New study documents increasing frequency, cost, and severity of gunshot wounds

The rise in firearm violence has coincided with an increase in the severity of injuries firearms inflict as well as the cost of operations to treat those injuries; policy makers must be more aggressive in addressing violence to curb these trends, researchers report in a large national study of gunshot wounds that appears as an “article in press” on the Journal of the American College of Surgeons website ahead of print.

“Taken together, our findings suggest that gun violence has increased in numbers, at least for the sector that meets surgical criteria, and that these injuries result in a substantial financial burden in addition to the obvious psychosocial burden and other downstream effects,” said lead study author Peyman Benharash, MD, MS, with the Cardiovascular Outcomes Research Laboratories and an associate professor-in-residence of surgery and bioengineering at the David Geffen School of Medicine at the University of California Los Angeles. “We hope that our findings are able to better inform policy in terms of violence prevention as well as reimbursement to hospitals, which are often in underserved regions, that care for these patients.”

The study authors note that gun violence overall carries an annual cost to the U.S. health care system of $170 billion, with $16 billion for operations alone. The researchers used the National Inpatient Sample (NIS) to identify all hospital admissions for gunshot wounds (GSW) from 2005 through 2016. The researchers did not look at all adult GSW victims admitted to the hospital, estimated at 322,599, but only at the 262,098 victims who required at least one major operation.

Dr. Benharash explained the rationale for the study. “We’re now seeing a lot more on the impact of gun violence,” he said. “In the past, gun violence was never really discussed in the open; it was thought to only affect a certain population. However, now we know that it affects everyone. In the hopes of trying to reduce it at a systemic level from top to bottom, we’re reporting, as surgeons, how gun violence in the patients that we treat has changed over the last decade.”

The costs for hospitalizations, measured as median costs adjusted for gross domestic product, increased more than 27 percent over the 12-year study period, from $15,100 to $19,200 (p<0.001). The amount of time these patients spent in the hospital—a major cost driver—also increased from an average of 7.1 days to 12.6 days (p<0.001). The percentage of fatalities declined, from 8.6 percent in 2005 to 7.6 percent in 2016, despite an annual increase in overall admissions for GSW-related operations, from 19,832 in 2005 to 23,480 in 2016. The severity of these injuries, based on billing codes, increased slightly over that period, with predicted survival decreasing from 81 to 79 percent (P<0.001). The authors used a non-parametric test for trends to judge the significance of temporal changes in their analysis.

The cost analysis categorized operations by type and three different cost ranges: low, medium and high, with average costs of $7,400, $17,200, and $58,800, respectively. “We found that compared with those who were not operated on, patients having head-neck, vascular, and gastrointestinal operations had increased odds of being in the high-cost tertile,” Dr. Benharash said. “Being in the Western United States was also a predictor [of being in the high-cost tertile], as was being of Black race and having insurance by Medicaid. So there are certainly disparities that are socioeconomic in origin as well.”

For example, the study found that while 3.4 percent of all patients had operations for head and neck injuries, these operations were disproportionately represented in the low- and high-cost ranges, accounting for only 0.81 percent of the former but 7.1 percent of the latter. “Gunshot wounds to the neck, for example, can be very costly because they can affect many delicate structures as compared with lower extremities, and these patients often require extensive hospitalization and a greater number of procedures,” Dr. Benharash said.

The finding that costs in the West were higher is also important, Dr. Benharash noted, because it’s in line with what other studies have reported with other specialties. “It’s very important for policy makers and health services researchers to evaluate the disparities in cost,” he said.

The improved survival of GSW patients is a function of improvements in trauma transport from the field, better prehospital resuscitation, and improved techniques, patient management and adjunct therapies once they get to the hospital, Dr. Benharash said. “It appears that patients are reaching surgery more often because of reduced mortality before they get to the hospital,” he said.

The study also attributed these improvements in survival to efforts by the American College of Surgeon’s Committee on Trauma, including the Advanced Trauma Life Support curriculum and Stop the Bleed campaign. The latter trains the public in techniques to stop life-threatening bleeding in everyday emergencies.

But those improvements don’t obviate the need for addressing the underlying problem, Dr. Benharash noted. “It’s very important to put it in perspective that this entity is quite economically burdensome,” he said. “If you’re looking at prevention vs. treating a gunshot wound from an economic standpoint, it would make sense to invest in anti-violence interventions that can reduce assaults that are often preventable.”

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Study shows liver injury is common and prognostic in COVID-19 patients

Researchers from the Faculty of Medicine at The Chinese University of Hong Kong (CU Medicine) have recently conducted a study to investigate the impact of liver injury on clinical outcomes in COVID-19 patients. Data from over 1,000 COVID-19 patients in Hong Kong was analysed and liver injury was found in around 20% of the patients. The estimated risk of COVID-19 patients with liver injury experiencing adverse clinical outcomes such as intensive care unit (ICU) admission, use of invasive mechanical ventilation or death was almost eight times of other patients. It is suggested that liver function monitoring is important regarding its association with adverse clinical outcomes in COVID-19 patients. These findings have been published recently in the world-renowned medical journal Gut. In view of the high prevalence of various chronic liver diseases in the Asia-Pacific region, CU Medicine’s researchers led a group of experts from Mainland China, Japan, Singapore and Australia to issue a position statement on the management of COVID-19 patients with liver derangement. The statement has been published recently in another international medical journal The Lancet Gastroenterology & Hepatology.

About 20% of COVID-19 patients in Hong Kong were found to have liver injury

Liver injury, in the form of hepatitis, cholestasis or both, can be observed in patients infected by different coronaviruses. For the territory-wide study in Gut, researchers from CU Medicine analysed the data from 1,040 COVID-19 patients in Hong Kong. It was found that the level of liver enzyme alanine aminotransferase (ALT) or aspartate aminotransferase (AST) was elevated in 23% of the COVID-19 patients, which indicated liver damage.

An association between liver injury and the chance of adverse clinical outcomes was also identified. Overall, 53 (5.1%) were admitted to ICU, 22 (2.1%) received invasive mechanical ventilation, and 4 (0.4%) died. Among them, 71% had liver injury. The analysis indicated that the estimated risk of patients with liver injury having adverse clinical outcomes is eight times of others.

First author of the study, Dr. Terry Cheuk Fung YIP, post-doctoral fellow of the Department of Medicine and Therapeutics at CU Medicine, explained, “Our study shows that liver injury was common in COVID-19 patients. Although the exact impact of the novel virus on the liver has not been well elucidated so far, our findings proved that the chance of patients with liver injury having adverse clinical outcomes is obviously higher than that of others. This shows that liver injury is prognostically significant in COVID-19 patients.”

Professor Grace Lai Hung WONG, Professor, Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics at CU Medicine, added, “Liver injury is possibly caused by systemic inflammation and adverse drug reactions in severe COVID-19 patients who have been receiving different medical treatments. As the degree of liver injury could be impacted by coexisting chronic hepatitis in patients, a thorough review of medical history and detailed investigation for concomitant liver diseases are crucial to improve patient outcomes.”

Furthermore, cautious use of appropriate medications with least hepatotoxicity as well as vigilant monitoring of liver biochemistries are recommended in order to minimise liver injury in COVID-19 patients.

As the pandemic continues and CU Medicine’s study has proved that the risk of adverse clinical outcomes in COVID-19 patients is closely related to liver health, it would be clinically helpful to provide practice recommendations for various common clinical scenarios of liver derangement, especially in the Asia-Pacific region where the prevalence of liver diseases is the highest worldwide. According to the World Health Organization, liver diseases caused 4.6% of deaths in the Asia-Pacific region in 2015, compared with 2.7% in the U.S. and 2.1% in Europe.

In response to this utmost need, the Asia-Pacific Working Group for Liver Derangement, led by the hepatologists from CU Medicine, published an Asia-Pacific position statement in June this year on the management of COVID-19 patients who have been or are at risk of developing liver derangement. Clinical scenarios covered in the statement included the precautions for the use of pharmacological treatment for COVID-19 in patients with liver derangement, for example liver test should be conducted twice weekly in patients on potentially hepatotoxic medication, those with pre-existent liver disease, and more frequently in any patients with abnormal liver function.

The statement also proposed the assessment and management of patients with hepatitis B or hepatitis, non-alcoholic fatty liver disease, liver cirrhosis, and liver transplantation during the pandemic.

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Botox injections may reduce depression, study finds

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People who received Botox (botulinum toxin) injections for certain conditions reported less depression less often compared to patients who did not receive the injections for similar diagnoses, according to a study published Thursday in the journal Scientific Reports.

“For years, clinicians have observed that Botox injected for cosmetic reasons seems to ease depression for their patients,” said Ruben Abagyan, Ph.D., professor of pharmacy and one of the lead researchers of the study, in a statement.

“It’s been thought that easing severe frown lines in the forehead region disrupts a feedback loop that reinforces negative emotions. But we’ve found here that the mechanism may be more complex because it doesn’t really matter where the Botox is injected," the author stated in a news release.

GOOD SENSE OF SMELL MAY INDICATE LOWER RISK OF DEMENTIA IN OLDER ADULTS: STUDY

The research team at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego combed through the U.S. Food and Drug Administration (FDA)’s Adverse Effect Reporting System (FAERS) database to see the side effects reported by nearly 40,000 people who received Botox injections for various reasons, according to a news release by the university.

The treatments were not just in the forehead but included several different sites, including the neck, limbs and forehead. The release stated the researchers used an algorithm to find significant statistical differences between patients who used Botox and those who did not for the same issue.

The treatments were not just in the forehead but included several different sites, including the neck, limbs, and forehead. (iStock)

The researchers found depression was reported 40 to 88 percent less often by Botox users for six of the eight conditions and injection sites, according to the release.

“This finding is exciting because it supports a new treatment to affect mood and fight depression, one of the common and dangerous mental illnesses — and it’s based on a very large body of statistical data, rather than limited-scale observations,” Tigran Makunts, PharmD, one of the researchers in the study, stated in the release.

More research is needed to determine how Botox potentially acts as an antidepressant, according to the study. The researchers have a few theories that need further investigation. For instance, Botox being absorbed systemically to the central nervous system, which is involved in mood or emotions, they hypothesized, or possibly Botox indirectly affecting a person’s depression because the Botox helped relieve an underlying chronic condition that may have been a contributing factor to the patient’s depression.

Health experts say Botox is commonly used not only for cosmetic reasons, such as combatting wrinkles but also for muscle spasms, tight muscles, migraines, temporomandibular joint dysfunction, as well as other conditions including excessive sweating and bladder conditions.

DIETS HIGHER IN PROTEIN, PARTICULARLY PLANT PROTEIN, LINKED TO LOWER RATES OF EARLY DEATH: STUDY

The FAERS data used in this study was not exclusively gathered for the purpose of investigating the link between Botox and depression, according to the news release.  The data represents only a subgroup of Botox users who reported experiencing negative side effects. The authors note they excluded data from patients who were taking antidepressants; however, in some of the cases, the use of medications could have been underreported.

The release stated there is a clinical trial underway that is directly investigating Botox treatment for people with depression, but it is only testing forehead injection sites,. The authors said additional clinical trials are necessary to investigate which site is best to specifically inject to treat depression.

According to the World Health Organization, an estimated more than 264 million people worldwide experience depression.

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Sperm don’t swim anything like we thought they did, new study finds

Under a microscope, human sperm seem to swim like wiggling eels, tails gyrating to and fro as they seek an egg to fertilize. 

But now, new 3D microscopy and high-speed video reveal that sperm don’t swim in this simple, symmetrical motion at all. Instead, they move with a rollicking spin that compensates for the fact that their tails actually beat only to one side. 

“It’s almost like if you’re a swimmer, but you could only wiggle your leg to one side,” said study author Hermes Gadêlha, a mathematician at the University of Bristol in the U.K. “If you did this in a swimming pool and you only did this to one side, you would always swim in circles. … Nature in its wisdom came [up] with a very complex, ingenious way to go forward.” 

Strange swimmers

The first person to observe human sperm close up was Antonie van Leeuwenhoek, a Dutch scientist known as the father of microbiology. In 1677, van Leeuwenhoek turned his newly developed microscope toward his own semen, seeing for the first time that the fluid was filled with tiny, wiggling cells. 

Under a 2D microscope, it was clear that the sperm were propelled by tails, which seemed to wiggle side-to-side as the sperm head rotated. For the next 343 years, this was the understanding of how human sperm moved. 

“[M]any scientists have postulated that there is likely to be a very important 3D element to how the sperm tail moves, but to date we have not had the technology to reliably make such measurements,” said Allan Pacey, a professor of andrology at the University of Sheffield in England, who was not involved in the research. 

The new research is thus a “significant step forward,” Pacey wrote in an email to Live Science. 

Gadêlha and his colleagues at the Universidad Nacional Autónoma de México started the research out of “blue-sky exploration,” Gadêlha said. Using microscopy techniques that allow for imaging in three dimensions and a high-speed camera that can capture 55,000 frames per second, they recorded human sperm swimming on a microscope slide. 

“What we found was something utterly surprising, because it completely broke with our belief system,” Gadêlha told Live Science. 

The sperm tails weren’t wiggling, whip-like, side-to-side. Instead, they could only beat in one direction. In order to wring forward motion out of this asymmetrical tail movement, the sperm head rotated with a jittery motion at the same time that the tail rotated.The head rotation and the tail are actually two separate movements controlled by two different cellular mechanisms, Gadêlha said. But when they combine, the result is something like a spinning otter or a rotating drill bit. Over the course of a 360-degree rotation, the one-side tail movement evens out, adding up to forward propulsion.

“The sperm is not even swimming, the sperm is drilling into the fluid,” Gadêlha said. 

The researchers published their findings today (July 31) in the journal Science Advances.

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Asymmetry and fertility

In technical terms, how the sperm moves is called precession, meaning it rotates around an axis, but that axis of rotation is changing. The planets do this in their rotational journeys around the sun, but a more familiar example might be a spinning top, which wobbles and dances about the floor as it rotates on its tip. 

“It’s important to note that on their journey to the egg that sperm will swim through a much more complex environment than the drop of fluid in which they were observed for this study,” Pacey said. “In the woman’s body, they will have to swim in narrow channels of very sticky fluid in the cervix, walls of undulating cells in the fallopian tubes, as well have to cope with muscular contractions and fluid being pushed along (by the wafting tops of cells called cilia) in the opposite direction to where they want to go. However, if they are indeed able to drill their way forward, I can now see in much better clarity how sperm might cope with this assault course in order to reach the egg and be able to get inside it,” Pacey said

Sperm motility, or ability to move, is one of the key metrics fertility doctors look at when assessing male fertility, Gadêlha said. The rolling of the sperm’s head isn’t currently considered in any of these metrics, but it’s possible that further study could reveal certain defects that disrupt this rotation, and thus stymy the sperm’s movement. 

Fertility clinics use 2D microscopy, and more work is needed to find out if 3D microscopy could benefit their analysis, Pacey said. 

“Certainly, any 3D approach would have to be quick, cheap and automated to have any clinical value,” he said. “But regardless of this, this paper is certainly a step in the right direction.”

Originally published in Live Science.

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New study reveals older adults coped with pandemic best

Adults aged 60 and up have fared better emotionally compared to younger adults (18-39) and middle-aged adults (40-59) amid the COVID-19 pandemic, according to new UBC research published recently in the Journal of Gerontology: Psychological Sciences.

Based on daily diary data collected between mid-March and mid-April of this year, the researchers found that older adults experienced greater emotional well-being and felt less stressed and threatened by the pandemic.

“Our findings provide new evidence that older adults are emotionally resilient despite public discourse often portraying their vulnerability. We also found that younger adults are at greater risk for loneliness and psychological distress during the pandemic,” says Patrick Klaiber, the study’s lead author and a graduate student in the UBC department of psychology.

For the study, the researchers analyzed data from 776 participants aged 18-91, who lived in Canada and the U.S. and completed daily surveys for one week about their stressors, positive events and their emotional well-being during the first several weeks of the pandemic. The time period was selected as it was likely to be the period of greatest disruption and uncertainty as local, provincial and state governments began issuing stay-at-home orders.

Klaiber says the difference in reported stress levels may be a result of age-related stressors and how well the different age groups respond to stress.

“Younger and middle-aged adults are faced with family- and work-related challenges, such as working from home, homeschooling children and unemployment,” says Klaiber. “They are also more likely to experience different types of ongoing non-pandemic stressors than older adults, such as interpersonal conflicts.”

Klaiber adds, “While older adults are faced with stressors such as higher rates of disease contraction, severe complications and mortality from COVID-19, they also possess more coping skills to deal with stress as they are older and wiser.”

The study also reveals older and middle-aged adults experienced more daily positive events—such as remote positive social interactions—in 75 per cent of their daily surveys, which helped increase positive emotions compared to younger adults.

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Study links increased exercise with lower sleep apnea risk

A study published online as an accepted paper in the Journal of Clinical Sleep Medicine found that increased physical activity is associated with a lower risk of obstructive sleep apnea, a common sleep-related breathing disorder. The study is the largest to date focused on the relationship between sleep apnea and levels of physical activity in the general community.

Researchers reviewed lifestyle, medical, socio-demographic and sleep health data collected from more than 155,000 adults participating in the Ontario Health Study. Based on the physical activity of participants with and without sleep apnea, the investigators determined that a modest increase in physical activity, including walking, is associated with a 10 percent reduction in the risk of developing sleep apnea.

“Our results highlight the importance of physical activity as a preventive measure against developing sleep apnea,” said senior author Lyle Palmer, who is professor of genetic epidemiology at the University of Adelaide in Australia. “One surprising finding was that not only vigorous physical activity but also just walking alone was associated with a decreased risk of sleep apnea.”

The authors found that adding 20 minutes to a daily walk and increasing vigorous daily activity by eight minutes would be enough to achieve a lower sleep apnea risk. The finding is independent of other known risk factors for sleep apnea such as sex, age, ethnicity and obesity.

It is estimated that more than 29 million American adults have sleep apnea, many of them undiagnosed. Untreated sleep apnea is associated with an increased risk of heart disease, stroke, high blood pressure and other potentially serious conditions.

“The rates of sleep apnea in children and adults are continuing to rise. Therefore, understanding the role of modifiable protective factors for sleep apnea is important,” said Palmer. “Exercise is one such protective factor and has many other positive effects on general health. Sleep health care professionals should be trying to get their patients to exercise more.”

The cross-sectional, population-based study analyzed baseline questionnaire data from 155,448 adult residents of Ontario, Canada (60% women and 40% men). Their mean age was 46 years, and about 75% were white. About 6.9% of participants reported being told by a doctor that they have sleep apnea. Those with sleep apnea were more sedentary, sitting for a median of 4.4 more hours per week than those without sleep apnea.

Due to the cross-sectional nature of the study, the authors were unable to make temporal inferences on the observed associations between physical activity and sleep apnea. However, they report that previous studies also have suggested that physical activity can reduce the severity of sleep apnea.

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UK modelling study finds case isolation and contact tracing vital to COVID-19 epidemic control

In the absence of a vaccine or highly effective treatments for COVID-19, combining isolation and intensive contact tracing with physical distancing measures—such as limits on daily social or workplace contacts—might be the most effective and efficient way to achieve and maintain epidemic control, according to new modelling research published in The Lancet Infectious Diseases journal.

Using social-contact data on more than 40,000 individuals from the BBC Pandemic database to simulate SARS-CoV-2 transmission in different settings and under different combinations of control measures, the researchers estimate that a high incidence of COVID-19 would require a considerable number of individuals to be quarantined to control infection. For example, a scenario in which 5,000 new symptomatic cases were diagnosed each day would likely require 150,000-200,000 contacts to be quarantined every day if no physical distancing was in place.

The study is the first time researchers have used social contact data to quantify the potential impact of control measures on reducing individual-level transmission of SARS-CoV-2 in specific settings. They aimed to identify not only what would theoretically control transmission, but what the practical implications of these measures would be in terms of numbers quarantined.

However, the authors note that the model is based on a series of assumptions about the effectiveness of testing, tracing, isolation, and quarantine—for example about the amount of time it takes to isolate cases with symptoms (average 2.6 days) and the likelihood that their contacts adhere to quarantine (90%)—which, although plausible, are optimistic.

“Our findings reinforce the growing body of evidence which suggests that we can’t rely on one single public health measure to achieve epidemic control”, says Dr. Adam Kucharski from the London School of Hygiene & Tropical Medicine, UK. “Successful strategies will likely include intensive testing and contact tracing supplemented with moderate forms of physical distancing, such as limiting the size of social gatherings and remote working, which can both reduce transmission and the number of contacts that need to be traced.”

He adds: “The huge scale of testing and contact tracing that is needed to reduce COVID-19 from spreading is resource intensive, and new app-based tracing, if adopted widely alongside traditional contact tracing, could enhance the effectiveness of identifying contacts, particularly those that would otherwise be missed.”

In the study, researchers analysed data on how 40,162 people moved about the UK and interacted with others prior to COVID-19 to simulate how combinations of different testing, isolation, tracing, and physical distancing scenarios—such as app-based tracing, remote working, limits on different sized gatherings, and mass population-based testing—might contribute to reducing secondary cases. They also modelled the rate at which the virus is transmitted—known as the reproductive number (R), or the average number of people each individual with the virus is likely to infect at a given moment—under different strategies. To keep the COVID-19 epidemic declining, R needs to be less than 1.

In the model, the secondary attack rate (the probability that a close contact of a confirmed case will be infected) was assumed to be 20% among household contacts and 6% among other contacts. The researchers calculated that, had no control measures been implemented, R would be 2.6—meaning that one infected person would infect, on average, 2-3 more people.

The model suggested that mass testing alone, with 5% of the population undergoing random testing each week (i.e. 460,000 tests per day in UK), would lower R to just 2.5, because so many infections would either be missed or detected too late.

Compared with no control measures, self-isolation of symptomatic cases (at home) alone reduced transmission by an estimated 29% (lowering R to 1.8); whilst combining self-isolation, household quarantine, and tracing strategies could potentially lower transmission by as much as 47% (R 1.4) when using app-based contact tracing (assuming the app is adopted by 53% of the population), and by 64% with manual tracing of all contacts (R 0.94).

Achieving such a thorough level of contact tracing may be impractical, but the new study suggests that a large reduction in transmission could also be achieved by supplementing with moderate physical distancing measures. For example, they estimate that, limiting daily contacts outside home, school, and work to four people (e.g. by restricting mass gatherings) along with manual tracing of acquaintances only (i.e. people they have met before) and app-based tracing, would have the greatest impact, reducing disease spread by 66%, and lowering R to 0.87. However, they note that the effectiveness of manual contact tracing strategies is highly dependent on how many contacts are successfully traced, with a high level of tracing required to ensure R is lower than 1, especially if it takes time to isolate symptomatic cases.

The researchers also modelled the number of contacts that might need to be quarantined under different contact tracing strategies. They estimate that a scenario in which 1,000 new symptomatic cases were reported daily would likely require a minimum of 15,000 contacts quarantined every day (isolation plus app-based testing) and a maximum of 41,000 (isolation plus manual tracing all contacts). This could increase to an average of 150,000-200,000 contacts quarantined daily in a scenario where 5,000 new symptomatic cases were diagnosed each day.

“Our results highlight several characteristics of SARS-CoV-2 which make effective isolation and contact tracing challenging. The high rate of transmission, the short time between one person becoming infected and infecting another, and transmission that occurs without symptoms all make things difficult”, says co-author Dr. Hannah Fry from University College London, UK. “If there are a lot of symptomatic COVID-19 cases, then tracing, testing, and trying to quarantine a huge number of contacts will be a big challenge. How well we manage it will affect how and when it is possible to reduce transmission predominantly through targeted isolation and tracing measures or whether ongoing physical distancing measures will be required to control the epidemic.”

According to co-author Professor Julia Gog from the University of Cambridge, UK, “Planning for control based on isolation and contact tracing should consider the likely need for large numbers of cases to be tested and also a large number contacts rapidly quarantined. Crucially, this work is able to quantify the scales of what is needed for a successful control strategy involving tracing and isolation by making use of the dataset from the BBC pandemic project. The BBC data gives a uniquely detailed picture of how people in the UK mix and thus the extent of contact tracing necessary if we return to social mixing patterns as they were before the pandemic.”

The authors highlight several limitations to their study, including that it did not consider more detailed settings beyond home, school, work, or ‘other’ categories, or explicitly include imported infections, which may be detected at a different rate to local infections.

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Biomedical sciences researchers provide methods to inactivate and safely study SARS-CoV-2

Detailed methods on how to perform research on SARS-CoV-2, the virus that causes COVID-19, including procedures that effectively inactivate the virus to enable safe study of infected cells have been identified by virologists in the Institute for Biomedical Sciences at Georgia State University.

The peer-reviewed paper on the novel coronavirus, published in the journal Viruses, is a resource for newcomers in the field.

“Importantly, the study defines specific methods that fully inactivate the virus, that is make it non-infectious, in ways compatible with further scientific analysis,” said Dr. Christopher Basler, professor in the Institute for Biomedical Sciences, director of the Center for Microbial Pathogenesis and a Georgia Research Alliance Eminent Scholar in Microbial Pathogenesis.

“This allows researchers to study the proteins and genes of the virus and how the infected host responds to infection outside of high containment. Confirming that such analyses can be done safely, with no risk of infection, will increase the rate of discovery about the virus and COVID-19.”

When the disease COVID-19 appeared in humans, virologists in Basler’s lab, who study emerging pathogens, wanted to contribute to the effort to understand SARS-CoV-2 and develop medical countermeasures for the virus. Because the new pathogen causes serious disease for which there are no definitive treatments, biosafety level 3 (BSL3) facilities are required. It was also necessary to handle the virus with extra care because so little was known about it.

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Public torn over COVID-19 contact tracing apps, study shows

Early results from a study by researchers at Swansea University and The University of Manchester shows people are torn over whether they will use the COVID-19 contact tracing smartphone app planned for release in the UK.

The study finds:

  • Only one-third of people taking part said they will be downloading the app, with the rest either saying they will not be downloading it or are not yet sure.
  • Common concerns are that the app will infringe on people’s privacy, will stigmatise those with COVID-19, or will not be used by enough people for it to be effective.
  • Misinformation about the app and how it works is common.
  • Some people are actively avoiding COVID-19 news coverage which may be contributing to lack of information about the app and might affect whether they use it.

The researchers conducted online focus groups with UK adults across a range of gender, ethnic, age and occupational backgrounds to explore their attitudes on the proposed NHSX contact tracing app currently being trialled in the Isle of Wight.

Though the five focus groups consisted of 22 people, the researchers say because it is a qualitative study, it is likely to be indicative of general public opinion.

The research is led by Dr. Simon Williams, Senior Lecturer in People and Organisation at Swansea University, with collaborations from Dr. Kimberly Dienes and Professor Christopher Armitage of The University of Manchester’s Centre for Health Psychology, and Dr. Tova Tampe, an independent consultant at the World Health Organization (WHO).

Dr. Williams from Swansea University said: “Our study suggests that the government is far from guaranteed the level of support they need to have the kind of uptake that will make a big difference. A lot of work needs to be done to build public confidence and trust in their handling of COVID-19, and to improve communication around the app, especially after recent criticism over the handling of lockdown easing.

“The protection of privacy remains a widespread concern. People associated the app with the growth of ‘Big Brother’ surveillance. People were also concerned that uptake would not be high enough for it to be effective. The irony of course is that if enough people decide not to use it because they think others won’t, it becomes a kind of self-fulfilling prophesy.”

Dr. Dienes, lecturer in clinical and health psychology at the University of Manchester and co-author of the study said: “People who told us they would download the app indicated they would do it for the “greater good”, which means those people trusted the app and what the government is trying to achieve. Indeed, the question of whether they trusted the government had their wellbeing at heart, seemed to be at the centre of their concerns and positive intent to download.

“It seems one of the main reasons why some people are worried about privacy is they either do not have enough information or have the wrong information. For example, one of the big misconceptions is that the app allows its users to specifically identify, and even stigmatise, those with COVID-19 symptoms among their contacts and in their vicinity, which is not the case. Also, some people are starting to actively avoid news on COVID-19, because they find it too overwhelming. So, it is important that Government gets the information out there in as many ways as possible, much as they did initially with the lockdown guidance.”

Dr. Williams added: “We recommend that government should communicate as clearly as possible and using a variety of media. They should switch to a de-centralised approach, focus on reassuring the public over privacy, and promote the key message that using the app is part of a collective responsibility to stop the spread of the virus and can help save lives.”

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Study shows patients with hemorrhagic brain disease have disordered gut microbiomes

A new study shows that people with a rare genetic disease that causes bleeding in the brain have gut microbiomes distinct from those without the disease. Moreover, it is the molecules produced by this bacterial imbalance that cause lesions to form in the brains of these patients.

The results are the first in any human neurovascular disease. They have implications both for treating the disease and in examining other neurovascular diseases that could be affected by a person’s gut microbiome.

The study was led by investigators at University of Chicago Medicine and published May 27 in Nature Communications. It examined the gut bacteria of patients with cavernous angioma (CA), a disease where blood vessel abnormalities develop in the brain and cause strokes, seizures and serious neurologic complications. The disease is caused by a genetic mutation in the lesion —which may be inherited or occurs sporadically—and its severity and course vary widely among patients.

UChicago is a leader in studying this disease. It has been designated as a cavernous angioma center of excellence and treats patients with the condition from all over the world.

Investigators had hints that the disease could be affected by the gut microbiome: Senior author Issam Awad, MD, the John Harper Seeley Professor of Neurosurgery and Director of Neurovascular Surgery at UChicago Medicine, was a partner in a previous study in mice, which showed that the cells that lined the blood vessels of the brain reacted to the animals’ gut bacteria.

“The implications of that were very big,” he said. “But we didn’t know if this concept of a unique microbiome that favors the development of lesions would be true in human beings.”

To find out, UChicago researchers—working with investigators at the University of California San Francisco, University of New Mexico, University of Pennsylvania, and the Angioma Alliance patient support group—collected stool samples from more than 120 CA patients.

The samples were then analyzed for their bacterial content and compared with samples from the general population. The CA samples showed significantly higher amounts of gram-negative bacteria and less gram-positive bacteria. The researchers identified a combination of three common bacterial species, whose relative abundance can distinguish CA patients from control patients without CA lesions, with high sensitivity and specificity.

The CA samples also showed an imbalanced network of bacteria that was much more disordered than the general population’s bacterial network. “The CA patients from all the different collection sites had the same distinctive microbiome, regardless of whether they had inherited the mutation or had a sporadic lesion, and regardless of the number of lesions they had,” Awad said. The investigators further showed that the bacterial imbalance in patients with CA produces lipopolysaccharide (LPS) molecules, which travel through the bloodstream to the brain and attach to the brain’s blood vessel lining, facilitating lesion development. “All this evidence pointed to the microbiome as a cause of lesions rather than an effect,” Awad said.

The investigators also collected blood from several CA patients and used advanced computational machine learning to identify the combination of molecular signals associated with the disease. Those with CA had significantly different LPS-related related blood biomarkers and inflammatory molecules. The result was essentially a smart, personalized test for each CA patient. “By looking at both bacteria combinations and the blood biomarkers, we were able to measure just how aggressive the disease was in each patient,” said Sean Polster, MD, a neurosurgery resident at UChicago Medicine and first author on the paper. Polster spent two years of his neurosurgery residency coordinating the study among the different institutions.

The researchers are beginning to think about how these results affect treatment. Earlier studies in mice showed that those fed emulsifiers—which are often used as preservatives in processed foods—had more bleeding in the brain, likely due to the way they disrupted the gut’s bacterial network. The researchers now tell patients to avoid these preservatives.

Though antibiotics and probiotics might seem like natural courses of treatment, they could change the bacterial balance in ways that lead to bigger problems. “This is more complicated than it appears,” said Awad. However, he tells CA patients who have infections caused by gram-negative bacteria (such as urinary tract infections or prostatitis) to have them treated right away to avoid more potential brain lesions.

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