Body

A detailed analysis of UK data from a global obesity study (the ACTION-IO study) has shown that, on average, people with obesity (PwO) in the UK were struggling with their weight for 9 years before they sought help from a healthcare professional/HCP, much longer than the global average of 6 years found in this study.

This delay puts PwO at additional risk of developing obesity-related conditions such as type 2 diabetes (T2D), obstructive sleep apnoea (OSA) and cancer. Additionally, more than half of the PwO had never discussed their weight with an HCP.

Reasons identified for the findings were that PwO felt that it was their own sole responsibility to manage their excess weight, and UK doctors incorrectly perceived their patients to be not motivated to lose weight. Short appointment times were also a barrier to weight loss conversations in the UK.

The study is by UK obesity experts, including medical doctors and a patient representative, and is led by Dr Carly Hughes, Fakenham Weight Management Service, Fakenham Medical Practice, Fakenham, Norfolk, UK, and Professor Jason Halford, University of Leeds, UK. It is presented at this year's European and International Congress on Obesity, held online from September 1-4.

In the ACTION-IO study, an online survey was conducted in 11 countries: Australia, Chile, Israel, Italy, Japan, Mexico, Saudi Arabia, South Korea, Spain, UAE and the UK. This particular study looks at the UK results, where 1500 PwO and 306 HCPs (156 primary care physicians/PCPs, 150 in secondary care/SC) completed the survey (with a response rate of PwO 14%, HCPs 28%). Respondents were recruited through email via online companies to whom they had given permission to be contacted for research purposes.

Two-thirds of PwO and most HCPs (84% PCPs, 89% SC) agreed that obesity is a chronic disease. PwO (81%) believed that obesity has a large impact on health, similar to diabetes (82%), cancer (82%), and stroke (88%). However, only 68% of UK HCPs (compared with an average of 76% of HCPs from all 11 countries) recognised the impact of obesity on health, and it was rated less serious than diabetes, cancer and stroke by 40%, 65% and 62% of HCPs, respectively.

Around 8 in 10 PwO (78%) had made 1 or more serious weight loss (WL) efforts in the past, and 18% had no plans for WL within the next 6 months. Only one in 10 PCPs (10%) and one in six SC (17%) thought their patients were motivated to lose weight.

A WL of 5% or greater in the past 3 years was reported by 37% of PwO; of those, 28% maintained this for at least 1 year (representing 10% of the total PwO). A total of 85% of PwO assumed full responsibility for their own WL; 41% of PCPs and 25% of SC also placed the responsibility for WL on PwO.

Among the 47% of PwO (compared with 54% across all 11 countries) who had a discussion with an HCP about weight in the past 5 years, it took a mean of 9 years (versus an average of 6 years across all 11 countries) from the start of struggles with weight until a discussion took place. PwO who had a weight discussion with an HCP reported positive (56%) and negative (45%) feelings, while 4% felt offended.

PCPs discussed weight (61%) and provided a diagnosis of obesity (64%) with a smaller proportion of their patients with obesity than SC (73% and 71% respectively). More UK HCPs (68%) than the average across all 11 countries (54%) selected short appointment time as a top reason for not discussing weight management.

The authors say: "UK health care providers underrate the impact of obesity on health, with few believing their patients are motivated to lose weight. In the UK, the time from the start of struggles with weight until the initial discussion with their doctor - which is the gateway to treatment in the UK NHS - was longer than the global average, and we believe addressing this time gap is key. Such a delay puts people with obesity at increased risk of developing obesity related conditions."

They add: "The narrative around obesity must be changed in the UK for the whole population, including people with obesity, with less focus on individual responsibility which encourages self-blame and stigma. Obesity education should address the barriers to weight loss discussions which may include doctors' perceptions and misconceptions regarding the motivations of people with obesity, knowledge of treatments and time barriers in consultations."

People with obesity who gain weight have a tendency to perceive their own body size as smaller than it actually is compared to those who maintain a stable weight, according to new research following more than 2,000 people with obesity from the Swedish Obese Subjects (SOS) study over 10 years.

The study, being presented at The European and International Congress on Obesity (ECOICO 2020), held online this year from 1-4 September, also found that while accuracy of body image perception appeared to improve over the years in people who maintained a stable weight (weight change less than 10% after 1 year follow-up), the degree of body image distortion (the difference between perceived and actual body size) remained in weight gainers (with a 10% or higher weight gain).

"People with obesity often suffer from body image distortion, as they tend to underestimate their own body size", explains author Dr Verena Parzer from Rudolfstiftung Hospital Vienna, Austria. "Underestimating body size may be associated with lower body dissatisfaction resulting in a reduced motivation to lose weight."

In the study, researchers examined whether there is a difference in body image perception between weight gainers and weight maintainers in 2,015 patients with obesity (71% females, average age 49 years, average BMI 40.3 kg/m²) from the SOS study who received conventional non-surgical weight management over 10 years.

Participants were asked to identify their own body figure at the start of the study and 3 ,4, 6, 8 and 10 years later using the Stunkard Scale which consists of silhouette drawings ranging from 1 being the leanest silhouette to 9 the largest silhouette. Body perception index (BPI) was calculated by dividing estimated body size (body mass index (BMI) based on an adjusted Stunkard Scale) by actual BMI.

Results showed that body image distortion was present in weight gainers as well as in weight maintainers, with both groups underestimating their body size. However, compared to maintainers, weight gainers significantly underestimated their body size at 3, 4, 8 and 10 years of follow-up (represented by BPI values of less than 1; table 1). At 3 years, weight gainers underestimated their actual body size by on average 7.5 BMI units (around 21 kg), compared to 6 BMI points (around 17 kg) by maintainers.

Body image perception was found to improve over the years in weight maintainers but not in gainers. After 10 years, weight gainers underestimated body size by on average 8 BMI units (approximately 23 kg) and maintainers by 5 BMI units (approximately 15kg).

"Our results indicate that body image distortion may be associated with the regulation of body weight", concludes co-author Dr Magdalena Taube from the University of Gothenburg, Sweden.

The authors acknowledge that the findings show associations, so no conclusions can be drawn about cause and effect. They point to several limitations, including that figure rating scales may not be large enough to represent people with severe obesity; and that body image perception is a continuous variable, while figure rating scales are limited to a number of figures.

As we get older, many of our body's processes start slowing down. For instance, a cut on the hand will take longer to heal after middle age than in youth. That said, it still heals.

Unfortunately, this isn't the case for the cells at the back of the eye, which simply don't repair much after we pass age 65. This can lead to age-related macular degeneration (AMD), the primary cause of vision loss in older adults. Over 2 million cases were reported in the U.S. in 2010, and the National Eye Institute estimates AMD will affect more than 3.5 million adults in the country by 2030.

Researchers at UC Santa Barbara have overcome a major hurdle in creating a platform to test therapies for this disease, the most common form of which currently has no treatment. The results appear in the journal PLOS ONE.

Our sharpest vision occurs at the center of the retina, in an area called the macula. "This region is packed full of cones, the cells that are necessary for seeing in detail," said author Pete Coffey, a researcher at UCSB's Neuroscience Research Institute. "They are the cells that are involved in reading, recognizing faces, the ability to drive, et cetera."

Just behind them is a layer of retinal pigment epithelial (RPE) cells. These are responsible for maintaining the health of our rods and cones, the eye's photo receptors. And these are the cells that stop working properly in AMD.

Age-related macular degeneration comes in two forms. Wet AMD occurs when blood vessels infiltrate the retina. There are treatments for this variety, which aim to prevent the growth of blood vessels where they're not wanted.

However, roughly nine out of ten cases are what scientists call 'dry AMD,' which involves progressive degeneration of the macula simply due to the inability of the RPE cells to heal. And while ophthalmologists can identify the disorder's onset early on, there are currently no treatments for dry AMD.

"Part of the struggle of finding a treatment option is that we've not been able to really model the progression of the disease in cell culture or in animals," said lead author Lindsay Bailey-Steinitz, a doctoral student in the Department of Molecular, Cellular, and Developmental Biology.

Bailey-Steinitz and her collaborators set out with two objectives in mind. The first was to understand what might be going on at the cellular level as the disease progresses. The other was to develop a model that could be used to test therapeutics.

As the RPE cells flounder in their efforts to repair themselves, a hole develops in this layer of the retina that continues to expand. Bailey-Steinitz aimed to recreate this hole in the lab. She cultured RPE cells on a plate with an electrode, then she zapped them. This created a hole very similar to the one that appears in AMD.

However, these were young cells, so they began healing and mending this hole. That's great for the cells, but not for the team, which was trying to model the disease. So Bailey-Steinitz shocked the cells again. She found that after 10 pulses of electricity over the course of 10 days, the cells were no longer able to effectively repair the damage.

To shed light on how the RPE cells responded to this stress, Bailey-Steinitz sequenced their RNA to figure out what proteins they were synthesizing in their damaged state. She found that some of the most important genes involved in the RPE cells' function were suppressed, especially if the cells had been shocked multiple times.

The team also saw changes in gene expression that matched conditions seen in AMD. What's more, the matrix which provides structural and biochemical support to the RPE cells also changed in ways that resembled the disease pathology.

"I wasn't surprised that the RPE profile was down-regulated," Coffey said. "If someone gives you a kick, then you're not going to feel well.

"But, for that immunology to change -- and the matrix around the cells as well -- and to look similar to exactly that profile you see in AMD, I was very surprised."

Now that they've recreated a similar profile in cultured cells as in the actual disease, the team is progressing to bigger holes, around six millimeters in diameter. Bailey-Steinitz is also planning a similar experiment with older cells, which show a decreased ability to heal.

"If we can improve this setup, then we've got a therapeutic testbed for AMD," Coffey said.

North Chesterfield, Va. - The Ellipsys Vascular Access System reduces the time before patients with kidney failure can start lifesaving dialysis treatments, while requiring fewer secondary procedures, according to a new study led by interventional radiologist Jeffrey Hull, M.D., of Richmond Vascular Center. This could have a significant impact on patient safety and healthcare costs by reducing the need for other forms of dialysis access that are associated with higher rates of complications.

For patients with end-stage renal disease (ESRD) who require hemodialysis, the preferred type of vascular access is an arteriovenous fistula (AVF), a permanent connection between a vein and artery in the arm. Until recently, surgery was the only way to create an AVF, but that subjects patients to longer recovery times and, as a result, delayed dialysis. Dr. Hull helped develop the Ellipsys System as a non-surgical alternative; the technology uses just a small needle puncture and catheter to create an endovascular AVF (endoAVF).

The prospective study, involving 123 patients at Richmond Vascular Center, evaluated patient selection and best practices for preparing ("maturing") Ellipsys fistulas for dialysis. The results show that use of the Ellipsys System along with early maturation procedures reduced the average time from fistula creation to dialysis to just 66 days, down from 100 days in the initial U.S. Pivotal Trial. In the U.S., literature reports the time to dialysis with surgical fistulas averages 135 days.

This "rapid maturation" is important because it can potentially reduce or even eliminate the length of time patients require a central venous catheter (CVC) for dialysis. Compared to fistulas, CVCs are associated with significantly higher rates of complications, like infection and even death. Despite these risks, 80 percent of patients in the U.S. still start their dialysis with a catheter.

"Catheters are a less than optimal choice for dialysis access and the goal is to always get them out as soon as possible to avoid serious complications," said Dr. Hull. "With Ellipsys, we have the unique ability to create fistulas in the office during the patient's initial visit, thus avoiding surgery at the hospital and reducing physician visits. This enables us to streamline the dialysis timeline and reduce patients' total catheter contact by a significant amount--sometimes by as much as four months. This will have a tremendous impact on quality of life for patients."

Published in a recent issue of the Journal of Vascular and Interventional Radiology (JVIR), Dr. Hull's study demonstrates real-world outpatient use of the Ellipsys endoAVF System. It is also the first U.S.-based study to evaluate the application of best practices for early maturation. These best practices include performing balloon angioplasty during fistula creation to improve blood flow, as well as completing maturation after just four weeks. In addition to shortening the dialysis timeline, this protocol decreased the overall number of secondary maturation procedures required to prepare the fistula for dialysis and reduced the rate of thrombosis, a common complication with fistula creation.

Decreasing the number of procedures a patient must undergo to prepare for dialysis, as well as moving fistula creation from hospitals to outpatient settings, is a particular advantage for both patients and healthcare providers as the U.S. deals with COVID-19, according to kidney patient advocate Terry Litchfield.

"The ability to create a fistula with a minimally invasive procedure in an outpatient setting preserves limited hospital resources and lowers the risk of exposure for kidney patients, who already have a higher risk of developing complications with the virus," said Litchfield. "Ellipsys enables physicians to safely create dialysis access, even in the midst of a pandemic, which will make it easier for these vulnerable patients to get the lifesaving dialysis treatments they need."

Recently published long-term data show that 92 percent of Ellipsys fistulas are still functional after two years. The study also found high levels of patient satisfaction with the procedure. Dr. Hull was an author on the 2017 study that demonstrated the safety and efficacy of the Ellipsys system.

Cleared by the FDA in 2018 for patients with end-stage kidney disease, Ellipsys is the first significant innovation in AVF creation in over 50 years. It transforms a complex surgery into a minimally invasive procedure that can be performed in a hospital outpatient setting, ambulatory surgery center or a physician office. Since 2015, more than 2,000 patients worldwide have had the Ellipsys procedure.

WASHINGTON--Obesity may cause a hyperactive immune system response to COVID-19 infection that makes it difficult to fight off the virus, according to a new manuscript published in the Endocrine Society's journal, Endocrinology.

Obesity not only leads to problems like heart disease and diabetes, but also influences the immune system in many ways. Obesity causes a chronic, low grade activation of some parts of the immune system. When someone with this preexisting condition is faced with an infection, this could lead to hyper-activation of the immune system, but in a detrimental way that does not fight infection.

"The COVID-19 pandemic has made us aware of the complex interactions of obesity with infectious diseases, and the gaps in our understanding of how chronic health conditions affect our immune responses to acute infection," said the study's corresponding author, Durga Singer, M.D., of the University of Michigan in Ann Arbor, Mich. "Recent evidence has highlighted how one part of the immune system, the macrophage, may be a culprit in driving severe COVID-19 disease. Our manuscript focuses on what is already known about the interaction of obesity, macrophages and other infections like influenza. These findings highlight the importance of understanding how obesity might interact with new drugs or vaccines that are developed for COVID-19."

In this review, the authors describe the impact of obesity on the immune system. They discuss the irregular immune responses caused by obesity that drive organ injury in severe COVID-19 infection and impair a person's ability to fight the virus.

PITTSBURGH, September 2, 2020 - In a tremendous demonstration of global collaboration, clinician-scientists have pooled data from 121 hospitals in eight countries to find that inexpensive, widely available steroids improve the odds that very sick COVID-19 patients will survive the illness.

The findings were made through the "Randomized Embedded Multifactorial Adaptive Platform-Community Acquired Pneumonia" (REMAP-CAP) trial and are reported today in JAMA as part of a four-article package. The World Health Organization is updating its COVID-19 treatment guidance as a result.

REMAP-CAP is one of seven randomized control trials to test corticosteroids -- a class of drug that lowers inflammation and modulates immune system activity -- for treating COVID-19 in critically ill patients. An analysis combining all the trial data reinforces the June results of the UK RECOVERY trial, which found the steroid dexamethasone reduced deaths by 29% in ventilated COVID-19 patients.

"It is relatively rare in medicine that you find drugs where the evidence of their effectiveness in saving lives is so consistent," said lead author Derek Angus, M.D., M.P.H., professor and chair of the Department of Critical Care Medicine at the University of Pittsburgh and chief health care innovation officer at UPMC. "This is, in many respects, the single clearest answer we've had so far on how to manage terribly ill COVID-19 patients. People on ventilators or oxygen and under intensive care should definitely be given corticosteroids."

Between March and June, the REMAP-CAP corticosteroid trial randomized 403 adult COVID-19 patients admitted to an intensive care unit to receive the steroid hydrocortisone or no steroids at all. The trial found a 93% probability that giving patients a seven-day intravenous course of hydrocortisone would result in better outcomes than not giving the steroid. The results were consistent across age, race and sex.

"At the beginning of the year, it felt almost hopeless at times, knowing that we had no specific treatments. It was a worrying time," said senior author Anthony Gordon, M.D., professor of anesthesia and critical care at Imperial College London and an NIHR research professor. "Yet less than six months later, we've found clear, reliable evidence in high-quality clinical trials of how we can tackle this devastating disease. We now have more than one choice of steroid treatment for those who need it most. Steroids are not a cure, but they help improve outcomes. Having a choice of different types of steroids, all of which seem to improve patient recovery, is great as it helps ease the problem of drug supply issues."

REMAP-CAP and the other corticosteroid trials did not test the drugs in patients with less severe COVID-19. Steroids are not currently recommended for these patients because they can dampen the immune system and have serious side effects.

It also was mostly conducted in resource-rich countries across Europe, North America and Australasia, so the findings may not translate to low- and middle-income countries.

Because it is designed to simultaneously test multiple combinations of potential therapies -- as opposed to the traditional, slow clinical trial process that tests one therapy at a time -- REMAP-CAP is particularly well-suited for rapidly identifying effective treatments during the COVID-19 pandemic. It currently is testing thousands of different treatment regimens, including various doses and combinations of vitamin C, convalescent plasma, blood thinners, antivirals and immune modulators.

"The publication of our results, those of the other trials as well as the prospective meta-analysis, all within seven weeks of the RECOVERY publication, is a great example of what we can accomplish with global collaboration," said co-author Lennie Derde, M.D., Ph.D., from the University Medical Center in Utrecht, the Netherlands. "And the joint effort of so many people across the globe to deliver this trial has been especially inspiring."

Additional authors on the JAMA publication are from the Raymond-Poincaré Hospital - AP-HP (Greater Paris University Hospitals), University of Versailles and University Paris Saclay, all in France; King Saud Bin Abdulaziz University for Health Sciences in Saudi Arabia; University of Oxford, Bristol Royal Informatory, University of Bristol, NHS Blood and Transplant, Queen's University Belfast, and Intensive Care National Audit & Research Centre, all in the UK; Berry Consultants, LLC, the Global Coalition for Adaptive Research, University of California at Los Angeles and Harbor-UCLA Medical Center, all in the U.S.; St. Michael's Hospital of Unity Health Toronto, Université de Sherbrooke, University of Toronto, University Health Network, University of British Columbia and University of Manitoba, all in Canada; Jena University Hospital in Germany; Monash University, Alfred Health, Princess Alexandra Hospital University of West Australia, The George Institute for Global Health and St. John of God Hospital, all in Australia; University of Amsterdam and Radboud University Medical Center, both in the Netherlands; Antwerp University Hospital in Belgium; Network for Improving Critical Care Systems and Training in Sri Lanka; Mahidol Oxford Tropical Medicine Research Unit in Thailand; Auckland City Hospital, The Health Research Council of New Zealand and University of Auckland, all in New Zealand; and St. Vincent's University Hospital and University College Dublin, both in Ireland.

A new international study published today [02 September] has shown that treating critically ill patients with COVID-19 with the steroid hydrocortisone improves their chances of recovery.

The study, led in the UK by Professor Anthony Gordon from Imperial College London with collaborators from the Intensive Care National Audit & Research Centre, found that patients receiving intensive care who were treated with a regular fixed dose of the steroid hydrocortisone for seven days had a better chance of recovery, compared with the patients who were not treated with the steroid. Patients in the UK were treated at 88 hospitals including Imperial College Healthcare NHS Trust Hospitals.

This research is one of three studies, published today in The Journal of the American Medical Association (JAMA), that suggests steroids improve survival of the sickest COVID-19 patients. As a result, the World Health Organisation will be issuing new guidelines to include the use of steroids to treat critically ill COVID-19 patients.

Professor Gordon, Chair in Anaesthesia and Critical Care at Imperial and a Consultant in Intensive Care Medicine at Imperial College Healthcare NHS Trust, said: "At the beginning of the year at times it felt almost hopeless, knowing that we had no specific treatments. It was a very worrying time. Yet less than six months later, we've found clear, reliable evidence in high quality clinical trials of how we can tackle this devastating disease."

The work was funded by the National Institute for Health Research and supported by the NIHR Imperial Biomedical Research Centre.

Professor Gordon added: "The studies published today show that we now have more than one choice of treatment for those who need it most. Steroids are not a cure, but they help improve outcomes. Having a choice of different types of steroids, all of which seem to improve patient recovery, is great as it helps ease the problem of drug supply issues."

NHS chief executive Sir Simon Stevens said: "One of the distinctive benefits of having our NHS is that we've been able to mobilise quickly and at scale to help researchers test and develop proven coronavirus treatments. Just as we did with dexamethasone, the NHS will now take immediate action to ensure that patients who could benefit from treatment with hydrocortisone do so, adding a further weapon in the armoury in the worldwide fight against Covid-19."

Professor Jonathan Van-Tam, Deputy Chief Medical Officer said:

"These findings offer further evidence that corticosteroids can be an important part of COVID-19 treatment for severe patients.

"Both the REMAP-CAP and the Bristol University papers show the important work that has been done here in the UK by researchers in making further major contributions towards the international evidence. It is impressive to see so many UK participants willing to take part in studies, and able to volunteer due to the rapid recruitment response of the NIHR's Clinical Research Network. Research such as this will make the difference in controlling this virus."

Steroids are anti-inflammatory drugs, and evidence strongly suggests that they reduce the lung inflammation in patients with COVID-19 who are seriously ill and require oxygen support for their breathing difficulties.

In the hydrocortisone study, 403 patients with suspected or confirmed COVID-19 who required respiratory or cardiovascular organ support (such as mechanical ventilation or drugs to support their blood pressure) were enrolled between March and June 2020. The cohort included patients of mixed ethnicities in the UK, Ireland, Australia, the US, the Netherlands, New Zealand, Canada and France and patients were randomly assigned to different treatment regimes. One group were treated with a fixed dose of 50mg hydrocortisone four times a day for seven days, another group were treated with hydrocortisone only if their blood pressure dropped, and a third group received no hydrocortisone.

The trial showed that using the fixed dose of hydrocortisone led to a 93% chance of a better outcome (greater chance of survival and less need for organ support) than not using hydrocortisone. If the hydrocortisone was given only when the blood pressure was low, the chance of a better outcome was 80%.

A different study, called the RECOVERY trial, was also investigating whether another type of steroid, called dexamethasone, helped improve recovery of patients with COVID-19. The first results from the study, published in early June, suggested dexamethasone boosted recovery.

Because the dexamethasone study showed positive results, the hydrocortisone steroid study stopped recruiting patients on 17 June. These new results add to the previous study and provide additional support that steroids improve recovery in severe COVID-19.

The findings are published in JAMA alongside two further clinical trials which have also evidenced the benefits of steroids as a treatment for the severely ill COVID-19 patients. This journal edition also includes an overall analysis of the three independent studies, plus data from the original RECOVERY trial and three other smaller trials. It concludes that a range of steroids - all safe, cheap and readily available - can improve the outcomes of patients receiving intensive care.

Professor Gordon, from the Department of Surgery and Cancer at Imperial, added: "This been an incredible international effort. We were all aware of the other studies and were happy to share our raw data before it was published. Only by collaborating were we going to make real advances and make them fast."

A new and quicker method of diagnosing diseases in patients has been created by researchers at the University of Leeds.

The team has developed a system of examining individual molecules to detect the presence of disease in blood.

The molecules - known as biomarkers - are currently collected in their billions - if not trillions - in order to create a detectable signal of a disease.

The new system, which has already been used to detect a protein linked to cystic fibrosis, can compile a detectable signal from just a few biomarkers, and can be done in just a few minutes.

Although in its infancy, the new process could, in theory, speed up coronavirus testing and provide accurate results.

Dr Mukhil Raveendran, the lead researcher of the project said: "One of the main advantages is the minimal sample needed.

"We are able to isolate individual molecules from small samples to identify specific illnesses. The process is very quick, and takes just minutes to provide results."

The new method involves using DNA origami - a nanoscale technique that involves folding DNA into specific shapes.

The DNA shapes are then used to capture biomarkers, which are indicators of particular diseases.

Dr Raveendran said: "The captured biomarkers are then read with nanopores and we can do this one molecule at a time.

"By coupling DNA origami and nanopores we are able to quantitatively detect disease biomarkers with single molecule sensitivity."

The group, headed by Professor Christoph Wälti at Leeds' School of Electronic and Electrical Engineering, is working to adapt the technology to enable the detection of a range of illnesses, including coronavirus (COVID-19).

By modifying the DNA origami to capture COVID-19 molecules, the researchers are aiming to detect the proteins that the coronavirus uses to invade human cells.

Dr Paolo Actis, University Academic Fellow and co-supervisor of the project, said: "We have already demonstrated the detection of an inflammation marker called C-reactive protein (important for the management of many diseases including cystic fibrosis) in diluted serum.

"Sensitive detection of biomarkers is important for diagnosis and for disease management. Our read-out is entirely electrical so it can be miniaturized, enabling point-of-care detection."

BUFFALO, N.Y. -- Foodborne pathogens are very common and usually benign, but certain virulent strains of pathogens can result in severe disease and even death. Distinguishing specific strains of pathogens can help scientists better understand them and develop biomarkers to help detect them in patients, expediting diagnosis and treatment.

University at Buffalo researchers have now completed the genomic analysis of a specific strain of Shiga-toxin E. coli (STEC) that can cause severe disease outbreaks and is increasingly common. The research could play a role in expanding the understanding of STEC infections and, potentially, in developing vaccines against them.

According to the Centers for Disease Control and Prevention, STEC are estimated to cause more than 265,000 infections per year in the U.S., and are associated with more than 3,600 hospitalizations and approximately 30 deaths.

Published in BMC Genomics last month, the paper describes the genomic analysis completed on a unique STEC strain isolated from an otherwise healthy 2 ½-year-old child living in Davidson County, Tennessee. The pathogen caused severe illness, including hemolytic uremic syndrome, a condition that destroys red blood cells, lowers platelets and blocks blood vessels in kidneys, resulting in anemia and kidney damage.

The child survived but was hospitalized for a month and sustained severe complications affecting multiple organ systems, including her lungs, heart, kidney, brain, circulatory system and gastrointestinal tract.

A growing public health concern

The Shiga-toxin producing E. coli she was infected with is a non-0157 STEC. While the pathogens classified as 0157 STEC infections generally are more common and result in more severe disease, the number of emerging, non-0157 STEC pathogens has been on the increase. Some lead to severe disease, creating a growing public health concern, according to the UB researchers.

The paper states that there are more than 400 of these non-0157 STEC strains, and more than a quarter are reported to cause gastrointestinal disease, often presenting first as bloody diarrhea with hemolytic uremic syndrome and if untreated, in rare cases, death.

The specific pathogen the child was infected with was a STEC 0145:H25. "Since genomic studies on emerging non-0157 STEC are limited, our studies are significant because they reveal the genetic makeup of emergent STEC 0145:H25 in comparison with other STEC strains," said Oscar G. Gómez-Duarte, MD, PhD, corresponding author on the paper, associate professor and chief of the Division of Pediatric Infectious Diseases in the Department of Pediatrics in the Jacobs School of Medicine and Biomedical Sciences at UB and a pediatrician with UBMD Pediatrics.

PHOTO: http://www.buffalo.edu/news/releases/2020/09/001.html

"The findings reveal how this emerging STEC causes severe disease and that it may be as virulent, or even more virulent, than more common STEC strains, leading to severe and even deadly disease in susceptible hosts," he said. "It also provides information on how this potentially preventable infection continues to affect vulnerable individuals."

Virulence genes

A key finding of the study, he said, was that this 0145:H25 serotype leads to particularly severe infection. Moreover, in addition to carrying virulence genes present in 0157 STEC, it has additional genes and new potential virulence genes as compared to other non-0157 strains that have been studied. "These findings deserve further analysis to understand the pathogenesis of these emergent STEC infections," said Gómez-Duarte.

While virtual medical and rehabilitation appointments seemed novel when COVID-19 first appeared, they now seem to be part of the new norm and might be paving the way to the future.

A recent review paper, co-authored by Brodie Sakakibara with the Centre for Chronic Disease Prevention and Management (CCDPM) has determined that virtual appointments, in the form of telerehabilitation, also work for people recovering from a stroke.

After a stroke, a client is provided with a therapy program to help re-gain loss of skills or motion--this can range from speech and memory, strength, balance and endurance. While not initially introduced for disease outbreaks, Sakakibara a UBCO assistant professor says research shows remote therapy can be effective during stroke recovery.

"Telerehabilitation has been promoted as a more efficient means of delivering rehabilitation services to stroke patients while also providing care options to those unable to attend conventional therapy," says paper co-author Sakakibara. "These services can be provided to remote locations through information and communication technologies and can be accessed by patients in their homes."

To learn how effective telerehabilitation can be, six different clinical trials--examining stroke telerehabilitation programs--were launched across Canada as part of a Heart and Stroke Foundation initiative. People recovering from a stroke were provided with interventions ranging from lifestyle coaching to memory, speech skills and physical-exercise training.

"Researchers from each of the six trials came together to write a review paper describing their experiences conducting a telerehabilitation study, and to report on the facilitators and barriers to the implementation of telerehab services within a research context," says Sakakibara.

Going forward with telerehabilitation as a new reality, Sakakibara says the study authors determined there are important lessons learned from each of the six trials. Most notably, the efficacy and cost of telerehabilitation is similar to that of traditional face-to-face management. He also notes patients mostly reported satisfaction with the telerehabilitation when therapists were trained appropriately, and when there was some social interaction. Overall, clinicians prefer face-to-face interactions but will use telerehabilitation when face-to-face is not feasible.

And finally, since seniors are a key target group for stroke rehabilitation--as stroke is associated with aging--the technology needs to be easy to use and suit the needs of the end users.

"The older adult of today, in terms of technology comfort and use, is different than the older adult of tomorrow," he says. "While there might be some hesitation of current older adults using technology to receive health and rehab services, the older adult of tomorrow likely is very comfortable using technology. This represents a large opportunity to develop and establish the telehealth/rehabilitation model of care."

Sakakibara notes COVID-19 has amplified the necessity for telehealth and telerehabilitation for many Canadians--especially those in remote areas or for the estimated 70 per cent of stroke victims who are no longer able to drive.

"Prior to the outbreak, telehealth/rehabilitation was highly recommended in Canadian stroke professional guidelines, but was underused," he says. "Now in response to COVID-19, the use of telerehabilitation has been accelerated to the forefront. Once these programs are implemented in practice, it'll be part of the norm, even when the outbreak is over. It is important that we develop and study telerehabilitation programs to ensure the programs are effective and benefit the patients."

New Rochelle, NY, September 2, 2020—The COVID-19 pandemic has illuminated three main pathologies of American voting rights, according to Richard Hasen. The pandemic has revealed the lack of systematic and uniform protection of voting rights in the United States, as described in the peer-reviewed Election Law Journal. Click here to read the article now.

Richard Hasen, Chancellor’s Professor of Law and Political Science, UC Irvine School of Law, retains some optimism in his article entitled, “Three Pathologies of American Voting Rights Illuminated by the COVID-19 Pandemic, and How to Treat and Cure Them.”

“Despite these three pathologies, and the Supreme Courts recent decision in RNC v. DNC, which decided against expanded voting rights, there is room for some hope that at least some courts will provide measure of protection for voting rights during the pandemic,” says Hasen.

“Rick Hasen, one of the leading scholars of election law, argues that three characteristics of our election system feature pose serious challenges for the November elections: the fragmentation of election administration, 'polarized and judicialized' decision making concerning voting rights, and weak constitutional protections for voting,” states Election Law Journal Editor-in-Chief David Canon, University of Wisconsin.

About the Journal
Election Law Journal is an authoritative peer-reviewed journal published quarterly online with open access options and in print that provides global, interdisciplinary coverage of election law, policy, and administration. Led by Editor-in-Chief David Canon, University of Wisconsin, the Journal covers the field of election law for practicing attorneys, election administrators, political professionals, legal scholars, and social scientists, and covers election design and reform on the federal, state, and local levels. Complete tables of contents and a sample issue are available on the Election Law Journal website.

About the Publisher
Mary Ann Liebert, Inc., publishers is known for establishing authoritative peer-reviewed journals in many promising areas of science and biomedical research and law. A complete list of the firm’s 90 journals, books, and newsmagazines is available on the Mary Ann Liebert, Inc., publishers website.

DOI

10.1089/elj.2020.0646

A first-of-its-kind study from the Boston University School of Public Health (BUSPH) finds 27.8% of U.S. adults had depression symptoms as of mid-April, compared to 8.5% before the COVID-19 pandemic.

Published in the journal JAMA Network Open, the study also found that income and savings are the most dramatic predictors of depression symptoms in the time of COVID.

"Depression in the general population after prior large scale traumatic events has been observed to, at most, double," says study senior author Dr. Sandro Galea, Dean and Robert A. Knox Professor at BUSPH, citing examples such as September 11, the Ebola outbreak, and civil unrest in Hong Kong.

"We were surprised to see these results at first, but other studies since conducted suggest similar-scale mental health consequences," Galea says. These studies have mainly been conducted in Asia and focused on specific populations such as healthcare workers and college students (one such study found depression symptoms among half of Chinese healthcare workers who had treated COVID patients).

But the new BUSPH study is the first nationally-representative study in the U.S. to assess the change in depression prevalence before and during COVID using the Patient Health Questionnaire-9 (PHQ 9), the leading self-administered depression screening tool.

The researchers used data from 5,065 respondents to the 2017-2018 National Health and Nutrition Examination Survey (NHANES), and 1,441 respondents from the COVID-19 Life Stressors Impact on Mental Health and Well-Being (CLIMB) study, which was conducted from March 31 to April 13, 2020, when 96% of the U.S. population was under stay-at-home advisories or shelter-in-place policies.

Both surveys used the PHQ 9 to assess depression symptoms and gathered the same demographic data, and the 2020 survey also gathered data on COVID-related stressors including job loss, the death of a friend or loved one from COVID, and financial problems.

Across the board, the researchers found an increase in depression symptoms among all demographic groups. Not surprisingly, experiencing more COVID-related stressors was a major predictor of depression symptoms.

However, the biggest demographic difference came down to money. After adjusting for all other demographics, the researchers found that, during COVID, someone with less than $5,000 in savings was 50% more likely to have depression symptoms than someone with more than $5,000.

"Persons who were already at risk before COVID-19, with fewer social and economic resources, were more likely to report probable depression, suggesting that inequity may increase during this time and that health gaps may widen," says study lead author Catherine Ettman, a doctoral student at the Brown University School of Public Health and director of strategic development in the Office of the Dean at BUSPH.

"We would hope that these findings promote creating a society where a robust safety net exists, where people have fair wages, where equitable policies and practices exist, and where families can not only live on their income but can also save money towards the future," she says.

As COVID continues to grip the country, Ettman says, "There may be steps that policymakers can take now to help reduce the impact of COVID-19 stressors on depression, such as eviction moratoria, providing universal health insurance that is not tied to employment, and helping people return to work safely for those able to do so."

At the same time, Ettman says she and her colleagues hope the study findings will also help those who are experiencing depression in this incredibly difficult time see that they are not alone: On the contrary, one in four U.S. adults is probably going through the same thing.

Caring for a partner or spouse with a new diagnosis of Alzheimer's or related dementia is associated with a 30% increase in depressive symptoms, compared to older adults who don't have a spouse with dementia--and these symptoms are sustained over time, a new University of Michigan study found.

This sustained depression over time is important because partners are often caregivers for many years, said Melissa Harris, a doctoral student in the U-M School of Nursing and the study's lead author.

Research suggests that depression can spike after a traumatic event--cancer diagnosis, accident, death, etc.--but that most people often return to their previous emotional health. That didn't happen with the dementia caregivers.

Harris and U-M nursing professors Geoffrey Hoffman and Marita Titler analyzed Health and Retirement Study data from 16,650 older adults--those without a partner diagnosis of dementia, those with a partner whose diagnosis was within the past two years and those with a partner whose diagnosis was older than two years.

The U-M study differs from previous studies in a couple of important ways, Harris says. She and her colleagues looked at depressive symptoms over time (rather than a snapshot in time) and at the number of reported depressive symptoms, as opposed to only diagnoses of major depression--a threshold that's rarely met. Depression can range from severe and persistent to mild and temporary, but even the latter can significantly reduce quality of life.

The average number of depressive symptoms reported by older adults with partners without dementia was 1.2. People whose partners were diagnosed within the last two years reported an additional .31 symptoms (27% increase) and those with partners diagnosed more than two years ago reported an additional .38 symptoms (33% increase). Researchers adjusted for sociodemographic, health and health behavior differences in partners.

"This may not seem like a huge increase in depressive symptoms, but think about feeling depressed or feeling restless everyday. That can mean a lot in the life of a caregiver," Harris said.

The increase in symptoms is also important because previous research conducted by Hoffman, assistant professor of nursing and senior author on the current study, found that similar changes in depressive symptoms was associated with a 30% increase of fall risk.

"We know that falls are another common debilitating outcome for this group, so the change in depressive symptoms we saw could also imply changes in a caregiver's physical and functional health," Harris said.

"Whether it's carers protecting family members from injury, as we found in prior work, or a spouse's dementia status affecting the carer, as we found in this study, we have seen that family members deeply affect each other's health, so clinical and supportive care must orient more around the needs of the family," Hoffman said.

The social isolation caused by the pandemic only adds to the caregiver's burden.

"The pandemic is adversely affecting family caregivers because of social isolation, and also because resources have been canceled or now have limited access," Harris said. "Many caregivers have said they already felt socially isolated and that the pandemic has just amplified those feelings."

Most people in the early stages of dementia still live at home and are cared for by unpaid family members, primarily partners and spouses, Harris said.

The takeaway for caregivers?

"It's so important to ask for advice and support early on," Harris said. "We saw these increases within two years and they were sustained for two years and beyond. Caregivers should remember that their health is just as important as their partner's and substantially impacts the health of the person with dementia.

Giant balloons launched into the stratosphere to beam internet service to Earth have helped scientists measure tiny ripples in our upper atmosphere, uncovering patterns that could improve weather forecasts and climate models.

The ripples, known as gravity waves or buoyancy waves, emerge when blobs of air are forced upward and then pulled down by gravity. Imagine a parcel of air that rushes over mountains, plunges toward cool valleys, shuttles across land and sea and ricochets off growing storms, bobbing up and down between layers of stable atmosphere in a great tug of war between buoyancy and gravity. A single wave can travel for thousands of miles, carrying momentum and heat along the way.

Although lesser known than gravitational waves - undulations in the fabric of space-time - atmospheric gravity waves are ubiquitous and powerful, said Stanford University atmospheric scientist Aditi Sheshadri, senior author of a new study detailing changes in high-frequency gravity waves across seasons and latitudes. They cause some of the turbulence felt on airplanes flying in clear skies and have a strong influence on how storms play out at ground level.

High-flying balloons

Published Aug. 30 in the Journal of Geophysical Research: Atmospheres, the new research draws on superpressure balloon data from the company Loon LLC, which designed the balloons to provide internet access to areas underserved by cell towers or fiber-optic cables. Spun out of Google parent company Alphabet in 2018, Loon has sent thousands of sensor-laden balloons sailing 12 miles up in the stratosphere - well above the altitude of commercial planes and most clouds - for 100 days or more at a stretch.

"This was just a very lucky thing because they weren't collecting data for any scientific mission. But, incidentally, they happened to be measuring position and temperature and pressure," said Sheshadri, who is an assistant professor of Earth system science at Stanford's School of Earth, Energy & Environmental Sciences (Stanford Earth).

The researchers calculated gravity wave motions from data that balloons collected over 6,811 separate 48-hour periods from 2014 to 2018. "To mount an equivalent scientific campaign would be terribly expensive. With the Loon data, the analysis is messier because the data collection was incidental, but it has near-global coverage," Sheshadri said.

Small waves, planetary impact

Gravity waves are an important part of atmospheric dynamics. "They help to drive the overall circulation of the atmosphere, but some gravity waves are too small and too frequent to be observed with satellites," said the study's lead author, Erik Lindgren, who worked on the research as a postdoctoral scholar in Sheshadri's lab. "These are the gravity waves we have focused on in this study." Earlier studies using atmospheric balloons to track high-frequency gravity waves have typically incorporated data from no more than a few dozen balloon flights, covering smaller areas and fewer seasons.

The Loon data proved particularly valuable for calculating high-frequency gravity waves, which can rise and fall hundreds of times in a day, over distances ranging from a few hundred feet to hundreds of miles. "They're tiny and they change on timescales of minutes. But in an integrated sense, they affect, for instance, the momentum budget of the jet stream, which is this massive planetary scale thing that interacts with storms and plays an important role in setting their course," Sheshadri said.

Gravity waves also influence the polar vortex, a swirl of frigid air that usually hovers over the North Pole and can blast extreme cold into parts of Europe and the United States for months at a time. And they interact with the quasi-biennial oscillation, in which, roughly every 14 months, the belt of winds blowing high over the equator reverses direction - with big impacts on ozone depletion and surface weather far beyond the tropics.

As a result, understanding gravity waves is key to improving weather forecasts at the regional scale, especially as global warming continues to disrupt historical patterns. "Getting gravity waves right would help constrain circulation responses to climate change, like how much it's going to rain in a particular location, the number of storms - dynamical things such as wind and rain and snow," Sheshadri said.

Building better models

Current climate models estimate the effects of high-frequency gravity waves on circulation in a kind of black box, with few constraints from real-world observations or application of the limited existing knowledge of the physical processes at play. "Until now, it has not been entirely clear how these waves behave in different regions or over the seasons at very high frequencies or small scales," Lindgren said.

Sheshadri and colleagues focused on energy associated with high-frequency gravity waves at different time scales, and how that energy varies across seasons and latitudes. They found these waves are larger and build up more kinetic energy in the tropics and during the summer; smaller waves moving with less energy are more common close to the poles and during the winter. They also found gravity waves changing in sync with the phases of the quasi-biennial oscillation. "We uncovered distinct shifts in gravity wave activity at different times of the year and over different parts of the globe," Lindgren said. "As to exactly why is not clear."

In future research, Sheshadri aims to identify which gravity wave sources are responsible for these differences, and to extrapolate gravity wave amplitudes at very high frequencies from relatively infrequent observations. She said, "Understanding how gravity waves drive circulation in the atmosphere, the interaction between these waves and the mean flow - it's really the next frontier in understanding atmospheric dynamics."

One year after the diagnosis of low-grade malignant brain tumor, a University of Gothenburg study shows, just under three people in ten were in full-time employment. Another year later, the proportion remained below half. For this young patient group, returning to work is a key health factor.

Every year, some 100 people in Sweden are diagnosed with low-grade brain tumor (also known as low-grade glioma). This type of tumor is incurable but grows slowly and, thanks to modern treatments, survival expectancy has successively increased.

The study, published in the journal Neurology, comprised 381 patients aged 18-60 with first onset of low-grade glioma in the years 2005-15. Data were retrieved from the Swedish National Quality Registry for Brain Tumors, Swedish Social Insurance Agency, Swedish National Board of Health and Welfare, and Statistics Sweden. The matched control group comprised 1,900 people.

Given the patients' low age -- averaging 40 years when they fell ill -- their work capacity is seen as an especially important factor in quality of life. Being able to work again is, for many, a crucial aspect of returning to a normal life.

The results show that 52 percent of the patient group studied were working on some scale, but only 28 percent were in full-time employment, a year after their diagnosis. After a further year, 63 percent of the patients were in work and 45 percent were working full-time.

The researchers were able to show that factors associated with a lower rate of return to work were advanced age, low functional level, other morbidity, previous sick leave irrespective of cause, radiation treatment and chemotherapy. Undergoing surgery involving tumor removal was, on the other hand, associated with a greater likelihood of return to work.

"Brain surgery as such doesn't seem to be an obstacle. On the other hand, resuming work -- especially a full-time job -- generally takes a long time. Our interpretation is that, for many people, rehabilitation is a relatively long drawn-out process," says Isabelle Rydén, lead author and doctoral student in clinical neuroscience at Sahlgrenska Academy, University of Gothenburg.

Asgeir Jakola, associate professor of neurosurgery at Sahlgrenska Academy, who has been heading the research, emphasizes the importance of patients' return to work, and the variables concerned, now being understood in greater detail. As a result, risk factors and rehabilitation requirements are identifiable at an earlier stage.

"Access to rehabilitation for this group of patients is fairly limited. The explanation given is that the patients have a malignant disease, but we can see that many of them survive for long periods. And we know that work is an important part of normal, healthy life," Jakola says.

"We're going to carry on studying these patients. Future studies will focus on cognitive, affective and life-quality factors, and on identifying, and describing more clearly, this patient group's problems and needs of assistance," he concludes.