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The need to evacuate an intensive care unit (ICU) or operating theatre complex during a fire or other emergency is a rare event but one potentially fraught with difficulty: not only is there a risk that patients may come to significant harm but also that staff may be injured and unable to work.

Therefore, the Association of Anaesthetists and the Intensive Care Society are today publishing new 2021 guidelines regarding fire safety and emergency evacuation of ICUs and operating theatres in Anaesthesia (a journal of the Association of Anaesthetists).

These guidelines have been drawn up by a multi-professional group including frontline clinicians, healthcare fire experts, human factors experts, clinical psychologists and representatives from the National Fire Chiefs Council, Health and Safety Executive (HSE), NHS Improvement, Medicines and Healthcare Products Regulatory Authority (MHRA), and representatives from relevant industries.

Three fires have occurred in UK ICUs over the past 10 years - at the Royal Marsden Hospital, London (2008), the Royal United Hospital Bath (2011) and the Royal Stoke Hospital (2017) - all of which required full-scale emergency evacuation of patients, staff and relatives. At least five major ICU fires have occurred worldwide during the COVID-19 pandemic, and in the last few weeks three tragic fires have occurred in ICUs in India and Iraq where large numbers of COVID-19 patients were being treated, resulting in multiple fatalities.

During the COVID-19 pandemic, issues around fire safety, emergency evacuations and the safe use of oxygen have become especially relevant, and these are discussed in more detail in an appendix to the guidelines (more details below).

"Our new guidelines include many strategies put in place in Bath following our ICU fire, including additional fire training for staff in their place of work, bespoke fire and emergency evacuation cards placed next to all manual fire call points and changes to the way in which we use oxygen cylinders," explains lead-author Dr Fiona Kelly, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.

"Other safety issues raised by our fire required discussion with experts at a national level and were the driver for creating our working party: these include training nominated clinical staff to select and safely use fire extinguishers, improved ventilation of clinical areas where high oxygen flow rates are used and updated recommendations for the design of new ICUs and operating theatres. We hope that the publication of these new guidelines will allow other hospitals to learn from our experience. While these guidelines are designed for ICUs and operating theatres, they are also relevant for respiratory high care areas, emergency departments, coronary care units and monitored beds elsewhere in the hospital."

The guidelines recommend a number of changes to training and preparation, including:

1. Clinical staff of all grades should receive multidisciplinary training in their place of work as part of annual mandatory training, covering the management of a fire and evacuation of their work area. Nominated clinical staff should be trained to select and use fire extinguishers.

2. Designing new and refurbished ICUs and operating theatres is an opportunity to incorporate mandatory fire safety features. New strategies covered in these guidelines include modern sprinkler systems, emergency low level lighting and oxygen pipelines designed so that the oxygen supply to an ICU area affected by a fire to be cut off without interrupting the oxygen supply to the whole ICU.

3. Ventilation of ICUs and clinical areas where high-flow nasal oxygen and non-invasive respiratory support are in use should be good enough to prevent oxygen enrichment of the ambient atmosphere: the recommended minimum ventilation rate of these areas is 10 air changes per hour.

4. Laminated fire and emergency evacuation action cards, specific for that clinical area, should be placed next to all manual fire call points so that they can be followed in the event of a fire or if an emergency evacuation is required for another reason.

5. Oxygen cylinders should be stored, handled and used according to the gas supplier's instructions, using the correct sequence of actions when administering oxygen and using an oxygen cylinder bed bracket at all times.

6. Major incident planning should include plans for internal incidents, where the staff themselves are victims and unable to work and where ICU and theatre suites become unusable for patient care. All staff involved in a fire or similar emergency should be supported following the event and assessed by their occupational health team before restarting work.

COVID-specific issues

ICU fires occurring in Russia, Romania, Turkey, Ukraine and India were believed to have been caused by faulty ventilators, faulty electrical equipment and/or electrical issues and necessitated large scale evacuation of patients and staff with many fatalities. Specific issues relevant to the COVID-19 pandemic in the UK include:

* The open plan nature of the Nightingale Hospitals with no option for fire doors or compartmentalisation, some with minimal ventilation and with the potential for oxygen enrichment of the ambient air and for a fire to spread extremely rapidly

* Escalation ICU areas created in operating theatre suites and wards to provide additional ICU capacity and treat as many patients as possible, with limited/no ability to compartmentalise a fire and existing evacuation policies not adequate for ICU patients

* Extra beds added to existing ICU bays and side rooms to create additional capacity, potentially blocking emergency evacuation routes

* Significant increase in the use of oxygen, including high-flow nasal oxygen and non-invasive respiratory support both inside and outside of ICU areas. This raised concerns about oxygen enrichment of the ambient air and a possible risk of fire if the ambient oxygen levels rose above 23%: for this reason, our guidelines recommend enhanced ventilation of clinical areas where high oxygen flow rates are used to levels of more than 10 air changes per hour (see link to document on this below)

* The need to don Personal Protective Equipment (PPE) before entering an isolation room or tend to a patient, which takes time and slows down the response to an emergency. In addition, the fact that most PPE is flammable creates additional fire safety issues

* Reservist staff in temporary ICUs being, in most cases, non-ICU trained and not necessarily aware of the evacuation policies for that unit or of guidelines for the safe use and storage of oxygen cylinders

* Use of electrical extension cables and multiple devices on one socket

Dr Fiona Kelly commented: "The COVID-19 pandemic has made all who work in ICUs and operating theatres look again at the risk of a fire in a clinical area, and at the practicalities of carrying out an emergency evacuation. We hope that improved fire safety and emergency evacuation procedures will be one of the good things to come out of the COVID-19 pandemic and will improve the safety of our patients and staff for years to come. Our thoughts are with all the patients, families and staff involved in the terrible fires elsewhere in the world that have occurred during the COVID-19 pandemic."

Dr Mike Nathanson, President of the Association of Anaesthetists, said: "Fires in ICUs have occurred for many years. This guideline is hugely important right now following the recent oxygen therapy related fires during the COVID-19 pandemic. Dr Fiona Kelly and colleagues are to be congratulated on producing this document; every life lost is a tragedy and we hope further deaths from such awful incidents can be avoided."

President of the Intensive Care Society, Dr Stephen Webb said: "The emergency evacuation of an ICU or operating theatres is complex. Our patients are critically unwell and are likely to be receiving some form of mechanical intervention or organ support which creates a challenge in moving them in an emergency."

"Alongside technical experts in this field, the Intensive Care Society and the Association of Anaesthetists have produced this important guidance. It shares learning from previous evacuations, seeks to help support staff in these emergencies and to safeguard vulnerable patients. It provides the baseline on which standard operating procedures should be built and encourages best practice in emergency planning and preparedness."

Dr Kelly, Dr Webb and Dr Nathanson finish with "We are all deeply saddened by the recent fires in India, Iraq, and Romania and it is our hope the publication of this guidance will support our Intensive Care and Anaesthesia colleagues across the globe, help keep their patients safe and reduce the risk of fire and the need for emergency evacuation in the future."

World-first nanotechnology developed by the University of South Australia could change the lives of thousands of people living with cystic fibrosis (CF) as groundbreaking research shows it can improve the effectiveness of the CF antibiotic Tobramycin, increasing its efficacy by up to 100,000-fold.

The new technology uses a biomimetic nanostructured material to augment Tobramycin - the antibiotic prescribed to treat chronic Pseudomonas aeruginosa lung infections in severe cases of CF - eradicating the infection in as little as two doses.

In Australia, cystic fibrosis (CF) affects one in 2500 babies - or one baby born every four days - causing severe impairments to a person's lungs, airways and digestive system, trapping bacteria and leading to recurrent infections. Lung failure is the major cause of death for people with CF.

The UniSA research team, which includes Professor Clive Prestidge, Dr Nicky Thomas, and PhD candidate, Chelsea Thorn, says the discovery could transform the lives of people living with CF.

"CF is a progressive, genetic disease that causes persistent, chronic lung infections and limits a person's ability to breathe," Thorn says.

"The disease causes thick, sticky mucus to clog a person's airways, attracting germs and bacteria, such as Pseudomonas aeruginosa, which leads to recurring infections and blockages.

"Tobramycin is commonly used to treat these infections but increasingly antibiotics are failing to make any significant difference to lung infections, leaving sufferers requiring life-long antibiotic therapy administered every month.

"Our research successfully treats advanced human cell culture lung infections using nano-enhanced Tobramycin and shows how it can eradicate serious and persistent infections after only two doses.

"This could be a real game-changer for people living with CF."

Researchers enhanced the Tobramycin with a biometric, nanostructured, lipid liquid crystal nanoparticle (LCNP)-based material, testing it on a new lung infection model to showcase its unique ability to penetrate the dense surface of the bacteria and kill the infection.

Dr Nicky Thomas, says the discovery continues the global battle to eradicate and prevent Pseudomonas aeruginosa.

Tobramycin works by inhibiting the synthesis of bacteria and causing cell membrane damage. Yet, as it's a concentration-dependent antibiotic, achieving a sufficiently high concentration is critical," Dr Thomas says.

"Our technology improves the performance of Tobramycin without increasing the toxicity of the drug, so what we're doing is a far more effective and efficient treatment for chronic lung infections."

The technology is currently entering pre-clinical trials and hopes to be on the market in the next five years.

Cancer death rates have fallen dramatically in the United States, but factor in obesity, as researchers did at the University of North Carolina Gillings School of Global Public Health, and the picture changes.

In a study published May 10 in JAMA Network Open, researchers showed that obesity-related cancer deaths are improving, but at a slowing pace.

Based on mortality data for 50 million people, deaths from cancers not associated with obesity -- that's lung cancer and skin cancer, among others - are declining at a rate almost three times faster than cancers linked to obesity, such as stomach, colorectal, uterine, thyroid and postmenopausal breast cancer.

"These are cancers where we could see even larger mortality improvements with creative and practical tools to combat obesity," said study senior author Hazel B. Nichols, associate professor in the Department of Epidemiology at the UNC Gillings School of Global Public Health.

Most Americans weigh more than recommended and being overweight or obese puts them at risk for certain cancers.

Extra weight can cause changes in the body that help lead to cancer, such as long-lasting inflammation and higher than normal levels of insulin and hormones that can fuel cell growth, according to the U.S. Centers for Disease Control and Prevention.

Measuring progress

Cancer death rates are one of the best measures researchers use to track progress against cancer.

Study authors set out to answer whether widespread obesity could stall progress against cancer the same way it has with heart disease. Improvements in heart disease mortality slowed after 2011 and obesity may have contributed to the deceleration.

"What was puzzling was that we didn't see the same pattern of slower improvements when looking at cancer overall - which is surprising because obesity contributes to both cancer risk and heart disease risk," said Nichols, who studies cancer trends to improve decision-making in cancer care. "When we focused on the differences between obesity-related cancers and non-obesity related cancers we saw that improvements for obesity cancers were not as impressive - consistent with the pattern for heart disease."

For example, the study showed that in 2011, 110 people out of 100,000 died from cancers not related to obesity. In 2018, the mortality rate for those cancers fell to 93.8 deaths per 100,00 people, representing a 2.29% annual decline.

During the same period, the decline for obesity-related cancers was much slower, changing from 58.4 to 54.9 deaths per 100,000 people, roughly a third the rate -- at .83% -- of non-obesity related cancers.

Additionally, obesity may be contributing to more of the cancer deaths in the U.S. Cancers not associated with obesity accounted for 66.8% of cancer deaths in 1999, decreasing to 62.6% in 2018, according to the study.

Declines in cancer deaths are owed to fewer people smoking, along with better screening and treatments, according to the American Cancer Society.

But the findings by the UNC researchers, which include Christy Leigh Avery, an associate professor at Gillings School of Global Public Health specializing in cardiovascular epidemiology and a fellow at the Carolina Population Center and Annie Green Howard, an associate professor in biostatistics at Gillings and fellow at Carolina Popular Center, reinforces the effect of obesity on cancer.

"Obesity is a risk factor for many, but not all, types of cancer," Nichols said. "We need to make maintaining a healthy weight an obtainable goal for everyone in terms of safe public spaces, availability and affordability of nutritious foods, and other structural factors. The good news in that is if we're able to make these changes as a society, we will be able to improve the health of a nation."

Pregnant Aussie mums are being denied access to medications which treat severe nausea and vomiting by pharmacists and medical practitioners because of misleading labels and a lack of awareness about clinical guidelines.

A new study surveyed 249 Australian women who suffered from severe nausea and vomiting during pregnancy (NVP) or hyperemesis gravidarum (HG) and examined their experiences in accessing medications during pregnancy.

One in four women reported being denied medications for NVP/ HG at some stage during pregnancy. This most commonly involved the over-the-counter medicine doxylamine and interactions with community pharmacists.

The research, published in ANZJOG, coincides with International Hyperemesis Gravidarum Awareness day on May 15th.

Caitlin Kay-Smith, co-author and founder of the consumer organisation Hyperemesis Australia, has committed her life to improving awareness and supporting women suffering from HG.

"HG is a severe form of NVP and affects 5-10% of pregnancies. Research shows that women with HG have a higher risk of negative maternal and fetal outcomes, but these possible harms are poorly recognised. This means that ensuring women have access to safe and effective treatments is really important."

The researchers state fresh approaches to identify and effectively address barriers towards the provision of effective treatments for severe NVP and HG while pregnant are urgently needed.

Associate Professor Luke Grzeskowiak, a Hospital Research Foundation Mid-Career Fellow at Flinders University and SAHMRI, says women's feelings of not being taken seriously or the trivialisation of symptoms is a common finding in studies and needs to be addressed appropriately.

"Underlying explanations for women being denied access to medications can include a lack of provider awareness of clinical practice guidelines, misleading labelling produced by pharmaceutical manufacturers (e.g. most doxylamine packaging states not to use during pregnancy), or genuine concern or uncertainty regarding the fetal safety of specific medications with or without consideration of the benefits of treatment."

The research highlights the need for the Australian Therapeutic Goods Administration (TGA) to consider following international efforts aimed at improving medication labelling laws, such as the Pregnancy and Lactation Labelling Rule introduced by the Food and Drug Administration in the United States.

"This would require all medication packaging and consumer medicines information to include evidence-based information on use in pregnancy, such that consumers and providers are able to rationally weigh up risks and benefits people," says Associate Professor Grzeskowiak.

""Further studies evaluating healthcare professional attitudes towards recommending or prescribing medications for severe NVP and HG are warranted."

In a study conducted by researchers at Hospital for Special Surgery (HSS), cumulative opioid use was reduced by 30% in a patient group that received duloxetine after total knee arthroplasty (TKA) compared with patients who received placebo. Patients who received duloxetine also reported higher pain management satisfaction and less pain interference with mood, walking, normal sleep, and work activities. These findings were presented at the 2021 Spring American Society of Regional Anesthesia and Pain Medicine (ASRA) Annual Meeting.1

Studies have demonstrated that many patients report joint pain two weeks after TKA.2 Given the status of the ongoing opioid epidemic, it is critical to study safe and effective alternative pain treatments.

"Previous research has shown us how to keep most patients relatively comfortable for the first one to two days after TKA. However, patients often have significant and troubling pain during the first two weeks, once the nerve blocks wear off. They often take large amounts of opioids," said principal investigator Jacques Ya Deau, MD, PhD, an anesthesiologist at HSS. "It is important to reduce postoperative opioid use without increasing pain or worsening the patient experience."

Finding alternative strategies for pain relief after TKA is imperative, as improved postoperative pain management is linked to improved patient satisfaction, faster rehabilitation, and reduced complications.

Dr. Ya Deau and colleagues enrolled 160 patients undergoing TKA into the study and randomized them into a duloxetine or placebo group. Patients took 60 mg of oral duloxetine or placebo once daily for 14 days after surgery and answered questions on postoperative days one, two, seven, 14, six weeks, and 90 days. Postoperative pain management also included acetaminophen, ketorolac, meloxicam, and oxycodone as needed.

The researchers collected data on numerical rating scale (NRS) scores for pain management, opioid consumption, patient satisfaction, and questions based on the Brief Pain Inventory.

Duloxetine was found to be better than placebo for reducing opioid use and was of equal efficacy to placebo for reducing pain. Duloxetine was also better than placebo for patient satisfaction and for the effect of pain on mood, walking, working, and sleeping.

"Duloxetine, given on the day of surgery and once daily for 14 days afterwards, reduces opioid use by about 30%. Patients receiving duloxetine are more satisfied with their pain management, and pain interferes less with their activities and mood," Dr. Ya Deau said.

HSS is committed to patient safety and being a leader in effective pain management. Its Controlled Substances Task Force continues to make strides in patient education and safe prescribing.

In addition to this study, HSS is ramping up further research on opioids with the help of a $3 million grant from the Starr Foundation. "Future research could examine optimum duration of therapy and determine whether duloxetine is also useful for other orthopedic procedures. We also need to try to understand barriers to adoption of duloxetine as a postoperative analgesic," Dr. Ya Deau concluded.

COLUMBIA, Mo. - When Ram Raghavan heard from a former colleague at the Centers for Disease Control and Prevention that a 7-year-old girl had died from Rocky Mountain spotted fever as the result of a tick bite, he thought of his own daughter, also 7 years old at the time, and the potentially fatal danger posed to vulnerable populations by tick-borne diseases.

Now a professor at the University of Missouri College of Veterinary Medicine and School of Health Professions, Raghavan is an epidemiologist studying how ticks, mosquitos and other arthropods spread disease that impact people, pets and livestock over time in various geographical regions.

In a recent study, the most comprehensive of its kind in the Midwest region of the United States, Raghavan and former graduate student Ali Hroobi collected and identified various species of ticks on the outskirts of Pittsburg, Kansas, twice a month for a 3-year period. They not only found a majority of the ticks to be most active in the humid spring and summer seasons, but their comprehensive documentation of what, when and where ticks are present help public health officials better understand the threat of tick-borne diseases to humans, companion animals and livestock.

"We have seen increases recently in both the number and severity of tick-borne diseases in the Midwest, particularly in the humid climates of Missouri, Kansas, Oklahoma and Arkansas," Raghavan said. "Since more people get infected by tick-borne diseases each year than any other vector-borne disease, it is important that we better understand what type of ticks are present in our region, where they are located and what time of year they are most prevalent. This information will help keep us, our families, pets and livestock safe."

Raghavan explained that several factors have contributed to the rise in tick-borne diseases. Humans are increasingly relocating from densely populated urban cities to more suburban areas on the outskirts of towns near forests and grasslands where ticks are often present. Outdoor fitness activities such as hiking, biking and walking have also become more popular, especially since the COVID-19 pandemic and particularly during the warmer spring and summer seasons in the Midwest.

Climate change has played a role as well, as the warmer temperatures and humidity seem to be creating perfect conditions for ticks and the pathogens they carry to thrive. Finally, a sharp increase in population of white-tailed deer, the primary animal host for the most common tick found in the Midwest, Amblyomma Americanum, is another contributing factor.

"This comprehensive research study helps us create a baseline understanding of the current situation from a public health perspective," Raghavan said. "These contributing factors will likely continue to play a role going forward, and now we have meaningful, relevant data to look back on for comparisons to see if certain trends continue in the future."

Raghavan added that because there are currently no vaccines for tick-borne diseases, prevention practices and tick awareness are the best ways to avoid tick bites.

"Wearing protective clothing such as long sleeve shirts and pants when walking outdoors or on hiking trails is highly recommended, and spraying permethrin insect repellent can help as well," Raghavan said. "Other common sense safety practices such as staying on the main trails away from vegetation and keeping dogs on leash can help protect you and your pets from ticks. Always check oneself and pets for any attached ticks after being outdoors. Also, visit with your doctor if you start to have any flu-like symptoms, as most tick-borne diseases are entirely curable, but early diagnosis is crucial."

The research can help inform future studies to better identify when and where specific pathogens amplify within various ticks, their effects on disease severity, and the impact of climate change and land use change on the prevalence of tick-borne diseases.

"It is important to remember health does not operate separately for humans compared to animals or the environment," Raghavan said. "This is a 'One Health' issue, and as humans, we are just a small part of an enormous ecosystem. The more we learn and understand the problems, the better we can protect ourselves against these preventable diseases."

DALLAS - May 12, 2021 - Scientists with UT Southwestern's Peter O'Donnell Jr. Brain Institute have identified the molecular mechanism that can cause weight gain for those using a common antipsychotic medication. The findings, published in the Journal of Experimental Medicine, suggest new ways to counteract the weight gain, including a drug recently approved to treat genetic obesity, according to the study, which involved collaborations with scientists at UT Dallas and the Korea Advanced Institute of Science and Technology.

"If this effect can be shown in clinical trials, it could give us a way to effectively treat patients for their neuropsychiatric conditions without this serious side effect," says lead author Chen Liu, Ph.D., assistant professor of internal medicine and neuroscience, and with UTSW's O'Donnell Brain Institute and Hypothalamic Research Center.

Up to 20 percent of people who take risperidone, an atypical antipsychotic prescribed for a wide variety of neuropsychiatric conditions, add more than 7 percent to their baseline weight within a few weeks of treatment, contributing to other health problems such as high blood cholesterol and type 2 diabetes. The weight gain leads many patients to stop using the medication.

In the study, Liu and his colleagues developed a diet for mice that incorporates the drug and identified changes in gene expression and neuronal activity within the animals' hypothalamus, a brain region long associated with appetite control. They quickly honed in on a gene called melanocortin 4 (Mc4r), which also is linked to obesity in humans. The Food and Drug Administration recently approved a drug that promotes Mc4r activity to treat some genetic forms of obesity, and Liu and his team showed that giving mice this drug along with risperidone prevented weight gain while maintaining effective treatment in models of schizophrenia - offering hope that this strategy might be effective for human patients as well.

A small drug molecule that appears to protect normal tissue from the damaging effects of radiation, may simultaneously be able to boost the cancer-killing effect of radiation therapy, according to a new study led by scientists at University of Iowa, University of Texas Southwestern Medical Center, and Galera Therapeutics, Inc.

The study, published online May 12 in Science Translational Medicine, suggests that the drug's dual effect is based on a fundamental difference between the ability of cancer cells and healthy cells to withstand the damaging effects of a highly reactive molecule called hydrogen peroxide, which is produced during the dismutation of superoxide.

The drug, known as Avasopasem manganese, is made by Galera Therapeutics. It acts like a natural enzyme called superoxide dismutase and converts superoxide into hydrogen peroxide. Based on its ability to "mop up" damaging superoxide molecules, which are produced by radiation treatment, the drug is currently in clinical trials to test its ability to protect mucosal tissue from the side-effect of radiotherapy.

Since radiation generates large amounts of superoxide, combining the drug with radiation therapy can generate high levels of hydrogen peroxide. This does not harm normal tissue because healthy cells have metabolic systems that remove hydrogen peroxide. In contrast, cancer cells, which are biologically abnormal, can be overwhelmed by high levels of hydrogen peroxide.

"Cancer cells and healthy cells respond very differently to the increased amount of hydrogen peroxide," says Douglas Spitz, PhD, UI professor of radiation oncology and co-lead author of the study. "Our study shows that Avasopasem manganese interacts synergistically with high doses of radiation to create hydrogen peroxide that selectively kill cancer cells but is relatively harmless to normal tissue."

The study showed that in mouse models of lung and pancreatic cancer the drug synergized with radiotherapy to such an extent that the treatment was able to destroy the tumors. The study also showed the greatest synergy occurred with high daily dose radiotherapy, similar to the doses delivered with Stereotactic Body Radiation Therapy (SBRT) currently used to treat some patients with cancer.

The researchers used several experiments to confirm that hydrogen peroxide was the key component in the synergistic effect. They showed the effect was blocked by adding in an enzyme that removes hydrogen peroxide and was enhanced when hydrogen peroxide breakdown was prevented.

"These findings are the result of collaborative efforts over several years by scientists primarily at Iowa, UT Southwestern Medical Center, and Galera, and are already being translated into several ongoing clinical studies," adds Spitz, who is a member of Holden Comprehensive Cancer Center at the UI. "One of those early phase trials recently reported that Avasopasem manganese in combination with high daily dose radiotherapy appears to nearly double overall survival in patients with pancreatic cancer compared to a placebo plus the same radiotherapy. Our study lays out the novel scientific basis for this potentially ground-breaking therapy for patients."

Laura Riesenberg was visiting a local amusement park with three of her children when she suffered a massive heart attack.

"I was down for about 20 minutes and they defibrillated me twice on site, possibly three times," she says. "Obviously, I was unaware of it. I know from reading the reports what happened."

"I was extremely fortunate that someone found me within seconds of collapsing," says Riesenberg. "Had it happened anywhere else I wouldn't be talking to you right now. If I had been in the basement doing laundry, I would have been in trouble."

The 51-year-old Loveland, Ohio, resident was transported to UC Health's West Chester Hospital where she learned she was a Type 2 diabetic and had suffered previous damage to the heart that led to a big blockage of her left coronary artery while at the amusement park. That type of blockage is often referred to as the "widow maker."

Donald Lynch Jr., MD, assistant professor at the University of Cincinnati College of Medicine and UC Health cardiologist, says that the link between diabetes and heart disease often leads to adverse health outcomes for patients. Approximately 65% of deaths among patients with diabetes are due to cardiovascular disease.

Lynch, also Riesenberg's current cardiologist, will be presenting preliminary research virtually at the American College of Cardiology on Saturday, May 15, that suggests plasma proteins discovered in the blood samples of diabetic patients who went on to develop obstructive coronary disease (OCAD) may serve as biomarkers of severe heart blockage. The findings might benefit patients like Riesenberg in the future.

Riesenberg says an internal defibrillator was implanted in her heart after her heart attack.

"There was no explanation why I survived the first heart attack or second heart attack. They also diagnosed me as diabetic that day. Mind you, I should have known. I had been a gestational diabetic, and I had been overweight, but I thought I was doing all the right things."

"I had lost a significant amount of weight, and I was active. I was eating well or at least I thought I was eating well. I had absolutely no idea," she adds. "I wish someone had been able to tell me that there was a strong link between diabetes and heart disease."

Riesenberg, a homemaker, and her husband, Jay, are both diabetic and they worry if their medical hereditary history might someday impact their family; in addition to the three children who joined their mom at the park the couple have another seven.

As part of his research Lynch, a researcher in the UC Division of Cardiovascular Health and Disease, looked at stored plasma samples from 70 diabetic patients: one group was found to have obstructive coronary disease while the second group did not. A total of 248 plasma proteins were identified; 15 were present in patients with obstructive coronary disease while only three were present in patients without OCAD.

"We took samples of plasma and used mass spectrometry to see if we could find biomarkers that were predictive of patients developing obstructive coronary disease," says Lynch. "The significance of this is I see patients who have diabetes and unfortunately develop blockages but no symptoms."

Lynch says Riesenberg was fortunate that she survived her heart attack and cardiac arrest. "For many patients that's not the case," he says. "We know patients with diabetes are much more likely to have blockages in the heart and unfortunately they are more likely to be asymptomatic which places them at significant risk. We don't have good tools to figure out which patients will develop blockages."

"What we found is that we can use a blood test and identify patients with diabetes who might develop obstructive coronary disease," says Lynch. "It is a challenge to identify which patients with diabetes are at higher risk. This may be a good tool in our toolbox to help us in our fight against cardiovascular disease in patients with diabetes."

"We can get them to a provider and have them assessed early for the possibility of developing obstructive coronary disease," says Lynch.

The research is particularly important to Lynch, who disclosed he also battles diabetes. He has planned future studies to further evaluate the ability of these biomarkers to identify patients with coronary disease and improve cardiac outcomes for patients with diabetes.

The preliminary research has definitely captured the interest of Riesenberg, who spoke with Lynch about his findings.

"It fascinates me that a simple blood test might be able to tell my children that this is on their horizon, and you don't have to be dependent on a cardiac device for the rest of your life," says Riesenberg.

In a study carried out in mice at the University of Chicago, researchers found that lasofoxifene outperformed fulvestrant, the current gold-standard drug, in reducing or preventing primary tumor growth. It also was more effective at preventing metastasis in the lung, liver, bone and brain, the four most common areas for this cancer to spread.

Additionally, while fulvestrant and similar drugs often cause unwanted, menopausal-like side effects, lasofoxifene prevents some of these symptoms. The research was published on May 13 in Breast Cancer Research.

"I think people should be very excited about this," said senior author Geoffrey Greene, MD, PhD, Chair of Ben May Department of Cancer Research at UChicago. "In addition to being more effective, this drug is better able to treat the whole person, including bone density and some vasomotor symptoms, such as vaginal atrophy."

About 75% of breast cancers are estrogen receptor positive, or ER-positive. This means that cancer cells have receptors that respond to the hormone estrogen and use it to feed the tumor and cause it to grow. Postmenopausal patients are often treated with drugs that suppress estrogen production, called aromatase inhibitors.

However, around 40% of patients eventually become resistant to this treatment. Importantly, some of these tumors develop mutations in the estrogen receptor that make it active all the time, which contributes to aromatase inhibitor resistance. When that happens, the patient is usually switched to an estrogen receptor antagonist such as fulvestrant. These drugs work by blocking the estrogen receptors that feed the cancer.

While effective, drugs like fulvestrant can cause side effects similar to menopause, including bone density loss, hot flashes and vaginal atrophy. "You get these undesirable side effects that really make people unhappy," Greene says.

Originally developed to prevent osteoporosis, lasofoxifene is a selective estrogen receptor modulator, a type of drug found to have both estrogenic and antiestrogen effects in different tissues, which are mediated by estrogen receptors. Previous observational studies had found that in addition to preventing bone loss, it was also effective at preventing breast cancer, reducing the incidence of ER-positive breast cancer by around 80%, compared to other drugs.

"It has a good safety profile, maintains bone density, prevents vaginal dryness and doesn't stimulate the uterus," Greene says.

But while it was clear that lasofoxifene could help prevent breast cancer, it was not yet known whether it also had tumor-fighting properties.

For the new study, UChicago researchers worked with mice that had ER-positive breast cancer tumors with activating ER mutations. They treated some of the mice with lasofoxifene, and some with fulvestrant. They also tested both drugs in combination with palbociclib, a common chemotherapy drug that works by preventing cancer cells from multiplying.

They found that lasofoxifene was more effective than fulvestrant at preventing tumor growth and reducing metastases when used on its own. Adding palbociclib improved the effectiveness of both drugs, but once again, the lasofoxifene/palbociclib combination was more effective.

"This study demonstrated that lasofoxifene seems to be superior, both alone, as well as in combination, compared to fulvestrant," Greene says.

In addition to having fewer side effects, lasofoxifene offers several other noteworthy benefits. Unlike fulvestrant, which has to be injected, lasofoxifene can be taken orally. It also has a long half-life, which means it lingers in the body for a long time.

"What you want is that every time a new estrogen receptor is synthesized, especially if it has a mutation, that there's a drug there to block it," Greene explains. "One of the advantages of lasofoxifene is that it's more likely to be there to do its job."

A phase 2 clinical trial is now underway at UChicago Medicine to study lasofoxifene as a second-line treatment in postmenopausal women with ER positive metastatic breast cancers that have ER mutations. A separate clinical trial, now enrolling patients, will study lasofoxifene in combination with abemaciclib, a chemotherapy drug similar to palbociclib.

"Most women with ER-positive metastatic breast cancer right now are treated with fulvestrant, and based on our study, I don't think it's the best drug for this purpose," says Muriel Laine, PhD, a Research Associate in the Ben May Department for Cancer Research at UChicago, and lead author on the study. "Lasofoxifene definitely appears to be more promising for these women."

Parks played an important role for people seeking respite from the toll of social isolation during the pandemic, and according to new research from Drexel University, they did so without increasing the spread of COVID-19. The study looked at how people used 22 parks in Philadelphia and New York during the height of the pandemic and it found no strong correlation between park use and the number of confirmed cases in surrounding neighborhoods.

Published in the Journal of Extreme Events, Drexel's study "Urban Park Usage During the COVID-19 Pandemic" surveyed park visitors over a three-month period from May to July 2020 at small and mid-size parks in New York and Philadelphia. And it compared park usage numbers to rates of COVID-19 transmission in the areas directly surrounding the parks.

"Despite early speculation that parks could become gathering points for large groups of people and contribute to transmission of COVID-19, our research did not find a strong correlation between COVID-19 cases in neighborhoods near parks and the number of people using them," said Franco Montalto, PhD, a professor in Drexel's College of Engineering who led the research team.

In the early months of the pandemic last spring, public health guidance recommended avoiding gathering in large groups outside. As a result, many municipalities closed public playgrounds with high-touch areas, like swings and sliding boards, out of an abundance of caution. But most public parks remained open and, according to the study, those in Philadelphia and New York continued to be used throughout the pandemic.

The researchers selected 22 small, urban parks, 15 in Philadelphia and seven in New York City, located in or near neighborhoods representing a variety of levels of relative population density and vulnerability, according to Census data and the CDC's Social Vulnerability Index -- a tool that uses Census data to identify communities that could need support during natural disasters and crisis situations. This allowed the team to account for these factors when examining the possibility of a link between park use and COVID-19 transmission.

What it found is that, regardless of city or social vulnerability of the adjacent neighborhoods, in areas that were more densely populated, parks tended to see more use. But this increased usage did not equate to higher transmission of COVID-19 -- which was more closely associated with the vulnerability of the neighborhoods, according to the study.

"Though a more extensive epidemiological study is required, this research provided no evidence that park usage contributed to COVID-19 spread," they wrote. "The number of park visitors increased with density in Philadelphia, as did the number of confirmed COVID-19 cases.

Citizen scientists assigned to each park observed how much and in what ways they were used and whether or not visitors were engaging in activities deemed to be "high-risk" for transmitting COVID-19, such as playing contact sports, not wearing a mask, or coughing without covering.

Overall, only a small percentage of park users -- 22.7% in Philadelphia and 1.2%, in New York -- never wore masks, according to the study. The majority of park users that were observed did not engage in high-risk behaviors -- only 0.7% in Philadelphia and 0.9% in New York were observed frequently coughing or spitting without covering their mouths. And just 1.6% and 12.9% of people were observed frequently participating in contact sports in Philadelphia and New York City, respectively.

"While the municipalities that did close parks during the pandemic likely did so out of an abundance of caution, our work shows no evidence to support closing the parks during the pandemic," Montalto said. "That people continued to visit parks during lockdowns and the early stages of the pandemic underscores the evident value of parks as a respite for urban residents during the early phases of the pandemic."

Philadelphia, May 12, 2021 - The COVID-19 pandemic has resulted in an abrupt change in healthcare delivery, including a shift from in-person visits to telemedicine. However, a Canadian survey found that a significant proportion of cardiology trainees are uncomfortable with using telemedicine and feel that better preparation for new-tech medicine is needed. Experts draw attention to the need for a telemedicine curriculum that includes supervision to prepare trainees for the expanding role of telemedicine in cardiovascular care. Survey results are published in the Canadian Journal of Cardiology.

"Our outpatient care shifted almost overnight from in-person visits to providing care to patients via telephone or video platforms (known as telemedicine) as a result of COVID-19," explained principal investigator Parvathy Nair, MD, FRCPC, Division of Cardiology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada. "It was clear that training had to adapt to this change."

Virtual visits are fundamentally different from face-to-face encounters. They require providers to employ key communication skills such as effective web-side manners, agenda setting, reflective listening, virtual physical examination skills, and understanding the medicolegal boundaries of virtual healthcare. Of equal importance is recognizing situations in which virtual visits should not replace face-to-face encounters, for example in acutely ill patients requiring full physical examination.

In December 2020, the investigators distributed a self-administered survey of 22 questions in four categories (background, exposure to telemedicine before COVID-19, current telemedicine experience, and perceived barriers to telemedicine). A total of 86 cardiology trainees from 12 programs in Canada completed the survey, a response rate of 65 percent.

Before COVID-19, 39 trainees (45 percent) reported having been exposed to telemedicine. This increased to 67 trainees (78 percent) after COVID-19. Junior trainees had less exposure to telemedicine compared with senior trainees: 16 out of 25 (64 percent) versus 51 out of 61 (84 percent), respectively. When engaged in telemedicine, only four of the 67 trainees reported full supervision with an attending physician overseeing the entire virtual visit, while 13 reported partial supervision and 50 had minimal or no supervision.

"We found that only 51 percent of the trainees were comfortable or very comfortable with providing outpatient care via telemedicine," noted Dr. Nair. "We attributed this to the lack of dedicated telemedicine training. Additionally, our finding that three-quarters of trainees had minimal or no supervision when carrying out virtual visits suggested that lack of staff oversight may contribute to this lack of trainee comfort. Trainees with higher telemedicine exposure were more likely to feel comfortable with its practice and intend to adopt it in their future careers."

The reasons given by trainees as barriers to telemedicine practice included fear of weakening the patient-physician relationship; concerns about ease of use by patients; and unfamiliarity with telemedicine technology. Not surprisingly, the majority of trainees (78 percent) believed training in telemedicine was needed. In particular, trainees expressed the need to learn more about the medicolegal aspects of telemedicine, how to conduct virtual clinical assessment, and how to document their patients' visits.

A recent survey published by the Canadian Medical Association reported that four of every 10 Canadians would prefer to have their medical care provided via telemedicine even after the COVID-19 pandemic is resolved. As telemedicine technology continues to evolve and provincial authorities increase their support, more and more Canadians are expected to prefer virtual options for their healthcare needs.

According to Dr. Nair, "The findings that only one in two trainees is comfortable with telemedicine and one in four do not plan to provide telemedicine services in the future are therefore concerning." To address this educational gap, Dr. Nair and Dr. Aws Almufleh, the lead investigators, are now developing a telemedicine curriculum to better prepare cardiology trainees to take part in providing evidence-based, high quality virtual outpatient care.

"The pandemic has magnified the need for accessible virtual outpatient care in medicine. As educators, it is incumbent upon us to train the future generation of cardiology specialists to provide the highest quality virtual care services for all patients who need them. We are optimistic that by collaborating with educators from around the country, we can accomplish this goal," commented Dr. Nair.

Two-thirds of California prisoners who were offered a COVID-19 vaccine accepted at least one dose, according to a new study by researchers at the Stanford University School of Medicine.

"We found that many incarcerated people in California prisons were willing to be vaccinated for COVID-19," said Elizabeth Chin, the lead author of the study and a PhD candidate in biomedical data science. "This is an encouraging sign for other states at an early stage of rolling out vaccination programs in their prisons and jails."

The researchers also found that nearly half of those who initially turned down a COVID-19 vaccine accepted it when it was offered to them again. The finding is an important indication that vaccine hesitancy is not necessarily fixed.

Two-thirds of 97,779 incarcerated residents in the state's 35 prisons were offered vaccines and 66.5% of offerees accepted at least one dose, the researchers found, although uptake varied across different groups.

Acceptance was highest among Hispanic (72.6%) and white incarcerated people (72.1%); slightly lower among American Indian or Alaska Native and Asian or Pacific Islanders (67.7%); and substantially lower among Black incarcerated people (54.9%). Vaccine acceptance levels did not differ according to whether those offered had previously been infected with the coronavirus.

The study, conducted by members of the Stanford-CIDE Coronavirus Modeling Team based at Stanford Health Policy, was published May 12 in the New England Journal of Medicine.

"Prisons and jails are high-risk settings for COVID-19, with case and mortality rates far exceeding those in the general community," said Chin. "Achieving and maintaining sufficient population-level immunity to avoid large outbreaks will be challenging in carceral settings. High and equitable uptake of vaccination is crucial. Attaining it may depend on successful efforts to build trust and vaccine confidence, and regular re-offers to decliners."

Using data from the California Department of Corrections and Rehabilitation, the researchers tracked the vaccine rollout at California's 35 prisons, which incarcerate roughly 100,000 people. From Dec. 22, 2020, when vaccinations began, through March 4, 2021, two-thirds of the residents had received offers of the Pfizer or Moderna vaccines, and two-thirds of those who received offers accepted them.

Younger and healthier residents were less likely to accept vaccines than older and medically vulnerable residents, respectively. Black residents also had lower rates of acceptance than residents of other racial or ethnic groups.

"The disparities in acceptance, particularly along racial lines, are cause for concern," said David Studdert, LLB, ScD, MPH, a professor of medicine at Stanford Health Policy and of law at Stanford Law School. Studdert is the study's senior author. "But there is encouraging news here too. Nearly 80% of the most vulnerable residents accepted, which is close to what we have seen in nursing homes. And the surprisingly high rate of acceptance among people who initially passed on receiving the shot suggests re-offers should be a key component of these programs."

Jeremy Goldhaber-Fiebert, an associate professor of medicine and a study co-author, noted, "This is one of the largest state prison systems in the country, and if it can achieve high vaccination coverage among its incarcerated population, then the federal and other state prisons systems can and should do the same for the more than 2 million people that they currently incarcerate."

The quest to create safer, more successful pregnancies is one of the top goals of modern science. While pregnancy is better understood today than ever before, with improvements in technology helping to lower the risk of negative outcomes, there is much researchers still don't know about a vital part of the pregnancy process: uterine fluid.

Secreted by glands in the uterus during pregnancy, uterine fluid is believed to play an important role in supporting a developing embryo by sending information from the uterus to the embryo, along with a host of other speculated functions. But studying this fluid in women presents myriad dilemmas, given that studies might require invasive monitoring or experimentation during an active pregnancy.

Now, in a new study published in the Proceedings of the National Academy of Sciences (PNAS), researchers at the University of Missouri have found a way to study uterine fluid in the lab, thereby avoiding invasive procedures during pregnancy, while at the same time developing a potential model for using precision medicine to improve pregnancy outcomes.

"Using stem cell-derived organoids, we were able to isolate an analogue to uterine fluid in the lab," said Constantine Simintiras, a postdoctoral research fellow in the College of Agriculture, Food and Natural Resources Division of Animal Sciences. "For such an understudied element of human pregnancy, being able to grow and study this fluid in the lab makes it much easier to advance our understanding of this important function of the uterus."

Working in National Academy of Sciences member Thomas Spencer's lab, Simintiras and his colleagues used "organoids" -- simplified versions of the tissue that forms the lining of the uterus, grown from stem cells -- as the source for a fluid that closely resembles uterine fluid. Inside the body, uterine glands secrete this fluid to support sperm migration and the early development of embryos.

Using organoids as a model not only sidesteps potential issues with extracting samples during pregnancy, but it also paves the way for a precision medicine approach to maintaining a healthy pregnancy. The hope is that by obtaining stem cells from expectant mothers, even before they conceive, researchers could study the composition of their uterine fluid to determine if any issues are present. For example, a deficit in NAD+ -- a "coenzyme" considered crucial for metabolism -- has been linked to birth defects and miscarriage.

"We know the composition of uterine fluid is extremely important, so we need to understand how that composition is regulated," Simintiras said. "In women it is likely influenced by hormones, but are there other factors at play? This model for lab study gives us a means to tackle such questions, and in the future, this could help us detect and correct problems with uterine fluid before they lead to complications."

A portable, rapid testing platform can detect gonorrhea infections in patient samples in under 15 minutes, far faster than standard-of-care tests that can take hours or days. The platform accurately detected infections and determined resistance to a common antibiotic in 217 patient samples from sexual health clinics in Baltimore and Uganda. The technology's speed and low cost could empower quicker and more affordable gonorrhea testing in low-resource regions, as well as help combat the spread of drug-resistant strains. Rates of gonorrhea and other sexually transmitted infections (STIs) have soared worldwide, and an estimated 1 million people now acquire an STI every day globally. Clinicians are especially concerned about gonorrhea, as Neisseria gonorrhoeae bacteria are rapidly becoming resistant to standard antibiotics. Furthermore, current tests for gonorrhea are expensive and take hours to complete, making it harder for patients to receive a timely diagnosis and appropriate antibiotics. There is therefore an urgent need for faster and cheaper testing, especially in low-income countries that lack testing capabilities and face a high burden of drug-resistant infections. Alexander Trick and colleagues present their PROMPT platform, a cartridge-based PCR testing device that both detects N. gonorrhoeae and analyzes the bacteria's resistance to the antibiotic ciprofloxacin. When applied to 66 penile swab samples from Baltimore, MD and 151 swab samples from Kampala, Uganda, PROMPT detected infections in under 15 minutes with a sensitivity and specificity of 97.7% and 97.6%, respectively. Trick et al. note their study has limitations, as more work is needed to test the platform with vaginal and urine samples and to improve the cartridge system. "Nonetheless, [these] advances ... show promise for delivering rapid, gold standard infectious disease diagnostics in a scalable and accessible format ..." the authors conclude.