Heart disease is the leading cause of death for both men and women, according to the Centers for Disease Control and Prevention (CDC). In the U.S., one in every four deaths is a result of heart disease, which includes a range of conditions from arrhythmias, or abnormal heart rhythms, to defects, as well as blood vessel diseases, more commonly known as cardiovascular diseases.
Predicting and monitoring cardiovascular disease is often expensive and tenuous, involving high-tech equipment and intrusive procedures. However, a new method developed by researchers at USC Viterbi School of Engineering offers a better way. By coupling a machine learning model with a patient’s pulse data, they are able to measure a key risk factor for cardiovascular diseases and arterial stiffness, using just a smart phone.
Arterial stiffening, in which arteries become less elastic and more rigid, can result in increased blood and pulse pressure. In addition to being a known risk factor for cardiovascular diseases, it is also associated with diseases like diabetes and renal failure.
“If the aorta is stiff, then when it transfers the pulse energy all the way to the peripheral vasculature – to small vessels – it can cause end organ damage. So, if the kidneys are sitting at the end, the kidneys get hurt; if the brain is sitting at the end, the brain gets hurt,” said Niema Pahlevan, assistant professor of aerospace and mechanical engineering and medicine.
By measuring pulse wave velocity, which is the speed that the arterial pulse propagates through the circulatory system, clinicians are able to determine arterial stiffness. Current measurement methods include MRI, which is expensive and often not feasible, or tonometry, which requires two pressure measurements and an electrocardiogram to match the phases of the two pressure waves.
The novel method developed by Pahlevan, Marianne Razavi and Peyman Tavallali uses a single, uncalibrated carotid pressure wave that can be captured with a smart phone’s camera. In a previous study, the team used the same technology to develop an iPhone app that can detect heart failure using the slight perturbations of your pulse beneath your skin to record a pulse wave. In the same fashion, they are able to determine arterial stiffness.
“An uncalibrated, single waveform – that means that you eliminated two steps. That’s how you go from an $18,000 (€15,000)tonometry device and intrusive procedure to an iPhone app,” Pahlevan said.
“It’s very easy to operate,” added Razavi, who is the director of biostatistics for Avicena LLC, the startup company developing the app. “I actually taught my kid to do it.”
Instead of a detailed waveform required with tonometry, their method needs just the shape of a patient’s pulse wave for the mathematical model, called intrinsic frequency, to calculate key variables related to the phases of the patient’s heartbeat. These variables are then used in a machine learning model that determines pulse wave velocity (PWV) and, therefore, arterial stiffness.
To validate their method, they used existing tonometry data collected from the Framingham Heart Study, a long-term epidemiological cohort analysis. Using 5,012 patients, they calculated their own PWV measurements and compared them with the tonometry measurements from the study, finding an 85 percent correlation between the two.
But more importantly, they needed to determine whether their method could be used to predict cardiovascular disease.
“What the clinician wants to know is whether or not you’re helping them to improve outcome,” Pahlevan said. “And we showed that it is as predictive as the actual tonometry.”
Through a prospective study using 4,798 patients, they showed that their PWV measurement was significantly associated with the onset of cardiovascular diseases over a ten-year follow up period. Their study was published in Nature Scientific Reports in January.
 “A lot of people have tried to bring machine learning to medical devices, but pure AI by itself doesn’t work,” Pahlevan said. “When you get a high correlation, you can be missing all of the diseased patients because, in medicine, the outliers are the cases you want to capture – they’re the important ones.”
The reason their machine learning method is able to capture clinically significant outcomes is due to their intrinsic frequency algorithm, which is the mathematical analysis used to calculate physically relevant variables relating to the patient’s heart and vascular function. The main variables represent the heart’s performance during the contraction phase (systole) and the vasculature’s performance during the relaxed phase (diastole).
The method was developed just three years ago during Pahlevan’s postdoctoral work.  The team plans on expanding on the intrinsic frequency algorithm so that it can be applied to a number of other applications, such as detecting silent heart attacks.

USC Viterbi School of Engineeringhttps://tinyurl.com/y74uolb2

The world’s largest randomized controlled trial of acupuncture in emergency departments has found the treatment is a safe and effective alternative to pain-relieving drugs for some patients.
Led by RMIT University, the study found acupuncture was as effective as pain medicine in providing long-term relief for patients who came to emergency in considerable pain.  But the trial, conducted in the emergency departments of four Melbourne hospitals, showed pain management remains a critical issue, with neither treatment providing adequate immediate relief.
Lead investigator Professor Marc Cohen, from RMIT’s School of Health and Biomedical Sciences, said pain was the most common reason people came to emergency, but was often inadequately managed.
“While acupuncture is widely used by practitioners in community settings for treating pain, it is rarely used in hospital emergency departments,” Cohen said.
“Emergency nurses and doctors need a variety of pain-relieving options when treating patients, given the concerns around opioids such as morphine, which carry the risk of addiction when used long-term.
“Our study has shown acupuncture is a viable alternative, and would be especially beneficial for patients who are unable to take standard pain-relieving drugs because of other medical conditions.
“But it’s clear we need more research overall to develop better medical approaches to pain management, as the study also showed patients initially remained in some pain, no matter what treatment they received.”
Patients who identified their level of pain as at least 4 on a 10-point scale randomly received one of three types of treatment: acupuncture alone, acupuncture plus pharmacotherapy or pharmacotherapy alone.
One hour after treatment, less than 40 per cent of patients across all three groups felt any significant pain reduction (2 or more pain points), while more than 80 per cent continued to have a pain rating of at least 4.
But 48 hours later, the vast majority found their treatment acceptable, with 82.8 per cent of acupuncture-only patients saying they would probably or definitely repeat their treatment, compared with 80.8 per cent in the combined group, and 78.2 per cent in the pharmacotherapy-only group.
RMIT Universityhttps://tinyurl.com/yaclex5p

A small clinical trial led by Richard S. Hotchkiss, MD, at Washington University School of Medicine in St. Louis, shows that a drug that revs up the immune system holds promise in treating sepsis. The approach goes against the grain of earlier strategies that have relied on antibiotics and inflammatory medications to tamp down the immune system.
While many people have never heard of sepsis, it causes about 250,000 deaths annually in the United States. The condition develops when an infection triggers an overwhelming immune response, ultimately wreaking havoc on the immune system. Standard treatment involves high doses of antibiotics that fight the infection, but they often don’t work well and fail to boost the body’s immune defences.
Now, a small clinical trial led by researchers at Washington University School of Medicine in St. Louis shows that a drug that revs up the immune system holds promise. The approach goes against the grain of earlier strategies that have relied on antibiotics and inflammatory medications to tamp down the immune system.
 “Mortality rates from sepsis have remained essentially the same over the last 50 years,” said senior investigator Richard S. Hotchkiss, MD, a professor of anaesthesiology, of medicine and of surgery. “Hundreds of drugs have been tried and have failed. It may sound counterintuitive when inflammation is such a problem early in sepsis, but our approach is to stimulate certain immune cells to help the patient’s system take control of the infection.”
The trial involved 27 sepsis patients, ages 33 to 82, who were treated at Barnes-Jewish Hospital in St. Louis, Vanderbilt University Medical Center in Nashville or two medical centers in France — Dupuytren University Hospital in Limoges and Edouard Herriot Hospital in Lyon. Although the study was too small to see a statistical benefit in mortality, the researchers noted an improved immune response in patients who were given a drug to beef up their immunity.
The patients were treated with a drug made of interleukin-7 (IL-7), which enhances the proliferation and survival of two types of immune cells: CD4 and CD8. These cells are important because they recruit other immune cells to fight severe infections that can lead to organ failure and death.
“Patients who develop the most serious form of sepsis, called septic shock, often have very low counts of these key immune cells,” said co-investigator Edward R. Sherwood, MD, PhD, a professor of anaesthesiology at Vanderbilt. “We believe that could play a role in the development and course of sepsis because without those cells, patients aren’t able to clear as much harmful bacteria.”
The patients in the trial, who were hospitalized and severely ill with septic shock, were randomly assigned to one of two therapies. Seventeen patients received the IL-7 drug, and 10 received a standard treatment. Those who received the drug experienced a threefold to fourfold increase in CD4 and CD8 counts.
“Even though the study was small, we were encouraged that IL-7 helped restore key cells in the immune systems of these patients,” said Andrew H. Walton, a staff scientist in the Hotchkiss lab and co-author of the study. “Overall, that should help improve patient survival.”
The researchers showed that IL-7 boosts adaptive immunity, in which CD4 and CD8 T cells help recruit other immune cells — called macrophages, monocytes, neutrophils and dendritic cells — to kill bacteria that cause infections. Traditional approaches to sepsis therapy do not address the critical problem of patients’ severely compromised immune systems. Without restoring immune function, Hotchkiss said, many patients develop lingering infections and are helpless to fight any new infections.
“We know that 40 percent of patients die in the 30- to 90-day period after the initial septic infection,” Hotchkiss said. “Their bodies can’t fight secondary infections, such as the blood infections and staph infections that can develop later on because their immune systems are shot. By strengthening adaptive immunity with IL-7 and increasing the numbers of CD4 and CD8 cells available to help fight infections, we think this approach can make a big difference.”
Hotchkiss credits recent approaches to cancer treatment as evidence that this strategy for sepsis therapy may be a game changer for many patients. Several cancer researchers have begun using IL-7 to rev up a patient’s own immune system to fight cancer. In addition, under compassionate-use guidelines, IL-7 has been given to some critically ill patients with serious viral infections and has successfully restored their CD4 and CD8 counts while improving survival.
As a next step, Hotchkiss and Sherwood are planning a larger trial to determine whether the same holds true for sepsis patients. They estimate a study involving 300 to 400 patients should have the statistical strength to determine whether IL-7 can improve survival rates.
Washington University School of Medicinemedicine.wustl.edu/news/new-way-fight-sepsis-rev-patients-immune-systems

Nominations for the International Hospital Federation Awards are due on 17 May 2019. All hospitals and health service providers that want their outstanding projects and programs recognized internationally are encouraged to submit their entries now for a chance to bag one of the four awards.
IHF/Dr Kwang Tae Kim Grand Award

Open to IHF Full and Associate Members and their healthcare provider members. This recognizes excellence and achievements at health system or facility level in multiple areas including quality and patient safety, corporate social responsibility, innovations in service delivery at affordable costs, and healthcare leadership and management practices. To check if your organization or association is an IHF member, click here.

IHF Excellence Awards
These awards are open to all IHF Member and non-member public and private healthcare provider organizations. These recognize excellence or outstanding achievements in specific fields:

• IHF/Bionexo Excellence Award for Corporate Social Responsibility 
• IHF/EOH Excellence Award for Leadership and Management in Healthcare 
• IHF/Austco Excellence Award for Quality & Safety and Patient-centered Care 

The nomination process is simple and there is no cost to enter. Interested organizations just need to create an account in the IHF Awards website and complete the entry form.
Winners will be awarded in front of industry peers during the 43^rd IHF World Hospital Congress in Muscat, Oman in November. The Awards Ceremony will once again provide organizations from across the globe the opportunity to come together and celebrate the hard work they have put in to their outstanding programs.  https://congress.ihf-fih.org/ihf_awards

Rapid whole-genome sequencing (WGS) of acutely ill neonatal intensive care unit (NICU) patients in the first few days of life yields clinically useful diagnoses in many cases, and results in lower aggregate costs than the current standard of care, according to recent  findings.
Shimul Chowdhury, PhD, FACMG, Clinical Laboratory Director at the Rady Children’s Institute for Genomic Medicine, and his colleagues focused their analysis on a broad swath of NICU patients for whom a genetic diagnosis might help inform treatment decisions and disease management. They studied the clinical utility and cost-effectiveness of sequencing infants and their parents.
“Newborns often don’t fit traditional methods of diagnosis, as they may present with non-specific symptoms or display different signs from older children,” said Dr. Chowdhury. In many such cases, he explained, sequencing can pinpoint the cause of illness, yielding a diagnosis that allows doctors to modify inpatient treatment and resulting in dramatically improved medical outcomes in both the short and long term.
Because of the potential for early intervention and immediate adjustment in care, the researchers used a rapid WGS procedure that took three to seven days from sample collection to delivering results to patients’ families. The process can be further accelerated if medically necessary. In contrast, most clinical diagnostic tests take four to six weeks.
In 34 (35%) of the 98 patients enrolled in the study, WGS yielded a genetic diagnosis, and in 28 (80%) of those patients, that diagnosis led to changes in medical management, such as the use of medications targeted to the underlying disease, avoidance of unnecessary surgery, and guidance about palliative care. Cost-effectiveness analyses are ongoing, but among the first 42 infants sequenced, the researchers calculated a $1.3 million net cost savings for that hospitalization versus the current standard of care.
“The cost savings were especially striking, given that sequencing costs are still high – even with those costs, we found that rapid WGS was not just clinically useful but economically prudent,” Dr. Chowdhury said. Currently, the researchers are looking to expand their study and assess the effectiveness of their approach across health systems and populations. Ongoing partnerships with children’s hospitals in California and Minnesota involve scaling up the rapid WGS process to meet demand and yield new insights about its clinical utility, cost-effectiveness, and ease of implementation in different environments.
Dr. Chowdhury noted the important contribution of genetics research to their progress so far. “Translational research leading to improvements in the speed and accuracy of sequencing tests is so important to our work, and has a real impact on patients and their families,” he said.

American Society of Human Geneticshttps://tinyurl.com/yda3rc6g