Diabetes Educational Meeting

The School of Medicine is delighted to continue its long support of Prof Ian Campbell, Emeritus Professor of Medicine, and Merck in running a Post-Graduate educational meeting,  ‘Expanding the Benefits of Metformin: Research and Clinical Update’ which took place on November 6th by webinar for diabetes specialists from Jordan, Lebanon and Iraq.  The lectures were delivered by Prof Ian Campbell and Dr Harry Howlett from HHMS Global Diabetes Research and Education, Amersham.   The topics included an update of the benefits of metformin in type 2 diabetic subjects with heart failure and chronic kidney disease, and looking to the future the potential benefits of metformin in the treatment of cancer and dementia.

Reopening Primary Schools during the Pandemic

It is inexcusable to open nonessential services for adults this summer if it forces students to remain at home even part-time this fall.

 

As communities and families navigate the complicated issues around reopening schools, experts argue that children returning to primary school is essential, not only because of the educational, social, and developmental benefits for kids themselves, but also for the longterm economic and civic health of the country.  Every effort should be made to reopen them full-time in the autumn, according to an article in the New England Journal of Medicine co-authored by Meira Levinson, Muge Cevik and Marc Lipsitch.  Doing so safely will require reducing or eliminating community transmission while ramping up testing and surveillance.

Authors recommend that any region/city with moderate, high, or increasing levels of community transmission “should do everything possible to lower transmission” including closing nonessential indoor spaces such as retail establishments, movie theatres, restaurants and pubs.

The authors — Meira Levinson of the Harvard Graduate School of Education; Muge Cevik of Scotland’s University of St. Andrews; and Marc Lipsitch of  T.H. Chan School of Public Health; emphasise that “school closures have brought social, economic, and racial injustice into sharp relief, with historically marginalized children and families — and the educators who serve them — suffering the most and being offered the least.”

Until elementary school children physically return to school full-time, “many will lose out on essential educational, social, and developmental benefits; neither the economy nor the health care system will be able to return to full strength given parents’ caretaking responsibilities; and profound racial and socioeconomic injustices will be further exacerbated,” the authors wrote.  They added, “It is inexcusable to open nonessential services for adults this summer if it forces students to remain at home even part-time this fall.”

The authors argue that “children, families, educators, and society deserve to have safe and reliable primary schools should not be controversial.”  Primary schools should be recognized as essential services, school personnel as essential workers — and that school reopening plans should be developed and financed accordingly.  “Schools are more like grocery stores, doctors’ offices, and food manufacturers than like retail establishments, movie theatres, and bars.”  “Like all essential workers, teachers and other school personnel deserve substantial protections, as well as hazard pay.  Remote working accommodations should be made if possible for staff members who are over 60 or have underlying health conditions.”

The authors specifically emphasise opening primary schools as a priority although they also acknowledge that “fully reopening schools for middle and high school students should be a national priority, but given the more challenging transmission dynamics at older ages, we confine ourselves here to elementary schools.”

According to the literature review conducted by the authors (Goldstein E, Lipsitch M, Cevik M. on the effect of age on the transmission of SARS-CoV-2 in households, schools and the community. July 28, 2020 https://www.medrxiv.org/content/10.1101/2020.07.19.20157362v1) children aged under 10 years have lower susceptibility to infection compared to adults, but the susceptibility increases with age, especially over 15 susceptibility and infection rates reach similar to adults.  Authors argue that “opening secondary/high schools is likely to contribute to the community spread, and greater safeguards to reduce transmission is needed while opening secondary and high schools”.  The authors suggest that “compared to secondary/high schools, opening primary schools and daycare facilities may have a more limited effect on the spread of SARS-CoV-2 in the community, particularly under smaller class sizes and in the presence of mitigation measures.” Every effort should be taken to avoid crowding in the classroom and other mitigation measures should be implemented, to the extent possible, when opening primary schools.

This highlights that different approaches are needed when opening schools for different age groups.

For many reasons, decisions about school reopenings will remain complex and contested as the authors argue that school openings “is not just a scientific and technocratic question.  It is also an emotional and moral one.  Our sense of responsibility toward children — at the very least, to protect them from the vicissitudes of life, including the poor decision making of adults who allow deadly infections to spiral out of control — is core to our humanity.”

ECLS trial shows reduction in late-stage diagnoses of lung cancer

Lung cancer affects more than 5000 people every year in Scotland and within a year 4000 have died, usually because the diagnosis is made too late for curative treatment.

Now results from the Early detection of Cancer of the Lung Scotland (ECLS) trial have shown a combination of blood tests followed by CT scanning can help detect lung cancer earlier, when surgery is still possible. The trial has demonstrated a statistically significant 36% reduction in late stage diagnoses of lung cancer.

Frank Sullivan, Professor of Primary Care Medicine at the University of St Andrews and Chief Investigator for the ECLS trial, said: “I hope that the results of this trial will have globally significant implications for the early detection of lung cancer by showing how a simple blood test, followed by CT scans, is able to increase the number of patients diagnosed at an earlier stage of the disease, when surgery is still possible and prospects for survival much higher.”

Results from the trial have been published by The European Respiratory Journal in an online pre-print of the peer-reviewed results.

The ECLS trial is believed to be the largest randomised controlled trial for the detection of lung cancer using blood-based biomarkers. The trial is supported by the University of Dundee and NHS Tayside, and co-funded by Oncimmune, the Scottish Chief Scientist Office and the Scottish Government. It involves collaborators at the University of Glasgow, with further work from the Universities of Aberdeen, St Andrews, Nottingham and Toronto, NHS Scotland, Scottish Government, The Canberra Hospital and Oncimmune, the company that developed the new blood test. Tayside Clinical Trials Unit was responsible for trial delivery, data management and analysis.

To determine whether the EarlyCDT Lung blood test reduced the incidence of patients with stage III/IV lung cancer, the ECLS trial in 12,208 patients compared the use of the EarlyCDT Lung blood test followed by low dose computerised tomography (CT) scanning to standard clinical practice over two years.

In addition, the ECLS trial results indicated a lower rate of deaths among people in the intervention arm of the trial after two years compared with people in the control group. Lung cancer-specific deaths were also lower in the intervention group. This suggests that the EarlyCDT Lung test followed by CT imaging could produce a mortality benefit: the three-year follow up data, which is scheduled to be imminently available, will be valuable in understanding the significance of this finding.

The paper concludes that blood-based biomarker panels, such as the EarlyCDT Lung test, followed by low dose CT, can detect stage I/II lung cancers earlier than standard NHS care. Earlier diagnosis means that more patients should benefit from newer, more effective, chemotherapy, surgery and radiotherapy and so reduce the impact of this disease.

Further follow-up analyses will be performed after five and ten years.

The paper is available online at The European Respiratory Journal and is to be included in the 2020 print edition.

Issued the the Press Office of the University of Dundee.

RECOVERY trial initial findings

Dr Devesh Dhasmana, the lead for NHS Fife in the national clinical RECOVERY trial which aims to identify treatments that may be beneficial for people hospitalised with suspected or confirmed COVID-19 has recently been speaking to Kingdom FM on their most significant breakthrough in finding steroid dexamethasone can reduce the number of patients dying from Covid-19.  You can hear Dr Dhasmana speaking here

 

Further details on the trial and findings can be found on the RECOVERY trial website

 

RECOVERY Trial logo

Feel the beat: implanted microlasers scan heart from inside

Leading an interdisciplinary team of scientists, Dr Samantha Pitt of the School of Medicine and Dr Marcel Schubert and Professor Malte Gather of the School of Physics at the University of St Andrews, embedded tiny lasers into individual heart cells, and by analysing the light these lasers produce they monitored the contractions of the heart muscle.

The paper “Monitoring contractility in cardiac tissue with cellular resolution using biointegrated microlasers” by Marcel Schubert, Lewis Woolfson, Isla R M Barnard, Amy M Dorward, Becky Casement, Andrew Morton, Gavin B Robertson, Paul L Appleton, Gareth B Miles, Carl S Tucker, Samantha J Pitt and Malte C Gather is published in Nature Photonics (June 15th 2020) and is available online.

Although the research is still in its early days, the present study proves that microlasers can act as versatile contractility sensors that can resolve fast dynamic processes inside individual live cells and whole hearts.

The University press release can be found here https://news.st-andrews.ac.uk/archive/feel-the-beat-implanted-microlasers-scan-heart-from-inside/

Unlocking the spread of Covid-19

Medical scientists at the University of St Andrews have joined forces with data scientists Blue Hat Associates to further medical research and understanding about the spread of Covid-19 within the community.

How Covid-19 spreads within the community and individual households remains uncertain as current data is based on people who receive medical care.

A Covid-19 tracker app allows people to share data on the members of their household including symptoms.

This research, one of three research projects awarded to St Andrews as part of the Scottish Government’s Covid-19 Rapid Research programme, aims to extract key information from households’ reports of Covid-19 and link these with medical records to get a better idea of the true number of people with the disease.

The project will look to see if people who stay at home with Covid-19 have different symptoms to those who need medical help or are admitted to hospital.

Using data being collected in the recently launched c19track.org website, this crowd-sourced data will help researchers understand the profile of the pandemic within households and within communities.

Key advantages of this tracking includes:

  • Capturing data and updates on an entire household or neighbourhood
  • Tracking the disease in children
  • Recording all symptoms of illness
  • Simple technology allowing those without smartphones to record their data

St Andrews Medical School intend to use the data to research the outcomes for patients recovering in a home setting against those who seek GP support.

The data collected will be made available to research institutions and those signing up will be able to see the profile of their local area. Those signing up are agreeing to share their anonymous data with other organisations, and can opt in to share personal data for St Andrews medical research.

Professor Colin McCowan from the School of Medicine at St Andrews said: “One of the big unanswered questions with Covid-19 is how many people actually have caught it. We know about the people who contact the NHS but not those who have stayed at home self-isolating.

“This work will help us identify that group of people and allow us to examine if there are differences between them and the people who have contacted the NHS. This will give us a more accurate picture of how many people have Covid-19 and also help in planning how best we look after them.”

Blue Hat founder, Tim Palmer, said: “As experts in data and analytics, we saw a lack of breadth in the data being collected, focussing on a narrow set of symptoms of those within a medical environment. We developed a crowd sourced data tracker in March to catch data from families who may only have minor symptoms and are delighted St Andrews will be using the data to aid the research.”


What is the purpose of the website?
In March a group of data scientists launched c19track.org. At this point no one knows exactly how many people have been infected with Covid-19. There are many people with the virus who are invisible in the official numbers or only have mild symptoms. Without testing it is hard to know, so the aim is to help record peoples’ symptoms to get a better snapshot of where the infections are and how many people really have the disease.

Who is Blue Hat?
Blue Hat is a team of data scientists who want to help, coming together to gather the missing information and provide it to the scientists who can help stop this virus. Blue Hat believes you can help by self-reporting online using this website, which will help understand more about the virus in our communities.

What is it trying to capture?
The website looks to build up a picture of the health for all members of a household, and for as many households in a geographic location as possible. This will provide crucial information and permit analysis at a postcode and local level of both the spread and current existence of the Covid-19 virus.

The data will help scientists to understand the profile of the disease at a local level, not a national or even county-wide level, but at a level which will be more relevant for each household, their local school and local community.

Is it any different to the others already out there?
Other symptom tracking apps are available, but Blue Hat’s website allows an entire household’s data to be captured on a simple web page allowing the scientists to track children and vulnerable people who could not fill in the forms for themselves. Occasional updates of this data are requested.

Unlike a number of apps which look to track a person’s Covid-19 symptoms in considerable detail, asking a significant number of specific health questions, the Blue Hat website approaches pandemic data gathering from the perspective of the community effect of the disease.

The aim is to build up a picture of the spread of the virus within households and within communities.  This is something personal app trackers do not do, and is something that Blue Hat believes is going to become crucial in understanding the spread of the pandemic, the real level of infection in a community, and the potential for any local relaxation of quarantine in due course.

How does this link to the NHS contract tracking app?
Blue Hat’s tracking works in an entirely different way and for a different purpose. The website is asking households to record contact information, creating a sample of a different cross section of the population without access to the latest technology.

What personal information will it hold?
The information collected by the website is simple, limited, and focused on the health of each member of a household in relation to Covid-19 symptoms. It includes:

  • email address to communicate
  • postcode to identify geographic location
  • names of people of household
  • health of each member of the household
  • IP address for data security management

Isn’t it becoming too late to capture this information?
It is clear that in a number of regions and communities there is a growing instance of suspected Covid cases, and tracking this information is going to be increasingly important.

It is likely that there will be great benefit for researchers, for purposes such as immunisation, to have accurate information and this can only be collected at the time a community is experiencing the pandemic. Surveys undertaken after the event are likely to be of limited use or have sufficient detail to be able to make critical judgements from.

Will my neighbours be able to see if I have had Covid-19 through the website?
Data will not be shared at a level where it will be possible to identify an individual household. Data will be anonymised and reporting is done on groups of households. The size of the area disclosed to a registered user will depend on the uptake in the area, but will not permit any sole households to be identified within a postcode.

How do I know my details will be safe?
The website has been properly registered with the information commissioners and will operate within all the regulations of the UK/EU in terms of data protection and GDPR. All information will remain within the EU and held securely on a globally recognised cloud platform.

Only aggregated and anonymised data will be shared – no personal information will be shared unless specifically requested and then only for the purposes of medical research. The underlying data will be made available free of charge to academic researchers working to understand the virus and helping to prevent future outbreaks.

Who has developed the website?
The c19track website has been developed by a group of experts in high security data systems who are used to working in government and banking technology software. The software team working on c19track are all affiliated with Blue Hat Associates, a London-based software development business.

What will St Andrews do with the information?
Subject to approval from the individuals, St Andrews will combine the tracker data sourced in the community with NHS medical data.

Is anyone going to make money from the Covid-19 data?
No, the purpose of the website is to help medical researchers and academics better understand the spread of Covid-19, and for contributors to see the profile of their local area. The data is being made available to these groups for free, and individual data will only ever be shared for medical purposes and only if explicit consent has been given.

Issued by the University of St Andrews Communications Office.

 

Unlocking the spread of Covid-19