Culture

DALLAS, Nov. 17, 2020 -- A new American Heart Association collaborative model for COVID-19 research, using data from the new AHA COVID-19 Cardiovascular Disease Registry, found Hispanic and Black adults with COVID-19 were far more likely to be hospitalized than their white counterparts, as were people with obesity and COVID-19, according to three late-breaking research studies presented today at the American Heart Association's Scientific Sessions 2020. The virtual meeting is 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.

The AHA COVID-19 Cardiovascular Disease Registry: Design, Implementation, and Initial Results

This abstract details the structure, implementation and initial results of the new American Heart Association COVID-19 Cardiovascular Disease Registry. Identifying a need to rapidly collect and provide insights into patients hospitalized with the novel coronavirus, volunteer leaders and staff of the American Heart Association created the registry within weeks of the declaration of the global pandemic. Hospitals began uploading patient records into the registry before the end of April. As of September 9, 2020, health data for more than 17,000 patients from 101 U.S. health care centers in 33 states have been saved in the registry.

More than 200 data points are collected on each patient record submitted to the registry, including patient demographics, cardiovascular risk factors and other comorbidities, medications prior to admission and treatments received during hospitalization including emerging COVID-19 therapies. In addition, disease severity measures, such as the need for intensive care unit management, mechanical ventilation or mechanical circulatory support, are being captured. Extensive serial laboratory data (information from blood tests, nasal swabs, saliva samples or other tests) are also being collected, including cardiovascular and inflammatory biomarkers, as well as results of cardiovascular testing performed during hospitalization.

The COVID-19 CVD Registry is powered by the American Heart Association's Get With The Guidelines® program and pools de-identified health data about patients treated for COVID-19 at hospitals across the country. The data is available for research and analysis through the Association's cloud-based Precision-Medicine Platform. The Precision Medicine Platform allows multiple teams of investigators to pursue different questions using the registry's data simultaneously, which expands research capacity, reduces costs and shortens the time to discovery and sharing of new information.

"We call it 'burst science,'" said James A. de Lemos, M.D., an author of all three studies and co-chair of Association's COVID-19 CVD Registry Steering Committee. "With this robust library of data on patients hospitalized and treated for COVID-19 here in the U.S., we can conduct many more analyses and research projects in a much shorter period of time."

"The registry is allowing quick collection, analysis and distribution of important information during this pandemic," said de Lemos, who is a professor of medicine and the Sweetheart Ball-Kern Wildenthal, M.D., Ph.D., distinguished chair in cardiology at the University of Texas Southwestern Medical Center in Dallas. "And these collaborative efforts have implications for accelerating and sharing research beyond the current COVID-19 pandemic."

de Lemos noted that "the rates of heart attack, heart failure and stroke in patients with COVID-19 were lower than we had expected," based on preliminary reports from smaller studies.

Co-authors are David Morrow, M.D., M.P.H.; Tracy Wang, M.D., M.H.S., M.Sc.; Fatima Rodriguez, M.D., M.P.H.; Heather Alger, Ph.D.; Christine Rutan, B.A.; Steven Bradley, M.D., M.P.H.; Mitchell S. V. Elkind, M.D. M.S.; and Sandeep Das, M.D., M.P.H. Author disclosures are in the abstract.

Racial and Ethnic Differences in Treatment and Outcomes for Patients Hospitalized with COVID-19: Findings from the American Heart Association COVID-19 Cardiovascular Disease Registry

Researchers reviewed the data from about 8,000 patients with COVID-19 treated at 88 hospitals across the U.S. between Jan. 17-July 22, 2020. They found significant racial and/or ethnic differences:

Among hospitalized COVID-19 patients in the registry, 33.0% were Hispanic, 25.5% were non-Hispanic Black, 6.3% were Asian and 35.2% were non-Hispanic white.

On average, Hispanic patients were 12 years younger, and Black patients were nine years younger than white patients.

Hispanic patients were more likely to not have health insurance.

Black patients had higher rates of obesity, high blood pressure, diabetes and prior cerebrovascular disease.

Black patients also were more likely to require a ventilator or kidney dialysis.

Asian patients had the longest duration from symptom onset to hospital admission - an average of seven days, compared with five days among the other three population groups.

"The results highlight the disproportionate burden of COVID-19 especially among Black and Hispanic communities and imply there are factors in the U.S. that existed prior to a coronavirus diagnosis that are driving these disparities," said the study's lead author Fatima Rodriguez, M.D., M.P.H., an assistant professor in cardiovascular medicine at Stanford University Medical Center in Palo Alto, California.

The manuscript of this study is simultaneously published today in Circulation, the flagship journal of the American Heart Association.

Co-authors are Nicole Solomon, Ph.D.; Sandeep Das, M.D., M.P.H.; David Morrow, M.D., M.P.H.; Steven Bradley, M.D., M.P.H.; Mitchell S. V. Elkind, M.D., M.S.; Joseph Williams, B.S.; DaJuanicia Simon, M.S.; Roland Matsouaka, Ph.D.; Divya Gupta, M.D.; Ty Gluckman, M.D.; Marwah Abdalla, M.D., M.P.H.; Michelle A. Albert, M.D., M.P.H.; Clyde W. Yancy, M.D., M.Sc.; and Tracy Y. Wang, M.D., M.H.S., M.Sc. Author disclosures are in the abstract.

Association of Body Mass Index with Death, Mechanical Ventilation, and Cardiovascular Outcomes in COVID-19: Findings from the AHA COVID-19 Cardiovascular Disease Registry Analysis of data for about 8,000 patients in the registry found obesity in patients with COVID-19 is associated with a higher risk of blood clots and death, as well as a greater need for a ventilator.

Almost half (44%) of the patients were obese or severely obese. Rates of obesity, and particularly severe obesity (for this study, a Body Mass Index (BMI) >40 kg/m2 was the criteria for obesity) were much higher among patients in the COVID-19 registry than in a general population sample of U.S adults. The researchers noted this indicates that obesity is an important risk factor for needing hospitalization with COVID-19.

Compared with their peers who did not have obesity, severely obese patients were, on average, nearly 18 years younger and more likely to be Black. They also had about a 30% higher relative risk of in-hospital death.

Researchers also noted the relative risks of death and assisted breathing treatment (a mechanical ventilator) were highest among patients younger than age 50. This indicates that patients with severe obesity who were younger were not protected against the most critical complications of COVID-19.

"Overall, the new American Heart Association COVID-19 Cardiovascular Disease Registry illustrates COVID-19 prevention strategies are needed to specifically target Black and Hispanic communities, as well people with obesity, in order to reduce the risks of hospitalization and death," de Lemos said. "These groups should receive priority when a coronavirus vaccine becomes available."

A new study from researchers at the University of Chicago has found that neuronal population dynamics in the motor cortex are very different during reaching and grasping behavior, challenging a popular theory that indicated intrinsic, dynamic patterns control motor behaviors.

Prior research examining neural population dynamics in the motor cortex of macaque monkeys had shown that during the planning and execution of a reaching movement with the arm, populations of neurons exhibited rotational dynamics -- cascades of smooth and orderly waves of neuronal activity that pass through the motor cortex.

This population-level behavior has been interpreted as showing that the motor cortex acts as a pattern generator that drives muscles to give rise to movements.

"In the previous work on reaching, my colleagues and I showed that brain areas that control movement act like a little machine for generating muscle commands," said co-author Matthew Kaufman, PhD, an assistant professor of organismal biology and anatomy at UChicago. "That is, the activity followed mathematical "rules" that let it act like a music box, to get each muscle's commands timed correctly relative to the others."

Researchers suggested that these activity patterns represent a general principle of neuronal activity within the motor cortex, and that these elegant dynamics are a property of the neural circuits.

"The activity pattern is a bit like a domino effect," explained senior author Sliman Bensmaia, PhD, the James and Karen Frank Family Professor of Organismal Biology and Anatomy at UChicago. "The idea is that as the behavior starts, it's like knocking over that first domino, and then all the rest will fall in order. If you set it back up, it'll do the same sequence again."

However, this new research, looking instead at hand-grasping behavior rather than arm-reaching behavior, did not see such a neat pattern. The study, published Nov. 17 in E-Life, examined neural activity in the motor cortex.

"We wanted to know whether the same type of neural dynamics was present during hand movements, which involve a very different effector, producing very different movements," said co-first author Aneesha Suresh, PhD, a former graduate student in the Bensmaia lab. "We recorded neural activity in the motor cortex of monkeys as they performed a reach task and a grasp task to compare the dynamics of the two motions."

In contrast to past results, the investigators found that grasping behaviors instead produced less orderly neuronal activity patterns at the population level and little evidence of the rotational dynamics seen with reaching motions.

"We expected neurons in this network to be activated in orderly, predictable sequences, like the ones thought to drive the arm as it reaches toward a target," said co-first author James Goodman, PhD, now a postdoctoral scientist at the German Primate Center. "Instead, the patterns of activity we saw during grasping were far more complex and chaotic, in some respects suggesting an especially important role for the senses of touch and proprioception during hand movements."

These results make sense in the context of the differences between reaching movements and grasping movements. "Conceptually, the jobs that the arm and the hand do are different," said co-author Nicholas Hatsopoulos, PhD, a professor of organismal biology and anatomy and neurology at UChicago. "The arm moves the hand and brings the hand to different locations for actions like waving or reaching for a cup. The hand, on the other hand, is usually involved in manipulating objects such as grasping things, typing on a keyboard, and so on."

This study raises new questions, such as why this elegant activity pattern exists for reaching movements but not for grasping, and whether similar patterns exist for other types of movement patterns. "The brain uses this kind of pattern for reach, and the implication was that the brain would use it for other movements, too, and that maybe the pattern applies even in other systems," said Bensmaia. "But we've shown that this pattern doesn't generalize everywhere, and then the question is, how general is it, really?"

Hershey, Pa. -- Cannabidiol (CBD) oils are equally or less effective at inhibiting the growth of certain cancer cells compared to pure CBD, according to Penn State College of Medicine researchers. The results of their recent study indicate that future research into the clinical applications of cannabinoids should include an analysis of whether the pure cannabinoid compound or intact plant material is more effective at achieving the therapeutic effect.

The researchers evaluated whether CBD oils were better than pure CBD at inhibiting the growth of different cancer cell lines. They studied brain, skin and colorectal cancers -- using two cell lines for each cancer type -- and found that pure CBD was able to reduce cell viability in three of the six cell lines tested and that the effect was cell line specific and not specific to select cancers. None of the CBD oils tested were able to reduce viability to a greater extent than pure CBD.

Prior research found that CBD or tetrahydrocannabinol (THC) can reduce cancer cell viability in some cancer cell models. Proponents of medical marijuana argue that there is an additive effect between the various compounds in the plant material that increases its therapeutic efficacy compared to individual, pure cannabinoid compounds. Kent Vrana, professor and chair of the Department of Pharmacology, said the study did not support this concept, known as the "entourage" effect.

"Based on our results, we recommend that specific investigations on the entourage effect be carried out when determining the therapeutic uses of medical marijuana and other cannabinoid products," Vrana said.

Wesley Raup-Konsavage, co-author of the study published in the journal Medical Cannabis and Cannabinoids, said the study was carefully designed so that the amounts of CBD oil used for testing had an equivalent amount of CBD as the pure CBD in the experiments. The researchers obtained three types of CBD oil with certificates of analysis and had their composition verified by a third party laboratory. Equal concentrations of CBD were used to treat the six cell lines.

After evaluating the viability of the treated cell lines, researchers determined that the CBD had an effect on one of each of the colorectal cancer, melanoma and glioblastoma cell lines tested. The viability of the other cell lines tested was not significantly reduced.

Because a previous study evaluating the use of THC for treating breast cancer cells suggested that there is an entourage effect in that context, Vrana cautioned that careful testing of cannabinoids should be done for each proposed therapeutic context.

"Pure CBD had the ability to reduce certain cancer cell types' viability in this study," Vrana said. "It would be reckless for a consumer to assume that a CBD oil product off the shelf could have the same effects for them, which is why careful studies around the entourage effect are needed for each intended therapeutic application."

Vrana said that even if there were cases where the entourage effect were proven for therapeutic uses, cannabinoid products are unregulated and consumers would not be able to know in many cases whether an off-the-shelf or off-the-street product had the right components to result in the desired therapeutic outcome.

"The variability in composition and activities of botanical extracts highlights difficulties in assessing their therapeutic potential compared to pure chemical compounds," Vrana said. Raup-Konsavage and Vrana plan to continue investigating the "entourage" effect of cannabinoids in other therapeutic applications.

Learning a language later in life changes how the two halves of the brain contribute. As skills improve, language comprehension changes hemisphere specialization, but production does not, according to new research published in JNeurosci.

The two sides of the brain don't evenly split labor for every function. In most people, language relies on the left hemisphere, but the right hemisphere can take over after an injury to the left. The right hemisphere can also contribute when learning a new language, making it unclear if the left hemisphere is actually specialized for language.

Gurunandan et al. used fMRI to compare neural activity between hemispheres in adult language learners while reading, listening, and speaking in their native and new languages. In the earlier stages of language learning, native and new languages looked quite similar in the brain, but in advanced learners, the two languages were more distinct. The native and new languages were able to recruit opposite hemispheres for comprehension but speaking either language remained reliant on the left hemisphere. These results suggest production is hard-wired to the left hemisphere, while comprehension is more flexible. This may explain why it is more difficult to learn to speak a new language as an adult, even though it is possible to learn to understand it quite well.

Many diseases, such as COVID-19, have made the jump from animals to people with serious consequences for the human host. An international research team, including researchers from the University of Göttingen, says that more epidemics resulting from animal hosts are inevitable unless urgent action is taken. In order to protect against future pandemics which might be even more serious, they call for governments to establish effective legislation addressing wildlife trade, protection of habitats and reduction of interaction between people, wildlife and livestock. Their review was published in Trends in Ecology & Evolution.

An infectious disease caused by a pathogen - such as a bacterium, virus or parasite - that has jumped from an animal to a human is known as "zoonosis". In the last thirty years, the majority of human pathogens which have caused substantial damage to human health and economies have originated from wildlife or livestock. Such diseases include Ebola, AIDS and SARS. COVID-19 is among the latest of these zoonotic diseases and is currently a pandemic that has resulted in more than a million deaths worldwide.

Two primary factors that facilitate such outbreaks are wildlife trade and fragmentation of natural habitat, both of which increase the frequency and potential for direct contact between humans and wildlife. Animals in wildlife markets are often housed in overcrowded and unsanitary conditions that create the perfect environment for pathogens to jump to humans. In addition, natural habitats are being cleared to meet the growing demands of an increasing human population, which puts livestock and people in closer contact with the wild hosts of potential zoonotic pathogens. Addressing these two factors could help prevent future zoonotic diseases.

Recognising that COVID-19 may have emerged from wildlife markets, the governments of China, Vietnam and Korea have all introduced some form of regulation to control wildlife trade since the outbreak, each of which goes some way to supporting wildlife conservation. These actions provide examples for other countries to consider. The authors, however, advise against a sudden blanket ban on wildlife markets as this will have a disproportionately high negative impact on disadvantaged, migrant and rural populations that depend on such markets for their subsistence. Rather, a range of measures should be considered, including governments working with local communities to create and maintain alternative means of subsistence before appropriate bans - specifically on live animals and non-food wildlife products - are considered.

"The coronavirus pandemic has inevitably focussed our energy on managing the disease. But in order to prevent the next outbreak - whatever form that might take - there needs to be recognition that people's relationship with the natural world must change," explains co-author Dr Trishna Dutta, University of Göttingen, Department of Wildlife Sciences. She goes on to say, "There needs to be urgent action to regulate the trade of wildlife and reduce consumer demand for wildlife parts and products. This should be done in tandem with protecting native ecosystems and reducing the wildlife-livestock-human interface which originally sparked this pandemic."

CHAMPAIGN, Ill. -- March through May saw a significant increase in deaths over previous years - and not just from COVID-19, says a new study from the University of Illinois at Urbana-Champaign.

When deaths attributed to COVID-19 were removed from the Centers for Disease Control and Prevention totals, the death rate in several demographics outpaced the same period in 2019, the study found. The timeframe represents the first three months of response to the COVID-19 pandemic in the United States.

Sheldon H. Jacobson, a professor of computer science and of the Carle Illinois College of Medicine, and Janet Jokela, the head of the department of internal medicine and acting regional dean of the University of Illinois College of Medicine at Urbana, published their findings in the journal Public Health.

"We know that the pandemic is selectively taking lives. It also seems to be causing ancillary deaths that are not directly caused by COVID-19, but are a consequence of the fact that we have COVID-19 in our society, in our health care system, in our jobs, in our lives. We're trying to capture those effects as data," Jacobson said.

The researchers used publicly available data from the CDC that are sorted by age and gender. Full numbers for 2019 are not yet publicly available, so the researchers calculated 2019 death estimates using 2018 CDC data and 2019 population estimates from the Census Bureau. They then compared those numbers with the CDC's provisional non-COVID-19 death numbers for 2020.

Even though the researchers chose a more stringent measure of statistical significance than commonly used in such analyses, they found a significant increase in excess deaths in 2020 for men between 15 and 59 years of age, and for women between 25 and 44.

"Although we don't know why, deaths increased to a greater degree than expected. As someone who has spent their career in medicine and public health, this concerns me," Jokela said. "The concern is that excess deaths will continue to occur during the pandemic, whether it's because people are delaying care for other conditions or because some COVID-19 deaths are going undetected. This is a phenomenon that requires ongoing monitoring and investigation."

There was, however, one demographic that saw a decrease in deaths - females between the ages of 5 and 14.

"The only explanation we can come up with is that if you look at the deaths that occur in that age group, the preponderance of them are accidents. Thus, the shutdowns in much of the country appear to have had a protective effect on young girls," Jacobson said.

Jacobson and Jokela continue to monitor the data as the CDC updates it. They plan to perform a six-month analysis for March through August, and eventually the whole year. They also urge public health officials to make data available and study non-COVID-19 causes of death to gain insights into the factors leading to excess deaths in each demographic.

"Is it because people are neglecting routine medical exams? Are they delaying treatment for other conditions, such as cancer or heart disease? Are mental health issues going unaddressed? Information about the causes of death in different age groups would be very useful, because then we can look at the appropriate countermeasures to reduce preventable deaths," Jacobson said.

Editor's note:

To contact Sheldon H. Jacobson, call 217-244-7275; email shj@illinois.edu.

To contact Janet Jokela, call 217-244-5955; email: jokela@illinois.edu.

The paper "Non-Covid-19 excess deaths by age and gender in the United States during the first three months of the Covid-19 pandemic" is available online.

UCLA researchers using a model of airway tissue created from human stem cells have pinpointed how smoking cigarettes causes more severe infection by SARS-CoV-2, the virus that causes COVID-19, in the airways of the lungs.

The study, led by scientists at the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research at UCLA and published in Cell Stem Cell, will help researchers better understand COVID-19 risks for smokers and could inform the development of new therapeutic strategies to help reduce smokers' chances of developing severe disease.

Cigarette smoking is one of the most common causes of lung diseases, including lung cancer and chronic obstructive pulmonary disease, and most demographic studies of COVID-19 patients have indicated that current smokers are at increased risk of severe infection and death. But the reasons why have not been entirely clear.

To help understand how smoking affects SARS-CoV-2 infection on a cellular and molecular level, Dr. Brigitte Gomperts partnered with co-senior authors Vaithilingaraja Arumugaswami, an associate professor of molecular and medical pharmacology, and Kathrin Plath, a professor of biological chemistry, to recreate what happens when the airways of a current smoker are infected with SARS-CoV-2.

The team utilized a platform known as an air-liquid interface culture, which is grown from human airway stem cells and closely replicates how the airways behave and function in humans. The airways, which carry air breathed in from the nose and mouth to the lungs, are the body's first line of defense against airborne pathogens like viruses, bacteria and smoke.

"Our model replicates the upper part of the airways, which is the first place the virus hits," said Gomperts, a professor pulmonary medicine and member of the UCLA Jonsson Comprehensive Cancer Center. "This is the part that produces mucus to trap viruses, bacteria and toxins and contains cells with finger-like projections that beat that mucus up and out of the body."

The air-liquid interface cultures used in the study were grown from airway stem cells taken from the lungs of five young, healthy, nonsmoking tissue donors. To replicate the effects of smoking, the researchers exposed these airway cultures to cigarette smoke for three minutes per day over four days.

"This type of model has been used to study lung diseases for over a decade and has been shown to mimic the changes in the airway that you would see in a person who currently smokes," said Gomperts, who is also vice chair of research in pediatric hematology-oncology at the UCLA Children's Discovery and Innovation Institute.

Next, the group infected the cultures exposed to cigarette smoke -- along with identical cultures that had not been exposed -- with live SARS-CoV-2 virus and the two groups were compared. In the models exposed to smoke, the researchers saw between two and three times more infected cells.

Digging further, the researchers determined that smoking resulted in more severe SARS-CoV-2 infection, at least in part, by blocking the activity of immune system messenger proteins called interferons. Interferons play a critical role in the body's early immune response by triggering infected cells to produce proteins to attack the virus, summoning additional support from the immune system, and alerting uninfected cells to prepare to fight the virus. Cigarette smoke is known to reduce the interferon response in the airways.

"If you think of the airways like the high walls that protect a castle, smoking cigarettes is like creating holes in these walls," Gomperts said. "Smoking reduces the natural defenses and that allows the virus to set in."

CHAMPAIGN, Ill. -- Urban planners may soon have a new way to measure traffic congestion. By capturing the different routes by which vehicles can travel between locations, researchers have developed a new computer algorithm that helps quantify regions of congestion in urban areas and suggests ways around them.

The study, published in the Journal of Physics: Complexity, used traffic speeds from taxis in New York City to demonstrate how road infrastructure and driver behavior can create complex road networks that differ among cities.

"Ride-hailing and ride-sharing services, and eventually autonomous vehicles, are disrupting traffic patterns in cities," said Richard Sowers, a professor of mathematics and of industrial and enterprise systems engineering at the University of Illinois at Urbana-Champaign and lead author of the study. "We identified a need for a tool that could help urban planners understand how and why this happens."

The team approached the issue by designing a computer algorithm to capture the topology - or relationship between the different routes between locations - of road networks. "Roads form complex networks, and the field of topological data analysis seemed to offer the right tools to study travel paths that commuters choose," Sowers said.

"We found that the most significant traffic bottlenecks in Manhattan seem to arise as a result of the city's structural layout," said study co-author Daniel Carmody, who recently completed a Ph.D. in mathematics at the U. of I. "For example, the fact that a bridge enters Manhattan at a latitude where traffic is already limited due to Central Park slows traffic in the area considerably."

The researchers performed a comparative analysis using traffic patterns in Chengdu, China, to test if the algorithm works equally well in areas with different layouts. Manhattan has a long and thin structure, while Chengdu is round. There are significant differences in the way traffic moves between these two different setups, the researchers said.

"The bottlenecks in Chengdu seem to arise due to the function of the buildings in a particular area," Carmody said. "For example, it is hard to travel in and out of the central business district in Chengdu because of the sheer volume of traffic alone. Beltways, or faster streets around congested areas, have emerged in circles around this area, which is not surprising because this feature was intentionally built into the city."

In Manhattan, the bridges and tunnels that form the entry and exit points cause traffic slowdowns. However, in lower Manhattan, where drivers seem to obey the lower posted speed limits, traffic moves more smoothly, forming a new traffic beltway with the southern end of Central Park acting as a barrier between lower and central Manhattan.

"It surprised us that there is an emergent beltway in such a congested area of Manhattan," Carmody said. "This indicates that, unlike in Chengdu, beltways seem to arise from driver behavior even when they aren't part of the structural plan of a traffic network."

Click here to see a video of how the algorithm defines connected routes, finds pathways around congested areas and compares traffic in different cities.

The researchers envision this technology giving urban planners a means to quantify traffic patterns, leading to better mitigation, Sowers said. "As methods of transportation evolve, new problems will emerge, and we hope that our tools will give planners new ways to measure what is going on with city traffic."

More than half of all in-hospital deaths due to COVID-19 during the first six months of 2020 were among Black and Hispanic patients, according to a new study led by researchers at the Stanford University School of Medicine and Duke University.

The researchers did not find any racial or ethnic differences in mortality rates among people hospitalized with the disease. Yet a disproportionate number of Black and Hispanic people became sick enough to require hospitalization, and they made up 53% of inpatient deaths.

Fatima Rodriguez, MD, assistant professor of cardiovascular medicine at Stanford, is the lead author of the study, which was published Nov. 17 in Circulation. Tracy Wang, MD, professor of medicine at Duke University, is the senior author.

"The COVID-19 pandemic has shown a spotlight on racial and ethnic disparities in health care that have been happening for years," said Rodriguez, an expert in health disparities in cardiovascular medicine. "Our study shows an over-representation of Black and Hispanic patients in terms of morbidity and mortality that needs to be addressed upstream before hospitalization."

Researchers examined a sample of 7,868 patients hospitalized with the coronavirus at 88 hospitals across the country between Jan. 17 and July 22. The data was collected from the American Heart Association's COVID-19 Cardiovascular Disease Registry. The average mortality rate for all patients was 18.4%.

The researchers found that white patients accounted for 35.2% of the sample, Hispanic patients for 33%, Black patients for 25.5% and Asian patients for 6.3%.

The U.S. Census Bureau estimates that white people make up 60% of the nation's population, Hispanic people 18.5%, Black people 13.4% and Asian people 5.9%.

Hospitals, not race and ethnicity, tied to mortality rate

"Interestingly, more of the variations in mortality were explained by the site of the care than by race or ethnicity," Rodriguez said. "We need to understand more about differences between hospitals. Is it different treatment protocols that are rapidly evolving during the pandemic? Or perhaps minority-serving hospitals have different resources? This is an active area of research within the registry used for this study as we enroll more sites across the country."

The study also found that Black and Hispanic patients were significantly younger than others, with an average age of 57 and 60, respectively, compared with 69 for white patients and 64 for Asian patients. In addition, Black and Hispanic patients had more underlying health conditions. Black patients had the highest prevalence of obesity, hypertension and diabetes. They also had the highest rates of mechanical ventilation and renal replacement therapy and the lowest rates of remdesivir use at 6.1%. The antiviral medication was the first treatment approved for COVID-19.

Somewhat surprisingly, heart problems occurred infrequently among all patients, Rodriguez said.

"Asian patients showed higher rates of cardiorespiratory disease severity when they arrived at the hospital," she said. "That was an interesting finding. They tended to be older and to come to the hospital later in the disease progression."

The study had some limitations, Rodriguez said, including an overrepresentation of urban and large academic teaching hospitals in the data sample, but the findings remain startling.

"My work focuses on preventing chronic disease before patients are hospitalized," Rodriguez said. "We need to invest in communities to increase opportunity for healthy lifestyles and good health care. Structural racism, we know, is a major roadblock for preventing good health."

Boston, MA -- Despite being known risk factors for poor cardiovascular outcomes, blood pressure and low-density lipoprotein (LDL) cholesterol remain undertreated among a large proportion of patients. To address this gap, a team from Brigham and Women's Hospital and Mass General Brigham Health System, led by Brigham cardiologist Benjamin Scirica, MD, MPH, developed a program that provides an end-to-end solution to improve blood pressure and cholesterol levels across a broad population of patients at high cardiovascular risk. Developed before the COVID-19 pandemic, the disease management program leverages task shifting, standardized treatment algorithms, and digital solutions such as home blood pressure cuffs to adjust medications based on how a patient is doing. The program relies on a team of navigators and pharmacists to help deliver personalized care remotely, without the need for in-person visits or physician involvement in every treatment decision. The new approach improved clinical outcomes for patients and may provide a model for expanding remote health care. Scirica presented results during the American Heart Association Scientific Sessions 2020, with simultaneous publication in the journal Circulation.

"Our program demonstrates that we can remotely improve cardiovascular health through cholesterol and blood pressure control faster, more efficiently and with greater personalization than standard practice," said Scirica. "And we see this as a transferable program -- one that could be adopted in other health care settings. It could be applied to a broad range of clinical scenarios across our system and across the world, especially in places where health care resources may be scarce."

This report summarized the interim results of the first 5,000 Mass General Brigham patients with uncontrolled LDL cholesterol, blood pressure or both, who were enrolled between Jan. 1, 2018 and May 21, 2020. Patients were mostly prescribed lower-cost generic drugs through the program. Pharmacists initiated and adjusted prescriptions for individuals based on clinical algorithms, prescribing more intensive medications if a patient needed them or adjusting a dosage if a patient was initially intolerant to a medication.

Non-licensed navigators served as the face of the program. They communicated directly with patients, providing treatment recommendation and education until treatment goals were met. Digital tools helped support the workflow and clinical decisions for the navigators and pharmacists. The program was supervised by specialists, and primary care physicians were updated on all treatment changes.

Of the 3,939 patients in the Lipid program, 1,343 had achieved their goal LDL cholesterol level by the time of this report, with the average decrease in LDL cholesterol being 52 mg/dl (42 percent). An overall drop in cholesterol levels of 24 mg/dl (18 percent) was seen in all patients, including those still being actively managed. Of the 1,437 patients enrolled in the high blood pressure group, blood pressure levels dropped by an average of 14/6mmHg (systolic/diastolic) in the 556 who had completed the program by the time of this report.

"These reductions are clinically meaningful. From decades of studies, we know that reductions of this magnitude in blood pressure and cholesterol result in fewer heart attacks, strokes and other cardiovascular events," said Scirica.

Scirica notes that there are challenges in a program like this one, especially around keeping participants engaged. He also acknowledges that virtual care can amplify inequities in care. The team is working on multiple solutions to try to increase access, including low-tech solutions that rely on phone calls rather than video. They also continue to update and enhance the program as guidelines continue to evolve.

Still, the team hopes the work provides a foundation for future broadly delivered population health initiatives.

"I'm especially excited for the future of disease management programs that can help at the intersection of diseases," said Scirica. "We've started with lipids and hypertension first, but our interests expand to heart failure, diabetes, mental health -- all of which overlap -- and it motivates us to look into a fully integrated system for remote chronic care management."

American College of Rheumatology Calls the Bipartisan Legislation a "Win-Win" for All Medical Specialties

ATLANTA - Today, more than 60 healthcare stakeholders, representing Medicare providers, signed a letter urging congressional leaders to support bipartisan legislation that would implement the Centers for Medicare and Medicaid Service's (CMS) Calendar Year 2021 Medicare Physician Fee Schedule (MPFS) final rule as written, and provide for a one-year waiver of budget neutrality adjustments to avoid payment reductions to providers during the COVID-19 public health emergency.

If enacted, H.R. 8505 , which was introduced by Representatives Michael Burgess (R-TX) and Bobby Rush (D-IL), would ensure that long overdue rate increases for evaluation and management (E/M) services provided by rheumatologists, neurologists, and other cognitive specialists under Medicare - as finalized by CMS in its final rule - would not lead to rate cuts to other medical specialties or to physical and occupational therapists, many of which are an integral part of the rheumatology patient care team. This is a legislative solution that meets the needs of all stakeholders by allowing CMS to implement the final rule, on schedule, while funding offsets to the reimbursement reductions using funds allotted for provider support during the public health emergency.

"H.R. 8505 is a win-win solution for all medical specialties, and we encourage congressional leaders to swiftly pass this legislation," said David Karp, MD, PhD president of the American College of Rheumatology (ACR), the group leading the letter. "Current E/M reimbursement rates suppress patient access to diagnosis, treatment, and health maintenance at a time when demand for care is increasing. If this dire situation is not addressed as planned in the MPFS, then patient access to care will continue to decline."

In 2018, CMS proposed a code collapse that would have resulted in significant cuts to rheumatology care provided to Medicare beneficiaries. But after hearing the concerns raised by the patient and specialty provider community, CMS finalized a new proposal that reflects the recommendations of the American Medical Association, the ACR and over 170 other specialty societies and state medical associations. When enacted, the new rule will provide long overdue updates to Medicare reimbursement for time-intensive healthcare services including examinations, disease diagnosis, risk assessments and care coordination.

"The E/M improvements that will go into effect in January 2021 are critical to the continued delivery of high-quality rheumatology care for millions of Medicare beneficiaries," said Karp. "Budget neutrality via H.R. 8505 is a fair and reasonable approach to ensure these needed updates are not made at the expense of other specialties."

TROY, N.Y. -- Despite additional costs, increased restrictions, and issues stemming from compliance directives, government-mandated stress tests are effective in strengthening the overall health of the multi-trillion-dollar American banking industry.

According to research recently published in the Journal of Banking and Finance by Raffi E. García, an assistant professor in the Lally School of Management at Rensselaer Polytechnic Institute, stress tests strengthen the industry by reducing a bank's risk and increasing its lending capital.

"The perception has been that stress tests are a drag on banks," García said. "It is believed that complying with the additional regulations of these bank stress tests is costly and that only the biggest banks should take on these expenses. This research finds otherwise."

Bank stress tests are analyses of bank performance under a range of hypothetical situations. They have been used by the banking industry since the 2008 global financial crisis revealed the vulnerabilities of many financial institutions.

García used a regression discontinuity design that studied all publicly traded banks and bank holding companies with $10 billion or more in assets between 2011 and 2016 and found that stress tests reduce the percentage of risky investment by banks.

He also found that investors perceive stress-tested banks as having a higher probability of earning expected gains. Those investors put more money into such banks, making it easier and cheaper for them to raise capital.

Furthermore, García found that the increase in regulatory oversight and stricter requirements do not induce stress-tested banks to manipulate their bank size just to avoid compliance. The findings have implications for legislators, banking executives, and every American taxpayer.

"Right now, these stress tests are mandatory only for the very largest banks," García said. "Most of us have our money in banks that aren't being stress-tested. If you include more banks that comply with these type of transparency requirements, it would be beneficial in protecting taxpayers from future losses."

CHAPEL HILL, NC - In a controlled study of smokers, nonsmokers, and e-cigarette users, University of North Carolina School of Medicine researchers found that e-cigarette users exhibited significantly altered immune responses to a model of influenza virus infection, suggesting increased susceptibility to disease.

The findings, published in the American Journal of Respiratory Cell and Molecular Biology, show that vaping changes the expression of genes and production of proteins in respiratory cells, as well as altering virus-specific antibody production.

"In many of the study participants, we observed more changes to the immune response in e-cigarette users than we did in smokers," said first author Meghan Rebuli, PhD, assistant professor in the UNC Department of Pediatrics and member of the UNC Center for Environmental Medicine, Asthma, and Lung Biology. "All of these factors have the potential to adversely affect response to a virus and immunity post-infection. While we used influenza as a model, this suggests that e-cigarette users are likely more susceptible to respiratory viruses than are non-smokers, and this likely includes SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19)."

The main reason to avoid smoking is the risk of cancer, heart disease, emphysema, stroke, diabetes, chronic obstructive pulmonary disorder, and other lung diseases. For these reasons, researchers also have been studying the potential effects of electronic cigarettes, which are composed of thousands of chemicals many of which are FDA-approved for ingestion, but not inhalation.

But for many years, inhalation of tobacco smoke has also been linked to increased risk of viral infection, such as influenza. Inhalation of e-cigarette aerosols has also been linked to immune suppression within the respiratory tract, specifically the protective mucosal layer lining the inside the nasal cavity.

Rebuli, senior author Ilona Jaspers, PhD, and colleagues, thought that changes in the nasal mucosal immune response could modify antiviral host defense responses in e-cigarette users. This is important because viruses, including the flu and SARS-CoV-2, have been shown to infect nasal cavities where they can replicate in cells, spread throughout the respiratory system, and be transmitted to other people. Jaspers, the director of the UNC Center for Environmental Medicine, Asthma, and Lung Biology, has led previous experiments showing that vaping altered hundreds of genes in epithelial cells involved in the body's natural immune defense. For the current study, the researchers wanted to study what happens when e-cigarette users are exposed to a respiratory virus.

For the study, non-smokers, cigarette smokers, and e-cigarette users, age 18-40, were inoculated with live attenuated influenza virus (LAIV) vaccine - a well-established model of influenza infection in the Jaspers lab- to safely examine innate immune response. Pre- and post-inoculation, the researchers collected nasal epithelial lining fluid, nasal lavage fluid, nasal scrape biopsies, urine, and blood. The scientists examined cytokines and chemokines, influenza-specific Immunoglobulin A (IgA), immune gene expression, and markers of viral load.

The researchers found that though the amount of markers of viral load did not differ among the three groups, expected increases in nasal epithelial lining fluid anti-LAIV IgA - which is a potential indicator of developed immunity post-infection - did not occur in e-cigarette users and cigarette smokers. Further, LAIV-induced gene expression changes in nasal biopsies differed in cigarette smokers and e-cigarette users as compared to non-smokers, with a greater number of genes changed in e-cigarette users, mostly resulting in decreased expression of immune genes critical for defense against viruses and generation of immune memory.

"This is not good," Jaspers said. "We want to see IgA levels increase during infection. It's the body's natural way to defend against an invader. Here we saw that both smoking and e-cigarette use hampers IgA levels. The suppressed expression of important immune genes is also concerning and in line with an overall suppression of appropriate immune responses."

Moreover, altered immune response in e-cigarette users and cigarette smokers could make vaccines less effective in these groups.

"We don't know for sure if people who vape are more susceptible to COVID-19, or if vaccines would be less effective for them," Rebuli said. "But we know we never want to see suppression of genes, proteins, and antibodies involved in our immune response. And this is what we see in our data related to smoking and e-cigarette use."

Arlington, Va. (November 16, 2020) -- A variety of ticks that carry the bacteria causing the deadly disease Rocky Mountain spotted fever (RMSF) are more than twice as likely to shift their feeding preference from dogs to humans when temperatures rise, a sign that climate change could expand and intensify human disease risks, according to a new study presented today at the Annual Meeting of the American Society of Tropical Medicine and Hygiene (ASTMH).

"Our work indicates that when the weather gets hot, we should be much more vigilant for infections of RMSF in humans," said Laura Backus, MPH, DVM, who led the study at the University of California, Davis School of Veterinary Medicine (UC-Davis). "We found that when temperatures rose from about 74 to 100 degrees Fahrenheit, brown dog ticks that carry the disease were 2.5 times more likely to prefer humans over dogs."

Cases of RMSF and related diseases, collectively known as spotted fever rickettsiosis, have risen dramatically over the last 20 years. The disease is treatable with antibiotics if detected in the first week of infection, but once an infection takes hold, the fatality rate for RMSF victims can exceed 20%. Complications can include damaged blood vessels; inflammation of the heart, lungs or brain; and kidney failure. Over the last 10 years, public health authorities have been particularly alarmed by a rash of deadly RMSF outbreaks among indigenous communities in Arizona and northern Mexico.

Backus said there have been indications from earlier work that brown dog ticks, which are found throughout the continental United States, may be more aggressive toward humans in hot weather. And scientists warn that climate change is greatly expanding areas of the country experiencing multiple days when temperatures top 100 degrees Fahrenheit, or about 38 degrees Celsius. Backus and her colleagues at UC-Davis wanted to gain more definitive insights into how rising temperatures might elevate the risk of RMSF infections.

For their experiment, they constructed two large wooden boxes measuring about 3 feet tall and 2 feet wide, which were then connected to each other by a clear plastic tube. They conducted a series of tests that involved putting a human in one box, a dog in the other and ticks in the clear plastic tube between them. The researchers then observed, over 20-minute intervals, whether the ticks, which seek out hosts to feed on based on smell, preferred dogs or humans--first at temperatures of around 74 degrees Fahrenheit (23.3 degrees Celsius) and then at 100 degrees Fahrenheit (37.8 degrees Celsius).

Backus said that at the higher temperature, one type of brown dog tick, known as the tropical lineage tick, was especially decisive in shifting its preferences from dogs to humans. Currently, tropical lineage brown dog ticks are found across the southern regions of the United States, in places like Arizona, Florida, southern California and southern Georgia. However, Backus said that their range is expected to move northward as climate change causes average temperatures to rise.

Brown dog ticks belonging to another lineage, the temperate lineage, are found throughout the lower 48 states and may also carry RMSF. Backus said that while the temperate ticks showed only a slight increase in preference for humans over dogs in the higher temperature test, they exhibited a pronounced decrease in their preference for dogs. Many ticks simply shifted from clearly pro-dog to neutral--they did not move toward either subject.

"We believe that this decreased preference for dogs--combined with a slight increase in preference for humans--suggests that hot temperatures may also elevate risks of RMSF in areas where the temperate ticks are more common," Backus said.

She added that it's important to identify conditions that can increase infection risks--and put health officials on higher alert--because symptoms in the crucial early phase of RMSF, when it's relatively easy to treat, can be mistaken for a number of more common ailments. They include headache, fever and muscle aches. Backus said there is also a need for better diagnostic tests since the existing test is time-consuming and may produce false negatives.

"The findings from the use of this simple but effective laboratory experiment to gauge how rising temperatures might lead to more human infections with a very dangerous tick-borne pathogen adds to the growing evidence of the increasing connection between climate change and its impact on health," said ASTMH President Joel Breman, MD, DTPH, FASTM. "Climate change is moving so quickly that it is critical to keep pace with the many ways it may alter and intensify the risk of a wide range of infectious diseases so we are better prepared to diagnose, treat and prevent them."

DALLAS, November 16, 2020 -- Adults with the healthiest sleep patterns had a 42% lower risk of heart failure regardless of other risk factors compared to adults with unhealthy sleep patterns, according to new research published today in the American Heart Association's flagship journal Circulation. Healthy sleep patterns are rising in the morning, sleeping 7-8 hours a day and having no frequent insomnia, snoring or excessive daytime sleepiness.

Heart failure affects more than 26 million people, and emerging evidence indicates sleep problems may play a role in the development of heart failure.

This observational study examined the relationship between healthy sleep patterns and heart failure and included data on 408,802 UK Biobank participants, ages 37 to 73 at the time of recruitment (2006-2010). Incidence of heart failure was collected until April 1, 2019. Researchers recorded 5,221 cases of heart failure during a median follow-up of 10 years.

Researchers analyzed sleep quality as well as overall sleep patterns. The measures of sleep quality included sleep duration, insomnia and snoring and other sleep-related features, such as whether the participant was an early bird or night owl and if they had any daytime sleepiness (likely to unintentionally doze off or fall asleep during the daytime).

"The healthy sleep score we created was based on the scoring of these five sleep behaviors," said Lu Qi, M.D., Ph.D., corresponding author and professor of epidemiology and director of the Obesity Research Center at Tulane University in New Orleans. "Our findings highlight the importance of improving overall sleep patterns to help prevent heart failure."

Sleep behaviors were collected through touchscreen questionnaires. Sleep duration was defined into three groups: short, or less than 7 hours a day; recommended, or 7 to 8 hours a day; and prolonged, or 9 hours or more a day.

After adjusting for diabetes, hypertension, medication use, genetic variations and other covariates, participants with the healthiest sleep pattern had a 42% reduction in the risk of heart failure compared to people with an unhealthy sleep pattern.

They also found the risk of heart failure was independently associated and:

8% lower in early risers;

12% lower in those who slept 7 to 8 hours daily;

17% lower in those who did not have frequent insomnia; and

34% lower in those reporting no daytime sleepiness.

Participant sleep behaviors were self-reported, and the information on changes in sleep behaviors during follow-up were not available. The researchers noted other unmeasured or unknown adjustments may have also influenced the findings.

Qi also noted that the study's strengths include its novelty, prospective study design and large sample size.

First-author is Xiang Li, Ph.D.; other co-authors are Qiaochu Xue, M.P.H.; Mengying Wang, M.P.H.; Tao Zhou, Ph.D.; Hao Ma, Ph.D.; and Yoriko Heianza, Ph.D. Author disclosures are detailed in the manuscript.