Category: Education

For the nearly 36 million Americans who experience panic attacks, the coronavirus pandemic is a potentially significant new trigger, a recent story in the Washington Post reported.

For panic attack sufferers facing these new anxieties, there is little recourse. Medication is minimally effective and has side effects. Cognitive behavioral therapy doesn’t work for nearly two-thirds of panic sufferers. And bio-feedback, which has shown promise, is cumbersome and impractical to use outside a laboratory or clinical setting.

A new app developed by faculty at the University of Vermont, PanicMechanic, may be part of a solution. The app adapts biofeedback-like monitoring so it can be used on a mobile phone. The app can work at any time and in any location, the first technology to do so for panic.

PanicMechanic is meant to be used as a supplement to professional clinical care.

“The challenge with panic attacks is that they’re episodic,” said one of the app’s developers, Ellen McGinnis, an assistant professor at the University of Vermont’s Center for Children, Youth and Families at the University of Vermont and a trained clinical psychologist.

“That means they’re not only difficult to treat in a traditional therapy setting, because a panic attack is hard to induce, but also that the one intervention that does seem to work for people—biofeedback—isn’t available when it’s needed.”

PanicMechanic uses the camera on a cell phone to measure the body’s panic response, using an approach similar to photoplethysmography

“Activating the app, then holding your finger against the flash can give you an objective measure of your reaction to stress,” said Ryan McGinnis, assistant professor of Electrical and Biomedical Engineering at the University of Vermont, and a co-developer of the app.

The concept for the app is grounded both in decades of research showing that enabling panic sufferers to observe their body’s reaction to stress reduces panic, and in the clinical practice of Ellen McGinnis.

“I’ve used a low tech version of this technique with a dozen patients,” she said. ‘The panic attack sufferer used just a pen, paper and timer to take their own heart rate and plot it on paper during the panic attack. It was very effective in helping patients manage, take control of and overcome their panic.”        

The explanation? Intervening with objective information targets a driving dynamic of panic, she says. 

“Panic takes hold and you feel like you’re out of control of your body. By showing someone their patterns of physiological arousal, it helps them gain a sense of mastery over their panic response.”

The app also works because it gives the panic sufferer something to do during an episode.

“One of the worst aspects of a panic attack is that you feel helpless,” Ellen McGinnis said.

In addition to displaying an objective measure of the body’s panic response, the app also asks, in a sequence of screens, “how much sleep and exercise you’ve had, what you ate, what your anxiety level is, and if you’ve consumed drugs or alcohol,” she said.

The screens both occupy the panic sufferer and serve a useful purpose, providing data on behaviors and triggers associated with the attack that could be avoided in the future.

The app also predicts how long the panic attack will last, based on past attacks.

That’s key, Ellen McGinnis said, because one of the most frightening aspects of a panic attack is that “it seems like it will never end.”

PanicMechanic employs machine learning to make sure the data gathered by the user on heart is accurate. 

“Our beta testing showed that people can’t always put their finger on their cell phone in free living settings and get an accurate reading of their heart rate,” Ryan McGinnis said. The machine learning functionality corrects for faulty finger placement. In a study that will be published later this year, Ellen and Ryan McGinnis and their collaborators demonstrate that data obtained by the app was as accurate as that obtained in a lab setting.

“PanicMechanic helps panic attack sufferers learn to understand their panic attacks,” Ellen McGinnis said. “When they do that, working in partnership with their therapist, they’ve gone a long way toward stopping them.” 

The team that developed PanicMechanic includes Steve DiCristofaro of Synbrix Software, LLC., in addition to Ellen and Ryan McGinnis.

The PanicMechanic app is available at the Apple App store.

 

 

Source: UVM News

The COVID-19 crisis has put the spotlight on the courageous doctors and nurses battling the disease at the front lines.

But behind the scenes, another group of medical professionals is fighting its own battle with the virus, readying the equipment and outfitting the spaces medical staff need to be effective.

Nearly 39 clinical engineers and biomedical technicians in Technical Services Partnership, or TSP, a unit in UVM’s Instrumentation and Technical Services division, have fanned out around the state at hospitals large and small to do this preparatory work. 

Their focus? Helping healthcare facilities expand their inventory of intensive care rooms and isolation space for Covid-19 positive patients.

“Like ventilators and testing kits, ICU rooms are in short supply,” said Mike Lane, director of Instrumentation and Technical Services, “and they’re going to be needed.”

To meet the demand they anticipate, hospitals are creating new ICU spaces and re-purposing existing rooms. With the help of the TSP biomedical team, UVM MC just expanded  a 17-bed  medical-surgical ICU and added a 10-bed space to the emergency room.

All the rooms need the sophisticated monitoring systems medical staff rely on to treat gravely ill patients, which track vital signs like body temperature, blood pressure, pulse rate and respiratory rate. For COVID-19 patients experiencing respiratory distress, they must also measure the amount of oxygen and carbon dioxide  in the blood stream.

Installing this complex equipment, integrating it into a hospital’s electronic health record system and making sure it is in working order is a critical mission for TSP right now.

 While TSP specializes in technology — it currently oversees 70,000+ devices in 35 hospitals — it also helps hospitals with procurement, and not all of its contributions are technical.

“I talked with a customer yesterday, and one of the big issues is beds, which are also in short supply,” Lane said. Adding more hours to an already long day, Lane got on the phone with TSP’s vendors and suppliers and tracked down the beds — at a reasonable price. 

But TSP’s emphasis now is on technology. In addition to the monitoring equipment, the group is also helping the Vermont Healthcare Emergency Planning Coalition, a collaborative of hospitals and other facilities in the state that plans for disasters, acquire ventilators.

In March and April, TSP’s clinical engineers tracked down and ordered nearly 250, which they will assemble, test and ready for deployment around the state.

 

Source: UVM News

On National Doctor’s Day, March 30, Forbes published “15 Heroic Firsthand Stories From the Coronavirus Front Lines.” Physicians featured included UVM alumna Dr. Lynn Black, a medical director of the Respiratory Illness Clinic at Massachusetts General Hospital. Previously, she did disaster response in Haiti after the Haiti earthquake and Hurricane Matthew and in Liberia during the Ebola epidemic. A graduate of UVM’s school of nursing, Black is on the College of Nursing and Health Sciences Advisory Board. 

Since March 11, I’ve been working on expanding our ability to care for patients with possible COVID-19. We had a small clinic, the Medical Walk-In, at the start, then about a week after we expanded to a unit in what had previously been the women’s health outpatient clinic. Then the following week we opened up in a larger off-site sports medicine clinic. It’s been a continuous evolution of finding larger and more appropriate areas to take care of sick and contagious people. Our exam rooms have been completely stripped down. There are no pillows or paper on the tables. There are no chairs. There is one stethoscope that stays in the room, because once a patient is seen in there, the entire room, along with equipment, needs to be cleaned. This is usually done by the physician in the room to lessen the need for another person needing personal protective equipment. 

Other disaster settings, such as Haiti and Liberia, have been low-resource settings. That’s a very different infrastructure. I have learned in those settings how to manage a disaster situation, how to keep a team together, and how to move quickly. There needs to be a very clear chain of command on how to get things done. My biggest worry is that there are not going to be enough restrictions to make sure that we can stop this virus, and that people won’t pay serious attention to the need for social distancing and isolation. But I am choosing to be hopeful. I think that everyone is taking this seriously now and working hard. The world has experienced Spanish flu, polio and other infectious illnesses, and I do think that we’ll come out the other side of this. 

Read a story from 2018 on Dr. Black’s disaster relief work.

Source: UVM News

As president and CEO of Delaware Health Sciences Alliance, an organization that includes the major health systems and research universities in the Delaware Valley, Dr. Omar Khan, MD ’03, is at the frontlines of the COVID-19 response. He’s been working with his team to ramp up testing and treatment, source personal protective equipment for healthcare workers, and keep the community informed, all while continuing to see patients himself as a family medicine physician. 

With the situation changing every day, sometimes minute-by-minute, he’s buoyed by the cooperation and sense of purpose he sees in the midst of an intense and unpredictable situation. 

“I feel fortunate to be able to serve communities in need,” he says. “I’m also grateful to work with exceptional people, many of whom work tirelessly behind the scenes and often don’t get the credit they deserve.” 

This isn’t the first time Khan has been in the thick of a battle against a global infectious disease. In 2006, he traveled through rural Pakistan, Afghanistan and Bangladesh as part of a World Health Organization polio eradication team. They traversed the countryside with one goal: vaccinate every child they could find. Equipped with maps down to the household level, they were hard at work when an 8.6 magnitude earthquake struck, devastating the region and forcing the team to adapt to new circumstances. It’s an experience that’s informed Khan’s work ever since, as a physician, a global health expert and healthcare leader.  

“You have to be willing to change the paradigm and adapt rapidly,” he says. 

Khan, who also holds a master’s degree from the Johns Hopkins University’s Bloomberg School of Public Health, has co-authored several books on global health and infectious disease, including The End of Polio with Tim Brookes, a Vermont resident and frequent contributor to VPR and other national publications. Behind the Mask, also authored by Brookes, traces the SARS outbreak of the early 2000s, a disease caused by a virus closely related to the one fueling the current COVID-19 pandemic. Most recently, Khan served as principal editor of Control of Communicable Diseases: Clinical Practice, partnered with his longtime colleague Dr. David Heymann, who oversaw polio and SARS responses while at the WHO. Published this February by APHA Press, an imprint of the American Public Health Association, it’s a companion to the Control of Communicable Diseases Manual, a go-to resource for physicians that has been in print for over 100 years.  

After growing up in Delaware and completing medical school and family medicine residency in Vermont, Khan considers both states home. Now with COVID-19 bearing down on the world, he sees hope in a place like Vermont, where “folks coming together to solve a problem” is part of the fabric of life.

“A small state and tight-knit community have a lot to offer the rest of the world,” he says. “Global health is local health.”

 

Source: UVM News

The impact of the coronavirus on the healthcare system and on financial markets is all too clear. But what about the stress it’s putting on the food system and on those who are food insecure?

University of Vermont researchers fielded a survey this week, developed in collaboration with faculty at Johns Hopkins University, to determine those impacts in Vermont.

To take the survey, visit www.coronavirusfoodsurvey.com or see Front Porch Forum and Facebook. Participants must be over the age of 18. Questions about the survey can be directed to the principal investigator, Meredith Niles at mtniles@uvm.edu.

Researchers plan to collect and analyze the results quickly enough that they could inform policies during the ongoing pandemic. They also hope to use the results of the Vermont survey to inform a national survey.

“The coronavirus pandemic has highlighted a number of instabilities in the food system,” said Niles, an assistant professor in UVM’s Nutrition and Food Sciences Department.

“People are changing their purchasing habits and stockpiling food, which could reduce access for others. We also know that fundamental programs that alleviate food insecurity, from Meals on Wheels to free school meals to assistance programs like 3Squares VT, have new demands and have had to make changes because of the coronavirus. And new groups of people, either because they are ill or have lost their jobs, may be experiencing food insecurity.”

The survey asks respondents where they obtained food over the last year for themselves and their families and if availability from that source has changed since the coronavirus outbreak. It also asks how worried respondents are that the coronavirus will affect their access to healthy food and seeks to understand their perspectives overall on the outbreak.

“The goal is to understand how people are responding to the crisis, learn what the impacts are and identify steps we can take to address these problems,” said Farryl Bertmann, another faculty member in Nutrition and Food Sciences who is collaborating on the project. “It’s critical to obtain this information, both to blunt the effects of the current pandemic and to prepare for future disease outbreaks and other shocks to society and the food system,” she said.

The researchers hope for a high response rate to the survey.

“We need as many people as possible to take the survey, so we have detailed data that will help us create the most informed public policy recommendations,” said another member of the research team, Emily Morgan, also a faculty member in Nutrition and Food Sciences.

Food insecurity is defined as access by all household members, at all times, to enough food for an active, healthy life. According to Map the Meal Gap 2019, 11.9% of Vermont households are food insecure, 15.9% of Vermont children live in food-insecure households, and as of 2017, 5.4% of Vermont seniors experience food insecurity.   

Source: UVM News

For teens interested in science — and parents and teachers seeking ways to enhance online instruction during the COVID-19 school closure — Virtual QuaranTeen Science Cafés, led by UVM Extension, are quickly proving to be a welcome resource.

This educational enrichment series is a free opportunity for teens to explore STEM topics with local scientists, engineers and technology experts from the University of Vermont and other institutions. Teens “meet a scientist,” learn about their work, and participate in informal discussions online.

UVM Extension teen and leadership specialist Lauren Traister has been offering an in-person, hands-on experience in recent years, and saw an opportunity to reach more youth when schools closed. “Switching to a virtual platform for the cafés allowed us to continue our programming and offer valuable enrichment opportunities for youth in Vermont and all across the country,” notes Traister.

The first 45-minute webinar featured Lake Champlain Sea Grant experts discussing “Benthic Basics”: stream management and biological indicators. The benthic layer is located at the bottom of a body of water. Sea Grant experts Ashley Eaton, Caroline Blake and Nick Trachte shared how to identify benthic organisms, and what they mean for water quality and stream health. More than 70 youth from Vermont and five other states, including California, connected and engaged with the experts through real-time polls and questions. 

This session was also a celebration of the United Nations World Water Day (March 22), an observance highlighting the global importance of fresh, clean water. This year’s theme was Water and Climate Change, a key component of the discussion of climate impacts on benthic macroinvertebrate communities in freshwater streams. 

More cafés are planned in April and May. Upcoming topics including small satellite propulsion systems, the science of maple sugaring, and human cell genetic editing. Program information, registration and session recordings are available at http://go.uvm.edu/4-hyouthopportunities.

4-H is developing additional no-cost programs for younger audiences, including distance learning socials for youth, age eight and older, to explore topics in science, healthy living and civic engagement.  

Source: UVM News

Two young UVM alumni are among business leaders pivoting their operations to address critical medical supply shortages during the COVID-19 pandemic. Isaac Howe ’08 and Colin Jaskiewicz ’10, are co-founders of Orucase, a San Diego, California-based manufacturer of fabric cases for air transport of bicycles and other accessories. On March 22, Orucase announced beginning production on protective face masks to help bridge supply gaps. 

“With our vast experience in producing sewn products, we asked ourselves what we could do to help out in these trying times. We have teamed up with our production partner in Mexico and are completely retooling our lines to meet this need,” Howe said. “We are ready to roll out both consumer-focused face masks as well as medical-grade masks to help out front-line medical workers both in the USA and Mexico.” 

Orucase is prepared to ship the consumer masks immediately and in the last stages of procuring fabric for the medical masks, with the capacity of making up to 500,000 per week, Howe said. Proceeds from the sale of the consumer masks will be used to facilitate additional production of masks for medical workers and those employed in essential industries. Orucase will distribute masks consumer-direct via their website at orucase.com, as well as working directly with medical facilities and charities in the United States and Mexico. 

The business partnership between Howe, a biochemistry major, and Jaskiewicz, a mechanical engineering major, began with their friendship on UVM’s cycling team, where both were standout riders and club officers. (Jaskiewicz won the collegiate national championship in road cycling in 2009.) They founded Orucase in a garage on Burlington’s South Winooski Avenue in 2012 and have since grown the business steadily, earning honors such as “Gear of the Year” from Roadbike Review for their handlebar bag named after Vermont’s iconic Smuggler’s Notch.  

Source: UVM News

“I like to make beverage alcohol,” insists the co-owner and president of Smugglers’ Notch Distillery (SND) Jeremy Elliott ’00. But the urgency and pride with which he talks about the company’s abrupt and total pivot from spirits to ethanol-based hand sanitizer production makes it clear that, right now, he’s never loved his job or employees more.

Barely three or four weeks ago — “time’s flying so fast,” he says of the rapidly evolving novel coronavirus pandemic — Elliott and his team at SND were creating 190 proof grain alcohol and distilling it into award-winning spirits including vodkas, gins, whiskeys and bourbon. When images of bare shelves and stories of hand sanitizer shortages began circulating in anticipation of the coronavirus’s arrival in the U.S., he connected the dots between the surgical-grade alcohol that they have unique access to and their ability to mass produce it into an entirely different, desperately-needed product.

So far, SND has bottled and distributed 20,000 personal hand sanitizers — made from 160 proof alcohol, glycerol and hydrogen peroxide — to essential service workers and municipalities across Vermont. 

“When I talked to my employees and told them we were doing this, we decided to shut down everything to make this. We’re not doing any other bottling,” Elliott says. No gin, no whiskey, no other beverage alcohol. As the financial fallout of COVID-19 continues to hit the service and small business industries hard, their tough decision subsequently has been a saving grace that allows SND to keep the lights on and its employees employed.

They’ve been working around the clock since word got out about the non-profit effort and supplied bottles to fire stations, post offices, schools — including his alma mater, the University of Vermont — government offices, gas station operators, hospice centers, ambulance technicians and more. “You name it, the list just keeps going. It’s just crazy the number of folks that need it to stay safe out there, the amount of social responsibility for this is absolutely out of control,” he says.

“It’s just the right thing to do now, it’s a need that needs to get done. I’ve assembled the best team that I’ve ever had and they can see who we’re helping. I can’t explain it in words…we’re keeping the whole framework of Vermont moving at this moment. We’re keeping everybody going and there’s a sense of pride in that.”

Source: UVM News

Italy native David Tomasi is more than just concerned about his friends, family and community back home in South Tyrol right now. As a psychology lecturer at UVM and psychotherapist at UVM Medical Center, he’s taking action to mitigate the psychological trauma associated with the COVID-19 outbreak.

“Psychological support and psychotherapy are emergency medicine. If we don’t act now, we will have an infinite series of untreated trauma in the population, especially healthcare workers and their families,” he says. “The comorbidity associated with COVID-19 is something we have seldom seen before. Not only are people dying at an unprecedented rate, but healthcare workers are under constant stress and risk developing PTSD symptoms.” 

Three times each week, Tomasi opens Zoom meetings to Italians and others currently residing in Italy, the European epicenter of the outbreak, for free group psychotherapy sessions and individual sessions. Upwards of two dozen patients attend the live sessions in which he integrates basic behavioristic approaches to therapy with their cultural and situational needs. “Spiritual care — religion plays an important role in Italy — and mind-body techniques focused on emergency response, including centering techniques, grief and loss approaches, etcetera,” he explains. Most patients follow up for individual consultations. 

“Mine is really a small contribution, but people who lost their loved ones and have been diagnosed themselves, in most cases, are really appreciative of having the chance to talk regularly to a psychologist,” he says.

Though he has utilized telemedicine in treatments prior to COVID-19, “This epidemic truly changes everything, both in terms of workload and technical difficulties.” Tomasi dedicates Saturdays, Sundays and Mondays to his patients in Italy, and the rest of the week with students and patients in Vermont. On the days he’s unavailable, a colleague and psychotherapist in Italy speaks with patients online, free of charge. 

So far, treatments have been going well, he says. Tomasi also commends Italy’s healthcare system and says the country’s warm attitude “could be the best response, in terms of resiliency and recovery, from the traumatic experience.”

“The strength of Italy partially contributed to its weakness in the pandemic — most research indicates that on average, Italians are very close to one another, both in figurative terms and in physical terms, which contributes to the speed and spread of the pandemic,” he says. “The situation is terrible and people are extremely aware.”

Source: UVM News

Sadly, it’s “a very busy time” to be a mathematical epidemiologist, says Laurent Hébert-Dufresne —professor of computer science at UVM and, yes, an expert on the mathematical modeling of epidemics. 

And at the top of his to-do list he’s been speaking to reporters and other scientists—because he wants people to understand why it’s so important, during the Covid-19 epidemic, to close schools, shut restaurants, cancel concerts and empty cruise ships.

“A lot of people wonder if it’s necessary, if it’s reasonable,” he says, “and the answer is yes.”

Not all diseases are like this, but the novel coronavirus appears to “live at the mesoscale,” Hébert-Dufresne says—the scale of universities, hospitals, churches and other medium-sized gatherings of people. Therefore, attacking it at this scale is a more powerful and efficient way to stop the spread than simply relying on individuals to wash their hands and keep their distance.

The show must not go on

On March 9, Pearl Jam received global press attention when the band announced it was postponing their North American tour. Many people wondered if it was an overreaction. A few days later, Hébert-Dufresne and three of his colleagues posted a pre-print edition of a new scientific study explaining why these kinds of event closures were critically important. It didn’t get quite as much attention as Pearl Jam, so here’s the gist:

Standard models assume that diseases simply move by diffusion through a pattern of random mixing. One-person-to-the-next-interactions are, of course, at a basic level, how the virus is spread. But Hébert-Dufresne’s work shows that more sophisticated models, that have “higher-order structures” built in, can identify how hotspots can build, say, within one school. In short, our real lives are not a web of random contacts but are organized around social institutions.

When an epidemic localizes around one of these kinds of structures, it could be that the odds of catching the virus “on the street,” Hébert-Dufresne says, would be 1 in 10,000, but in that school it might jump to 1 in 10. “So it makes sense to focus our interventions on these larger structures,” he says, at least as much as on individual behaviors, like hygiene. If an individual reduces their social contacts by 10% “we’re going to do roughly 10% better,” HD says. “It’s a linear return.” 

But since our contacts happen within the larger structures we’re part of—like schools and Pearl Jam crowds—interventions to stop large gatherings “means there’s actually an increasing return,” he says. “The more we intervene at this scale, the better. The second 10% is more useful than the first. The third 10% is more useful than the first two.”

And with a vigorous effort to close enough schools and cancel large gatherings, the “math makes it clear,” he says, that, at certain moments, an epidemic “can suddenly collapse.”

Source: UVM News