The joint research team — composed of Professor Chulhong Kim and Dr. Byullee Park of POSTECH’s Department of Electrical Engineering, Department of Convergence IT Engineering and Department of Mechanical Engineering, Professor Dong-Jun Lim and Professor Jeonghoon Ha of Seoul St. Mary’s Hospital of Catholic University of Korea, and Professor Jeesu Kim of Pusan National University — conducted a research to acquire PA images from patients with malignant and benign nodules and analyzed them with artificial intelligence. In recognition of their significance, the findings from this study were published in Cancer Research.

Currently, the diagnosis of a thyroid nodule is performed using a fine-needle aspiration biopsy (FNAB) using an ultrasound image. But about 20% of FNABs are inaccurate which leads to repetitive and unnecessary biopsies.

To overcome this problem, the joint research team explored the use of PA imaging to obtain an ultrasonic signal generated by light. When light (laser) is irradiated on the patient’s thyroid nodule, an ultrasound signal called a PA signal is generated from the thyroid gland and the nodule. By acquiring and processing this signal, PA images of both the gland and the nodule are collected. At this time, if multispectral PA signals are obtained, oxygen saturation information of the thyroid gland and thyroid nodule can be calculated.

The researchers focused on the fact that the oxygen saturation of malignant nodules is lower than that of normal nodules, and acquired PA images of patients with malignant thyroid nodules (23 patients) and those with benign nodules (29 patients). Performing in vivo multispectral PA imaging on the patient’s thyroid nodules, the researchers calculated multiple parameters, including hemoglobin oxygen saturation level in the nodule area. This was analyzed using machine learning techniques to successfully and automatically classify whether the thyroid nodule was malignant or benign. In the initial classification, the sensitivity to classify malignancy as malignant was 78% and the specificity to classify benign as benign was 93%.

The results of PA analysis obtained by machine learning techniques in the second analysis were combined with the results of the initial examination based on ultrasound images normally used in hospitals. Again, it was confirmed that the malignant thyroid nodules could be distinguished with a sensitivity of 83% and a specificity of 93%.

Going a step further, when the researchers kept the sensitivity at 100% in the third analysis, the specificity reached 55%. This was about three times higher than the specificity of 17.3% (sensitivity of 98%) of the initial examination of thyroid nodules using the conventional ultrasound.

As a result, the probability of correctly diagnosing benign, non-malignant nodules increased more than three times, which shows that overdiagnosis and unnecessary biopsies and repeated tests can be dramatically reduced, and thereby cut down on excessive medical costs.

“This study is significant in that it is the first to acquire photoacoustic images of thyroid nodules and classify malignant nodules using machine learning,” remarked Professor Chulhong Kim of POSTECH. “In addition to minimizing unnecessary biopsies in thyroid cancer patients, this technique can also be applied to a variety of other cancers, including breast cancer.”

“The ultrasonic device based on photoacoustic imaging will be helpful in effectively diagnosing thyroid cancer commonly found during health checkups and in reducing the number of biopsies,” explained Professor Dong-Jun Lim of Seoul St. Mary’s Hospital. “It can be developed into a medical device that can be readily used on thyroid nodule patients.”

Not only do babies experience pain, but the various levels can be standardized to help nurses recognize and respond to the babies’ cues — if the nurses have the opportunity to learn the scoring tools and skills needed to react appropriately. With tight schedules and limited in-person courses available, the researchers theorized, virtual e-learning may be able to provide a path forward for nurses to independently pursue training in this area.

To test this hypothesis, researchers conducted a pilot study of 115 nurses with varying levels of formal training and years of experience in seven hospitals across Japan. They published their results on May 27 in Advances in Neonatal Care.

“Despite a growing body of knowledge and guidelines being published in many countries about the preventions and management of pain in neonates hospitalized in the NICU, neonatal pain remains unrecognized, undertreated, and generally challenging,” said paper author Mio Ozawa, associate professor in the Graduate School of Biomedical and Health Sciences at Hiroshima University.

The researchers developed a comprehensive multimedia virtual program on neonatal pain management, based on selected standardized pain scales, for nursing staff to independently learn how to employ measurement tools. The program, called e-Pain Management of Neonates, is the first of its kind in Japan.

“The aim of the study was to verify the feasibility of the program and whether e-learning actually improves nurses’ knowledge and scoring skills,” said paper author Mio Ozawa, associate professor in the Graduate School of Biomedical and Health Sciences at Hiroshima University. “The results of this study suggest that nurses could obtain knowledge and skills about the measurement of neonatal pain through e-learning.”

The full cohort took a pre-test at the start of the study, before embarking on a self-paced, four-week e-learning program dedicated to learning standardized pain scales to measure discomfort in babies. However, only 52 nurses completed the post-test after four weeks. For those 52, scores increased across a range of years of experience and formal education.

Ozawa noted that the sample size is small but also said that the improved test scores indicated the potential for e-learning.

“Future research will need to go beyond the individual level to determine which benefits are produced in the management of neonatal pain in hospitals where nurses learn neonatal pain management through e-learning,” Ozawa said. “This study demonstrates that virtually delivered neonatal pain management program can be useful for nurses’ attainment of knowledge and skills for managing neonatal pain, including an appropriate use of selected scoring tools.”

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The study, published in a special issue of the journal Frontiers in Conservation Science: Human-Wildlife Dynamics called Understanding Coexistence with Wildlife documents how the Indigenous Warli people of Maharashtra, India, worship Waghoba, a leopard/tiger deity to gain protection from leopards, and how they have lived side-by-side with them for centuries (formerly tigers, too). The researchers have identified over 150 shrines dedicated to worshipping Waghoba. The researchers note that while there are still negative interactions with leopards such as livestock depredation, they are likely to be more accepted under the institution of Waghoba.

Warlis believe in a reciprocal relationship, where Waghoba will protect them from the negative impacts of sharing spaces with big cats if the people worship the deity and conduct the required rituals, especially at the annual festival of Waghbaras.

Researchers suggest that such relationships facilitate the sharing of spaces between humans and leopards that live in the landscape. In addition, the study addresses the ways in which the range of institutions and stakeholders in the landscape shape the institution of Waghoba and thereby contribute to the human-leopard relationship in the landscape.

Said the study’s lead author Ramya Nair of WCS India: “The main aim of the study is to diversify the way we understand and approach human-wildlife interactions. It does so by shedding light on how local institutions that contribute to co-existence are not devoid of conflict, but have a role in negotiating the conflicts that arise.”

Locally produced systems that address issues surrounding human-wildlife interactions may exist in several other cultures and landscapes. The authors note that while conservation interventions have shown a movement toward the inclusion and participation of local communities, we have to recognize that landscapes have a history before our own point of entry into them. This is relevant for present-day wildlife conservation because such traditional institutions are likely to act as tolerance-building mechanisms embedded within the local belief system. Further, it is vital that the dominant stakeholders outside of the Warli community (such as the Forest Department, conservation biologists, and other non-Warli residents who interact with leopards) are informed about and sensitive to these cultural representations because it is not just the biological animal that the Warlis predominantly deal with.

The study was conducted by researchers from WCS-India, NINA, Norway, Inland Norway University of Applied Sciences, Norway and supported by Wildlife Conservation Trust. Fieldwork was conducted across Mumbai Suburban, Palghar and Thane districts of Maharashtra in 2018-19. An ethnographic approach was taken to collect data wherein researchers conducted semi-structured interviews and conducted participant observation (particularly attending worship ceremonies) concurrent to documenting Waghoba shrines. Questions were asked to explore narratives on the role of Waghoba in the lives of the Warli, the history of Waghoba worship, associated festivals, rituals and traditions, and the ties between Waghoba and human-leopard interactions.

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If further studies confirm the findings, “this could lead to new therapies to prevent strokes and heart attacks in certain COVID-19 patients who are at the highest risk,” says Allison Hays, M.D., medical director of echocardiography programs at The Johns Hopkins Hospital and senior author of the published paper.

The COVID-19 pandemic has affected more than 170 million people around the world, and previous studies of complications and long-term effects of SARS-CoV-2 infection have found that patients who are hospitalized with COVID-19 have more than double the rate of arrhythmias, including atrial fibrillation and atrial flutter, a similar rapid rhythm that can lead to heart failure and stroke.

But exactly how the virus causes these heart complications, and who is most at risk of developing atrial fibrillation because of COVID-19, has been poorly understood.

In this study, Hays and her colleagues compared 80 patients with COVID-19 with 34 patients who did not have COVID-19 who were also treated at The Johns Hopkins Hospital in the intensive or intermediate care units for respiratory issues. None of the patients had a history of heart arrhythmia.

In the study, carried out between March and June 2020, the researchers analyzed echocardiograms of hospitalized patients, applying a special kind of analysis called speckle-tracking strain to determine how well the left atrium of the heart moves with each heartbeat.

The team found that, overall, patients with COVID-19 had reduced function of their left atrium, the chamber of the heart that receives oxygenated blood from the lungs. Left atrial strain — a measure of the movement of the left atrium’s walls — was significantly lower in patients with COVID-19 (28.2% compared with 32.6%, p=0.026; normal >38%) and left atrial emptying fraction — a measure of how much blood the atrium empties with each contraction — was also lower in the patients with COVID-19 (55.7% compared with 64.1%, p<0.001).

Moreover, left atrial strain was even lower among the 30% of patients with COVID-19 who developed atrial fibrillation or flutter during their hospital stay compared with other patients with COVID-19 (22.3% compared to 30.4%, p<0.001). This suggests that speckle-tracking analysis — and specifically, left atrial strain measurement.

“A lot of patients already get echocardiograms while in the hospital; the addition of strain analysis requires no extra scanning of the patient,” says Erin Goerlich, M.D., a cardiology fellow at the Johns Hopkins University School of Medicine and first author of the new paper. “So this is a safe and affordable new data point that can clue us in about who might develop atrial fibrillation.” Echocardiograms cost on average about $2,000, and are generally covered by health insurance.

When the researchers looked at the blood of patients with COVID-19 who developed atrial fibrillation, they saw some differences compared with other patients with COVID-19. People who developed atrial fibrillation had higher levels of troponin (0.07 versus 0.03, p=0.011) and NT-proBNP (946 versus 231, p=0.0007), two known markers of heart stress.

“This tells us that COVID-19 patients with high levels of these biomarkers should be followed more closely and may benefit from an echocardiogram,” says Goerlich.

Hays cautioned that the current study didn’t test whether treating patients with COVID-19 with blood thinners could help prevent the complications that can result from atrial fibrillation, which has been suggested by some clinicians. Blood thinners are generally prescribed to atrial fibrillation patients to lower the risk of blood clots and strokes.

However, the new study suggests that treating certain people — those with especially low left atrial strain, for instance — could be one path forward. More research is needed in this area, Hays says.

“We’re also actively studying how these effects on the heart might persist after SARS-CoV-2 infection,” she adds. “It’s important to know whether those measures of strain and emptying fraction improve over time.”

In addition to Allison Hays and Erin Goerlich, other authors on the JASE paper are Anum Minhas, Nisha Gilotra, Andreas Barth, Monica Mukherjee, Allyso Parziale and Katherine Wu of the Johns Hopkins University School of Medicine.

The research was supported by a Ruth L. Kirschstein Institutional National Research Service Award (T32HL007227); the National Heart, Lung, and Blood Institute (T32HL007024 and 1R01HL147660); the Magic That Matters Fund of Johns Hopkins Medicine; and a Johns Hopkins Clinician Scientist Award.

The simulations showed that, in a classroom with 25 students, anywhere from zero to 20 students might be infected after exposure, depending on even small adjustments to transmission rates for infected individuals or environments.

“When schools have reopened during the COVID-19 pandemic, in some places there have been large clusters of infections, and in others very little transmission,” says Colijn, SFU mathematics professor and Canada 150 Research Chair in Mathematics for Evolution, Infection and Public Health. “In our simulations, we explored what factors affect cluster size, and what interventions can be used to prevent large clusters.”

The researchers tested the effectiveness of two different transmission control strategies.

In the first, when a student (or teacher/staff member) develops symptoms, they are told to stay home, tested using a PCR test, and if the test result is positive, control measures are introduced in the classroom, such as telling the infected individual’s close contacts to stay home.

In the second strategy, all students in the class are tested using rapid tests on a regular basis, whether they have symptoms or not. When a student tests positive, there is an intervention to prevent further transmission.

The researchers found that in scenarios with high transmission rates, interventions used in the first control strategy, where preventive actions took effect after a positive test result, were too slow to prevent large outbreaks. Using rapid tests to screen the whole population and catch infections before symptoms developed, as in the second strategy, led to preventing large outbreaks.

“We found that interventions that only took effect after someone developed symptoms and tested positive were too slow to prevent large clusters; only regular monitoring of asymptomatic individuals could prevent the worst outcomes,” says Colijn.

Their study is timely as B.C. is expected to enter Step 4 of its reopening in September and concerns remain about a resurgence of COVID-19 in the fall. Regular screening for COVID-19 in the form of rapid testing has not been widely used in B.C. schools, though Alberta and Saskatchewan have plans to deploy rapid testing in schools in the fall, and Nova Scotia has long embraced rapid testing in a variety of settings.

Tupper says they hope to use data on transmission and cluster sizes in schools to estimate key unknowns about COVID-19 in schools, such as the rate of transmission, and how much it varies from classroom to classroom.

“We could then see how transmission depends on preventative measures that are put in place, such as mask use, improved ventilation and hand washing,” he says. “This would inform which interventions, after a case is detected, would be the most effective.”

The research results could be applied to other settings in which people spend multiple hours per day with the same group of approximately 20-30 others.

“Our results were based on simulations of a classroom, but the same considerations apply to other settings such as workplaces, or communal living settings such as long-term care homes,” says Tupper, noting that their previous work points to the effectiveness of regular rapid testing in protecting residents of long-term care homes.

Tupper’s research was supported by an NSERC (Canada) Discovery Grant. Colijn was supported by a Genome BC grant (COV142) and by the Canada 150 Research Chairs program of the Federal Government of Canada. The researchers also thank Covid Écoles Québec for the data on cluster sizes in Québec schools.

The Greenland ice sheet will lose mass at an accelerated rate throughout the 21st century, with a direct link between anthropogenic greenhouse gas emissions and the extent of Greenland’s mass loss. To combat this phenomenon, and therefore global warming, it is essential to reduce our greenhouse gas emissions. Every day new ideas emerge to slow down global warming, such as the use of solar geoengineering, a climate intervention that consists of artificially reducing solar radiation above the ice caps and thus limiting the melting of the ice. How can this be done? The idea is to inject sulphur into the stratosphere, a stable meteorological zone located between 8 and 15 km above sea level in the atmosphere,” explains Xavier Fettweis,climatologist and director of the Climatology Laboratory at ULiège. The sulphur will then act as a sort of mirror that will reflect part of the solar radiation back into space.” An intervention which therefore makes it possible to reduce the amount of sunshine on earth, similar to what happens during volcanic eruptions. In 1991, the eruption of Pinatubo (Philippines) injected millions of tonnes of sulphur dioxide into the stratosphere, causing a drop in global temperatures of around 0.5°C. This observation led to the development of solar geoengineering scenarios. Are these scenarios really reliable and risk-free? This is what the ULiège climatologists wanted to test.

We used a plausible scenario of solar geoengineering (G6solar) that would reduce global warming by a factor of 2 on a global scale compared with the most pessimistic scenario in which nothing would be done about the climate,” continues Xavier Fettweis. By forcing the MAR (Regional Atmospheric Model) developed at ULiège to use this scenario, we show that the reduction in solar radiation associated with this scenario would make it possible to locally reduce the melting at the surface of the Greenland ice sheet by 6% in addition to the global reduction in global warming. While these results seem encouraging, the researchers insist that this type of scenario would not be sufficient to maintain the ice cap in a stable state by the end of this century. Moreover, this type of intervention is not without risk since it could have a significant impact on the ozone layer and on water cycles and precipitation, accentuating the disparities between wet and dry regions. Only solar geoengineering scenarios, which are much more ambitious but becoming unrealistic and dangerous, would make it possible to save the cap,” concludes Xavier Fettweis. We are talking here about human and intentional intervention in the climate. A plan B that is not! It is therefore urgent to drastically reduce our greenhouse gas emissions by means that we know but are struggling to implement.

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