. Jeffery Dangl, John N. Couch Distinguished Professor at UNC-Chapel Hill and an HHMI investigator explains: "To date, most science in this field has used a handful of epitopes. We sampled thousands, derived from synthetic biology and commensal communities. This depth of analysis allowed us to uncover a rich diversity of host response mediated by a single receptor."

Reverse evolution and new insights on co-evolution

The researchers examine how the Arabidopsis immune sensor FLS2 (flagellin sensing 2) influenced the evolution of its interacting epitope on the Pseudomonas flagellin, and how this, in turn, influenced Pseudomonas motility. Using reverse evolutionary methods, Parys et al. uncover a new mechanism of co-evolutionary force between FLS2 and flagellin, and frame it as a molecular form of the scarcely studied theory of antagonistic pleiotropy (AP) in plant immunology. AP is the ability of a gene to induce opposing effects in different contexts, a prevailing theory for the evolutionary origin of aging in humans. The researchers demonstrate that AP fosters stable colonization of Arabidopsis by commensal communities by weighing out bacterial motility against sensor detection. This strategy results in flagellin epitopes that either mildly activate or outright block the receptor (gain in virulence), while losing in motility as a trade-off (loss in virulence). Even more excitingly, they find signatures of these synthetic experiments in naturally occurring commensal communities, suggesting that natural microbiomes might be less dependent on flagella-mediated motility and willing to trade it off against another form of immune evasion in order to stay in harmony with the plant.

Friend or foe?

In the second, natural sampling approach, Colaianni et al. demonstrate that immune evasion mechanisms in plant root commensal communities are rampant and are a determining factor of the community's structure. Moreover, this conceptual breakthrough is accompanied by the corroborating findings of complex immune response fine-tuning mechanisms in Arabidopsis. The diversity of the ligand epitopes is translated in a complexity of the immune responses engaged by the plant, which is capable of detecting threshold variations in its microbiome, and thus, discriminating between "friend and foe."

On immune evasion and plant growth promotion

Asked about possible applications of this joint work, GMI group leader Youssef Belkhadir elaborates: "Sometimes, it is good to know how to turn on an immune response, but we often forget that, sometimes, it might also be good to turn it off. For example, you could help a growth-promoting microbe better colonize the plant by providing it with an additional way to evade the plant's immune response. And here we discovered synthetic antagonistic peptides that could do just that."

CAPTION

Plant-colonizing bacterial communities (commensal communities) can produce diverse variants of the flg22 peptide, the antigenic determinant that induces diverse immune response outputs from the Arabidopsis immune sensor FLS2. Colaianni et al. propose that FLS2 monitors the proportionality of the flg22 diversity present in a commensal community to identify the presence pathogens.

CREDIT

Colaianni/GMI/UNC-Chapel Hill

Back to the (plant) roots

This collaboration draws on an exchange in expertise between the alternating first authors of the two publications, but also refreshes long-dating, outstanding, scientific contacts. In fact, Nicholas Colaianni, Ph.D. student in the Dangl lab at UNC-Chapel Hill, is a computational expert, whereas the main fields of expertise of Katarzyna Parys (former Ph.D. student in the Belkhadir lab) lie in biochemistry and wet lab genetics. Colaianni also visited the Belkhadir lab at GMI and both he and Parys benefited from hands-on training in each other's field of expertise. In addition, as a third co-first author on both publications, Ho-Seok Lee, postdoctoral fellow in the Belkhadir lab, contributed his skills in microscopy imaging.

After many years of separate research, the two main principal investigators who share seniority and alternate corresponding authorships on the two publications, decided to make a comeback together. The shared seniority also includes Corbin Jones, Biology Professor at UNC-Chapel Hill and Colaianni's co-mentor. Youssef Belkhadir is a UNC-Chapel Hill alumnus who worked with Jeffery Dangl as a Ph.D. student. Referring to the UNC Tar Heels basketball team that Dangl loves, Belkhadir says "17 years after I co-authored my first paper with Jeff, it was a lot of fun to get on the court and 'slam-dunk' it with him once more!". Dangl adds "Just like basketball, science is a team effort and the best teams play fluidly together."

An international consortium

GMI and UNC-Chapel Hill share a deep commitment to international collaboration and the present work rallied an international consortium of scientists spearheaded by Youssef Belkhadir, including the University of Geneva and the University of Lausanne in Switzerland, the Max Perutz Labs of the University of Vienna in Austria and the University of Würzburg in Germany. The researchers also acknowledge the contribution of the Vienna Biocenter member institutes and facilities.

###

Original publications:

Parys et al., "Signatures of antagonistic pleiotropy in a bacterial flagellin epitope", Cell Host & Microbe, 2021. DOI: https://doi.org/10.1016/j.chom.2021.02.008

Colaianni et al., "A complex immune response to flagellin epitope variation in commensal communities", Cell Host & Microbe, 2021. DOI: https://doi.org/10.1016/j.chom.2021.02.006

 

Pediatric heart transplant method developed by U of A doctors allows for more surgeries, better outcomes: Study

Blood type-incompatible heart transplant surgery for infants under the age of two pioneered in Canada, now used worldwide

UNIVERSITY OF ALBERTA FACULTY OF MEDICINE & DENTISTRY

Research News

 

IMAGE: U OF A RESEARCHER SIMON URSCHEL WITH PATIENT GEORGE KEMP, WHO RECEIVED A HEART TRANSPLANT AS A BABY AND IS NOW FOUR YEARS OLD. (PHOTO TAKEN PRE-COVID-19) view more 

CREDIT: LINDSEY KEMP

A pediatric heart transplant procedure pioneered by Canadian doctors--once deemed impossible--has been shown to be at least as effective as the traditional approach, according to newly published research in The Lancet Child & Adolescent Health.

ABO-incompatible heart transplantation was developed in the mid-1990s, after a Canadian transplant team led by Lori West realized that infants under the age of two have immature immune systems that would allow them to accept life-saving replacements for their defective hearts from donors with incompatible blood types.

"It's really important to see it has not only helped these very sick babies to get transplants faster, but also to live as long, with no more rejections, and better outcomes with regards to infections, as children who received a matched blood group heart," said principal investigator Simon Urschel, associate professor of pediatrics in the University of Alberta's Faculty of Medicine & Dentistry, director of pediatric cardiac transplantation at the Stollery Children's Hospital and member of the Women and Children's Health Research Institute (WCHRI).

ABO-incompatible heart transplantation is now routinely carried out in Canada and some other countries, but not everywhere. That should change thanks to these new study results, Urschel said.

"For example, Eurotransplant (the agency responsible for transplants in eight European countries) still considers it an inferior option to be used with caution," he said. "That concern will probably be relieved in those last places that were reluctant to do it, now that we have shown it is safe."

About 50 per cent of the population is born with type O blood, while 35 per cent has A type and 15 per cent has B or AB type blood. Organs from a donor with type O blood can be accepted by anyone, but adult type O patients can receive only type O organs. The development of ABO-incompatible pediatric heart transplantation meant that twice as many organs would be available to type O infants born with heart defects.

Urschel and his team analyzed data from more than 2,200 infant transplant recipients in Canada, the United Kingdom and the United States from 1999 to 2018. The records were from the Pediatric Heart Transplant Society registry, an international research collaboration that collects data from 58 transplant centres. This resulted in more than 11,000 cumulative patient-years of observation, by far the largest study of its kind.

Three hundred sixty-four of the babies received ABO-incompatible transplants, while 1,842 received ABO-compatible hearts. "We wanted to compare apples with apples, so the children were matched by characteristics such as their underlying disease and the age at which they underwent surgery," Urschel said.

The researchers found the survival rate was the same between the two groups, as were the rates of acute and chronic organ rejection and the risk of developing leukemia after transplant. They also examined the rates of post-transplant bacterial, viral and fungal infections, which they were concerned might be higher among the ABO-incompatible transplant recipients.

"Interestingly, we found that there were fewer of the infections that we were worried about in the ABO-incompatible patients," Urschel said.

Earlier work by Urschel's research team showed that wait times for these patients were significantly shortened, with the average time to transplant being about 50 per cent shorter thanks to the innovative transplant technique.

"It's easier and faster to find a heart for these patients, which is crucial because they are extremely sick, often on mechanical heart support devices or on ventilators in intensive care units," he said. "This gives them a chance not only to survive, but to stay healthier and be in better condition before and after transplantation."

The pioneering pediatric heart surgeons who started it all in 1996--West and Ivan Rebeyka--refined their method after being recruited to join the U of A faculty, with help from other faculty members such as Urschel. Urschel and West's work has received funding from the Stollery Children's Foundation through WCHRI.

CAPTION

Pediatric heart surgeon Lori West led a team that pioneered ABO-incompatible heart transplants after realizing that infants' immature immune systems wouldn't reject organs from donors of a different blood type.

CREDIT

Laughing Dog Photography

The "rule" requiring ABO-compatible donors was instituted for older patients and had never been revisited from the perspective of the immunologic immaturity of infants, said West, now Canada Research Chair (Tier 1) in Cardiac Transplantation, and director of the Alberta Transplant Institute and the Canadian Donation and Transplantation Research Program.

"This, in combination with an extremely high mortality for infants on our transplant waiting list, is why we instituted the first ABO-incompatible transplant protocol," she said.

"Transplantation has always been about pushing the boundaries of risks in order to offer reasonable options to patients who would otherwise have no options."

Urschel will continue his work to understand the mechanism in infant immune systems that allows them to accept blood type-incompatible hearts, in hopes of being able to one day use what is learned to help older transplant recipients. He is also involved in projects to improve the quality of life of young transplant patients and their families.

"It's a real lesson in the need for scientific vigour to guide our operationalization of clinical protocols, not just the blind adoption of previously accepted regulations," said West.

The fact that heart transplant recipients can now survive with a normal lifespan is a credit to both West and Rebeyka, who has a clinical faculty position with the U of A's Cardiovascular Research Centre, said Urschel, who continues to provide clinical care for teenage and young adult patients who received ABO-incompatible transplants as babies.

"It's just amazing to see them, knowing that at one time they were so sick in the intensive care unit that they might not make it to the next day," Urschel said.

###

ABSTINENCE KILLS

Carrying naloxone can save lives but newly abstinent opioid users resist

UNIVERSITY OF CALIFORNIA - SAN DIEGO

Research News

Opioids are the main driver of fatal drug overdoses in the United States, according to the Centers for Disease Control and Prevention, resulting in 46,802 deaths in 2018, usually because the person stops breathing.

Naloxone -- a Food and Drug Administration-approved medication used to reverse overdoses from opioids, such as heroin, morphine and oxycodone -- works by restoring normal respiration to a person whose breathing has slowed or stopped.

"Opioid overdoses cause the largest number of accidental and avoidable deaths," said Peter Davidson, PhD, associate professor in the Department of Medicine at University of California San Diego School of Medicine. "The human toll of drug addiction is devastating. Using naloxone to prevent opiate overdoses can and has saved many lives."

In a study published in the March 23, 2021 online edition of the International Journal of Drug Policy, Davidson and an international group of researchers, found that opioid users who participate in a 12-step abstinence program and recently stopped using drugs refused to take home naloxone, even if having it on hand might save lives.

For the study, trained interviewers visited areas known for high drug use in three Southern California counties: San Diego, Orange and Ventura. Forty-four participants were asked questions about drug use initiation, overdose experiences, both their own and observed and past treatments.

"In our research, individuals who were newly abstinent from opioid use believed that carrying naloxone symbolically tied them to a drug-use identity that they were trying to leave behind," said first author Jeanette Bowles, DrPH, who is now a postdoctoral fellow with the Centre on Drug Policy Evaluation in Toronto, Canada, but was a UC San Diego School of Medicine postdoctoral fellow at the time of the study.

"Twelve-step programs promote abstinence through social behaviors that include staying away from people, places and things considered to be tied to drug use. Naloxone was seen as an item linked to their drug use and clashing with these sober behaviors and their goal of abstinence."

To reduce the stigma associated with naloxone, researchers suggest reframing the meaning of carrying naloxone to represent a commitment to group safety and the wellbeing of those "who still suffer" and relabeling naloxone training programs in substance use disorder treatment settings as "overdose first aid."

In addition, researchers propose focusing on the lifesaving impact those trained to administer naloxone can have on their peers, and re-targeting naloxone distribution efforts to include persons at any phase of their drug use, including abstinence.

"It is very important that people understand that after periods of abstinence, the body is less tolerant if an individual resumes drug use, making them physiologically more vulnerable to overdose and death," said Davidson, co-corresponding author and principal investigator. "If someone is experiencing an opioid overdose, it is important to recognize the signs and respond quickly to prevent death."

In the United States, laws now allow people to access and use naloxone to respond to overdose with protection from liability.

The Addiction Recovery and Treatment Program at UC San Diego Health provides patients with outpatient behavioral treatment for substance use, such as cannabis, alcohol and opioids.

###

Co-authors include: L.R. Smith, M.L. Mittal, E. Copulsky, and G. Hennessy, all of UC San Diego; R.W. Harding and K.D. Wagner, University of Nevada, Reno; and A. Dunkle, Solace Foundation.

 

COVID-19: A retrospective by the numbers

Godot is in sight

SOCIETY FOR DISASTER MEDICINE AND PUBLIC HEALTH, INC.

Research News

 

Presents a brief overview of the eight COVID-19 editorials published in DMPHP over the past year and using them as a framework to follow the evolution of the Pandemic over time. A review of the salient epidemiological and clinical dimensions of COVID-19 over time is given as well as a discussion of the medical and public health impacts of the disease and the interventions and policies put in place to contain and mediate the virus.

The concluding discussion questions the validity of the criteria used in selection of priority groups for vaccination in the US and notes that had a uniform program supporting the immunization of all over age 65 (accounting for 80% of COVID-19 deaths), the most lives would be spared while simultaneously cutting across all socio-economic and ethnic groups. Continuing this line of reasoning globally would provide an opportunity for the US to reburnish its humanitarian image through a vaccine diplomacy initiative with a goal to vaccinate the over 65 of every nation. To date, almost 500 million doses of vaccine have been administered; had they been targeted to the over 65 global population of some700 million, we would be well on our way to a return to the old normal.

THIRD WORLD USA

Rural US has more heart failure deaths than urban areas

Greatest increases are in Black men under 65 years old

NORTHWESTERN UNIVERSITY

Research News

 

• 'A persistent and troubling rural disadvantage'
• Strategies needed to support rural Americans

CHICAGO ---Heart failure deaths are persistently higher in rural areas of the United States compared with urban areas, reports a new Northwestern Medicine study. The research also showed race disparities in heart failure are prevalent in rural and urban areas with greatest increases among Black adults under 65 years old.

Heart failure deaths have been increasing nationally since 2011, but there is significant geographic variation in these patterns based on race.

"This work demonstrates a persistent and troubling rural disadvantage with significantly higher rates of death in rural areas compared with urban areas," said lead study author Dr. Sadiya Khan, an assistant professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine cardiologist.

The study was published in the journal PLOS ONE this month.

Possible factors for the disparities are higher levels of adverse social factors (e.g., lower income), risk factors such as obesity and diabetes in rural areas and fewer physicians, specifically cardiologists.

"Research is needed to identify barriers and define best strategies to prevent heart failure and optimize guideline-directed medical therapies, once heart failure develops," Khan said.

This is the first study that:

• Focuses on geographic heterogeneity in heart failure mortality rates by rural or urban area

• Demonstrates patterns of heart failure mortality are changing unfavorably with increases since 2011 in both rural and urban areas; these increases are greater among younger adults under age 65 years with greatest increases among Black men younger than 65.

The study used national death certificate data from the Centers for Disease Control that capture all deaths that occur in the U.S. Investigators identified cardiovascular deaths related to heart failure that occurred since 2011 and calculated annual age-adjusted mortality rates and trends in rural and urban areas, overall, by age groups and by race and sex.

###

Other Northwestern authors include Jacob Pierce, Nilay Shah, Lucia Petito, Lindsay Pool, Dr. Donald M. Lloyd-Jones and Joe Feinglass.

This work was supported by grants from National Institutes of Health's National Center for Advancing Translational Sciences Grant Number KL2TR001424 and the American Heart Association.

 

Face masks associated with reducing healthcare workers' risk of acquiring COVID-19

Early action to protect team members maximized Henry Ford's ability to care for patients during onset of COVID-19 pandemic

HENRY FORD HEALTH SYSTEM

Research News

DETROIT - A study published in the Journal of Occupational and Environmental Medicine from researchers at Henry Ford Health System has found that Henry Ford's early implementation of a universal mask policy in the COVID-19 pandemic was associated with reducing the risk of healthcare workers at Henry Ford acquiring COVID-19.

Through retrospective analysis of an internal hospital quality metric reporting analytics database that was not associated with electronic medical records, researchers discovered a correlation between the implementation of Henry Ford's universal mask policy and a significant drop in the rate at which its Healthcare workers tested positive for SARS-CoV-2. As COVID-19 diagnoses and hospitalizations across the State of Michigan continued to rise through late March 2020, the cases among Henry Ford's healthcare workers began to fall. By the time the first peak in COVID-19 cases occurred in the general population, the rate of cases among Henry Ford healthcare workers was already trending downward.

"This research reinforces the fact that mask wearing is effective in reducing the risk of acquiring COVID-19 and validated our decision early on to implement the universal mask policy, not only to protect our team members, but also to ensure they are able to care for members of the community who had contracted COVID-19," said Steven Kalkanis, M.D., CEO of Henry Ford Medical Group. "At Henry Ford Health System, our universal mask policy issued on March 26, 2020 ensured all staff, both clinical and non-clinical, received surgical or procedural masks and mandated that staff wear a mask at work while also following all other personal protective equipment requirements. Our hope is that the findings of this study continue to encourage members of the community to wear a mask in line with Centers for Disease Control and Prevention recommendations."

Healthcare workers have a threefold increased risk of reporting testing positive for SARS-CoV-2, the virus that causes COVID-19, compared to the general population, according to a study published in Lancet Public Health. As of March 22, 2021, the Centers for Disease Control and Prevention (CDC) has reported more than 450,000 SARS-CoV-2 infections among healthcare workers in the U.S. since the onset of the pandemic, and nearly 1,500 COVID-19 related deaths among healthcare workers.

From March 12 - August 10, 2020, 19.2% of healthcare workers at Henry Ford were symptomatic for COVID-19 and underwent SARS-CoV-2 testing. Before March 28-30 - the single changepoint in the data when the rate of new cases began to trend downward - the odds of a tested healthcare worker having a positive SARS-CoV-2 test result doubled every 4.5 - 7.5 days. After March 30, the odds of a tested healthcare worker having a positive result reduced by half every 10.5 - 13.5 days.

"This effort would not have been possible without the leadership of our executive team, including our president and CEO Wright Lassiter, III, Dr. Steven Kalkanis, chief clinical officer Dr. Adnan Munkarah, and chief operating officer Bob Riney," said Dee Dee Wang, M.D., Director of Structural Heart Imaging at Henry Ford Hospital and principal investigator of the study. "At a time when much was unknown about the novel coronavirus, this initiative truly helped keep our healthcare workers safe. I would also like to acknowledge Dr. Betty Chu, our associate chief clinical officer and chief quality officer; Dr. William O'Neill, director of our Center for Structural Heart Disease; Dr. Geehan Suleyman, medical director of Infection Control; Dr. Marcus Zervos, chief of our Infectious Disease division; and so many others who were instrumental in the creation and successful implementation of our universal mask policy."

With the arrival of COVID-variants in the community, even with COVID-19 vaccines now being rolled out, healthcare workers and community members should remain vigilant and continue to wear a mask in accordance with CDC recommendations.

Henry Ford is providing onsite expertise and oversight for the vaccine administrations, medical care and operations at the Ford Field mass vaccination site. Vaccines administered at Ford Field are in addition to Michigan's regular statewide vaccine allotment. Key facts to know:

- Will operate seven days a week from 8 a.m. - 8:30 a.m. for eight weeks

- The U.S. Air Force will provide vaccination support

- 68 vaccination pods will be set up on the Concourse at Ford Field. Vaccinations are open to those who meet the Michigan Department of Health and Human Services vaccine guidelines.

Registration and appointment scheduling are being managed by Meijer. People may register in the following ways:

- Online at clinic.meijer.com/register/CL2021

- Text EndCOVID to 75049

- Call the State of Michigan COVID hotline at 888-535-6136 (Press 1) Monday-Friday 8 a.m. - 5 p.m. and Saturday/Sunday 8 a.m. - 1 p.m.

###

About Henry Ford Health System

Founded in 1915 by Henry Ford himself, Henry Ford Health System is a non-profit, integrated health system committed to improving people's lives through excellence in the science and art of healthcare and healing. Henry Ford Health System includes Henry Ford Medical Group, with more than 1,900 physicians and researchers practicing in more than 50 specialties at locations throughout Southeast and Central Michigan. Acute care hospitals include Henry Ford Hospital in Detroit, MI and Henry Ford Allegiance Health in Jackson, MI - both Magnet® hospitals; Henry Ford Macomb Hospital; Henry Ford West Bloomfield Hospital; and Henry Ford Wyandotte Hospital.

The largest of these is Henry Ford Hospital in Detroit, a quaternary care research and teaching hospital and Level 1 Trauma Center recognized for clinical excellence in cardiology, cardiovascular surgery, neurology, neurosurgery, and multi-organ transplants. The health system also provides comprehensive, best-in-class care for cancer at the Brigitte Harris Cancer Pavilion, and orthopedics and sports medicine at the William Clay Ford Center for Athletic Medicine - both in Detroit.

As one of the nation's leading academic medical centers, Henry Ford Health System annually trains more than 3,000 medical students, residents, and fellows in more than 50 accredited programs, and has trained nearly 40% of the state's physicians. Our dedication to education and research is supported by nearly $100 million in annual grants from the National Institutes of Health and other public and private foundations.

Henry Ford's not-for-profit health plan, Health Alliance Plan (HAP), provides health coverage for more than 540,000 people.

Henry Ford Health System employs more than 33,000 people, including more than 1,600 physicians, more than 6,600 nurses and 5,000 allied health professionals.