Researchers have found that a new urine test is extremely accurate at detecting aggressive prostate cancer with few false negatives.

The test could have possibly avoided one third of unnecessary prostate cancer biopsies while failing to detect only a small number of cancers, according to a validation study of more than 1,500 patients.

The MyProstateScore test measures levels of cancer-specific genes in a patient’s urine. It’s based on previous research that discovered half of all prostate tumors harbor a certain genetic anomaly in which the genes TMPRSS2 and ERG relocate on a chromosome and fuse together—creating an on-switch for prostate cancer development.

One of the best current methods for detecting prostate cancer is a blood test for prostate-specific antigen, commonly known as the PSA test. Elevated PSA levels may indicate cancer, but the majority of men with an elevated PSA don’t actually have prostate cancer.

To determine which patients do and do not have cancer, men with an elevated PSA test undergo an invasive procedure called a transrectal biopsy. Prostate biopsies are uncomfortable for patients and carry a small risk of complications. MRI scans are also used to detect prostate cancer, but these can also miss cancerous lesions and come with much higher costs and limited availability.

“Our ultimate goal was to determine whether the MyProstateScore test could be a practical, reliable test that could rule out the need for more costly or invasive testing in men referred for a prostate biopsy,” says study lead author Jeffrey Tosoian, a clinical lecturer in urology at Michigan Medicine.

Not all prostate cancers are equally worrisome. Many arise later in life and are so slow growing that the best course of action is to simply monitor them. It is patients with these slow growing cancers or no cancer who, despite elevated PSA levels, could be spared from the more invasive or expensive procedures with a better test, researchers say.

The validation study included patients seen at academic health centers and in community health settings. Among these 1,525 patients, 338—2%— had cancers detected on biopsy tagged group grade 2 or higher, meaning they were serious enough to warrant immediate treatment.

If the MyProstateScore test was available to patients in the study, 387 biopsies that found no cancer or slow-growing cancer could have been avoided, the study finds. Meanwhile, the test would have missed only 10 clinically significant cancers that would have warranted immediate treatment.

“The data show that this straightforward, secondary testing approach could reduce the use of more costly and invasive procedures following a PSA test,” Tosoian says.

Additional coauthors of the study, published in the Journal of Urology, are from Johns Hopkins University, the Fred Hutchinson Cancer Research Institute, and the University of Michigan.

The Prostate Cancer Foundation, the National Institutes of Health, the A. Alfred Taubman Medical Research Institute, and the University of Michigan funded the work.

LynxDX, a University of Michigan startup company that Tosoian and colleagues founded and hold an equity stake in, is commercializing the test.

Source: University of Michigan

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A liquid biopsy examining blood or urine can help gauge the effectiveness of therapy for colorectal cancer that has just begun to spread beyond the original tumor, a new study shows.

This kind of biopsy can detect lingering disease and could serve as a guide for deciding whether a patient should undergo further treatments due to some tumor cells evading an initial attempt to eradicate the cancer.

The findings appear in the Journal of Clinical Oncology Precision Oncology.

While the Food and Drug Administration has approved a few liquid biopsies, mostly for lung, breast, ovarian, and prostate cancers, it has not approved any for colorectal cancer.

Patients in the study had oligometastatic colorectal cancer, meaning each patient’s cancers had spread beyond his or her original tumor but only to a small number of sites.

These patients undergo chemotherapy to shrink the tumors before having surgery to remove whatever remains of the primary tumor. There is debate in the field about whether, after initial therapy, oligometastatic cancer should be treated like metastatic cancer, with more chemotherapy, or like localized cancer, with more surgery plus radiation at those limited sites.

Contributing to the problem is the fact that doctors have a limited ability to predict how patients will respond to early chemotherapy, especially since most patients don’t have access to cancer genome sequencing to identify the DNA mutations in their original tumors.

“Being able to measure response to early chemotherapy without prior knowledge of the tumor’s mutations is a novel idea and important for being able to determine whether the patient responded well to the therapy,” says senior author Aadel A. Chaudhuri, assistant professor of radiation oncology at Washington University School of Medicine in St. Louis.

“This can provide guidance on how to treat oligometastatic disease. For example, if the liquid biopsy indicates that a patient responded well to the early chemotherapy, perhaps they should be offered the possibility of more surgery, which could potentially cure their disease.

“But if they didn’t respond well, it’s likely the cancer is too widespread and can’t be eradicated with surgery, so those patients should receive more chemotherapy to control their disease.”

Liquid biopsies for colorectal cancer detect tumor DNA that has broken free of the cancer and is circulating in the blood and, to a lesser extent, has collected in the urine.

The biopsies described in this study are unique compared with other liquid biopsies being developed for colorectal cancer in three major ways. First, most such biopsies have been developed to track metastatic cancers or to verify that local cancers have not started to spread. Second, most liquid biopsies for cancer rely on knowledge of the original tumor’s mutations, to see if those mutations are still present in the blood after therapy.

But many patients don’t get the opportunity to have their original tumors sequenced. Instead, the new biopsies rely on detecting DNA mutations in the blood or urine and comparing them with DNA mutations measured in the treated primary tumor, after it’s surgically removed. And finally, the urine biopsy is unique for colorectal cancer as most urine biopsies have been limited to use in cancers of the genitourinary system, especially bladder cancer.

“The levels of circulating tumor DNA that we were able to measure in urine were lower than what we measured in blood, but this is still a proof of concept that it is possible to measure residual disease in a nonurinary cancer in this totally noninvasive way,” says Chaudhuri, who also treats patients at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.

“We will need to develop more sensitive techniques to detect colorectal tumor DNA in urine to make this a useful clinical test. But this is a promising start.”

The study shows that lower circulating tumor DNA levels correlated with better responses to early chemotherapy. Indeed, most patients who had undetectable levels of tumor DNA in blood samples also had no measurable cancer in their surgical specimens.

There was also evidence that the residual disease detected in liquid biopsies was more predictive of outcomes than residual disease found in the surgical specimens.

For example, the researchers described the experience of one man who, after early chemotherapy to shrink or eliminate the tumor, still had detectable cancer removed during surgery. But his blood sample taken that same day showed no circulating tumor DNA. He experienced long-term survival with no cancer recurrence.

On the other hand, a woman with no detectable cancer cells in her surgical specimen, removed after early chemotherapy, was found to have circulating tumor DNA in her same-day blood sample. Eight months later, the cancer returned in her liver.

The study suggests that such liquid biopsies could help personalize treatment for oligometastatic colorectal cancer. Beyond identifying patients at high risk of recurrence and helping guide decisions about which traditional therapies should be given, the new study also identified patients who might benefit from immune therapies and other targeted treatments.

“Based on mutations in the blood biopsy, we could identify patients who might benefit from a type of immune therapy called immune checkpoint inhibitors after their initial therapy is complete,” Chaudhuri says.

“We also found mutations that could be targeted with drugs approved for other cancers. Our current study is observational, but it paves the way for designing future clinical trials that could test some of these potential therapies.”

Co-first authors of the study are Bruna Pellini, who conducted the work while a medical oncology fellow at Washington University and who is now with the Moffitt Cancer Center in Tampa, Florida; Nadja Pejovic, a visiting medical student in Chaudhuri’s lab; and Wenjia Feng, a research assistant in radiation oncology.

The National Cancer Institute of the National Institutes of Health, the Cancer Research Foundation, the American Surgical Association Foundation, the American Cancer Society, the Society of Surgical Oncology, the Sidney Kimmel Translational Science Scholar Award, and the David Riebel Cancer Research Fund funded the work.

Chaudhuri serves as a scientific adviser/consultant and has received speaker honoraria, travel support, and research support from Roche Sequencing Solutions, which was the sequencing platform used in this study.

Source: Washington University in St. Louis

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A vaccine administered directly to the bladder clears the bacteria that cause urinary tract infections, a new study with mice shows.

Anyone who has ever developed a urinary tract infection (UTI) knows that it can be painful, pesky, and persistent. UTIs have a high recurrence rate and primarily afflict women—as many as 50% of women will experience at least one UTI during their lifetime.

As reported in the Proceedings of the National Academy of Sciences, researchers say they think a new vaccination strategy could re-program the body to successfully fight off the bacteria that cause urinary tract infections.

“Although several vaccines against UTIs have been investigated in clinical trials, they have so far had limited success,” says senior author Soman Abraham, professor of pathology, immunology, and molecular genetics and microbiology in the Duke University School of Medicine.

“There are currently no effective UTI vaccines available for use in the US in spite of the high prevalence of bladder infections,” Abraham says. “Our study describes the potential for a highly effective bladder vaccine that can not only eradicate residual bladder bacteria, but also prevent future infections.”

The strategy, which the team proved effective in mouse models, involves re-programming an inadequate immune response that the team identified last year.

They observed that when mouse bladders get infected with E. coli bacteria, the immune system dispatches repair cells to heal the damaged tissue, while launching very few warrior cells to fight off the attacker. This causes bacteria to never fully clear, living on in the bladder to attack again.

“The new vaccine strategy attempts to ‘teach’ the bladder to more effectively fight off the attacking bacteria,” says lead author Jianxuan Wu, who recently earned his doctorate from the immunology department.

“By administering the vaccine directly into the bladder where the residual bacteria harbor, the highly effective vaccine antigen, in combination with an adjuvant known to boost the recruitment of bacterial clearing cells, performed better than traditional intramuscular vaccination.”

The bladder-immunized mice effectively fought off infecting E. coli and eliminated all residual bladder bacteria, suggesting the site of administration could be an important consideration in determining the effectiveness of a vaccine, the researchers report.

“We are encouraged by these findings, and since the individual components of the vaccine have previously been shown to be safe for human use, undertaking clinical studies to validate these findings could be done relatively quickly,” Abraham says.

The National Institutes of Health funded the work.

Source: Duke University

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Dogs can learn to detect chemicals in a man’s urine that may signal a higher risk of having aggressive prostate cancer, according to a new study.

Prostate cancer is the second leading cause of cancer death in men in the developed world. Clinicians have sought accurate and reliable noninvasive diagnostic tools to differentiate early stage, less dangerous, and more treatable stages of the disease from the aggressive, high-grade, and likely-to-spread forms.

Standard blood tests for early detection, such as the prostate specific antigen (PSA) test, often miss cancers in men whose PSA levels are within normal levels or overdiagnose men with clinically insignificant tumors or no cancer at all.

In a small study in PLOS ONE, researchers had two dogs sniff samples of urine from men diagnosed with high-grade prostate cancer and from men without cancer.

The researchers had trained the animals, Florin, a 4-year-old female Labrador, and Midas, a 7-year-old female wirehaired Hungarian vizsla, to respond to cancer-related chemicals—known as volatile organic compounds (VOCs)—added to urine samples and not respond to ones without them.

“Besides PSA, other methods to detect prostate cancer make use of a molecular analyzer called a gas chromatography-mass spectrometer [GC-MS] to find specific VOCs or profiling bacterial population in a urine sample looking for species associated with cancer, but these have limitations,” says Alan Partin, urologist-in-chief at Johns Hopkins Hospital.

“We wondered if having the dogs detect the chemicals, combined with analysis by GC-MS, bacterial profiling, and an artificial intelligence (AI) neural network trained to emulate the canine cancer detection ability, could significantly improve the diagnosis of high-grade prostate cancer.”

Adding the AI analysis, helped the researchers filter the more than 1,000 VOCs present in a typical urine sample down to those most beneficial for cancer diagnosis, Partin says.

The dogs performed their cancer detection roles well, Partin says. Both Florin and Midas identified five of seven urine samples from men with cancer, or 71.4% accuracy. Florin correctly identified 16 of the 21 non-aggressive or no cancer samples (76.2%), and Midas picked out 14 (66.7%).

When researchers combined the canine olfactory (smell) results with GC-MS, bacterial profiling and AI analysis, the multisystem approach proved a more sensitive and more specific means of detecting lethal prostate cancer than any of the methods alone.

A long history of “biobanking” valuable patient samples made the recent study, and other prostate cancer research at Johns Hopkins Medicine, possible, Partin says, adding that “larger sample pools will be the key enabler of statistically powered, multi-institutional future studies seeking to fully integrate VOC and microbiota profiling.”

Additional coauthors are from Medical Detection Dogs in the UK, Massachusetts Institute of Technology, the Prostate Cancer Foundation, and the Cambridge Polymer Group.

Source: Johns Hopkins University

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A new urine screening test can detect new or recurrent cases of bladder cancer, researchers report.

The test uses a protein called keratin 17 as a cancer biomarker.

Accurate detection of bladder cancer, or urothelial carcinoma (UC), is often difficult, expensive, and involves invasive testing. Going forward, this new method, based on the detection of K17 in urine specimens, could improve diagnostic accuracy to help guide treatment.

Some 81,000 cases of bladder cancer are diagnosed in the United States each year, according to the American Cancer Society.

“It is important to find new biomarkers to more accurately detect UC since standard methods used in most cytology labs are based primarily on microscopic details that do not always clearly distinguish cancer from benign cells,” says Kenneth Shroyer, professor and chair of pathology at the Renaissance School of Medicine at Stony Brook University and inventor of the K17 test.

Previously, Shroyer and his colleague, Luisa Escobar-Hoyos, an assistant professor at Yale University, co-directed a team to demonstrate that K17 is a highly sensitive and specific biomarker for UC in tissue biopsy and surgical specimens.

The current study in the American Journal of Clinical Pathology builds on these findings to show that K17 testing could also be performed as a non-invasive test on urine specimens.

Using various urine sample sets, the team found that the urine K17 test detected UC in 35/36 (97%) of cases that a biopsy confirmed, including 100% of cases with high-grade UC.

From these results and other findings based on the testing, the authors conclude that K17 testing is a highly sensitive and specific diagnostic test for initial screening and for detection of recurrence across all grades of UC.

Shroyer and his colleagues believe the potential of this test as a noninvasive way to detect UC will help to transform not only diagnostic practices but earlier treatment intervention and prognosis of UC.

For years, the Shroyer lab, in collaboration with Escobar-Hoyos, has explored K17 as a biomarker for various cancers, including UC and pancreatic cancer. Furthermore, the research team continues to advance the understanding of how K17, once thought to be only a structural protein, fundamentally impacts numerous hallmarks of cancer.

KDx Diagnostics, Inc., a start-up biotech company, which has a license with the Research Foundation for the State University of New York, is commercially developing the test.

Source: Stony Brook University

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The urine-caked nests of ancient desert pack rats are offering scientists a glimpse of the genetic makeup of insects from more than 34,000 years ago.

For many years, scientists have been extracting DNA from the bones of ancient humans, humanoids, and animals to paint a picture of evolution and species movement. Despite what the movie Jurassic Park portrays—dinosaurs resurrected based on preserved ancient DNA (aDNA)—scientists have had little success extracting genetic material from the preserved remains of insects.

Insects leave scant DNA behind, and little of it is preserved over thousands of years. However, a scientist has developed a novel way to use extraction methods previously reserved for ancient vertebrate DNA to isolate and amplify insect aDNA, thanks to ancient desert pack rat nests.

“Ancient DNA as a field has mostly been used for hominids, humans, and their close relatives, and to a fair degree for vertebrates, but not for insects,” says Aaron Smith, an assistant professor of entomology at Purdue University and lead author of a paper describing the work in the journal Scientific Reports. “In just the last few years, some papers have described identifying insect DNA through metagenomics, examining all the DNA in a sample without being specific. But we’ve been able to go deeper and identify ancient insects to the species level based on their DNA.”

The reason so much ancient DNA work focuses on vertebrates is because their bones seem to protect DNA for longer periods. It’s also possible to find and analyze those bones. Insects are much smaller and often only leave behind fragments of their exoskeletons, and few insect remains from thousands of years ago have survived intact well enough to draw genetic material from or identify.

Smith, who studies mostly desert insects, realized that ancient pack rat nests, called middens, could contain insect remains suitable for DNA sequencing. Pack rats pull materials together for nests and then urinate on them. The urine crystallizes, protecting the nest. Over time, the nest passes on to other rats who do the same, and the nest becomes solid, trapping insects and other materials in a type of time capsule.

“Eventually the center has accreted enough to be as hard as asphalt,” Smith says. “We can radio-carbon date these accurately back to 50,000 years and see what plants and insects were in a specific area at a specific time.”

Smith was able to identify several Asidini (darkling beetles) and draw DNA from samples gathered at Joshua Tree National Park in California. The DNA, preserved enough to recover the mitochondrial genome, was compared with genomes of modern and museum beetle specimens to confirm the species.

The beetles Smith’s team used date back approximately 1,600, 2,000, 8,400, and 34,400 years. Comparing the DNA sequences of the beetles at different times can tell scientists about species distribution for an area at a particular time and the traits the beetles evolved at those times.

“Now we can open up the field of paleobiology to include insects,” Smith says. “I’m interested in what these insects can tell us about changes in climate for these areas. Being able to look at the past distribution of a species and where it occurred over thousands of years is a powerful tool to have at our disposal.”

The National Science Foundation ARTS Program and the US Department of Agriculture’s National Institute of Food and Agriculture funded Smith’s work.

Source: Purdue University

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A new web tutorial could help people manage a leaky bladder.

If your bladder leaks when you cough, sneeze or laugh, or every time you come home–even if you left 10 minutes ago–you’re not alone.

It’s thought that 30%-50% of women will experience some sort of bladder issue by middle age. This problem worsens with age, but many women still hate talking about incontinence, even with their health care provider. Janis Miller, a professor at the University of Michigan School of Nursing and Medical School, has spent a career studying women’s bladder health.

Her research suggests that for many women, a simple change in thinking can dramatically improve bladder control by retraining the bladder to respond differently to common urge triggers. For other women, simple, well-timed pelvic floor contractions (not the hundreds of daily Kegels you’ve likely been told to do) performed when the urge to urinate strikes can reduce or even solve the problem of poor bladder control.

To that end, Miller developed the 15-minute web tutorial called My Confident Bladder that women can watch at home. The tutorial introduces skills and self-assessment tools that can help women develop healthy bladder control habits.

Here, Miller explains this approach:

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A new study suggests that women who get recurrent UTIs may be caught in a vicious cycle in which antibiotics meant to eradicate one infection predispose them to develop another.

One of the greatest frustrations regarding urinary tract infections (UTIs) is that they so often recur. UTIs are caused by bacteria in the urinary tract and characterized by frequent and painful urination.

A round of antibiotics usually clears up the symptoms, but the relief is often temporary: A quarter of women go on to develop a second UTI within six months. Some unfortunate individuals get UTIs over and over, and require antibiotics every few months.

The new study in Nature Microbiology shows that a round of antibiotics eliminates disease-causing bacteria from the bladder but not from the intestines. Surviving bacteria in the gut can multiply and spread to the bladder again, causing another UTI.

At the same time, repeated cycles of antibiotics wreak havoc on the community of helpful bacteria that normally live in the intestines, the so-called gut microbiome. Similar to other disorders in which gut microbes and the immune system are linked, women with recurrent UTIs in the study had less diverse microbiomes that were deficient in an important group of bacteria that helps regulate inflammation, and a distinct immunological signature in their blood indicative of inflammation.

“It’s frustrating for women who are coming in to the doctor with recurrence after recurrence after recurrence, and the doctor, who’s typically male, gives them advice about hygiene,” says co-senior author Scott J. Hultgren, professor of molecular microbiology at Washington University in St. Louis.

“That’s not necessarily what the problem is. It’s not necessarily poor hygiene that’s causing this. The problem lies in the disease itself, in this connection between the gut and the bladder and levels of inflammation. Basically, physicians don’t know what to do with recurrent UTI. All they have is antibiotics, so they throw more antibiotics at the problem, which probably just makes things worse.”

Gut microbiomes and UTIs

Most UTIs are caused by Escherichia coli (E. coli) bacteria from the intestines that get into the urinary tract. To understand why some women get infection after infection and others get one or none, Hultgren teamed up with Ashlee Earl, the senior group leader for the Bacterial Genomics Group, the paper’s co-senior author, and lead author Colin Worby, a computational biologist.

The researchers studied 15 women with histories of recurrent UTIs and 16 women without. All participants provided urine and blood samples at the start of the study and monthly stool samples. The team analyzed the bacterial composition in the stool samples, tested the urine for the presence of bacteria, and measured gene expression in blood samples.

Over the course of a year, 24 UTIs occurred, all in participants with histories of repeated UTIs. When participants were diagnosed with a UTI, the team took additional urine, blood, and stool samples.

The difference between the women who got repeated UTIs and those who didn’t, surprisingly, didn’t come down to the kind of E. coli in their intestines or even the presence of E. coli in their bladders. Both groups carried E. coli strains in their guts capable of causing UTIs, and such strains occasionally spread to their bladders.

The real difference was in the makeup of their gut microbiomes. Patients with repeat infections showed decreased diversity of healthy gut microbial species, which could provide more opportunities for disease-causing species to gain a foothold and multiply. Notably, the microbiomes of women with recurrent UTIs were particularly scarce in bacteria that produce butyrate, a short-chain fatty acid with anti-inflammatory effects.

“We think that women in the control group were able to clear the bacteria from their bladders before they caused disease, and women with recurrent UTI were not, because of a distinct immune response to bacterial invasion of the bladder potentially mediated by the gut microbiome,” Worby says.

Antibiotic alternatives

The findings highlight the importance of finding alternatives to antibiotics for treating UTIs.

“Our study clearly demonstrates that antibiotics do not prevent future infections or clear UTI-causing strains from the gut, and they may even make recurrence more likely by keeping the microbiome in a disrupted state,” Worby says.

Hultgren has long worked on finding innovative therapies to eradicate disease-causing strains of E. coli from the body while sparing the rest of the bacterial community. His research forms the basis of an experimental drug based on the sugar mannoside and an investigational vaccine, both of which are being tested in people. Another strategy would be to rebalance the microbiome through fecal transplants, probiotic foods, or other means.

“This is one of the most common infections in the United States, if not the world,” Hultgren says. “A good percentage of these UTI patients go on to get these chronic recurrences, and it results in decreased quality of life. There is a real need to develop better therapeutics that break this vicious cycle.”

The National Institute of Allergy and Infectious Diseases of the National Institutes of Health, the NIH Mucosal Immunology Studies Team Consortium, and the Center for Women’s Infectious Disease Research at Washington University School of Medicine funded the work.

Source: Washington University in St. Louis

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A crystallized version of human urine could revitalize seagrasses, which provide food, habitat, and shelter in their ecosystems.

Urine contains two key ingredients in plant fertilizers: phosphorus and nitrogen. Even better, wastewater treatment facilities already process this abundant resource and create byproducts that would otherwise be sent to the landfill.

In its crystallized form, this byproduct is called struvite. Scientists applied the material applied to seagrass in a recent study.

“Struvite occurs during the wastewater treatment process because magnesium, ammonia, and phosphate are all readily available to form the crystal byproduct,” says Conor MacDonnell, who carried out the study as a PhD student in the University of Florida Institute of Food and Agricultural Sciences (UF/IFAS) department of soil, water, and ecosystem sciences.

“The result is a relatively insoluble, sustainable compound found in wastewater treatment plants.”

That relative insolubility led MacDonnell, now works a postdoctoral associate studying seagrass restoration, to team up with Gdańsk University of Technology student Franciszek Bydalek and UF/IFAS faculty members Patrick Inglett and Todd Osborne to investigate whether struvite could fertilize seagrass.

“Coastal ecosystems are dependent upon seagrasses,” Inglett says. “As they diminish, it leads to problems like declining water quality and marine life dying off or migrating to other areas.”

To add to the challenges, current methods of seagrass restoration are relatively expensive and unsuccessful compared to other coastal ecosystems. The study points to nutrient-related issues and competition with algae as reasons behind these difficulties.

In the study, scientists grew three types of plots of seagrass in a simulated setting at the University of Florida’s Whitney Laboratory for Marine Bioscience. One type received an application of struvite, another received a common controlled-release fertilizer, and the last received no fertilizer. Two experiments took place to test different dosages of fertilizer.

“From the two experiments, we found struvite performed better than the controlled-release fertilizer in seagrass growth,” MacDonnell says. “Struvite seems to provide a slower, more consistent release of nutrients to the seagrass.”

The advantages of using struvite in these efforts, extend into environmental sustainability, the researchers say.

“Struvite is potentially a win-win for the environment,” Inglett says. “It is removed from wastewater, so it lessens the impact on downstream ecosystems, and it doesn’t over-fertilize when used for restoration.”

Those downstream effects were the subject of a previous study from another then-PhD student in the same department. John Hallas worked with faculty members at the UF/IFAS North Florida Research and Education Center, Cheryl Mackowiak and Ann Wilkie, to investigate the outputs of water treatment facilities near the Quincy-based center.

“Recovering the struvite from wastewater treatment plants is an effective diversion of these useful nutrients for plant growth, rather than allowing them to enter the landfill,” Mackowiak says.

“It also results in a more useful biosolids product, making the wastewater treatment process more sustainable,” Wilkie adds.

MacDonnell explains that struvite’s sourcing also adds to its sustainability credentials over more traditional fertilizers. Mining phosphorus, for example, depletes that finite natural resource and degrades the land.

The potential research on struvite is just beginning, MacDonnell predicts. He has continued studying seagrass restoration and his current role includes working with Osborne as a postdoctoral associate. This work, he says, may include more struvite studies in the future.

“While using struvite in aquatic systems appears very promising, there aren’t many studies of it in marine restoration projects,” he says, “especially in combination with other restoration techniques.”

The study appears in the journal Science of the Total Environment.

Source: University of Florida

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Smart toilets could detect disease early, but squeamishness and privacy concerns could impede their use.

The smart toilet has the technology to interpret the data that’s dripped, dumped, or otherwise flushed to glean insights into health. Urine flow a bit light? That might indicate a problem with the prostate. Blood in the urine? That suggests a urinary tract or kidney infection. Different shapes and textures of waste can point to gastrointestinal problems. The smart toilet can even detect specific molecular signals that flag certain types of cancer or infectious diseases, such as COVID-19.

There’s a lot of potential in the idea, even though its data source is something we think so little of. “Toileting habits are especially sensitive to talk about,” says Seung-min Park, an instructor of urology at Stanford Medicine, who worked with the late Sanjiv Sam Gambhir to develop the smart toilet project. Park now collaborates with professor of urology Joseph Liao, and Nicole Martinez-Martin, an ethicist and assistant professor of pediatrics.

“There are big psychological barriers to advancing smart toilets. People think it’s too dirty, or they feel uncomfortable about it—it’s not socially acceptable to discuss, especially at work.”

The idea of a smart toilet isn’t new. Science fiction novels, such as Beyond the Blue Event Horizon, have made reference to them since the 1980s. As data interpretation and biomarker monitoring technology—two factors the smart toilet’s success depends on—advance, its promise grows. While the goal is to one day buy a smart toilet like you buy a bidet, it’s currently only available in a research setting.

The bigger roadblocks are the ethical and legal considerations, as well as public acceptance. As Park refines the toilets’ disease-detecting capability, he’s pursuing a parallel path to decrease skepticism and increase trust—an admittedly tall task as concerns of data privacy rise.

He hopes to demonstrate that smart toilets have a powerful, yet passive, ability to help people stay on top of their health and securely share the data with their doctor. That, he knows, can happen only to the extent that users feel comfortable installing the smart toilet in their homes—and possibly other public places. For those reasons, he’s exploring the ethical, legal, and public health ramifications of a techy toilet that’s poised to detect health information ranging from pregnancy to cancer.

(Data) leaks?

It’s a serious question: Could someone hack a smart toilet and get personal health data? If so, they could learn if a smart toilet user was pregnant, had cancer, or was taking specific medications, for example—information most people would likely want kept private. Technically, almost any data transmitted online is hackable. But Park says that the data from a smart toilet would be held to the same storage and privacy standards as the health data collected at a doctor’s office.

He’s also been asked about the potential for police to track drug usage. That, to him, would be crossing boundaries. The data from an individual’s home should be accessible only to their health care provider, in which case it would be protected by privacy laws. If illicit drugs were detected in someone’s urine, that person could seek care or recovery help from their doctor without legal ramifications—just as if they had reported drug use during a doctor’s appointment.

“I often get asked about consent—should a smart toilet user actively consent every time they use the bathroom?” says Park. That defeats the purpose of passive collection, which is key to the smart toilet’s success, as Park anticipates people would get tired of always having to opt in. Instead, he suggests a one-time, blanket consent that users agree to, and that they could revoke at any point.

“The smart toilet would need to be regarded as a medical device for the initial deployment, rather than a commercial product,” Park says. “Privacy has to come first.”

Smart toilets at scale

One smart toilet can provide a host of data about an individual or a family, but what about larger groups? An entire city, for example.

“That’s the next phase of this research that we’re really excited about—smart cities,” says Park, who is working with Stanford University’s civil engineering department and the Stanford Center at the Incheon Global Campus, in South Korea, on the concept. The smart toilet could be a perfect fit for a futuristic smart city, in which advanced technology makes city living more efficient and convenient, such as buildings that use the sun to monitor and regulate their own temperatures.

Any public information gathered from the smart toilet would need to be anonymized and protected so that organizations or agencies—government or otherwise—could not access that level of detail. Park sees a network of smart toilets as a powerful way to monitor public health concerns, such as emerging infectious disease outbreaks.

He and his collaborators are also thinking about installing the smart toilet in homes of clinical trial participants to help answer research questions. They’re exploring its use in trials that test treatments for irritable bowel syndrome or therapies for healthy pelvic floors, which help control urination, among other things.

“We’re seeing opportunities to use the smart toilet in broader public health and research settings, so as we think about how to advance the technology, we also have to spend equal time thinking about the ethical and legal issues—and people’s acceptance of the technology,” he says.

Source: Stanford University

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