Culture

DALLAS, Nov. 9, 2020 -- As the COVID-19 pandemic continues to affect people around the globe, research is ongoing to facilitate a greater understanding of the virus to improve patient care and outcomes. Heart health and medications and the potential role each have on patients with COVID-19 have been the focus of hundreds of studies. The American Heart Association will host experts presenting the latest COVID-19 research at its Scientific Sessions 2020; two studies are highlighted below. The meeting will be held virtually, Friday, November 13 - Tuesday, November 17, 2020, and is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science for health care worldwide.

Prevalence and Outcomes Among Hospitalized Patients With Covid-19 and Atrial Fibrillation or Flutter (Presentation P2355)

Previous studies have shown higher death rates in COVID-19 patients with evidence of heart damage. Heart damage can manifest as abnormal heart rhythms such as atrial fibrillation and atrial flutter. Atrial fibrillation is the most common form of heart arrhythmias and is an independent risk factor for death, especially in critically ill patients.

This study reviewed the prevalence and outcomes of hospitalized COVID-19 patients with atrial fibrillation and atrial flutter. Researchers reviewed medical records of 435* patients in the Yale Cardiovascular COVID Registry, who were adults, ages 18 and older (mean age 68.2 years; >50% were male) hospitalized between March and June 2020 in the Yale New Haven Health System. *Please note: This news release includes updated data compared to the abstract.

The data for the first 435 patients included in the registry revealed that 7.8% patients were diagnosed with atrial fibrillation/flutter for the first time in their lives, and 15.9% of the patients had a prior history of these types of arrhythmia. Overall, about one fifth of the patients had an episode of atrial fibrillation/flutter during hospitalization.

Additional analysis on the outcomes of the patients with atrial fibrillation/flutter showed that patients with a prior history of atrial fibrillation/flutter had a significantly higher risk of death or ICU mortality, independent of other health issues related to the heart, kidneys and lungs. Data also indicated in-hospital atrial arrhythmias were significantly associated with even higher risk of death and ICU mortality, as well as multi-organ failure, such as respiratory failure and renal failure.

"Our study suggests that the combination of COVID-19 and atrial arrhythmias may create a pathologic synergy that markedly increases the risk for major adverse cardiac events and death," said Zaniar Ghazizadeh, M.D., a lead author of the study and an internal medicine resident at Yale New Haven Hospital/Yale School of Medicine in New Haven, Connecticut. "COVID-19 places patients at a high risk for abnormal heart rhythms that are, in turn, associated with markedly worse outcomes including death and multi-organ failure. Patients and physicians need to monitor for these arrhythmias closely and treatments needs to be timely."

The researchers also cite the need for more investigation to understand the mechanisms of heart injury from COVID-19 infection and methods to prevent this complication.

Authors are Zaniar Ghazizadeh, M.D.; Chad Gier, M.D.; Avinainder Singh, M.D., M.M.Sc.; Lina Vadlamani, M.S., M.B.A.; Maxwell Eder, M.D.; Justin Pacor, M.D.; Jakob Park, M.D.; Manan Pareek, M.D., Ph.D.; Zain Ahmed, M.D., M.P.H., M.S.; Kim G. Smolderen, Ph.D.; Judith Lynne Meadows, M.D., M.P.H.; Tariq Ahmad, M.D., M.P.H.; Nihar R. Desai, M.D., M.P.H.; Rachel .J Lampert, M.D.; and James V. Freeman, M.D., M.P.H. The authors' disclosures are detailed in the abstract. No external funding sources were noted for this study.

Note: Session: EA.APS.25 - Atrial Fibrillation: Screening, Risk Factors, & Ablation Techniques and Outcomes

Meta-analyses for the Effect of Renin-angiotensin-aldosterone System Inhibitors on Mortality and Testing Positive of Covid-19 (Presentation 399)

There has been speculation that two types of medications used to treat high blood pressure and heart failure - angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) - may increase the risk of contracting COVID-19 .

The researchers examined MEDLINE and EMBASE databases for studies that detailed patients treated with ACE inhibitors and/or ARB medications. They conducted two meta-analyses to evaluate the results of 17 trials: 1) to investigate the rate of COVID-19 positive cases, and 2) to determine the death rate among those hospitalized with COVID-19.

Their analyses yielded these findings:

Patients taking ACE inhibitors or ARBs did not have an increased rate of COVID-19 infection; and

Hospitalized COVID-19 patients taking ACE inhibitors or ARBs did not have an increased rate of death.

A sub-analysis was also done, focused on the studies including patients treated for hypertension. The results indicate taking ACE inhibitors and ARBs was associated with a lower death rate among hospitalized COVID-19 patients with a history of hypertension.

"Our study results confirm that patients already taking ACE inhibitors and ARBs should not discontinue taking them due to COVID-19 infection," said lead study author Yujiro Yokoyama, M.D., surgeon at St. Luke's University Health Network's Easton Hospital in Pennsylvania. "Both medications have proven benefits for heart and kidney disease, and this further confirms previous findings that ACE inhibitors do not pose additional risk with COVID-19."

Early in the COVID-19 pandemic, the American Heart Association issued a joint statement with the Heart Failure Society of America and the American College of Cardiology to address the use of ACE inhibitors and ARB medications among patients at risk for developing COVID-19. The recommendations called for the continuation of ACE-i or ARB medications among patients already taking them for indications such as heart failure, hypertension or ischemic heart disease. Cardiovascular disease patients who are diagnosed with COVID-19 should be fully evaluated before adding or removing any treatments, and any changes to their treatment should be based on the latest scientific evidence and shared-decision making with their physician and health care team.

Embargoed until 4 a.m. CT/ 5 a.m. ET, Monday, Nov. 9, 2020

DALLAS, Nov. 9, 2020 -- Centhaquine, a new medication to treat patients who have severe blood or fluid loss, significantly improved outcomes and reduced death rate when added to standard of care, compared to standard care alone, according to preliminary research to be presented at the American Heart Association's Resuscitation Science Symposium 2020. The virtual meeting is November 14-16 and will feature the most recent advances related to treating cardiopulmonary arrest and life-threatening traumatic injury.

Severe loss of blood or fluids due to trauma, hemorrhage, gastrointestinal bleeding, excessive blood loss after surgery, diarrhea or vomiting can cause hypovolemic shock. About 60,000 people in the U.S. and 1.9 million people worldwide die each year due to hemorrhagic shock, with a large percentage of patients dying from blood loss within the first six hours.

"The primary goal when treating traumatic hemorrhage is to control blood loss and maintain cardiovascular function to prevent multi-organ failure and death," said Anil Gulati, M.D., Ph.D., lead author of the study and chairman and chief executive officer at Pharmazz, Inc., the company that produces centhaquine. "Despite advances in medical science, treatment for hypovolemic shock has changed little in the past 50 years, and there is an urgent need for an effective resuscitative agent for this serious and life-threatening condition. We investigated the safety and efficacy of centhaquine compared to standard care for the treatment of hypovolemic shock."

Centhaquine is a first-in-class resuscitative agent for treatment of hypovolemic shock with a unique mechanism of action. It increases pooled venous blood returning to the heart and redistributes that blood to vital organs, a critical process to preserve organ function and reduce mortality in patients with shock.

This multi-center, randomized, placebo-controlled phase III clinical study included 105 patients in India receiving standard of care for hypovolemic shock in a hospital or intensive care setting. Patients were randomized to receive either 1) standard of care and intravenous centhaquine, or 2) standard of care plus saline (control group).

Researchers found several markers of improvement in the group receiving centhaquine compared to those who received standard treatment alone:

At 24 hours of resuscitation, systolic blood pressure was raised from 90 mmHg or less to higher than 110 mmHg in 59% of patients in the control group and 81% of those in the centhaquine group.

Also, at 24 hours diastolic blood pressure was above 70 mmHg in 50% of the control group and 78% of those in the centhaquine group.

Reduction of blood lactate levels to 1.5 mmol/L or less occurred in 47% of the control group patients and 69% of the centhaquine patients. High levels of blood lactate are related to an increased risk of death for patients experiencing shock.

47% of patients in the standard treatment group had low base-deficit - a measure of oxygen imbalance - compared to 68% in the centhaquine group. Base-deficit is an indicator of low tissue blood perfusion and oxygenation. Lower numbers indicate better blood perfusion and tissue oxygenation.

The 28-day death rate was 12% in the control group and 3% in the centhaquine group.

Gulati added that the centhaquine group had improved acute respiratory distress syndrome and multiple organ dysfunction scores compared with the control group.

"Time is of the essence for hypovolemic shock patients, and these results suggest faster recovery towards normalization of blood pressure with centhaquine," Gulati said. "Centhaquine added to standard shock treatment also showed compelling mortality improvement over standard shock treatment, with a 9% absolute reduction in mortality compared to the control group."

Centhaquine is currently available to health care professionals in India and is advancing towards late stage clinical trials in the United States.

Embargoed until 4 a.m. CT/5 a.m. ET, Monday, Nov. 9, 2020

DALLAS, Nov. 9, 2020 -- Exposure to higher ozone concentrations in the air is significantly associated with a higher risk of out-of-hospital cardiac arrest (OHCA), according to preliminary research to be presented at the American Heart Association's Resuscitation Science Symposium 2020. The virtual meeting is November 14-16, 2020 and will feature the most recent advances related to treating cardiopulmonary arrest and life-threatening traumatic injury.

Previous studies have shown acute exposure to ozone and particulate matter in the air is associated with the development of chronic diseases. A 2010 scientific statement from the American Heart Association deemed ambient air pollutants a "modifiable factor that contributes to cardiovascular morbidity and mortality."

"Air pollutants have been associated with increased mortality in the U.S., however, it is unknown whether ozone and particulate matter in the air on any given day are associated with a higher risk of an individual experiencing cardiac arrest outside of the hospital," said Ali Malik, M.D., M.Sc., a clinical cardiology and cardiovascular outcomes research fellow at Saint Luke's Mid America Heart Institute in Gladstone, Missouri, and lead author of the study.

Researchers used data from the Cardiac Arrest Registry to Enhance Survival to examine if higher concentrations of ozone and particulate matter were associated with incidents of cardiac arrest. This study included 187,000 individuals with non-traumatic OHCA during 2013-2016. Participants were age 63 years on average, 61% were men and 53% were non-white. Individual exposures to particulate matter and ozone were estimated using data from the U.S. Environmental Protection Agency's atmospheric models that predict daily ozone levels by census tract.

The results of the analysis found that for every 12 parts per billion (ppb) increase in the ozone level, the odds of a OHCA increased by 1%, which is statistically significant. However, there was no association between particulate matter concentration and OHCA, and no difference in risk for air-quality-related OHCA tied to age, sex or race.

"We found that a higher concentration of ozone on the day the out of hospital cardiac arrest occurred was significantly associated with a higher risk," Malik said. "Importantly, we found that the relationship between ozone and risk of OHCA was present even at concentrations below the EPA air quality standard. These findings may have important public health implications."

Malik added, "Mechanisms by which acute ozone exposure increases the risk of cardiac arrest need to be better defined. It is important to limit exposure to high ozone levels, and we need more aggressive measures to decrease ambient air ozone concentrations."

Malik noted that this is an observational study and exposure to air pollutants was derived from outdoor estimates. Further study is needed to determine the exact relationship between air pollution and cardiac arrest.

Embargoed until 4 a.m. CT / 5 a.m. ET Nov. 9, 2020

DALLAS, Nov. 9, 2020 - Adults from underrepresented racial groups who have acute heart blockages and cardiac arrests received fewer early interventions, had longer hospital stays and higher death rates than their white counterparts, according to preliminary research to be presented at the American Heart Association's Resuscitation Science Symposium 2020. The 2020 meeting will be held virtually, November 14-16 and will feature the most recent advances related to treating cardiopulmonary arrest and life-threatening traumatic injury.

Researchers set out to investigate whether health inequities exist for racial and ethnic minorities with heart problems that could increase their risk for hospitalization or poorer outcomes after a heart event.

"As medical professionals, we need to continue to evaluate our own practice and perceptions. Race is a powerful determinant of a patient's health, along with their sex, age, insurance status and socio-economic status, and these factors work additively from a risk standpoint. For example, an older Black woman from a low-income household without medical insurance will likely have worse health outcomes than a middle-aged white man from an affluent home with good health insurance," said Saraschandra Vallabhajosyula, M.D., M.Sc., the study's senior author and a fellow of interventional cardiology at Emory University School of Medicine in Atlanta. "The complex interplay of these important non-clinical risk factors, also called social determinants of health, need careful evaluation. Only when we eliminate these disparities can we say health care is truly equitable."

Using data from the National Inpatient Sample, researchers examined more than 3 million hospital admissions across the U.S. between 2012 and 2017, 182,000 of which had cardiac arrest complications, making it the largest study of its kind.

The analysis found:

Racial and ethnic minority patients received fewer early treatment methods including coronary angiographies (uses contrast dyes and x-ray pictures to detect heart blockages) and percutaneous coronary interventions (PCI, formerly known as an angioplasty with a stent). (Rates for coronary angiography were 61.9% for Black patients; 70.2% for other groups; and 73.1% among white patients. PCI rates were 44.6%; 53.0%; and 58.1%, respectively).

Black patients experienced longer hospital stays, higher rates of palliative care consultation, less frequent use of a do not resuscitate (DNR) order and fewer discharges to home (they more frequently discharged to another type of care facility).

Asian, Pacific Islanders, Hispanics and Native Americans all had higher in-hospital death rates than white patients.
These findings are suggestive of a higher disease burden and a lower level of social support for patients from an underrepresented racial or ethnic group.

Further research into equitable care is required to address the disparities in care and outcomes for people from racial subgroups. This study is a retrospective analysis, so authors suggest careful validation is needed in future research. Additionally, patients self-reported race, and the information was not independently verified.

Embargoed until 4 a.m. CT, 5 a.m. ET Monday, Nov. 9, 2020

DALLAS, Nov. 9, 2019 - Due to the COVID-19 pandemic, safety precautions were initiated for health care professionals who are administering CPR, and the new protocols have not had a negative effect on patient outcomes or survival, according to preliminary research presented at the American Heart Association's Resuscitation Science Symposium 2020. The 2020 meeting will be held virtually, November 14-16, and will feature the most recent advances related to treating cardiopulmonary arrest and life-threatening traumatic injury.

"The increased precautions taken by health care professionals are for their own safety and for the safety of other patients in the hospital, and help the greater community," said Priyanka Sheth, lead author of the study and a master's candidate at the University of Louisville in Kentucky. "Based upon this analysis, the use of equipment such as N-95 face masks, face shields and protective gowns do not appear to be degrading the quality of patient care, at least specifically during CPR procedures."

Due to the COVID-19 pandemic, new interim CPR guidance was introduced by the American Heart Association and the Centers for Disease Control and Prevention (CDC) encouraging health care professionals to increase precautions with respect to personal protective equipment (PPE) and protocols used when administering cardiopulmonary resuscitation (CPR). The interim guidance has been widely adopted during emergency situations involving patients with known COVID-19, as well as for patients suspected to have COVID-19. There has, however, been debate about possible strain the new guidance places on health care professionals and whether or not the additional protective equipment is impacting the quality of CPR administered, potentially leading to poor patient outcomes.

To assess the safety and effectiveness of the updated CPR practices during the pandemic, this study analyzed the outcomes for patients at one medical center in Kentucky who were treated with in-hospital CPR. Researchers compared patient outcomes from March to June 2020 to outcomes of patients treated from March to May 2019.

Researchers examined the patients' demographics, comorbidities and body mass index (BMI) measurements, as well as the characteristics of CPR performed and patient outcomes. The patient groups were matched by patient characteristics, although the patients who were COVID-19 positive had significantly higher BMI than the patients without COVID-19.

A total of 94 hospital codes (codes indicating that CPR was performed) identified 80 patients for the study. In 2019, in-hospital CPR was performed 41 times, and none of the patients had COVID-19. Of the 2020 in-hospital CPR treatment codes analyzed, 43 patients did not have COVID-19, and 10 patients were COVID-19 positive.

The average amount of time of the CPR event was significantly greater for the patients with COVID-19. The year-to-year comparison did indicate, however, there was no significant difference in the percentage of patients who survived. Of the patients who were COVID-19 positive, 50% survived the code event, compared to 64% of the patients without COVID-19. Data also indicated that only one of the patients with COVID-19 (10%) survived to hospital discharge, compared to 25% of patients without COVID-19.

Study researchers concluded patient outcomes were similar for the patients in 2019 and 2020, indicating that additional precautions taken by health care professionals because of the COVID-19 outbreak are not degrading the quality of CPR administered.

"The safest practice for both health care professionals and for patients is to continue following the American Heart Association and CDC guidance when it comes to extra precautions during CPR administration," said Sheth. "Future research could potentially replicate this study on a national scale to assess if the same trends can be observed across multiple medical centers."

PHILADELPHIA--Food insecurity is one of the nation's leading health and nutrition issues--about 13.7 million (10.5 percent) of households in the United States were food insecure at some time during 2019, a trend likely to increase in light of the COVID-19 pandemic. According to preliminary research conducted by researchers at Penn Medicine, increasing rates of food insecurity in counties across the United States are independently associated with an increase in cardiovascular death rates among adults between the ages of 20 and 64.

The large-scale, national study, which will be presented at the American Heart Association's Scientific Sessions 2020, provides evidence of the link between food insecurity and increased risk of cardiovascular death. This is one of the first national analyses to evaluate changes in both food security and cardiovascular mortality over time, and to see if changes in food insecurity impact cardiovascular health. The findings were also published today in Circulation: Cardiovascular Quality and Outcomes.

"This research gives us a better understanding of the connection between economic distress and cardiovascular disease," said Sameed Khatana, MD, MPH, senior author of the study and instructor of Cardiovascular Medicine in the Perelman School of Medicine at the University of Pennsylvania. "What's going on outside the clinic has significant impact on patients' health. There are many factors beyond the medications we may be prescribing that can influence their wellbeing, food insecurity being one of them."

Researchers analyzed data from the National Center for Health Statistics and the Map the Meal Gap study, to examine county-level cardiovascular death rates and food insecurity rates from 2011 to 2017, among adults age 20 to 64, and those 65 years and older.

The researchers found that while the overall food insecurity rates for the entire country declined between 2011 and 2017, the counties that had the most increase in food insecurity levels had cardiovascular death rates that increased from 82 to 87 per 100,000 individuals. Additionally, for every 1 percent increase in food insecurity, there was a similar increase in cardiovascular mortality among non-elderly adults (0.83 percent).

"There has been a growing disparity when it comes to food insecurity, and this data demonstrates that parts of the country are being left behind. Unfortunately, this may only get worse as the country grapples with the ramifications of the COVID-19 pandemic," Khatana said. "However, interventions that improve a community's economic wellbeing could potentially lead to improved community cardiovascular health."

The authors intend to study whether interventions that improve food insecurity can lead to better cardiovascular health.

Researchers from Western University and University of Houston published a new paper in the Journal of Marketing that examines whether spoiler movie reviews harm box office revenue.

The study, forthcoming in the Journal of Marketing, is titled "Do Spoilers Really Spoil? Using Topic Modeling to Measure the Effect of Spoiler Reviews on Box Office Revenue" and is authored by Jun Hyun (Joseph) Ryoo, Xin (Shane) Wang and Shijie Lu.

"No spoilers!" say many directors. Their concern is that if publications or moviegoers reveal plotlines and surprises, the public won't want to pay for the movie. But is that concern well-founded?

To examine this question, the research team examined daily box office revenues for movies released between January 2013 and December 2017 in the United States. These movies were then matched with their respective reviews collected from Internet Movie Database (IMDb), the most popular movie review platform in the United States. The researchers also developed a measurement of spoiler intensity, or the degree of plot uncertainty resolved by reading spoilers in movie reviews. The study results indicate that spoiler intensity has a positive and significant relationship with box office revenue.

Ryoo explains that "We postulate that uncertainty reduction is the driving mechanism behind this positive spoiling effect. If potential moviegoers are unsure about the quality of a movie, they are likely to benefit from the plot-related content of spoiler reviews when making their purchase decisions." Consistent with this, the research reveals an inverted-U relationship between average ratings and spoiler intensity, which suggests that the positive spoiling effect is stronger for movies that receive moderate or mixed ratings compared to movies that receive either very high or very low ratings. The positive spoiling effect is also stronger for movies that receive less advertising. Advertising can serve an informative function for consumers and is seen as a credible signal of quality in the movie industry. Less advertising should therefore lead to greater uncertainty about movie quality for potential moviegoers. Wang adds "The positive spoiling effect is also stronger for movies with limited release, which is a strategy often employed by independent and arthouse studios associated with greater uncertainty in terms of artistic quality. And the positive spoiling effect declines over time, likely because consumers have greater uncertainty in the earlier periods of a movie's life cycle."

This leads to several implications for stakeholders in the movie industry. Foremost among these is that online review platforms can potentially increase consumer welfare by using spoiler reviews. "The uncertainty-reduction mechanism suggests a spoiler-friendly review platform can help consumers make appropriate purchase decisions. We recommend that review platforms keep the warning labels on spoiler reviews because of the benefit of allowing consumers to self-select into the exposure to spoilers," says Lu.

At high concentrations, reactive oxygen species - known as oxidants - are harmful to cells in all organisms and have been linked to ageing. But a study from Chalmers University of Technology, Sweden, has now shown that low levels of the oxidant hydrogen peroxide can stimulate an enzyme that helps slow down the ageing of yeast cells.

One benefit of antioxidants, such as vitamins C and E, is that they neutralise reactive oxygen species - known as oxidants - which may otherwise react with important molecules in the body and destroy their biological functions. Larger amounts of oxidants can cause serious damage to DNA, cell membranes and proteins for example. Our cells have therefore developed powerful defence mechanisms to get rid of these oxidants, which are formed in our normal metabolism.

It was previously believed that oxidants were only harmful, but recently we have begun to understand that they also have positive functions. Now, the new research from Chalmers University of Technology shows that the well-known oxidant hydrogen peroxide can actually slow down the ageing of yeast cells. Hydrogen peroxide is a chemical used for hair and tooth whitening, among other things. It is also one of the oxidants formed in our metabolism that is harmful at higher concentrations.

The Chalmers researchers studied the enzyme Tsa1, which is part of a group of antioxidants called peroxiredoxins.

"Previous studies of these enzymes have shown that they participate in yeast cells' defences against harmful oxidants," says Mikael Molin, who leads the research group at Chalmers' Department of Biology and Biological Engineering. "But the peroxiredoxins also help extend the life span of cells when they are subjected to calorie restriction. The mechanisms behind these functions have not yet been fully understood."

It is already known that reduced calorie intake can significantly extend the life span of a variety of organisms, from yeast to monkeys. Several research groups, including Mikael Molin's, have also shown that stimulation of peroxiredoxin activity in particular is what slows down the ageing of cells, in organisms such as yeast, flies and worms, when they receive fewer calories than normal through their food.

"Now we have found a new function of Tsa1," says Cecilia Picazo, postdoctoral researcher at the Division of Systems and Synthetic Biology at Chalmers. "Previously, we thought that this enzyme simply neutralises reactive oxygen species. But now we have shown that Tsa1 actually requires a certain amount of hydrogen peroxide to be triggered in order to participate in the process of slowing down the ageing of yeast cells."

Surprisingly, the study shows that Tsa1 does not affect the levels of hydrogen peroxide in aged yeast cells. On the contrary, Tsa1 uses small amounts of hydrogen peroxide to reduce the activity of a central signalling pathway when cells are getting fewer calories. The effects of this ultimately lead to a slowdown in cell division and processes linked to the formation of the cells' building blocks. The cells' defences against stress are also stimulated - which causes them to age more slowly.

"Signal pathways which are affected by calorie intake may play a central role in ageing by sensing the status of many cellular processes and controlling them," says Mikael Molin. "By studying this, we hope to understand the molecular causes behind why the occurrence of many common diseases such as cancer, Alzheimer's disease, and diabetes shows a sharp increase with age."

The fact that researchers have now come a step closer to understanding the mechanisms behind how oxidants can actually slow down the ageing process could lead to new studies, for example looking for peroxiredoxin-stimulating drugs, or testing whether age-related diseases can be slowed by other drugs that enhance the positive effects of oxidants in the body.

More about: The mechanism of slowed ageing by the enzyme Tsa1:

The Chalmers researchers have shown a mechanism for how the peroxiredoxin enzyme Tsa1 directly controls a central signalling pathway. It slows down ageing by oxidising an amino acid in another enzyme, protein kinase A, which is important for metabolic regulation. The oxidation reduces the activity of protein kinase A by destabilising a portion of the enzyme that binds to other molecules. Thus, nutrient signalling via protein kinase A is reduced, which in turn downregulates the division of cells and stimulates their defence against stress.

More about: Related results from other research groups:

Other studies have also shown that low levels of reactive oxygen species can be linked to several positive health effects. These oxidants are formed in the mitochondria, the 'powerhouse' of a cell, and the process, called mitohormesis, can be observed in many organisms, from yeast to mice. In mice, tumour growth is slowed by mitohormesis, while in roundworms it has been possible to link both peroxiredoxins and mitohormesis to the ability of the type 2 diabetes drug metformin to slow cellular ageing.

Metformin is also relevant in the hunt for drugs that can reduce the risk of older people being severely affected by Covid-19. Studies in China and the United States have yielded some promising results, and one theory is that metformin may counteract the deterioration of the immune system caused by ageing.

VANCOUVER, Wash. - Workers experiencing job and financial insecurity are less likely to follow the CDC's guidelines for COVID-19, such as physical distancing, limiting trips from home and washing hands, according to a Washington State University study.

The researchers, who surveyed 745 workers in 43 states, also found that state unemployment benefits and COVID-19 policies affected the connection between economic concerns and compliance with COVID-19 precautions.

The study shows that a scarcity mindset can play a role in how well people are able to focus on responding to the pandemic, said Tahira Probst, a WSU psychology professor and lead author in the study published recently online in the Journal of Applied Psychology.

"We all have a finite set of resources at our disposal, whether it's money, time or social support, and individuals who have fewer of those resources appear less able to enact the CDC-recommended guidelines," said Probst. "The extent to which economic stressors will impact that behavior is in part a function of where we live. Having a fall back, a strong safety net to catch you, seemed to help mitigate the risk factors of job insecurity that was otherwise associated with less adherence to the guidelines."

In states with lower unemployment benefits, job insecurity was associated with a 7% decline in compliance with COVID-19 prevention behaviors.

State-imposed COVID-19 mandates also had a positive effect on compliance but seemed to primarily benefit the financially secure workers more. In states that had fewer restrictions on behavior that could spread the disease, workers were less likely to follow the CDC's recommendations, whether the respondents were financially secure or insecure.

However, in states with a stronger response, including measures such as stay-at-home orders and shutting down non-essential businesses, financially secure employees had 13% higher enactment of the prevention behaviors compared to workers who felt more financially insecure.

These differences could have significant public health ramifications, the authors argue, since research suggests that even modest reductions in social contacts among adults can reduce infection and eventual death rates.

"It's important to acknowledge as a society that there are certain segments of the population, namely the economically secure, that are better equipped to follow the CDC recommendations to prevent the spread of COVID-19," said Probst. "This is a red flag since precarious work and financial strain can also co-occur with other COVID-19 risk factors and pre-existing health disparities."

The researchers recruited survey participants using Amazon's Mechanical Turk, an online crowdsourcing platform. The authors acknowledge that the demographics of that sample skewed more male, 62%, and more college-educated, 68%, than the general U.S. population which is about 50% male and 35% college-educated. However, using the platform did allow the researchers to survey groups of workers representing most states in the U.S. The respondents' median household income of $50,000-$59,000 was also close to that of the United States' median of $60,293.

The data for this study were collected in April, the month after the World Health Organization officially declared the pandemic on March 11. Probst and her colleagues are continuing to follow up with this survey group every 1-2 months to collect a total of seven waves of survey data. The researchers are looking to see if the disparities related to economic stress and protective behaviors translate into greater COVID-19 infection rates.

Bologna, Italy and Huntingdon Valley, Pa. -- Menarini Silicon Biosystems, the pioneer of liquid biopsy technology, today announced the publication of a research study providing support for the reliability of using circulating tumor cell (CTC) count to guide frontline therapy choice for patients with estrogen receptor-positive (ER+), HER2-negative (HER2) metastatic breast cancer. Published in the November issue of JAMA Oncology, this is the first study to support clinical utility of CTC count in a randomized clinical trial.

"Based on our research, the use of the CTC count represents the first objective and reproducible decision tool to help physicians choose between hormone therapy or chemotherapy for this particular group of patients," said lead author Francois-Clement Bidard, MD, PhD, Professor of Medical Oncology at Institut Curie and University of Versailles. "Furthermore, our results indicate that the CTC count complements but does not duplicate the physician's opinion on which treatment to choose and should be included in the decision algorithm. This CTC test may help customizing treatment decisions for all women suffering from ER+ HER2- metastatic breast cancer."

The randomized Phase III trial, known as the STIC CTC study, included 778 women with Stage 4 ER+, HER2- breast cancer and compared the outcomes of treatment decisions based on physician assessment vs. CTC count. Half of the patients were randomly assigned to the clinically driven treatment group, where treatment was selected by a physician based on clinical factors. The other half were assigned to a CTC-driven treatment group, in which patients with 5 or more CTCs in 7.5 mL of blood received chemotherapy, and those with less than 5 CTCs in 7.5 mL received hormone therapy. Menarini Silicon Biosystems' CELLSEARCH® CTC System was used to capture and isolate tumor cells circulating in the blood in all patients.

The results supported the reliability and clinical utility of using the CTC count to guide front line therapy choice. For most patients in the clinically driven arm, the CTC count correlated with the physician's choice of treatment. In the CTC-driven group, escalation of treatment to frontline chemotherapy for patients with high CTC count significantly improved progression free survival (PFS), while de-escalation to hormone therapy for patients with low CTC count did not have a detrimental impact on PFS or overall survival (OS).

"The results of the STIC CTC study provide evidence that the CTC count can support physicians when making effective treatment decisions," said Fabio Piazzalunga, President and CEO of Menarini Silicon Biosystems. "As a company, we will continue to support research aimed at demonstrating the clinical utility of CTC and we maintain our commitment to improve patient management."

Since the trial began, the introduction of CDK4/6 inhibitors (palbociclib, ribociclib and abemaciclib) in combination with endocrine therapy as a frontline option has changed the treatment algorithm for patients with ER+ HER2- metastatic breast cancer. As a result, Menarini Silicon Biosystems has now been asked to support the analysis of CTC count in an ongoing phase III study known as AMBRE, promoted by Unicancer, the only French hospital network entirely devoted to fighting cancer, and conducted within the French breast cancer intergroup (UCBG) network. The study (NCT04158362) compares chemotherapy and a combination of endocrine therapy with one of the new CDK4/6 inhibitors (abemaciclib) as the initial treatment for metastatic ER+/HER2- breast cancer with high tumor burdend.

Research has confirmed the nationwide Alert Level 4 COVID-19 lockdown had a significant toll on New Zealanders' well-being, especially for younger people - but the results were not all negative.

Researchers from the University of Otago conducted a demographically representative survey of adult New Zealanders between 15 and 18 April, corresponding to days 19 to 22 of the 33-day lockdown.

They found almost a third of participants experienced mental distress during the lockdown, but that many people also experienced some form of 'silver linings'.

They asked Kiwis about their levels of stress, anxiety and depression, about the state of their family relationships and whether there were any positive outcomes from lockdown.

Dr Susanna Every-Palmer, the Head of the Department of Psychological Medicine at the University of Otago, Wellington, says 30 per cent of those surveyed reported moderate to severe psychological distress and 16 per cent had moderate to high levels of anxiety. Almost 40 per cent said their level of well-being was low.

"New Zealand's lockdown successfully eliminated COVID-19 from the community, but our results show this achievement brought a significant psychological toll," Dr Every-Palmer says.

"Substantially increased rates of distress were seen among those who reported having lost their jobs or experienced a reduction in work as a result of the pandemic, those who had potential vulnerabilities to COVID-19, or identified their health status as poor, and those who had a past diagnosis of a mental illness."

The level of mental distress was much higher in younger adults, with almost half of those aged between 18 and 24 experiencing moderate to severe psychological distress compared to less than one in 10 adults aged 65 years and older.

Dr Every-Palmer says the lower level of mental distress among older people likely results from higher baseline levels of well-being. It may also reflect the resilience they have developed through overcoming past adversities and the fact that they were experiencing fewer daily disruptions and economic impacts as a result of lockdown.

"Older people may also have felt they were safer in New Zealand than elsewhere."

Just over six per cent of participants reported having suicidal thoughts during lockdown, although for most this was not a new experience, with 83 per cent saying they had similar thoughts in the 12 months prior to lockdown.

Almost one in 10 participants directly experienced some form of family harm over the lockdown period, including sexual assault, physical assault, or harassment, and threatening behaviour. This is three to four times higher than that reported in the 2018-2019 NZ Crime and Victims of Crime Survey. Reports from China, the US, Brazil and Australia also indicate increases in family violence coinciding with lockdown orders.

Dr Every-Palmer says not all the consequences of the lockdown were negative, with 62 per cent of respondents saying they enjoyed the 'silver linings' experienced during lockdown, including working from home, spending more time with family, and living in a quieter, less polluted environment.

"People reported taking the opportunity to pause, reflect, consider priorities, recreate healthy habits, and they appreciated the environmental benefits brought by reduced travel."

Dr Every-Palmer says the study is unique in international terms, with researchers able to conduct the survey during a stringent lockdown but in the absence of widespread direct effects of the virus.

"It is clear that the consequences of the pandemic will be pervasive and prolonged. Our findings emphasise the need to put resources into supporting mental well-being both during and after lockdowns.

"Governments should make providing mental health support a similar priority to other health measures, such as contact tracing, provision of personal protective equipment and procurement of ventilators."

Supporting the population's psychological well-being includes ensuring people have ready access to accurate information, basic necessities and community connection as well as specialist mental health services, she says.

"Free access to high quality e-therapies and telehealth support also becomes increasingly important if people are afraid or are not allowed to leave their homes."

Fast facts:

Planetary habitability, defined by a planet's ability to sustain liquid water on its surface, is one of the most important concepts in exoplanet science.

Exoplanets (planets that orbit stars outside of our solar system) are subject to space weather in the form of stellar flares, emissions of radiation from stars.

These emissions consist of extreme ultraviolet (XUV) photons and charged particles and can alter the upper atmosphere of the exoplanet. Current methods to determine a planet's ability to support life do not take stellar activity into consideration.

Abu Dhabi, UAE, November 9, 2020: In a new study researchers, led by Research Scientist Dimitra Atri of the Center for Space Science at NYU Abu Dhabi (NYUAD), identified which stars were most likely to host habitable exoplanets based on the calculated erosion rates of the planetary atmospheres.

In the paper titled Stellar flares versus luminosity: XUV-induced atmospheric escape and planetary habitability, published in the journal Monthly Notices of Royal Astronomical Society: Letters, Atri and graduate student Shane Carberry Mogan present the process of analyzing flare emission data from NASA's TESS (Transiting Exoplanet Survey Satellite) observatory.

It was found that more frequent, lower energy flares had a greater impact on an exoplanet's atmosphere than less frequent, higher energy flares. The researchers also determined how different types of stars extreme ultraviolet radiation (XUV) through stellar flares, and how nearby planets are affected.

The ability to sustain an atmosphere is one of the most important requirements for a habitable planet. This research provides new insights into the habitability of exoplanets, as the effects of stellar activity were not well understood. This study also highlights the need for better numerical modeling of atmospheric escape - how planets release atmospheric gases into space - as it can lead to the erosion of atmosphere and the diminishment of the planet's habitability.

"Given the close proximity of exoplanets to host stars, it is vital to understand how space weather events tied to those stars can affect the habitability of the exoplanet," said Atri. "The next research step would be to expand our data set to analyze stellar flares from a larger variety of stars to see the long-term effects of stellar activity, and to identify more potentially habitable exoplanets."

Public health agencies across the UK should launch a National Covid-19 Resilience Programme to support older people through the pandemic and to keep them healthy and resilient over the winter - that's the recommendation from a leading group of scientists and clinicians working in the fields of physiology, nutrition and physiotherapy.

The recommendation will be made in a new report by The Physiological Society and Centre for Ageing Better to be launched this Monday at a meeting of Parliamentary and Scientific Committee (1). The Expert Panel for the project brought together 20 leading scientists and clinicians. (2)

New polling carried out by YouGov for the project found that almost 1 in 3 older people did less physical activity during the first lockdown in March. Of those, 43% said that this was because they no longer had a reason, or had less reason, to get out of the house and be active; 32% were worried about catching Covid-19; and 29% reported lacking motivation to exercise. (3)

Physical activity is an important factor in staying healthy and resilient. Home confinement in older people will be associated with muscle loss, body fat gain and the development of insulin resistance, which are driving factors in the development of weakness and Type 2 diabetes. These changes happen within days if inactivity is marked. This could have dramatic functional consequences for older people, perhaps tilting the balance from being just able to do something, such as rise from a chair, to not.

Increased risks of Covid-19 hospitalisation, disease severity and death are associated with a high body mass index and frailty in older people. Therefore, it is essential to support older people in staying fit and healthy during lockdown to improve their resilience to Covid-19.
A National Covid-19 Resilience Programme would bring together a package of measures to support older people through the lockdown and beyond, keeping them healthy and resilient over the winter. The Government should repeat the approach taken at the start of the first national lockdown in March to identify and proactively contact those at highest risk to offer support and advice (4).

A National Covid-19 Resilience Programme should include:

A tailored exercise programme, focused on older people with key Covid-19 risk factors (obesity, type 2 Diabetes, cardiovascular disease, and sarcopenia). This can draw on existing programmes such as "Make Movement Your Mission"; (http://www.facebook.com/groups/MakeMovementYourMission);

Clear guidance about the importance of a healthy balanced diet containing sufficient levels of protein and appropriate energy content;

Enhance mental health through the creation of virtual communities to counter social isolation;

Enlist help of relatives and volunteers to support behaviour change among older people.

This programme should be supported by a digital platform and by national broadcasters such as through regular televised activity classes on the BBC.

Professor Paul Greenhaff, University of Nottingham, UK and Expert Panel Co-Chair said:

"With England now in its second lockdown it is likely that people across the country will be less physically active. Physical activity is an important factor in staying healthy and resilient and will help protect against risks from Covid-19.

"Lockdowns, while important to reduce transmission of Covid-19, can have a detrimental effect on both the physical and mental health of older people. These changes happen rapidly: within 3 days of not using muscles, people can experience significant decreases in muscle mass and quality which might be the difference of an older people being able to get out of a chair by themselves or not.

"We are calling on public health agencies to urgently address this by launching a National Covid-19 Resilience Programme to support older people through the pandemic. Older people need clear, tailored guidance, about how to keep healthy and resilient, that covers physical activity, nutrition and mental wellbeing.

"Older people are facing this lockdown as the days are getting shorter and colder and therefore we must all re-double efforts to keep older people healthy."

Dr Alison Giles, Centre for Ageing Better, and Expert Panel Co-Chair said:

"As this report highlights, coronavirus lockdowns can be particularly challenging for older people as they can exacerbate a variety of health issues, such as cardiorespiratory deconditioning and weight gain, as well as increased loneliness and social isolation.

"As the country enters a second national lockdown it's important to acknowledge that blanket advice based on age can lead people to feel that they don't have control over managing their own health and risk around COVID-19.

"A National Covid-19 Resilience Programme would give older people more control and offer guidance on how to take care of themselves as the pandemic continues. We must provide people with tools that will allow them to make their own informed decisions on their health, wellbeing and resilience."

A researcher from University of Southern California published a new paper in the Journal of Marketing that explores whether attractive food might seem healthier to consumers. The study forthcoming in the Journal of Marketing is titled "Pretty Healthy Food: How and When Aesthetics Enhance Perceived Healthiness" and is authored by Linda Hagen.

Consumers see almost 7,000 food and restaurant advertisements per year, with the vast majority touting fast food. In marketing materials, food is extensively styled to look especially pretty. Imagine the beautiful pizza you might see on a billboard--a perfect circle of crust with flawlessly allocated pepperoni and melted cheese. Advertisers clearly aim to make the food more appetizing. But do pretty aesthetics have other, potentially problematic, effects on your impressions of food?

On one hand, beautiful aesthetics are closely associated with pleasure and indulgence. Looking at beautiful art and people activates the brain's reward center and observing beauty is inherently gratifying. This link with pleasure might make pretty food seem unhealthy, because people tend to view pleasure and usefulness as mutually exclusive. For instance, many people have the general intuition that food is either tasty or healthy, but not both.

On the other hand, a specific type of aesthetics called "classical" aesthetics is characterized by the ideal patterns found in nature. For instance, a key classical aesthetic feature is symmetry, which is also extremely common in nature. Another prominent classical aesthetic feature involves order and systematic patterns, which, again, are ubiquitous in nature. It seems possible that sporting more of these nature-like visual features might make food depictions feel more natural. Seeming more natural, in turn, may make the food seem healthier because people tend to consider natural things (e.g., organic food or natural remedies) to be healthier than unnatural things (e.g., highly processed food or synthetic chemicals). So, by virtue of reflecting nature, the same food may seem healthier when it is pretty (compared to when it is ugly).

In a series of experiments, the researcher tested if the same food is perceived as healthier when it looks pretty by following classical aesthetics principles (i.e., symmetry, order, and systematic patterns) compared to when it does not. For example, in one experiment, participants evaluated avocado toast. Everyone read identical ingredient and price information, but people were randomly assigned to see either a pretty avocado toast or an ugly avocado toast (the pictures had previously been, on average, rated as differentially pretty). Despite identical information about the food, respondents rated the avocado toast as overall healthier (e.g., healthier, more nutritious, fewer calories) and more natural (e.g., purer, less processed) if they saw the pretty version compared to the ugly version. As suspected, the difference in naturalness judgments drove the difference in healthiness judgments. Judgments of other aspects, like freshness or size, were unaffected. Experiments with different foods and prettiness manipulations returned the same pattern of results, suggesting that the effect is unlikely idiosyncratic to certain pictures.

Importantly, these healthiness judgments affect consumer behavior. In a field experiment, people were willing to pay significantly more money for a pretty bell pepper than an ugly one, and a substantial portion of this boost in reservation prices was attributable to an analogous boost in healthiness judgments. In another study, even when people had financial incentives to correctly identify which of two foods contained fewer calories, they were more likely to declare a target food to be the lower calorie option when it was pretty than when it was ugly--even though this choice lost them money.

There are some key qualifications. First, the pretty=healthy effect is limited to classical aesthetics. "Expressive" aesthetics do not involve nature-like patterns, but instead please through imaginative execution of creative ideas, such as food cut into fun shapes or arranged to depict a scene. Second, the pretty=healthy bias can be muted by displaying a disclaimer next to the food reminding people that the food was artificially modified.

This effect of classical aesthetic principles has implications for marketers and public health advocates, albeit different ones. Hagen explains that "Classical aesthetics may be a costless and subtle new way to convey naturalness and healthfulness--attributes that consumers increasingly demand in food products. At the same time, pretty food presentation may optimistically distort nutrition estimates and negatively impact dietary decisions. Given these findings, policy-makers may want to consider modification disclaimers as an intervention or strengthen regulations around providing objective nutrition information with food images."

A new study led by Maria Manuel Mota, group leader at Instituto de Medicina Molecular João Lobo Antunes (iMM; Portugal), now shows that malaria parasites secrete the protein EXP2 that is required for their entry into hepatocytes. These findings, published today in the scientific journal Nature Communications*, open a new avenue for prophylactic anti-malarial strategies, since blocking or decreasing the infection of the liver can prevent the disease.

Plasmodium parasites are the causative agents of malaria, one of the most prevalent infectious diseases, that still infect yearly over 200 million people worldwide. After being transmitted, Plasmodium parasites travel to the liver, where they infect its cells, called hepatocytes. It is still largely unknown how parasites invade hepatocytes and consequently, few therapies are available to prevent this initial step. Now, a research team led by Maria Manuel Mota at iMM has discovered that these parasites secrete a protein named EXP2, before invading the hepatocyte, creating pores in the host cell's membrane. "We observed that the Plasmodium parasites, that are called sporozoites at this stage, secrete EXP2 molecules before entering the cell and this protein creates pores in the outer membrane of hepatocytes, facilitating parasite entry. If you image the hepatocyte as a house, the parasites are breaking window- in this case with the EXP2 proteins - to trigger the alarm system of the hepatocytes", explains João Mello-Vieira, PhD student and first author of this work.

EXP2 had been widely studied during the blood stage of infection, where it has a crucial role only after the parasite has established itself inside the red blood cell. However, its role during the liver infection was unclear. Vanessa Zuzarte Luis, senior author of the work explains: "We observed that sporozoites that lack EXP2, are not able to invade hepatocytes. But, if we produce this protein and add it to the cells, the parasites that lack EXP2 are now able to enter cells normally. This created another question: the pores created by EXP2 are not big enough for the parasite to go through them. So, how is EXP2 facilitating invasion?".

Other pathogens, such as adenoviruses, bacteria and another parasite (Trypanosoma cruzi) have been shown to invade using this type of pore-forming proteins. In such cases, the secreted pore-forming proteins, induce a damage in the membrane of the cell, so that the cell actively engulfs the pathogen, as it is repairing the pore. "If we go back to the image of the house, the parasites are breaking the window and using the moment that owner comes out to see who did it, to go in through the door.". We hypothesized that Plasmodium sporozoites induce a similar response. In fact, if we block the key human enzyme for this repair process, acid sphingomyelinase, we can reduce invasion of hepatocytes by sporozoites", adds Vanessa Zuzarte Luis.

On the importance of these results, Maria Manuel Mota states: "Our results hint at the convergent evolution of different pathogens, that evolved a common strategy to hitchhike their way into the cells. It also creates an opportunity for prophylactic interventions. If we are able to block parasite proteins or the repair process, we are able to prevent infection of the liver by Plasmodium parasites, preventing malaria before the parasite can cause any harm. Moreover, if we are able to block EXP2, we might be able to prevent the development of the parasite in the ensuing blood stage."