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New vaccine safety guide a resource for health care providers

CU Anschutz pediatrician Sean T. O’Leary, MD, MPH, has co-authored a new book entitled “The Clinician’s Vaccine Safety Resource Guide,” aimed at providing essential information on vaccines, the diseases they prevent and the kinds of safety questions often brought up by patients.

The book covers how to talk to patients about vaccinations, monitoring vaccine safety, vaccines and breastfeeding and vaccines and pregnancy. It also includes chapters on specific vaccines and vaccine-preventable diseases. The book features talking points to refer to when speaking with patients, along with potential adverse effects of vaccines. The book hopes to improve the efficiency and effectiveness of clinical vaccine discussions with patients, leading to more informed patients and timely vaccination. This is an ideal resource for all clinicians administering vaccines and their health care teams.

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10 holiday movies and specials for when you just can’t think anymore

Congratulations! You are done with finals. Or not, if you’re a doctor or aren’t a student or you work here on campus. But hopefully you have some time to relax over the holidays and can take an hour or two to watch one of my top 10 favorite holiday movies and specials.

1. How the Grinch Stole Christmas!

The original, from 1966. I’m not sure why Hollywood always has to try to better the best because it’s impossible. This is such a classic and nothing can replace it. Nice try, Jim Carrey.

2. Elf

This is obviously on the list for its plethora of quotable lines, the best being, “You disgust me. You sit on a throne of lies. You stink. You smell like beef and cheese. You don’t smell like Santa.”

3. Home Alone

I could watch this movie a million times and never get sick of it. Also, who doesn’t fantasize about having the house to yourself over Christmas (albeit, without the pesky burglars).

4. The Holiday

Such a great, feel-good movie. It makes me want to house swap for a little London cottage and dance to “Mr. Brightside” in my pajamas, in the hopes that Jude Law will show up.

5. The Family Stone

Definitely underrated, but any movie with Diane Keaton is a winner, so obviously, this makes the cut.

6. A Charlie Brown Christmas

The soundtrack cannot be beat and everyone loves a Charlie Brown Christmas tree.

7. The Santa Clause

What child hasn’t dreamed that her dad isn’t really Santa Claus?

8. Rudolph the Red-Nosed Reindeer 

Again, the original, because who doesn’t love claymation and the island of misfit toys.

9. A Christmas Story

“You’ll shoot your eye out!” will get stuck in your head for the next day and a half.

10. Die Hard

I will admit, I’ve never actually seen this movie because I didn’t have brothers to force me to watch it, but apparently, according to my colleague Matt Hastings, this should be on the list 10 times.

Honorable Mentions from the Office of Communications team

  • Bad Santa

I’m a sucker for dark comedies, and this is one of the all-time darkest. Definitely not recommended for anyone who considers “It’s a Wonderful Life,” “The Santa Clause” or “Miracle on 34th Street” as must-see holiday fare. Billy Bob Thornton is irredeemable in the extreme, until he encounters an oddball child who coaxes a whit of humanity from his circling-the-drain existence. – Chris Casey, managing editor

  • National Lampoon’s Christmas Vacation 

There’s something endearing and relatable about watching the Griswolds plan a big family Christmas and everything that can go wrong does, but in the end, the family still comes together. It’s also one of the many reasons we’ve never tried to harvest our own Christmas tree! – Ryan Nisogi, senior director, digital marketing strategy

  • It’s a Wonderful Life

It’s hard to beat this classic. It makes you smile, it makes you cry, it makes you grateful for the life you have – no matter how many times you’ve seen it. “George Bailey, I’ll love you till the day I die.” – Jenny Merchant, creative brand manager

  • Carol

While Kiley watches “The Holiday” in her pajamas and dreams of Santa bringing her Jude Law for Christmas, I’ll watch “Carol” – a romantic drama set during Christmas in 1950-something New York – in my Santa hat and hope Cate Blanchett comes to my home for the holidays. – Kristen “KO” O’Neill, senior director, content strategy

  • Love Actually

Multiple colleagues love this movie, but in my opinion, it still doesn’t compete with “The Family Stone” or “The Holiday.”

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CU Anschutz researchers discover an important breakthrough in pulmonary fibrosis

A team of investigators led by members of the University of Colorado School of Medicine faculty at CU Anschutz Medical Campus has identified a connection between mucus in the small airways and pulmonary fibrosis.

The findings are published in Nature Communications.

David Schwartz, MD
David Schwartz, MD, chair of the Department of Medicine at the CU School of Medicine

“The overproduction of a lung mucin (MUC5B) has consistently been shown to be the strongest risk for the development of idiopathic pulmonary fibrosis (IPF) and most recently rheumatoid arthritis-interstitial lung disease,” said senior and corresponding author David Schwartz, MD, chair of the Department of Medicine at the CU School of Medicine.

Schwartz adds, “The findings in this manuscript provide a critical breakthrough in understanding the cause and potentially the treatment of IPF by demonstrating that excess mucus in the small airways can cause lung fibrosis, in part, by impairing the mechanism of lung clearance. In aggregate, these discoveries have provided the means to identify an at-risk population, diagnose the disease prior to the development of irreversible scarring, focus on a unique therapeutic target (MUC5B) and a specific location in the lung (distal airway), and create a novel pathway for therapeutic intervention for a disease that is currently incurable.”

A critical need for early diagnosis

Idiopathic pulmonary fibrosis is the most common type of progressive lung fibrosis. Over time, the scarring gets worse and it becomes hard to take in a deep breath and the lungs cannot take in enough oxygen. The average length of survival of patients with IPF is three to five years, and a critical unmet need is to identify patients before the lung is scarred irreversibly.

image of lungsMucociliary dysfunction is an emerging paradigm in lung diseases. Previously considered a characteristic specific to obstructive diseases such as asthma and chronic obstructive pulmonary disease, and genetic diseases such as primary ciliary dyskinesia and cystic fibrosis, the importance of mucins, mucus, and mucociliary interactions has surfaced in diseases of the lung periphery, such as adenocarcinoma and IPF.

Genetic findings may prevent progression

The investigators on the current study in Nature Communications hypothesized that the potential role for mucociliary dysfunction as a driver of IPF pathology is supported by unique gene expression signatures in IPF. The investigators found that a specific genetic characteristic, known as the MUC5B promoter variant rs35705950, which results in a marked increase production of mucus in the lung is the strongest genetic risk factor for IPF. They also found this is the strongest risk factor for rheumatoid arthritis-interstitial lung disease.

The findings suggest that targeting MUC5B in the terminal airways of patients with preclinical stages of interstitial lung disease represents a strategy to prevent the progression of preclinical pulmonary fibrosis.

“This study shows how genetic findings in human diseases can generate new hypotheses, such as those related to impaired mucociliary clearance, that may lead to the discovery of novel molecular mechanisms and the development of early diagnostics and more accurate treatments for pulmonary fibrosis,” said James P. Kiley, PhD, Director of the Division of Lung Diseases at the National Heart, Lung, and Blood Institute.

The research in the study is supported by Jennifer Matsuda, PhD, at National Jewish Health for generating Muc5b transgenic mice, Melanie Sawyer at Parion Sciences for assistance with in vitro mucolytic testing, and Jake McDonald at Lovelace Respiratory Research Institute for support with aerosol delivery. This research was supported by the National Heart, Lung and Blood Institute, National Institute of Diabetes and Digestive and Kidney Diseases, Department of Defense, Cystic Fibrosis Foundation HILL16XXO and BOUCHER15RO, and Parion Sciences, Inc.

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Research initiative uses Big Data to improve patient care

Researchers at the University of Colorado College of Nursing are participating in an initiative to improve health care outcomes and efficiencies by using large clinical and administrative data in a pediatric acute care setting. The project was funded by a grant received from Data Science to Patient Value (D2V) from the CU School of Medicine.

D2V is a multidisciplinary research initiative that funds projects focusing on using technology and Big Data and their applications to health care through collaborations with multiple stakeholders, including providers, patients, health systems, payers and policy makers. Also playing key roles in the initiative are the CU College of Nursing and the Colorado School of Public Health (ColoradoSPH).

Using Big Data

The use of Big Data to improve health-care delivery is being studied by Principal Investigator John Welton, PhD, RN, FAAN, and Co-Investigators Marcelo Coca Perraillon, PhD, an assistant professor in the Department of Health, Systems, Management & Policy in the ColoradoSPH and Peggy Jenkins, PhD, RN, assistant professor in the College of Nursing. Their study focuses on developing a database warehouse called the Nursing Value Research Data Warehouse (NVRDW) that collects data for each nurse caring for each patient during hospitalization.

The PI for the study, Welton, states, “This is the largest database of its kind to date detailing the overall care delivered by individual nurses and provides exciting potential to better understand the factors leading to better hospital outcomes of care.”

‘This is the largest database of its kind to date detailing the overall care delivered by individual nurses.’ – John Welton, PhD, RN, FAAN

The NVRDW is a large “pool” of data collected from various sources within multiple organizations that can be used to improve patient outcomes or transform health-care systems and deliver quality care to patients. Additionally, it can be used by researchers as a resource to create innovative strategies that improve patient outcomes.

One of the products from the D2V study is the creation of a consortium of three schools of nursing including the University of Kansas and University of Minnesota to share expertise to collect Big Data across multiple institutions in the future and leverage the expertise developed from the D2V project to improve the quality of care and optimizing nursing care to lower health care costs.

“There is a distinct purpose for data stored in the warehouse, such as research or reporting to improve patient outcomes or transform health-care systems,” said Jenkins. “Because so much data are collected in health-care settings, it is important to resource teams working to standardize the data so it can be compared and used to inform innovation.”

Providing Quality Care

Playing a huge role in the future of health care, Big Data is becoming more important to measure the quality of care provided to patients. Jenkins believes that nurses are just one of many individual interprofessional providers of patient care who can help in improving the quality of health care.

Big Data’s impact on health care

With technology becoming more present in the delivery of health-care services, more data is being collected than ever before. From tracking vital signs to discover trends, charting patient care histories through electronic health records, or using multiple patients’ health histories to predict health conditions and create treatment plans, Big Data is being used to reduce costs, create innovative treatments and provide effective care in a timely manner.

“Interprofessional collaboration of data scientists, informaticians, nurse scientists, nurse leaders, academia, clinical practice sites, and industry is necessary to construct data warehouses,” she said.

Although not all hospitals and health-care settings have large database warehouses, the multidisciplinary work at the CU Anschutz Medical Campus is a step in the right direction. Problems such as incompatible data systems could make it hard to import data to use to improve quality of care. Patient confidentiality can also become an issue. With large amounts of data such as electronic health records being housed in one database, it can make patients’ information vulnerable to a security breech, so it is important to have clear protocols in place to make the data secure.

Additionally, Big Data can create higher-value care that is more efficient, effective, higher quality and more cost effective, which can improve the care patients receive from providers in all sectors of the health field. This is particularly essential to nursing care, Jenkins notes.

“Using new methods, nurses are viewed as unique providers of patient care, and the value of quality nursing care provided divided by costs can be measured,” she said. “There is much to be learned about nurse characteristics and processes contributing to quality patient outcomes.”

Welton adds, “We are at the start of our journey to better understand the inner workings of health care by examining the care of each provider. We know a lot about physician care, but we are just beginning to collect data at the individual nurse-patient unit of analysis.”

The foundational D2V project has started a national dialogue on how to use this work to collect increasingly larger datasets to complement the many efforts to improve future health-care systems.

Guest contributor: This story was written by freelance contributor Katherine Phillips

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Blood results revealed from contaminated water near Colorado Springs

Researchers at the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus and the Colorado School of Mines shared the preliminary blood results from a study on poly- and perfluoroalkyl substances (PFAS) found at high levels in groundwater wells associated with public drinking water systems near Colorado Springs in 2013. The contaminants are linked to firefighting foam used at nearby Peterson Air Force Base.

Researchers tested the blood of 220 residents in Security, Widefield, and Fountain, and discovered PFAS levels well above the national average. Dr. John Adgate, a professor at the Colorado School of Public Health, said blood samples show some chemicals at rates twice as high and up to 12 times as high as median levels found across the country.

Blood testing is just the first step in the study, which will look further at signs of immune function and other health markers among participants in the year to come.

For more information on the preliminary results, visit https://www.pfas-aware.org/

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Virtual human, a living cadaver, pushes boundaries of anatomical science

When Victor Spitzer, PhD, director of the Center for Human Simulation at the University of Colorado School of Medicine, talks about his friend Susan Potter, he often describes her as “persistent.”

Persistent because she refused to take no for an answer when she volunteered to donate her body to his Visible Human Project. Persistent because, after he accepted her request, she kept pushing when Spitzer initially refused to show her the large freezer where he stores cadavers, and the equipment he used to grind them into slices nearly the width of a human hair.

‘We need to bring her back to life, to develop a living cadaver.’ – Victor Spitzer

Now, almost four years after she died from heart disease, Potter persists in a most profound way. She’s been frozen, sectioned and sliced — all in support of medical education. And now she exists in 27,000 photos taken of her entire anatomy, which is gradually being assembled in high-resolution digital form.

Deep within the Fitzsimons Building, Spitzer sits in his laboratory which is festooned with roses on walls outside the freezer; the paintings were done by two students in the master’s program in Modern Human Anatomy. Potter, who was known as the flower lady at the Ninth Avenue and Colorado Boulevard location of the CU Health Sciences Center, requested that flowers be kept near Spitzer’s freezer, a place she always felt needed some brightening.

“I would think Susan is smiling because she ended up where she wanted,” Spitzer said. “She wanted to end up in the students’ minds.”

That’s the abridged version of an unusual story.

National Geographic: 14 years on a single story

This is what Potter read in a newspaper about the National Library of Medicine-supported Visible Human project some 25 years ago: A CU team led by Spitzer and David G. Whitlock, MD, PhD, had sectioned off, from head to toe, both a male and female cadaver, using a calibrated machine to grind off layers to as small as one-third of a millimeter. Each layer of the body was then photographed. Spitzer’s team took thousands of photos and then organized the data to allow users to interactively tour a virtual human body.

Now, another array of photos will document Potter’s story to a worldwide audience. National Geographic assigned a photographer and writer to chronicle Potter’s unusual journey. Back in the early 2000s, the magazine thought it would be a one-year assignment. Potter had been in a serious car accident, was in a lot of pain and was mostly confined to a wheelchair. She expected to die within a year. “National Geographic came on board to document her life for the next year and, in fact, continued on for the next 14 years,” Spitzer said.

When Potter lodged her request, Spitzer didn’t plan to become her friend. “I didn’t want to become her friend; I wasn’t particularly happy about imaging and sectioning my friend,” he said. “I knew her back when she sold flowers in front of the chancellor’s office on the Ninth Avenue campus every Christmas. She did a lot of things to support the medical school. This was her last wish to support it as best she could, in donating her body.”

A living cadaver

And, because technology improved since the original Visible Human project in 1993, much more detail will be seen in Potter’s virtual anatomy. The original Visible Human was ground into sections of 1,000 microns for the male (300 microns for the female); Potter’s body was ground off 63 microns at a time, resulting in thousands more photographs being taken. By comparison, a human hair is about the same diameter.

Susan Potter's upper body
Victor Spitzer, PhD, said Susan Potter’s body was ground off 63 microns at a time, providing high-resolution detail of her anatomical features.

Spitzer’s lab isn’t stopping at photos. Through his company, Touch of Life Technologies, located in the Fitzsimons Innovation Community, he is developing ways to fabricate the feeling of living tissue. “There’s no reason for us to keep a virtual cadaver,” he said. “We need to bring her back to life, to develop a living cadaver, one that you can see move or move in response to what you ask her to do. Being able to feel and touch and see is something very doable today.”

Behavior and personality join anatomy

Assembling the images is a small part of the overall project. Identifying everything in Potter’s body is an enormous task. When she is fully rendered, along with the material collected by National Geographic, medical students will be able to sift through her anatomical data, while getting a picture of her psychological background.

Potter’s background is somewhat murky. She didn’t talk much about her childhood, only that she grew up in Germany under difficult circumstances. As an adult she was plagued by health issues, confined to a wheelchair but always looking for some way to give back to the CU School of Medicine. “We care about everything,” Spitzer said. “We want to correlate the anatomical with her feelings and her behavior, which is more the social sciences.”

Support from the School of Medicine, the Department of Cell and Developmental Biology and his company allowed Spitzer to create a living cadaver of Potter. Still, many more donations are needed. “We need to look at the anatomy of the virtual world as close as we do in the real world,” he said. “Someday, we need a bookshelf of bodies, or virtual human anatomy, from the very young throughout the aging process,” including people of all ethnicities.

She continues to talk to students

Early in their medical school career, CU medical students are introduced to the cadaver process and hear from people who want to donate their bodies. Potter spoke to the class, and several students ended up following her life as they moved into their professional careers.

“Susan has passed, but the last two years she has continued to talk to our students through video recordings saying why she’s donating, how she’s trying to help them and the whole health care profession,” Spitzer said. “So, she’s already in front of our medical students, just not her anatomy. Next year, they’ll see some of her anatomy, and every year they’ll see more of her anatomy.”

In the video recordings of her life, they’ll also see how passionate she was about furthering the understanding of the human body. “She told people she would be in a freezer,” Spitzer said. “She agreed — but not at first — to being on the internet for the entire world to learn from her. She mainly wanted to be a donation to help the students at CU.”

When it came time to section Potter’s 87-year-old body, the professor was able to distance himself emotionally from what he was doing to his friend, the flower lady. “She was my friend, and I was happy to do what she wanted me to do,” he said.

He then paused and added, quite matter-of-factly (as you might expect of a scientist): “From dust thou art, to dust thou shall return.”

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Leslie Berg named chair of Department of Immunology and Microbiology

Leslie J. Berg, PhD, who specializes in understanding how T cells develop and help fight infection, has been named Chair of the Department of Immunology and Microbiology at the University of Colorado School of Medicine on the Anschutz Medical Campus, effective Feb. 1, 2019.

Berg is Professor of Pathology at the University of Massachusetts Medical School in Worcester, Mass., where she has served on the faculty since 1998. At UMass, Berg served as Vice-Chair of the Immunology-Virology Program from 2003 to 2006 and as chair from 2006 to 2009. From 2009 to 2014, she served as the program’s Graduate Director.

Her responsibilities at UMass have included teaching, leading a consistently funded research laboratory, and handling administrative duties for the Immunology and Virology Program. She brings to CU School of Medicine considerable expertise in studying the way the body addresses pathogens, which is key to developing treatments for ailments caused by immune system dysfunction.

“We are trying to understand how our T cells make decisions about what kind of T cell they’re going to be and what kind of response they’re going to make,” Berg explained in 2012 as part of the American Association of Immunologists Oral History Project.  “One way to think about that is when you have an infection, depending on the nature of the pathogen, if it’s a virus or a bacteria or a parasite, your immune system has to come up with a different response because you need a different response to clear different kinds of infections. And your T cells have to figure that out.”

Berg’s research has helped show that the T cells respond to signals in a way that is more complicated than a simple on-off switch. Rather, the cells respond to a type of protein that gives a signal on how the T cell should develop.

In a 2012 article in the Journal of Immunology, she wrote that some signaling proteins provide an on-off switch, while others function like a mechanism inside a water faucet where “turning the handle a small amount produces a trickle of water, whereas cranking the faucet handle all of the way open produces a gushing stream of water.” That variation affects how the T cell develops and responds.

“I am confident that Dr. Berg will continue making outstanding contributions to science as a leader at the School of Medicine,” said Dean John J. Reilly, Jr., MD. “We are fortunate to have her joining the world-class faculty we have in our Department of Immunology and Microbiology.”

Berg earned her BA in biology from Harvard University in 1980 and PhD in molecular biology from the University of California Berkley in 1986. She conducted postdoctoral training at Stanford University before joining the faculty of Harvard University’s Department of Cellular and Developmental Biology in 1990. She remained at Harvard until joining UMass in 1998.

Berg is the author of more than 100 articles in peer-reviewed journals, book chapters and invited articles. She served as President of the American Association of Immunologists in 2011-2012 and has received numerous academic awards and honors.

Guest contributor: CU School of Medicine

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CU Anschutz to Partner with New Allen Institute for Immunology

The Allen Institute today announced the launch of the Allen Institute for Immunology, a new division of the Institute that is dedicated to studying the human immune system. The new Institute will work directly with the University of Colorado Anschutz Medical Campus and other leading research organizations to understand the dynamic balancing act of the human immune system, how it senses friend from foe and what goes wrong when we’re ill.

The Allen Institute for Immunology’s goal is to improve human immune health and lay the groundwork for better ways to diagnose, treat and prevent immune-related diseases. In its initial phase, the Institute will focus on studies of two cancers, multiple myeloma and melanoma, and three autoimmune disorders, rheumatoid arthritis and inflammatory bowel disease, specifically, ulcerative colitis and Crohn’s disease. The researchers will also take a deep dive into the immune systems of healthy volunteers with the goal of understanding what makes a “normal” immune baseline and how to help patients return to that healthy state.

“By unraveling the mysteries of the dynamic immune system in healthy individuals and focusing the same cutting-edge tools on patients in various disease states, we believe we will find new ways to diagnose and ultimately treat disease,” said Thomas F. Bumol, PhD, executive director of the Allen Institute for Immunology. “We are looking at problems that have large unmet needs. Patients are not only suffering from these immune-based illnesses, patients are dying from some of these disorders, and we would like to change that.”

Kevin Deane, MD, PhD, and Michael Holers, MD, investigators at the University of Colorado Anschutz Medical Campus,

CU Anschutz School of Medicine professor Kevin Deane
CU Anschutz School of Medicine professor Kevin Deane, MD, PhD

will lead a collaboration with colleagues at the University of California San Diego. The fundamental goal of the research program is to identify novel mechanisms by which rheumatoid arthritis develops so that the disease can be halted before symptoms begin, and if not, reversed to the normal state once arthritis begins. This goal will be pursued by studying the immune changes that occur during two phases in the evolution of rheumatoid arthritis. The first phase is the transition from a normal immune baseline to the development of asymptomatic autoimmunity that is characterized by the presence of highly predictive autoantibodies in association with mucosal inflammation at several sites, including the lung and gut. The second phase is the transition from this asymptomatic autoimmune state to the development of joint inflammation and injury which is when patients initially experience pain and arthritis.

“This important new partnership with the Allen Institute for Immunology will allow us to use the most advanced cutting-edge technologies to dissect on a molecular level this debilitating disease. We will be able to build on nearly 18 years of work by our research group to learn how to find individuals on their way to developing rheumatoid arthritis and work to understand and stop this process. We are very pleased to join this innovative Institute begun through the vision of Paul Allen,” said Holers, chief of the Division of Rheumatology. Adds Deane, “With these approaches, and consistent with the long-term view of the Allen Institute for Immunology, we hope these efforts in rheumatoid arthritis, as well as the other diseases studied across the Allen Institute for Immunology, will in the near future be applied to the study and prevention of other autoimmune diseases.”

The Allen Institute for Immunology will build off the model of large-scale team science established by the Allen Institute’s other research divisions and will work directly with samples and data from patients and healthy volunteers, thanks to a unique partnership with established research organizations. The University of Colorado Anschutz Medical Campus joins Benaroya Research Institute at Virginia Mason, Fred Hutchinson Cancer Research Center, the University of California San Diego, and the University of Pennsylvania in partnering with the Allen Institute for Immunology to accelerate a direct impact on human health.

The new Institute will be funded by a generous commitment of $125 million by Allen Institute founder, the late Paul G. Allen.

“Paul Allen always challenged us to go after the really hard problems, to do work that would have a significant impact in our scientific fields,” said Allan Jones, PhD, president and chief executive officer of the Allen Institute. “Understanding the human immune system in detail and figuring out what goes wrong in disease is an incredibly complex but solvable problem. I’m thrilled to see us launch into this new area of complexity in biology with a real opportunity to directly impact human health.”

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Researchers find possible connection between cardiovascular disease indicators and living near oil and gas wells

Researchers at the Colorado School of Public Health have found a possible connection between the intensity of oil and gas exploration in an area and early indicators of cardiovascular disease among nearby residents.

In a pilot study of 97 people in Fort Collins, Greeley and Windsor, the scientists found that those who lived in areas of more intense oil and gas development showed early signs of cardiovascular disease (CVD), including higher blood pressure, changes in the stiffness of blood vessels, and markers of inflammation.

Lisa McKenzie, PhD, MPH, of the Colorado School of Public Health
Lisa McKenzie, PhD, MPH, Colorado School of Public Health

The study was published this month in the journal Environmental Research.

“We are not sure whether the responsible factor is noise or emissions from the well pads or something else, but we did observe that with more intense oil and gas activity around a person’s home, cardiovascular disease indicator levels increased,” said the study’s lead author Lisa McKenzie, PhD, MPH, of the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus.

From Oct. 2015 to May 2016, the researchers measured indicators of CVD in 97 men and women from Fort Collins, Greeley and Windsor who did not smoke tobacco or marijuana. The participants did not have jobs that exposed them to dust, fumes, solvents or oil or gas development activities.  None had histories of diabetes, chronic obstructive pulmonary disease or chronic inflammatory disease like asthma or arthritis.  CVD is the leading cause of mortality in the U.S. with more than 900,000 deaths in 2016.

“While behavioral and genetic factors contribute to the burden of CVD, exposure to environmental stressors, such as air pollution, noise and psychosocial stress also contribute to cardiovascular morbidity and mortality,” according to the authors.

John L. Adgate, PhD, MSPH, Colorado School of Public Health
John L. Adgate, PhD, MSPH, Colorado School of Public Health

One increasingly common source of these stressors is extraction of oil and gas in residential areas. Advances in fracking, horizontal drilling, and micro-seismic imaging have opened up many previously inaccessible areas for exploration. Some of those wells are in heavily populated areas. “More than 17.4 million people in the U.S. now live within one mile of an active oil and gas well,” McKenzie said.

Previous studies have shown that short and long-term exposure to the kind of particulate matter emitted from oil and gas operations may be associated with increases in cardiovascular disease and death. At the same time, noise levels measured in communities near these facilities have exceeded levels associated with increased risk of CVD and hypertension, the study said.

This study is the first to investigate the relationship between oil and gas development and CVD. But the results are consistent with an increase in the frequency of cardiology inpatient hospital admissions in areas of oil and gas activity in Pennsylvania.

“Our study findings support the use of these indicators of cardiovascular disease in future studies on oil and gas development in residential areas,” McKenzie said.

Those indicators included blood pressure, arterial stiffening and early markers of inflammation.

McKenzie acknowledged the limitations of the small sample size, saying that the results demonstrate the need for a much larger study.

The study co-authors include: John L. Adgate, Department of Environmental and Occupational Health, Colorado School of Public Health; James Crooks, Division of Biostatistics and Bioinformatics, National Jewish Health, Department of Epidemiology, Colorado School of Public Health; Jennifer L. Peel, Department of Environmental and Occupational Health, Colorado School of Public Health, Department of Epidemiology, Colorado School of Public Health, Department of Environmental and Radiological Health Sciences, Colorado State University; Benjamin D. Blair, Department of Environmental and Occupational Health, Colorado School of Public Health; Stephen Brindley, Department of Environmental and Occupational Health, Colorado School of Public Health; William B. Allshouse, Department of Environmental and Occupational Health,

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Book explains how to treat vertigo

When Carol Foster, MD, first publicized her home-remedy vertigo maneuver in 2013 — an online story and YouTube video both posted — the response was nothing short of phenomenal. The video has received over 3 million views and the CU Anschutz Today story has been clicked 256,000 times.

Overcoming Positional Vertigo
“Overcoming Positional Vertigo” is a comprehensive guide to the Foster maneuver and details simple preventative measures readers can take to avoid recurrence.

Now, Foster, an assistant professor of Otolaryngology at the University of Colorado School of Medicine, has written a book, “Overcoming Positional Vertigo.” It provides a comprehensive guide to the Foster maneuver and details simple preventative measures readers can take to avoid recurrence.

Worldwide interest

Because 10 percent of people over age 60 suffer from benign paroxysmal positional vertigo (BPPV), Foster is likely to field another wave of worldwide interest when her book is published in early January. “I get constant feedback from people all over the world — every day — and they have the same questions. They want more clarity than what’s on the video, such as: Can I repeat the maneuver? How many times should I do it? When should I see a doctor?”

She decided the best way to address these questions was to write an in-depth book about BPPV. Most literature about BPPV, she said, falls into the category of overviews that only glance upon the subject — and in highly technical language.

“I took my knowledge and translated it into a normal vocabulary for the layperson,” Foster said. “The idea was to allow the average person to learn all about the disease so they’d know about BPPV to the extent a doctor does. And so, they could do treatments on their own at home,” thereby also potentially saving them thousands of dollars in clinical care costs.

Personal history with vertigo

Foster’s own experience with vertigo — she suffers from Meniere’s Disease, an inner-ear disorder that causes hours-long bouts of dizziness — precipitated her groundbreaking discovery one day in her bedroom. She considered that BPPV could be what was afflicting her “good ear,” the one not affected by Meniere’s, as she woke up one morning. Unlike Meniere’s, where the cause is often unknown, BPPV is caused by gravity-sensing particles in the ear accidentally entering the spinning-motion sensors of the ear.

As she experimented with the Epley maneuver on herself that morning — a series of body and head maneuvers used to treat BPPV — she discovered the moves were intensifying her vertigo. She began to conceive a half-somersault-type maneuver that might return the particles to where they belonged: The Foster maneuver was born.

“To me, it’s trivial, and I think it should be that way for everyone,” she said. “Instead of being frightened, you should just know: ‘Oh, there’s that again. I’ll do the maneuver and be free.”

The do-it-yourself remedy has worked for people around the world who struggle with bouts of dizziness. One patient said, “Your exercises are wonderful — they changed my life.” Another commented, “I tried your maneuver when the spinning started … it worked! I did it three times and this morning it was GONE!”

The reason BPPV rates increase as people age has to do with those particles: the more your sensor ages, the more pieces break off. “When you lay down, there’s an opening above the gravity sensor. The pieces can fall in,” Foster said. “Imagine having pieces of buckshot in your ear and if you put your head down below the horizontal, they can fall in.”

More than 8 million people in the United States can expect to have BPPV. “It’s huge and worldwide,” she said, “and there are people who have it and don’t go to a doctor, so they aren’t reported.”   

Preventing recurrence

Carol Foster, MD
Carol Foster, MD, assistant professor of Otolaryngology at the CU School of Medicine

Foster included a chapter in the book about ways to prevent BPPV from recurring. Sufferers need to be aware of their limitations, she said, such as avoiding certain positions that prompt bouts of BPPV.

The book emphasizes how sufferers can essentially become their own physician. “Fundamentally, what you have here is a mechanical disorder,” Foster said. “It’s like having a splinter. Everyone knows how to get one out, but what if you had to spend $1,000 to remove it? Does it have to be a medical procedure that costs that much? Or can you do it at home? This is mechanical enough that it should be like removing a splinter. And if it doesn’t work, then you should go to the doctor.”

When she does the Foster maneuver, it never takes more than a couple minutes before she gets rid of the vertigo.

“I just wanted to get it out there and become kind of known about,” she said of the maneuver. “I didn’t expect it to become famous. It’s crazy, but it’s also great. The more people who can use it, the better.”

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