23 July 2021

Supporting China Scientists

Welcome back. About 17 months ago, an open letter was published in The Lancet, one of the world's oldest and best-known general medical journals. Some two dozen international physicians, veterinarians, epidemiologists, virologists, biologists, ecologists and public health experts joined to express solidarity with professional colleagues in China.

Following the emergence of COVID-19 in China, rumors, misinformation and conspiracy theories arose regarding the virus’s origins. Especially disconcerting was the targeting of scientists and health professionals in China who had shared data with unprecedented speed, openness and transparency, while working to learn more about the newly recognized virus and fight the outbreak. The unsubstantiated allegations threatened to undermine the very global collaborations that were vital to combat the disease.

Former President Trump delivering a prerecorded message to the U.N. General Assembly (22 Sep 2020) during which he called on China to be held accountable for unleashing the “China virus” (UNTV via AP from www.usatoday.com/story/news/politics/elections/2020/09/22/trump-blasts-china-coronavirus-pandemic-un-speech/5864039002/).  

In recent months, many of those who had signed the open letter were being asked if they still endorse what they had written in early 2020. The group’s response was published as a longer, more detailed correspondence in the same journal.

The Second Open Letter
The group reaffirmed its solidarity with colleagues in China as well as with health professionals around the world, working to exhaustion at personal risk to battle the virus--“Our respect and gratitude have only grown with time.”

They wrote how the pandemic highlighted the need to build a better understanding of how science proceeds, linking with health, public health and politics.

For example, in the initial correspondence, they expressed their working view that COVID-19 most likely originated in nature, not in a laboratory. This was based on early genetic analysis and previous emerging infectious diseases.

They still find the strongest evidence is that the virus evolved in nature, noting:
“Evidence obtained using the scientific method must inform our understanding and be the basis for interpretation of the available information. The process is not error-free, but it is self-correcting as good scientists endeavor to continually ask new questions, apply new methodologies…and revise their conclusions through an open and transparent sharing of data and ongoing dialogue.”

Suggestions of a laboratory-leak source remain without scientifically validated evidence.

China’s Wuhan Institute of Virology is at the center of speculation about where the COVID-19 pandemic may have begun (from www.sciencenews.org/article/coronavirus-covid-origins-questions-wuhan-lab-leak-nature).
Wrap Up
They emphasize that allegations and conjecture are of no help; recrimination will not encourage cooperation and collaboration. Because new viruses can emerge anywhere, maintaining transparency and cooperation among scientists everywhere is essential. Cutting professional links and reducing data sharing will not make us safer.

“It is time to turn down the heat of the rhetoric and turn up the light of scientific inquiry if we are to be better prepared to stem the next pandemic.”

The writers encourage the World Health Organization and scientific partners to extend their initial investigation with experts in China and the Government of China.

Perhaps I should add that, among international leaders in infectious disease research and public health, the list of signatories to the letters includes such renowned U.S. scientists as the former Asst. Surgeon General/former Head of CDC National Center for Emerging Diseases, former Head of the National Science Foundation, former Head of the National Institutes of Health Fogarty International Center, as well as multiple members of the U.S. National Academy of Medicine.

Thanks for stopping by.


First open letter: www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30418-9/fulltext
Second open letter: www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01419-7/fulltext
Petition in support of first open letter: www.change.org/p/government-agencies-and-people-of-the-world-support-for-the-public-health-professionals-of-china-combatting-covid-19
COVID lab-leak hypothesis: www.nature.com/articles/d41586-021-01529-3

16 July 2021

Hiccup Stopper

Welcome back. There’s a new device for stopping hiccups. I’m hesitant to blog about it since my post will come off as an advertisement, what’s worse, a promotion for something I’ve never tried.

The new device for stopping hiccups from the University of Texas (from news.uthscsa.edu/hiccaway-ut-health-san-antonio-physician-develops-device-to-relieve-hiccups/).
In my defense:
-The evaluation of the device was recently published in a Journal of the American Medical Association.
-The device was invented by a neurosurgeon affiliated with the University of Texas Health Science Center at San Antonio.
-Its development, testing and evaluation proceeded with colleagues at the Health Science Center and collaborators at Shiraz University of Medical Sciences, Iran; Sanatorio Pasteur, Argentina; and University of Z├╝rich and Klinik Arlesheim, Switzerland.
-The device is being marketed by a Colorado company under a license agreement with the university.
-The funder had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication.

And one more thing. Testing, which I’ll describe, reportedly had super results.

A hiccup is an involuntary contraction of the diaphragm, the major muscle of respiration, located between our lungs and abdomen. When the diaphragm spasms, we inhale suddenly, our vocal cords and larynx snap closed causing the characteristic hiccup sound, and our lungs take in air quickly.

For most of us, hiccups are an occasional annoyance that passes in a few minutes. For those affected longer or by frequent reoccurrence, they impact quality of life. Hiccups can be serious problem, especially for post-surgical patients, patients with brain and stroke injury and cancer patients (apparently some chemotherapies cause hiccups).

There are numerous remedies to stopping hiccups, such as holding your breath, breathing into a paper bag or eating a spoonful of sugar. Many are supported by centuries of anecdotal evidence, though none has any scientific basis. And that’s what makes the new device special.

Science-Based Hiccup Remedy
The Forced Inspiratory Suction and Swallow Tool (FISST) is a rigid drinking tube that’s been patented and branded HiccAway

The straw-like device has a cap at the bottom with a pressure value adjustable for adult or child. Forcefully suctioning and swallowing water from a half-filled cup usually stops hiccups in 1 or 2 attempts. (Graphic from jamanetwork.com/journals/jamanetworkopen/fullarticle/2781196)
With an inlet valve adjustable for adult or child, FISST requires significant suction to draw water from a cup into the mouth. The high negative pressure requires contraction of the diaphragm, triggering the phrenic nerve that regulates the diaphragm. When water reaches the mouth, the brain wants to swallow it, so it closes the epiglottis. The epiglottis is the flap of cartilage behind the tongue that folds to cover the larynx when we swallow, preventing food and liquid from entering the windpipe and lungs. This stimulates the vagus nerve, which regulates internal organ functions and certain reflex actions, including coughing and swallowing. The vagus nerve blocks signals to the vocal cords and eases the hiccups.

Surveying FISST Users
FISST was offered to volunteers through an online Kickstarter campaign. Globally, 674 people volunteered to receive the device. Of those, 290 gave written consent to participate and were provided an online questionnaire, which 249 completed (51% female, 79% white).

The questionnaire had participants compare FISST with home remedies on a scale of 1 to 5 (1-strongly favor home remedies, 5- strongly favor FISST). The primary outcome was the subjective effectiveness of FISST compared with home remedies. The secondary outcome was overall satisfaction with FISST.

Of the 249 surveyed participants, 70% had hiccups at least once a month, 66% had hiccups lasting less than 2 hours. FISST stopped hiccups in nearly 92% of cases and was rated favorably compared with home remedies across demographics, hiccup frequencies and hiccup durations. The mean subjective effectiveness score with FISST was 4.58 (standard deviation, 0.90); the mean satisfaction was 4.57 (standard deviation, 1.61), with 91% of participants rating FISST more feasible than home remedies. No adverse effects were reported.

Evaluation of Forced Inspiratory Suction and Swallow Tool by the participants’ demographic characteristics compared with home remedies (46 participants did not rate effectiveness) (from jamanetwork.com/journals/jamanetworkopen/fullarticle/2781196).
Wrap Up
Although the study showed FISST to be an easy-to-use tool to stop hiccups that users rated superior to home remedies, the researchers recognized the lack of a control group and the subjective nature of the scoring system were significant study limitations. They expected future testing to assess FISST in randomized clinical trials.

I’m going to guess that may not happen. The company under a license agreement with the university has already contracted with a major supermarket chain to sell the tool. Thanks for stopping by.

Study of FISST evaluation in JAMA Network Open journal: jamanetwork.com/journals/jamanetworkopen/fullarticle/2781196
Article on study on EurekAlert! website: www.eurekalert.org/pub_releases/2021-06/uoth-tds061821.php
Initial University of Texas Health San Antonio news release on hiccup device invention: news.uthscsa.edu/hiccaway-ut-health-san-antonio-physician-develops-device-to-relieve-hiccups/
26 ways to get rid of hiccups: www.healthline.com/health/how-to-get-rid-of-hiccups

09 July 2021

Vaccine Lotteries

Welcome back. Do you live in a state that’s running a lottery to give COVID-19 vaccinations a shot in the arm? Is your state one of those offering a million-dollar jackpot?

Having faith in statistics, I normally ignore state lotteries. But every vaccine lottery will have a winner, and the million-dollar prize won’t entice all anti-vaxxers, COVID-19 unbelievers, those fearing side effects or needles or distrusting the vaccines or government or lacking access or believing any of many conspiracy theories or who knows what else. As such, these lotteries will have a smaller pool of “players” and much better odds--except in states where eligibility extends to those already vaccinated.

Statistics and cash incentives aside, I think million-dollar jackpots are -- how shall I put it? -- absolutely nuts! Although they’ll surely attract more attention than Indiana’s box of Girl Scout cookies for getting a shot, there must be better ways to use that kind of money to promote vaccinations.

A recent study by researchers with the Boston University School of Medicine showed it's more than my opinion.

Announcement of Ohio’s Vax-a-Million lottery (fox8.com/news/coronavirus/ohio-vaccine-lottery/ohio-vaccine-lottery-who-is-eligible-for-the-weekly-1-million-scholarship-prizes-and-what-do-they-need-to-do/).
Ohio Vaccine Lottery
Ohio was the first state to announce a cash lottery. Its "Vax-a-Million" lottery initially seemed to produce the needed incentive, and several other states followed suit with their own million-dollar jackpots--alphabetically, California, Colorado, Kentucky, Louisiana, Maryland, Massachusetts, Nevada, New Mexico, North Carolina, Oregon, Washington and West Virginia.

Unfortunately for those states and vaccination incentives, the Boston University researchers dug a bit. They analyzed trends in CDC data on vaccination rates, comparing Ohio against states that did not yet have vaccine incentive lottery programs. They focused on vaccination rates both before and after the Ohio lottery. The vaccination rates in other states thus provided a reference or control for trends in Ohio, allowing the researchers to account for factors besides the Ohio lottery.

They found that the initial evaluations of the Ohio lottery had failed to account for other changes in the U.S. vaccination rate. Most notable was the expansion of vaccinations to those ages 12 to 15.

Wrap Up
The study findings suggest that vaccine lotteries, even those with million-dollar jackpots, are of limited value for increasing vaccine uptake.

Pointing to the critical importance of increasing COVID-19 vaccination rates, the researchers emphasize that strategies to increase vaccine uptake must be rigorously evaluated. Those judged successful should be rapidly employed.

No doubt you’ve been vaccinated, but best of luck if your state has a lottery and you're still eligible. And thanks for stopping by.

Study of vaccine lotteries in Journal of the American Medical Association: jamanetwork.com/journals/jama/article-abstract/2781792
Article on study on EurekAlert! website: www.eurekalert.org/pub_releases/2021-07/buso-lid070221.php
Forbes article on groups still refusing COVID-19 vaccine: www.forbes.com/sites/alisondurkee/2021/06/11/here-are-the-biggest-groups-that-are-still-refusing-the-covid-19-vaccine-poll-finds/?sh=28a0066d42cc
The New York Times article on state vaccine lotteries: www.nytimes.com/2021/07/03/world/covid-vaccine-lottery.html

02 July 2021

Ancient Memory Aid

Welcome back. Do you use a mnemonic or some other approach to remember things, or do you just remember? I keep slipping on just about everything except remembering when I could remember. Fortunately, I don’t have to remember much, unlike the medical students that compared memory techniques in a recently published study by researchers affiliated with Australia’s Monash and Deakin universities.

Loci mnemonics are techniques that use familiar spatial environments to facilitate the recall of information. The Australian study compared two loci memory approaches (graphic modified from www.microprof.io/the-science).
We can look up or ask Siri or even write things down in a pinch, so we tend to depend less and less on memorization. But for training in some professions, such as health, memorization is the most efficient means of ensuring the required information is readily available and that a foundation is laid for advanced training.

Study Structure and Initial Testing
As part of the Rural Health curriculum and the undergraduate Nutrition and Dietetics program in the Monash University Faculty of Medicine, Nursing, and Health Sciences, the researchers enlisted and randomly divided 76 first-year medical students into three groups to test different memorization techniques.

All of the students were given 10 minutes to memorize a list of 20 common butterfly names; then 5 minutes to write down as many names as they could recall. The choice of butterflies was intended to divorce the training from the medical curriculum. 

List of butterfly names used for testing memory recall (from journals.plos.org/plosone/article?id=10.1371/journal.pone.0251710).
After the recall test, students in two of the groups were given 30 minutes of instruction in one of two memorization techniques. The third group of students, instead of memory training, watched an unrelated documentary movie.

Memory Training
One group was trained in the memory palace technique. This approach, which traces to ancient Greek and Roman rhetorical treatises, uses visualizations of familiar spatial environments to enhance recall. Students were instructed to associate listed items to be remembered with specific objects and locations in a memory floor plan of their childhood home. To recall items, they were to imagine revisiting the room and approaching each object and location associated with a listed item.

The second group’s training was in the memorization technique developed by Australian Aboriginal people over more than 50,000 years of living in a custodial relationship with the land. This method also attaches facts to a familiar spatial environment, the landscape. Stories are added to describe the facts and placement to facilitate recall. For the training, the instructor led the students through a campus rock garden, incorporating listed items into a narrative related to elements in the garden. Students were encouraged to visualize walking through the garden during recall.

Rock garden and sketch map with path through rock garden used for Australian Aboriginal memorization (from journals.plos.org/plosone/article?id=10.1371/journal.pone.0251710).
Retesting Student Recall
After the training, all of students repeated the memory test procedure--10 minutes to memorize the butterfly list, five minutes to recall and record the names; took a 20-minute break; then repeated the recall test again, this time without reviewing the list.

Results from each student’s recall tests were scored, with recall errors counted in four categories: no entry, near miss, wrong word or phrase, and removal of correct answer with no replacement. The results were also assessed with regard to the sequence of items in the original list.

Wrap Up
Both memorization techniques improved the level of recall compared to no memory training.

Although the mean number of items recalled by the two memory-trained groups was similar, differences were apparent. Of students who did not initially recall all items correctly, the Aboriginal method resulted in approximately a 3-fold greater probability of improvement to accurate recall of the entire word list. Further, students taught the Aboriginal method exhibited significantly fewer errors of sequence.

Apart from testing memory techniques, the researchers also had 49 undergraduate students evaluate the use of the Aboriginal memory technique as an aid for classroom study of foundational biomedical knowledge. The responses were overwhelmingly favorable. They found the training and technique enjoyable, interesting and more useful than rote memorization.

I know I would. Thanks for stopping by.

Method of loci memorization techniques: en.wikipedia.org/wiki/Method_of_loci
Study of memorization techniques in PLOS ONE journal: journals.plos.org/plosone/article?id=10.1371/journal.pone.0251710
Article on study on EurekAlert! website: www.eurekalert.org/pub_releases/2021-05/mu-aaa051721.php

25 June 2021

Brain Signals to Text

Welcome back. There’s been some fascinating work on brain-computer interfaces (BCIs) aimed at restoring communication to those who have lost the ability to move or speak. While the primary focus has been on restoring gross motor skills--reaching and grasping or point-and-click typing with a computer cursor, a recently published pilot study by researchers affiliated primarily with Stanford and Brown universities described translating neural activity to text in real time. Got that? Converting thoughts about handwriting to computer screen text.

Cataloging the Study
The study report and media summaries appeared about a month ago. As you might expect, the research and development project actually began long before. 

BrainGate2 is NCT00912041 in the National Library of Medicine’s clinical trials database (www.clinicaltrials.gov/ct2/show/NCT00912041).
The U.S. National Library of Medicine, an institute of the National Institutes of Health, maintains a database of worldwide privately and publicly funded clinical studies. There you’ll find BrainGate2: Feasibility Study of an Intracortical Neural Interface System for Persons with Tetraplegia (i.e., paralysis in the upper and lower body). The study is described as an interventional clinical trial to identify the core methods and features for a medical device that could allow people with paralysis to recover a host of abilities that normally rely on the hands. The study began in 2009 with the estimated completion in 2022.

Study Procedures
The investigation focused on a single individual who lost nearly all movement below the neck after a spinal cord injury in 2007. Nine years later, the researchers implanted two BCI chips the size of baby aspirins on the surface of the left side of his brain. Each chip had 100 electrodes to receive electrical signals from neurons firing in the part of the brain’s motor cortex that controls hand and finger movement.

Brain’s motor cortex is in charge of planning, control and execution of voluntary movements (graphic from www.researchgate.net/journal/Frontiers-in-Human-Neuroscience-1662-5161).
The neural signals were transmitted via wires to a computer, where artificial-intelligence algorithms “learned” to decode the signals using a recurrent neural network approach to deduce the individual’s thoughts about handwriting motion.

The algorithm training had the participant mentally write letters of the alphabet on an imaginary legal pad with an imaginary pen, repeating each letter 10 times. Next, in many long sessions, the participant was shown groups of sentences and instructed to mentally handwrite each sentence. Over time, the algorithms improved in differentiating the neural signals of the different characters. 

Graphic of electrodes detecting neural signals of man mentally handwriting (from Howard Hughes Medical Institute video www.youtube.com/watch?v=pcApwQxbagg).
Wrap Up
Although the coupling of BCI with artificial-intelligence software to convert thoughts to screen-displayed text was only tested on one person, the proof-of-concept results were impressive. The participant was eventually able to generate about 18 words per minute with an accuracy of nearly 100% with a general purpose autocorrect. Healthy people of the same age reportedly text about 23 words per minute on a smartphone

When asked to write answers to open-ended questions, which required time for thought, the participant averaged close to 15 words per minute.

What the researchers found especially interesting was that, years after suffering the spinal cord injury and losing hand and finger movement, the neural activity associated with writing was not lost.

Thanks for stopping by.

Study of brain to text handwriting in Nature journal: www.nature.com/articles/s41586-021-03506-2
Example articles on study
National Library of Medicine’s clinical trials database and BrainGate2 entry: