AI beats docs at identifying patients likely to die of cardiac arrest

A new AI model is much better than doctors at identifying patients likely to experience cardiac arrest.

The linchpin is the system’s ability to analyze long-underused heart imaging, alongside a full spectrum of medical records, to reveal previously hidden information about a patient’s heart health.

The  research could save many lives and also spare many people unnecessary medical interventions, including the implantation of unneeded defibrillators.

“Currently we have patients dying in the prime of their life because they aren’t protected and others who are putting up with defibrillators for the rest of their lives with no benefit,” says senior author Natalia Trayanova, a researcher focused on using artificial intelligence in cardiology.

“We have the ability to predict with very high accuracy whether a patient is at very high risk for sudden cardiac death or not.”

Hypertrophic cardiomyopathy is one of the most common inherited heart diseases, affecting one in every 200 to 500 individuals worldwide, and is a leading cause of sudden cardiac death in young people and athletes.

Many patients with hypertrophic cardiomyopathy will live normal lives, but a percentage are at significant increased risk for sudden cardiac death. It’s been nearly impossible for doctors to determine who those patients are.

Current clinical guidelines used by doctors across the United States and Europe to identify the patients most at risk for fatal heart attacks have about a 50% chance of identifying the right patients, “not much better than throwing dice,” Trayanova says.

The team’s model significantly outperformed clinical guidelines across all demographics.

Multimodal AI for ventricular Arrhythmia Risk Stratification (MAARS), predicts individual patients’ risk for sudden cardiac death by analyzing a variety of medical data and records, and, for the first time, exploring all the information contained in the contrast-enhanced MRI images of the patient’s heart.

People with hypertrophic cardiomyopathy develop fibrosis, or scarring, across their heart and it’s the scarring that elevates their risk of sudden cardiac death. While doctors haven’t been able to make sense of the raw MRI images, the AI model zeroed right in on the critical scarring patterns.

“People have not used deep learning on those images,” Trayanova says. “We are able to extract this hidden information in the images that is not usually accounted for.”

The team tested the model against real patients treated with the traditional clinical guidelines at Johns Hopkins Hospital and Sanger Heart & Vascular Institute in North Carolina.

Compared to the clinical guidelines that were accurate about half the time, the AI model was 89% accurate across all patients and, critically, 93% accurate for people 40 to 60 years old, the population among hypertrophic cardiomyopathy patients most at-risk for sudden cardiac death.

The AI model also can describe why patients are high risk so that doctors can tailor a medical plan to fit their specific needs.

“Our study demonstrates that the AI model significantly enhances our ability to predict those at highest risk compared to our current algorithms and thus has the power to transform clinical care,” says co-author Jonathan Chrispin, a Johns Hopkins cardiologist.

In 2022, Trayanova’s team created a different multi-modal AI model that offered personalized survival assessment for patients with infarcts, predicting if and when someone would die of cardiac arrest.

The team plans to further test the new model on more patients and expand the new algorithm to use with other types of heart diseases, including cardiac sarcoidosis and arrhythmogenic right ventricular cardiomyopathy.

The findings appear in Nature Cardiovascular Research.

Additional authors are from Johns Hopkins; the Hypertrophic Cardiomyopathy Center of Excellence at University of California, San Francisco; and Atrium Health.

Support for the work came from the National Institutes of Health and a Leducq Foundation grant.

Source: Johns Hopkins University

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Wearable sensor can tell when you need water

Researchers have created a new noninvasive, wearable sensor designed to measure a user’s hydration levels continuously.

Such a device could help a football player stay hydrated on a hot September afternoon, keep a firefighter battling a blaze from getting too dried out, or just let an office worker know when it’s time to refill a water bottle.

“Dehydration is a silent threat that affects millions of people every day,” says Nanshu Lu, a professor in the University of Texas at Austin’s Cockrell School of Engineering’s aerospace engineering and engineering mechanics department, who led the study in the Proceedings of the National Academy of Sciences.

“Our wearable sensor provides a simple, effective way to monitor hydration levels in real time, empowering individuals to take proactive steps to stay healthy and perform at their best.”

It uses bioimpedance, a technique that measures how electrical signals pass through the body, to track hydration levels. Using strategically placed electrodes, the sensor sends a small, safe electrical current through the arm.

How the electrical current flows through the body depends on the amount of water in the tissues. Water is a good conductor of electricity, so hydrated tissues allow the current to pass more easily, while dehydrated tissues resist the flow.

Data collected by the sensor is wirelessly transmitted to a smartphone, allowing users to monitor their hydration levels.

The researchers conducted several experiments to test the device, including a diuretic-induced dehydration study and a 24-hour free-living trial. In the dehydration study, participants took a diuretic medication to promote fluid loss, and their hydration levels were monitored using the wearable sensor and then tested against a urine sample.

The results showed a strong correlation between changes in arm bioimpedance and body weight loss due to water loss.

“Our experiments demonstrated that arm bioimpedance is not only sensitive to hydration changes but also aligns closely with whole-body hydration measurements,” says Matija Jankovic, coauthor of the study and a postdoctoral researcher in Lu’s lab.

“This means the sensor can be a reliable surrogate for tracking hydration levels, even during everyday activities like walking, working or exercising.”

Traditional methods for assessing hydration, such as urine tests and blood analysis, are often invasive, time-consuming and impractical for continuous monitoring. Commercial hydration assessment devices typically require bulky equipment and stationary setups, limiting their use in everyday life.

Lu and her team have used similar technology to create sensors to measure other aspects of human health, including:

• A sensor to measure stress levels, which could help people working difficult jobs perform at their best.
• A conductive ink that can be printed on someone’s head to measure their brainwaves.

Hydration is essential for human health. It plays a critical role in maintaining organ function, regulating body temperature, and supporting vital physiological processes.

Yet dehydration—a condition caused by insufficient water in the body—remains a common and often overlooked issue. Even mild dehydration can impair cognitive function, physical performance and thermoregulation, while severe dehydration can lead to life-threatening conditions such as kidney stones, cardiovascular issues and heatstroke.

In addition to protecting workers in extreme environments, the device has potential applications in health care. Continuous hydration monitoring could aid in diagnosing and managing conditions such as kidney disease, cardiovascular issues and chronic dehydration.

While the current version of the sensor tracks relative changes in hydration, future research aims to establish reference data for absolute hydration levels. This would involve collecting bioimpedance measurements from a large population to create a baseline for comparison.

The researchers also plan to explore new designs, such as breathable e-tattoos and sweat-wicking wearables, to improve comfort and performance during extended use. They hope to expand testing to larger groups and explore applications for other body segments, such as the forearm or thigh.

“This is just the beginning,” Lu says. “Our goal is to make simple hydration monitoring accessible to everyone.”

Source: UT Austin

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Tuberculosis bacteria ‘play dead’ to beat vaccines

New research finds that tuberculosis bacteria play possum to evade vaccines.

A vaccine protects more than 100 million infants each year from severe tuberculosis (TB), including the fatal brain swelling it can cause in babies and toddlers. But the vaccine doesn’t prevent adults from developing the more common form of TB that attacks the lungs.

This allows TB to persist as the world’s deadliest infectious disease, killing 1.25 million people a year.

“This bug is incredibly good at surviving the immune system.”

The existing vaccine for TB elicits a strong immune system reaction, according to most studies. Since standard measures of immunity don’t predict protection in adulthood, researchers took a new approach—studying how the TB bacterium evades an immune system primed to destroy it.

Their genetic study in mice, recently published in npj Vaccines, reveals that TB bacteria can essentially play dead to outlast the immune response.

TB is also known by its historic name—consumption—a term that reflects the disease’s slow, wasting, and often fatal course.

“There’s a dire need for better prevention, because treatment alone is not going to contain the spread of TB,” says Amanda Martinot, an associate professor at Cummings School of Veterinary Medicine at Tufts University and co-senior author of the study.

“When drugs to treat TB became available more than 60 years ago, cases dramatically dropped worldwide. But TB reemerged alongside the HIV epidemic, and it is increasingly resistant to traditional antibiotics. With just a handful of newer drugs available to treat resistant tuberculosis, it’s now much harder to cure.”

While other respiratory diseases like the flu and COVID-19 are caused by viruses that mutate frequently and constantly need new vaccines, TB is caused by a very genetically stable bacterium, Mycobacterium tuberculosis. So, in theory, TB should be easily preventable by vaccine.

For their study, the research team used a tool called transposon insertion sequencing, or TnSeq, to identify which genes were essential for bacterial survival in four groups of mice.

The first group of mice was vaccinated with the current vaccine, which was developed more than 100 years ago from the type of TB seen in cows. The second group was given an experimental vaccine based on the TB seen in humans, which generated a stronger immune response than the only currently approved vaccine in a preclinical study. The third group of mice had been exposed to TB and then cured by antibiotics. And the final, control group had never been vaccinated for or infected by TB.

The researchers expected to find key genes that TB needs to survive in vaccinated hosts, and they did uncover some potentially worth exploring for future vaccines. But the bigger surprise was which genes the bug didn’t need after vaccination or past infection.

“We were most surprised to find that certain genes that are normally important for driving rapid bacterial growth and causing serious tuberculosis infection aren’t as necessary when the bacteria infect someone who already has an immune response, either because they’ve been vaccinated or previously infected,” says Martinot.

Instead, the researchers discovered that the TB bacteria seem to switch strategies, relying on different genes that help them deal with stress and stop growing in a hostile environment.

“We suspect that the bacteria hunkers down, going quiet until the immune response weakens, whether from waning vaccine protection, HIV, or other conditions,” says Allison Carey, an assistant professor at the University of Utah and co-senior author of the study.

This knowledge could help scientists create treatments that could be given alongside vaccines to help the immune system root out TB when it tries to hide.

The team also found that different vaccines, or how they’re given, can shift which genes TB needs to stay alive. This shows that different vaccines may put different kinds of pressure on the bacteria, which could lead to new, more effective combinations of a vaccine plus booster.

“This bug is incredibly good at surviving the immune system,” says Martinot.

“It’s been infecting humans since ancient Egypt. Additional studies are needed so we can finally outsmart TB and rein in the current global emergency.”

Additional researchers fromTufts, The University of Utah, Harvard T.H. Chan School of Public Health, and Texas A&M University contributed to the work.

Source: Tufts University

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‘Exploding’ pills could deliver insulin without a needle

Researchers have created a pill that could effectively deliver insulin and other injectable drugs, making medicines for chronic illnesses easier for patients to take, less invasive, and potentially less expensive.

Along with insulin, it also could be used for semaglutide—the popular GLP-1 medication sold as Ozempic and Wegovy—and a host of other top-selling protein-based medications like antibodies and growth hormone that are part of a $400 billion market.

These drugs usually have to be injected because they can’t overcome the protective barriers of the gastrointestinal tract. The new capsule uses a small pressurized “explosion” to shoot medicine past those barriers in the small intestine and into the bloodstream.

Unlike other designs, it has no complicated moving parts and requires no battery or stored energy.

“This study introduces a new way of drug delivery that is as easy as swallowing a pill and replaces the need for painful injections,” says Mark Prausnitz, who created the pill in his lab with former PhD student Joshua Palacios and other student researchers.

In animal lab tests, they showed their capsule lowered blood sugar levels just like traditional insulin injections.

The researchers reported their pill design and study results in the Journal of Controlled Release.

(Credit: Georgia Tech)

“It was important to us not to turn this capsule into a complex device or machine,” says Prausnitz, a professor and chair in the School of Chemical and Biomolecular Engineering at Georgia Tech.

“Others have made mechanical devices for protein delivery that you can stick in your mouth or swallow, but they are costly and complicated. We wanted to make a capsule that uses a simple pharmaceutical formulation that is inexpensive to manufacture, but has the power of a mechanical device to increase drug delivery.”

The pill relies on a tried-and-true bubbling reaction of water and sodium bicarbonate to build pressure inside the capsule after it is swallowed. Eventually the pressure overwhelms a small weak spot in the pill’s gelatin exterior, resulting in a jet of drug particles.

The high velocity of the “explosion” sweeps away the mucus that lines the intestine much like a burst of air might shove water aside. It puts the drug right next to the epithelial cells that can transfer it to the bloodstream. Because the drug particles are moving so fast, protein-eating enzymes don’t have a chance to break them down.

The capsule itself is made of the same gelatin material as pills already in your medicine cabinet. It’s been strengthened by exposure to ultraviolet light to help it stand up to the extreme environment in the stomach and small intestine. The capsule has a small internal compartment containing the drug and positioning it for efficient ejection.

“Right from the start, we set an objective to develop the capsule so it can plug right into conventional capsule manufacturing methods,” says Joshua Palacios, the study’s first author and a former PhD student in Prausnitz’s lab.

“Obviously, we’re doing a few things differently, but it’s critical to make these capsules at low cost and in large quantity. Leveraging existing manufacturing processes is key to making broad impact with this technology.”

So far, no oral delivery methods for insulin are available to patients. While there are a few other protein drugs taken by mouth, most aren’t absorbed well in the intestine. For example, the body takes up less than 1% of the oral form of semaglutide, called Rybelsus; the other 99% is wasted. The insulin-carrying capsule Prausnitz and his team have developed is designed to increase that absorption, requiring less drug and increasing its effectiveness.

Now the team is working to further increase the percentage of drug that’s absorbed and exploring other injected drugs beyond insulin that might work in their capsule, such as semaglutide.

Prausnitz is known for pioneering microneedles for drug delivery through the skin. His work on skin delivery inspired the self-pressurizing capsule.

“I was thinking about all the different ways that we deliver medications across the skin and how this could be applicable in the intestine,” he says.

“While there are mechanical, electrical, ultrasonic, laser, and other devices you can apply to the skin, they are too complicated to be swallowed. But jet injection, which has been widely used for needle-free vaccination, could work in the gut. It’s like a tiny bullet that shoots drug into tissue.

“In the end, there are some differences in the science and mechanism, but the thought process is the same: You shoot something at high pressure against your target.”

Source: Georgia Tech

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Young athletes focused on 1 sport are more likely to get injured

Researchers say that young athletes who specialize in just one sport experience more injuries and injury-related surgeries.

Switching sports for one season a year, or roughly three months, can keep young athletes safer and provide a better outlook for their long-term health.

This information is important for parents, coaches, young athletes, and their health practitioners as they make decisions about upcoming sports seasons.

Some professional football players practice ballet. An NCAA champion runner also swims. An Olympic gold medal speed skater does six-hour biking sessions.

According to the researchers, these athletes are ahead of the game because cross-training can help prevent injury in youth athletes.

Nathan Fitton, associate professor of orthopedics in the Michigan State University College of Osteopathic Medicine, chief medical information officer for MSU Health Care, and MSU Athletics team physician; Jared Lutsic, MSU College of Osteopathic Medicine alumni and orthopedic surgery resident at Henry Ford Warren; and others studied the effects of sport specialization on collegiate athletes.

Their findings in the Clinical Journal of Sport Medicine reveal a direct association between the intensity of sport specialization and incidence of injuries while as a college athlete.

“We expected to learn that highly specialized athletes would have higher injury rates,” Fitton says.

“What’s alarming is a statistically significant increase in surgical procedures after an injury. We found that the more specialized an athlete was, the more likely they were to need surgery to correct an injury. This was true for male and female athletes.”

“There are lifelong implications for youth sports injuries,” he adds. “Injured athletes don’t always return to their pre-injury state. In the short term, this may mean they don’t get back to the sport at a level where they want to be. Longer term, we see arthritis from trauma to joints at an earlier age than would be expected. And we see 30- and 35-year-olds who need additional surgeries or lifestyle modifications to recover from an injury they experienced as a youth athlete.”

In the survey, NCAA Division I, II, and III athletes were asked about their sports participation, specialization, injuries, recovery periods, and treatment methods. Findings showed that highly specialized athletes were more likely to report injuries and, of those who says they had been injured, more than half reported a re-injury.

“We asked college athletes about their specialization status and learned that those who had a history of being highly specialized in high school got injured more frequently in college and had more severe injuries,” Lutsic says.

“Parents, physicians, and coaches should consider this when advising student athletes.”

“Athletes can still be very committed to a single sport and reduce their risk of injury by playing just one other sport for three months,” Fitton explains.

“Cross-training is like rotating the tires on your car. You’ll get longer use and better performance when tires are regularly rotated. For our bodies, diversification of movement reduces the risk of injury and helps maintain healthy functioning.”

Fitton says that other activities, like dance class or participating in a school play, can offer the break young athletes need. Even taking a day or two a week to do something that uses different muscle groups would be beneficial, he adds.

Source: Michigan State University

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How social media and news drive gun sales

As gun sales in the United States continue to soar, researchers have uncovered insights into what drives Americans to buy firearms.

A new study in Proceedings of the National Academy of Sciences (PNAS) Nexus journal reveals the complex interaction among media coverage, social media activity, and firearm purchases.

Led by Igor Belykh, a professor of applied mathematics at Georgia State University, the research team—including Kevin Slote, a PhD student in Georgia State’s mathematics and statistics doctoral program; Kevin Daley, a recent graduate; and coauthors from New York University (NYU) and the New Jersey Institute of Technology (NJIT)—analyzed daily data from 2012 to 2020.

Their study explores how gun-rights organizations and regulation advocates influence short-term firearm purchases through social media activity and media coverage.

The study found that social media activity by both sides directly affects gun buying behavior, often triggering purchases within days of posts. Media coverage of violent crime also plays a role, as it spurs discussions among these organizations, further influencing public sentiment toward gun ownership.

While fear of mass shootings and new gun regulations are often cited as factors for impulsive gun purchases, the research indicates that social media lobbying by anti-regulation groups and targeted media coverage are more influential factors in driving firearm acquisitions. Personal safety concerns drive many gun buyers more than reactions to mass shootings or potential legislative changes.

The team used PCMCI+, a novel statistical technique, to capture real-time interactions among media, social media (specifically X, formerly known as Twitter) and FBI background checks. This method provided insights into how daily media coverage and social media posts shape decisions to purchase firearms in ways that previous, monthly data analyses had not revealed. Primarily, the team monitored results from X but plans to use other platforms in the future.

“We found this complex, interwoven web of media and social media variables and how it influences people’s decision to buy guns,” says Slote.

“It’s not as simple as people just reacting to news about mass shootings or gun laws.”

Belykh adds, “Our findings suggest that efforts to reduce gun purchases might be more effective if they focus on addressing fear of violent crime rather than mass shootings.”

Looking ahead, the research team plans to use similar research methods and apply them to TikTok to explore a younger generation’s views on mass shootings.

“We’re going to look at how a younger demographic’s opinions about mass shootings affect these same variables,” Slote says.

The study is part of WE-SAFE, a collaborative National Science Foundation-funded project involving NYU, the University of California, Los Angeles (UCLA), Georgia State University, and Northeastern University aimed at engineering a safer American “firearm ecosystem.”

For policymakers and public health officials, this research provides valuable insights into the complex factors driving gun sales in the United States. By understanding these dynamics, more effective strategies for gun violence prevention may be developed without infringing on Second Amendment rights.

Source: Georgia State University

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How do new genes get switched on?

After nearly a decade of charting new genes in fruit flies, researchers have discovered how these de novo genes are regulated.

Most genes are ancient and shared across species. But a small subset of genes are relative newcomers, spontaneously emerging from stretches of DNA that once encoded nothing at all.

In complementary studies, in Nature Ecology & Evolution and PNAS, the team showed how transcription factors and genomic neighbors switch these genes on and integrate them into cellular networks—the first studies to identify these master regulators.

Together, the findings shed light on how new genes become functional, with broad implications for understanding evolutionary biology and gene regulation—and diseases born from their dysfunction.

“The more we know about de novo regulation, the more information we have about gene expression and regulation itself,” says Li Zhao, head of the Laboratory of Evolutionary Genetics and Genomics at Rockefeller.

“That’s important not only for evolutionary biology but also for the study of diseases like cancer, which are associated with rapid genetic dysregulation.”

When Zhao started her lab eight years ago, the existence of de novo genes had only been recently discovered. As Zhao began identifying hundreds of these mysterious genes, Torsten Weisel, 1981 Nobel laureate and president emeritus of Rockefeller, took a personal interest in her work. Over lunch, Weisel asked her how the de novo genes that she was discovering were regulated.

“I was stunned,” Zhao recalls. “We knew nothing about this—it was a question, asked during a casual conversation, that I had not even thought about. I told him we could not answer that question yet, and that I did not know when we would be able to answer it.”

But the seed was planted. And as Zhao continued cataloguing de novo genes, she began exploring the possibility of figuring out how they are expressed. Technology improved, and new computational methods allowed her team to infer which transcription factors regulate specific genes.

Zhao’s lab also eventually figured out how to apply single-cell sequencing techniques to the testis of Drosophila, where many de novo genes are expressed.

“We finally had the genetic and the computational foundation to answer the question put to me years ago.”

In the Nature Ecology & Evolution paper, the team focused on how transcription factors regulate de novo genes, and discovered three factors that act as master regulators. After analyzing gene expression across hundreds of thousands of cells, they found that only about 10% of transcription factors were responsible for controlling the majority of de novo genes. Zhao and colleagues then engineered flies with different copy numbers of these factors, and performed RNA sequencing to observe the effects. Sure enough, the variations caused clear, often linear shifts in the expression of de novo genes, confirming their role as key regulators.

In their PNAS paper, the researchers turned their attention to the genomic neighborhoods of de novo genes. They investigated whether these young genes are co-regulated with nearby genes that are more evolutionarily well-established. By analyzing gene expression patterns and chromatin accessibility data, they found that de novo genes often share regulatory elements with adjacent genes, suggesting a mechanism of co-regulation.

“The papers are closely linked,” Zhao says. “One talks about how the cellular environment regulates new genes. The other asks how genes work together to regulate one another.”

Beyond explaining how de novo genes are regulated, the findings may shed light on how de novo genes are formed in the first place.

“We cannot say for sure that these transcription factors caused de novo genes to originate,” Zhao says.

“But we’ve now seen that tinkering with transcription factors can cause significant changes.”

As the lab continues studying the role that transcription factors play in de novo gene regulation, that link may become clearer.

As the lab continues studying de novo genes, Zhao also expects to uncover broader insights into how gene networks evolve—and what happens when they go awry. The study of cancer, among other diseases associated with relatively rapid dysregulation of genes, may benefit from work that explains how evolutionarily young genes arise and are regulated. And because of their shorter evolutionary history and more simple regulation, de novo genes may provide an accessible window into the trickier question of how the rest of the genome works.

“Expression and regulation is more complex than we think,” Zhao says.

“De novo genes may provide a simplistic model that helps us better understand gene expression and evolution.”

Source: Rockefeller University

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