Culture

Deaths caused by indirect effects of the pandemic emphasize the need for policy changes that address widening health and racial inequities.

More than 15 months into the pandemic, the U.S. death toll from COVID-19 is nearing 600,000. But COVID-19 deaths may be underestimated by 20%, according to a new, first-of-its-kind study from Boston University School of Public Health (BUSPH), the University of Pennsylvania, and the Robert Wood Johnson Foundation.

Published in the journal PLOS Medicine, the study uses data from the National Center for Health Statistics (NCHS) and the Centers for Disease Control and Prevention (CDC) to estimate the number of deaths in 2,096 counties from January to December 2020 above what would be expected in a normal year, or "excess deaths." For every 100 excess deaths directly attributed to COVID-19, there were another 20 excess deaths not attributed to COVID-19. In other words, 20 out of every 120 excess deaths, or 17%, were not directly attributed to COVID.

The researchers found that the proportion of these excess deaths not directly attributed to COVID-19 was higher in counties with lower average socioeconomic status and less formal education, as well as in counties located in the South and West. Counties with more non-Hispanic Black residents--who were already at high risk of dying directly from COVID-19--also reported a higher proportion of excess deaths not assigned to COVID-19.

"Our findings suggest that the impact of the COVID-19 pandemic on mortality has been substantially underestimated in many communities across the US," says study lead author Dr. Andrew Stokes, assistant professor of global health at BUSPH. "Several factors, including severe testing shortages, overwhelmed health care systems, and a lack of familiarity with the clinical manifestations of COVID-19 has likely led to significant underreporting of COVID-19 on death certificates, especially early in the pandemic. Official COVID-19 death tallies also fail to capture the pandemic's profound social and economic consequences, including the downstream effects of interruptions in receiving health care, loss of employment, evictions, and social isolation and loneliness."

In addition to deaths directly from the coronavirus that were not recorded as such, some of the excess deaths are likely from indirect consequences of the COVID crisis, including fear of going to the hospital for another condition, or any number of issues caused or exacerbated by the toll that COVID has taken on the economy and on mental health.

"Counties with high levels of COVID-19 mortality also had exceptionally high levels of mortality in 2020 from other causes of death. This result suggests that the epidemic is responsible for many more deaths than are attributed to COVID-19 alone," says study senior author Dr. Samuel H. Preston, professor of sociology at the University of Pennsylvania.

"Racial and socioeconomic inequities in U.S. mortality have widened significantly as a result of the COVID pandemic, especially when considering total excess deaths. To protect public health, policymakers must act decisively to address structural racism and reduce income inequality," says study co-author Dielle Lundberg, a research fellow at BUSPH.

Overall, the study makes clear that county-level measures of direct COVID-19 mortality were not accurate measures of excess mortality in many US counties.

"A more complete accounting of COVID-19 deaths in local communities using excess deaths could lead to increased public awareness and vaccine uptake, particularly in areas where the official death counts suggested the pandemic had a limited impact," Stokes says.

Today, proteins that can be controlled with light are a widely used tool in research to specifically switch certain functions on and off in living organisms. Channelrhodopsins are often used for the technique known as optogenetics: When exposed to light, these proteins open a pore in the cell membrane through which ions can flow in; this is how nerve cells can be activated. A team from the Centre for Protein Diagnostics (PRODI) at Ruhr-Universität Bochum has now used spectroscopy to discover a universal functional mechanism of channelrhodopsins that determines their efficiency as a channel and thus as an optogenetic tool. The researchers led by Professor Klaus Gerwert describe the results in the journal Communications Biology of 14 May 2021. They expect that the findings will help tailor more efficient optogenetic tools in the future.

Properties of natural proteins not optimal for optogenetics

"The introduction of light-sensitive proteins into organisms for the targeted control of certain functions from the outside offers enormous potential for neuroscientific research and its therapeutic application," says Klaus Gerwert. "Unfortunately, the properties of these naturally occurring proteins, for example in green algae, are not always optimal for the relevant optogenetic application."

For this reason, the properties of the proteins have to be adapted by changing their gene sequences. Currently, this is done based on trial and error. "In order to specifically optimise the proteins for their potential applications, a deep understanding of molecular reactions and the resulting ion conduction is necessary," points out Klaus Gerwert. "We obtain the necessary structural dynamic understanding of protein mechanisms with high spatial and temporal resolution by combining time-resolved Fourier-transform infrared spectroscopy and biomolecular simulations," explains PRODI researcher Dr. Till Rudack.

Molecular mechanisms determine efficiency

Using these methods, Klaus Gerwert and his team recently discovered the mechanism that causes the channelrhodopsin 2 protein, which is widely used in optogenetics, to lose its efficiency over time. Previously, researchers had assumed that light excitation stimulated a specific structural change in the protein. However, the group found that light exposure induces two different structural changes: One is the desired channel opening, which is useful for optogenetics. The second provides only a weak ion current, but gains the upper hand with longer exposure and suppresses the channel opening - a drawback for optogenetics.

In the current study, the researchers used time-resolved Fourier-transform infrared spectroscopy and biomolecular simulations to explore a different channel rhodopsin, called anion-channelrhodopsin-1. "This channel hardly has any loss of efficiency following prolonged exposure and also doesn't have a second parallel pathway of structural change," explains Dr. Max-Aylmer Dreier, first author of the study.

"We have thus proven that splitting into two parallel pathways leads to inefficient channels. In efficient channels there doesn't seem to be a second parallel pathway," concludes Klaus Gerwert. "In the future, we will use the insights into the underlying molecular mechanisms of channel efficiency to block the inefficient second pathway by targeted protein design and thus design improved optogenetic tools," predicts Till Rudack.

Since our ancestors infected themselves with retroviruses millions of years ago, we have carried elements of these viruses in our genes - known as human endogenous retroviruses, or HERVs for short. These viral elements have lost their ability to replicate and infect during evolution, but are an integral part of our genetic makeup. In fact, humans possess five times more HERVs in non-coding parts than coding genes. So far, strong focus has been devoted to the correlation of HERVs and the onset or progression of diseases. This is why HERV expression has been studied in samples of pathological origin. Although important, these studies do not provide conclusions about whether HERVs are the cause or the consequence of such disease.

Today, new technologies enable scientists to receive a deeper insight into the mechanisms of HERVs and their function. Together with her colleagues, virologist Michelle Vincendeau* has now succeeded for the first time in demonstrating the negative effects of HERV activation on human brain development.

HERV activation impairs brain development

Using CRISPR technology, the researchers activated a specific group of human endogenous retroviruses** in human embryonic stem cells and generated nerve cells (neurons). These viral elements in turn activated specific genes, including classical developmental factors, involved in brain development. As a result, cortical neurons, meaning the nerve cells in our cerebral cortex, lost their function entirely. They developed very differently from healthy neurons in this brain region - with much a shorter axon (nerve cell extension) that were much less branched. Thus, activation of one specific HERV group impairs cortical neuron development and ultimately brain development.

Clinical relevance

Since neurodegenerative diseases are often associated with the activation of several HERV groups, the negative impact of HERV activation on cortical neuron development is an essential finding. It is already known that environmental factors such as viruses, bacteria, and UV light can activate distinct HERVs, thereby potentially contributing to disease onset. This knowledge, in turn, makes HERVs even more interesting for clinical application. Switching off distinct viral elements could open up a new field of research for the treatment of patients with neurodegenerative diseases. In a next step, the group at Helmholtz Zentrum München will study the impact of HERV deactivation in neurons in the context of disease.

New paths for basic research

In addition, the research findings provide important indications that epigenetic mechanisms keep viral elements under control in healthy brain development. Michelle Vincendeau even suspects a functional role for the controlled HERVs in normal brain development. "We have carried these elements for about 40 to 70 million years. We assume that their presence is relevant to our natural processes, otherwise we would not have retained them for so long during evolution," Vincendeau says. Further basic research in this direction might reveal new functional roles for HERVs.

Passing down a healthy genome is a critical part of creating viable offspring. But what happens when you have harmful modifications in your genome that you don't want to pass down? Baby plants have evolved a method to wipe the slate clean and reinstall only the modifications that they need to grow and develop. Cold Spring Harbor Laboratory (CSHL) Professor & HHMI Investigator Rob Martienssen and his collaborators, Jean-Sébastien Parent and Institut de Recherche pour le Développement Université de Montpellier scientist Daniel Grimanelli, discovered one of the genes responsible for reinstalling modifications in a baby plant's genome.

A plant's genomic modifications--called epigenetic modifications--help turn off genes at the right times. Epigenetic changes accumulate with age. Martienssen explains:

"If you think about a tree, the flowers that arise a hundred years after it germinated, they're obviously a long way from the original acorn, and an awful lot of epigenetic changes could happen in that period. And so, these are important resets for development so that you don't inherit this epigenetic collateral damage."

Martienssen's team discovered that after baby plants remove the epigenetic modifications, the SUVH9 protein puts back the ones they need to survive. Without SUVH9, plants develop poorly because the wrong genes turn on at the wrong time. Parent, a research scientist at Agriculture and Agri-Food Canada, says:

"I remember this moment where we were like, 'Wow! This is not what we expected.' There was an opening for an actor that was not accounted for in the standard models, and that was the most innovative part of our story."

The SUVH9 protein uses small snippets of RNA to look for the right places to reinstall the beneficial modifications, which are on mobile genetic elements known as transposons. The SUVH9 protein adds the epigenetic modifications to them, and this ensures nearby genes are turned off at the right time. Reinstalling the beneficial modifications also stops the transposons from jumping around in the genome and disrupting other genes.

The scientists think SUVH9 protein contributed to today's plant diversity. By stopping harmful transposons from disrupting genes, the protein allowed different species to evolve. Parent says:

"One of the big mysteries about flowering plants is how they manage to become so diverse and to generate so many different species so quickly in evolutionary history. And, we believe that we are touching here a part of a molecular mechanism that can allow this sort of flexibility."

The study sought to describe and explain gender pay differences in the U.S. Department of Health and Human Services between 2010 and 2018. HHS comprises a quarter of the country's governmental public health workers, with over 80,000 employees.

Understanding what may be driving wage gaps at HHS provides opportunities for employers and legislators to take action to support women in the health care field, said lead author Zhuo "Adam" Chen, an associate professor of health policy and management at UGA's College of Public Health.

"A large percentage of the health care workforce are women," said Chen. "If you have underpaid women in the profession, I don't think it spells good things for the public health system."

Chen and his co-authors wanted to look at HHS in part for its size, but also because the agency is considered "gender neutral," meaning that it attracts male and female employees equally and promotes both genders equally.

"So, we would anticipate the gender pay gap should be minimal," said Chen.

Using a publicly available dataset of annual pay rates and job characteristics for federal employees, the team scraped information for HHS employees, classifying gender using first names.

Several factors could explain pay differences, including where employees lived and pay grade, a proxy of their levels of experience and education. In order to determine how much of a difference in pay could be attributed to these variables, the team systematically ran analyses controlling for job title, location and the employee's pay grade.

The results showed that overall, the gender pay gap narrowed from 13% to 9.2 % between 2008 and 2010. Job type, location and pay grade explained half of this gap, but 3.5% of the gap in 2018 was unexplained by these factors.

Chen says the key may be differences in promotion within the higher pay grades.

General schedule, the most common federal pay plan, has 15 levels, or pay grades. Higher pay grades often require advanced degrees, and the highest pay grades typically involve supervisory responsibilities. For each grade level, there are 10 "steps" through which employees can advance by serving a set length of time or by merit.

The analysis showed that women could be stuck in the last steps of level 13 and 14 pay grades.

"If you control pay grade, we get a 1% percent difference, which is getting close to parity. That is itself an indication of a gender promotion gap. Because of the rules of the pay grades in the federal government, differences in promotion are a major contributor of the pay difference," said Chen.

This is where some might point to gender discrimination, but Chen is not so certain.

"I know researchers like to say we need more data, but we do in order to say whether job segregation is self-selection or something else," he said.

Chen and his co-authors emphasize that increased data transparency and strengthening legislation action to ensure equal pay for equal work are needed to help close this gap.

A team of researchers at the University of Ottawa has found a way to use visible light to transform carbon dioxide gas, or CO2, into solid carbon forms that emit light. This development creates a new, low-energy CO2 reduction pathway to solid carbon that will have implications across many fields.

We talked to lead author Dr. Jaspreet Walia, Post-Doctoral Fellow in the School of Electrical Engineering and Computer Science at the University of Ottawa, and research lead Dr. Pierre Berini, uOttawa Distinguished Professor and University Research Chair in Surface Plasmon Photonics, to learn more.

Please tell us about your team's discovery.

Pierre Berini: "We have reduced carbon dioxide, a greenhouse gas, to solid carbon on a nanostructured silver surface illuminated with green light, without the need for any other reagents. Energetic electrons excited on the silver surface by green light transfer to carbon dioxide molecules, initiating dissociation. The carbon deposits were also found to emit intense yellow light in a process known as photoluminescence."

How did you come to these conclusions?

Jaspreet Walia: "We used a technique known as Raman Scattering to probe the reaction in real time to determine which products, if any, were forming. To our surprise, we consistently observed signatures of carbon forming on the surface, as well as bright and visible yellow light emanating from the sample."

Why is it important?

Pierre Berini: "Recently, there has been considerable global research effort devoted to developing technologies that can transform CO2 using visible light. Our work not only demonstrates that this is possible, but also that light emitting solid carbon can be formed."

What are the applications of this discovery in our lives?

Jaspreet Walia: "This fixed pathway for reagent-less CO2 reduction to light emitting solid carbon, driven by visible light, will be of interest to researchers involved in the development of solar driven chemical transformations, industrial scale catalytic processes, and light-emitting metasurfaces."

"More specifically, with respect to the creation of carbon directly from CO2 gas, our findings will have an impact on research involving plasmon assisted reactions and I would expect the emergence of applications in the oil and gas industries, where catalytic transformations involving carbon-based compounds is a key focus area."

"Next-generation reactions involving CO2 and light could also lead to other useful outcomes, such as the potential for artificial photosynthesis. Our findings could be used for light control and manipulation at the nanoscale, or to possibility realize flat light sources due to the light-emitting aspect of our discovery. The nanostructured carbon itself could also be used in catalysis."

"Finally, the wavelength (color) of the light emitted from carbon dots on a silver surface could be very sensitive to the local environment, making it an attractive sensing platform for pollutants, for example."

Is there anything you would like to add?

Pierre Berini: "We have learned how to form solid carbon deposits that emit light "out of thick air", in a breakthrough enabled by light-assisted transformation of CO2 gas driven by energetic electrons. The project was entirely driven by curiosity, with no set expectations on outcomes, and benefitted from close collaboration with graduate students Sabaa Rashid and Graham Killaire, as well as Professors Fabio Variola and Arnaud Weck."

May 20, 2021 - Comets that circle the Sun in very elongated orbits spread their debris so thin along their orbit or eject it out of the solar system altogether that their meteor showers are hard to detect. From a new meteor shower survey published in the journal Icarus, researchers now report that they can detect showers from the debris in the path of comets that pass close to Earth orbit and are known to return as infrequent as once every 4,000 years.

"This creates a situational awareness for potentially hazardous comets that were last near-Earth orbit as far back as 2,000 BC," said meteor astronomer and lead author Peter Jenniskens of the SETI Institute.

Jenniskens is the lead of the Cameras for Allsky Meteor Surveillance (CAMS) project, which observes and triangulates the visible meteors in the night sky using low- light video security cameras to measure their trajectory and orbit. There are CAMS networks now in nine countries, led by co-authors on the paper.

In recent years, new networks in Australia, Chile and Namibia significantly increased the number of triangulated meteors. The addition of these networks resulted in a better and more complete picture of the meteor showers in the night sky.

"Until recently, we only knew five long-period comets to be parent bodies to one of our meteor showers," said Jenniskens, "but now we identified nine more, and perhaps as many as 15."

Comets comprise only a small fraction of all impactors on Earth, but researchers believe they caused some of the biggest impact events over Earth's history because they can be big and the fact that their orbits are such that they can impact at high speed.

"In the future, with more observations, we may be able to detect fainter showers and trace the orbit of parent comets on even longer orbits," said Jenniskens.

Every night, the CAMS network determines the direction from which comet debris is entering Earth's atmosphere. Maps are created on an interactive celestial sphere (posted at http://cams.seti.org/FDL/) that shows the meteor showers as colored blobs. Clicking on those blobs shows the measured orbits in the solar system.

"These are the shooting stars you see with the naked eye," said Jenniskens. "By tracing their approach direction, these maps show the sky and the universe around us in a very different light."

An analysis of the data found that long-period comet meteor showers can last for many days.

"This was a surprise to me," says Jenniskens. "It probably means that these comets returned to the solar system many times in the past, while their orbits gradually changed over time."

Data also revealed that the most dispersed meteor showers show the highest fraction of small meteoroids.

"The most dispersed showers are probably the oldest ones," says Jenniskens. "So, this could mean that the larger meteoroids fall apart into smaller meteoroids over time."

Astronomers using NASA's Hubble Space Telescope have traced the locations of five brief, powerful radio blasts to the spiral arms of five distant galaxies.

Called fast radio bursts (FRBs), these extraordinary events generate as much energy in a thousandth of a second as the Sun does in a year. Because these transient radio pulses disappear in much less than the blink of an eye, researchers have had a hard time tracking down where they come from, much less determining what kind of object or objects is causing them. Therefore, most of the time, astronomers don't know exactly where to look.

Locating where these blasts are coming from, and in particular, what galaxies they originate from, is important in determining what kinds of astronomical events trigger such intense flashes of energy. The new Hubble survey of eight FRBs helps researchers narrow the list of possible FRB sources.

Flash in the Night

The first FRB was discovered in archived data recorded by the Parkes radio observatory on July 24, 2001. Since then astronomers have uncovered up to 1,000 FRBs, but they have only been able to associate roughly 15 of them to particular galaxies.

"Our results are new and exciting. This is the first high-resolution view of a population of FRBs, and Hubble reveals that five of them are localized near or on a galaxy's spiral arms," said Alexandra Mannings of the University of California, Santa Cruz, the study's lead author. "Most of the galaxies are massive, relatively young, and still forming stars. The imaging allows us to get a better idea of the overall host-galaxy properties, such as its mass and star-formation rate, as well as probe what's happening right at the FRB position because Hubble has such great resolution."

In the Hubble study, astronomers not only pinned all of them to host galaxies, but they also identified the kinds of locations they originated from. Hubble observed one of the FRB locations in 2017 and the other seven in 2019 and 2020.

"We don't know what causes FRBs, so it's really important to use context when we have it," said team member Wen-fai Fong of Northwestern University in Evanston, Illinois. "This technique has worked very well for identifying the progenitors of other types of transients, such as supernovae and gamma-ray bursts. Hubble played a big role in those studies, too."

The galaxies in the Hubble study existed billions of years ago. Astronomers, therefore, are seeing the galaxies as they appeared when the universe was about half its current age.

Many of them are as massive as our Milky Way. The observations were made in ultraviolet and near-infrared light with Hubble's Wide Field Camera 3.

Ultraviolet light traces the glow of young stars strung along a spiral galaxy's winding arms. The researchers used the near-infrared images to calculate the galaxies' mass and find where older populations of stars reside.

Location, Location, Location

The images display a diversity of spiral-arm structure, from tightly wound to more diffuse, revealing how the stars are distributed along these prominent features. A galaxy's spiral arms trace the distribution of young, massive stars. However, the Hubble images reveal that the FRBs found near the spiral arms do not come from the very brightest regions, which blaze with the light from hefty stars. The images help support a picture that the FRBs likely do not originate from the youngest, most massive stars.

These clues helped the researchers rule out some of the possible triggers of types of these brilliant flares, including the explosive deaths of the youngest, most massive stars, which generate gamma-ray bursts and some types of supernovae. Another unlikely source is the merger of neutron stars, the crushed cores of stars that end their lives in supernova explosions. These mergers take billions of years to occur and are usually found far from the spiral arms of older galaxies that are no longer forming stars.

Magnetic Monsters

The team's Hubble results, however, are consistent with the leading model that FRBs originate from young magnetar outbursts. Magnetars are a type of neutron star with powerful magnetic fields. They're called the strongest magnets in the universe, possessing a magnetic field that is 10 trillion times more powerful than a refrigerator door magnet. Astronomers last year linked observations of an FRB spotted in our Milky Way galaxy with a region where a known magnetar resides.

"Owing to their strong magnetic fields, magnetars are quite unpredictable," Fong explained. "In this case, the FRBs are thought to come from flares from a young magnetar. Massive stars go through stellar evolution and becomes neutron stars, some of which can be strongly magnetized, leading to flares and magnetic processes on their surfaces, which can emit radio light. Our study fits in with that picture and rules out either very young or very old progenitors for FRBs."

The observations also helped the researchers strengthen the association of FRBs with massive, star-forming galaxies. Previous ground-based observations of some possible FRB host galaxies did not as clearly detect underlying structure, such as spiral arms, in many of them. Astronomers, therefore, could not rule out the possibility that FRBs originate from a dwarf galaxy hiding underneath a massive one. In the new Hubble study, careful image processing and analysis of the images allowed researchers to rule out underlying dwarf galaxies, according to co-author Sunil Simha of the University of California, Santa Cruz.

Although the Hubble results are exciting, the researchers say they need more observations to develop a more definitive picture of these enigmatic flashes and better pinpoint their source. "This is such a new and exciting field," Fong said. "Finding these localized events is a major piece to the puzzle, and a very unique puzzle piece compared to what's been done before. This is a unique contribution of Hubble."

According to the Centers for Disease Control and Prevention, approximately 22 percent of older adults in the United States suffer from a functional impairment, defined as difficulties performing daily activities, such as bathing or getting dressed, or problems with concentration or decision-making affected by physical, mental or emotional conditions.

In a new study published in the May 20, 2021 online edition of the American Journal of Preventive Medicine, researchers at University of California San Diego School of Medicine found that functional impairments among adults aged 50 and older are associated with a higher risk of medical cannabis use; and prescription opioid and tranquilizer/sedative use and misuse.

"Our study implies that there may be a link between functional impairments and use and misuse of these prescribed drugs. It is important to recognize that any psychoactive substance may be risky for this vulnerable population," said Benjamin Han, MD, first author of the study and a clinician-researcher in the Division of Geriatrics, Gerontology, and Palliative Care in the Department of Medicine at UC San Diego.

"Many older adults use these substances due to chronic pain, insomnia or anxiety -- conditions that can affect daily functioning. These symptoms can be challenging to manage, especially in the setting of multiple chronic conditions and other prescribed medications."

Joseph Palamar, PhD, senior author of the study and a drug epidemiologist and associate professor at New York University Grossman School of Medicine, said: "It is important to recognize that prescription opioids and benzodiazepines can be risky among this demographic as effects can increase chances for falls, and overuse can lead to overdose or even addiction."

The study analyzed data from participants age 50 and older from the 2015-2019 National Survey on Drug Use and Health. Through a computer-assisted interview process, participants were asked about use of cannabis and prescription opioids and tranquilizers/sedatives in the past year, as well as the presence of any functional impairments.

Those reporting cannabis use were asked if it had been recommended by a doctor, and those reporting opioid or tranquilizer/sedative use, were asked about misuse, defined as using prescription drugs in any way not directed by a doctor, including use without a prescription or use in greater amounts or longer than prescribed.

The study found that adults age 50 and older reporting medical cannabis use, prescription opioid use and misuse, or prescription tranquilizer/sedative use and misuse were more likely to report having an impairment.

"Our findings suggest the symptoms of this patient population are not always being fully addressed or that something else is going on, such as a substance use disorder or a mental health issue like depression and anxiety," said Han. "As health care providers, we need to take a closer look at chronic symptoms among older patients with functional impairments. Managing these conditions often requires a multidisciplinary approach."

Palamar said further research is needed to identify and minimize the risks of psychoactive substance use in this population -- and more fully elucidate the role of cannabis.

"Cannabis may have benefits for this population, but we need to ensure that risks don't outweigh the benefits. It's great if cannabis can lessen your grandmother's anxiety, but not if she's already at an increased risk for falling down," said Palamar.

Han said patients should work closely with their health care providers to develop appropriate treatment plans with realistic expectations.

"It is also vital to communicate the risks of medications with older adults with functional impairments and the importance of balancing these risks with the potential benefits," Han said.

Leave voters in Cornwall wanted to exit the EU to "take back control" and express concern about immigration - even though most said the movement of people across the continent had not caused issues for them, a new survey suggests.

A total of 56.5 per cent of people in Cornwall voted to Leave the EU in 2016, yet the area has received some of the highest levels of EU structural funding in England.

There have long been campaigns for Cornwall to have more political autonomy, but hardly anyone who took part in the research said they voted to Leave said they do so to get more power for politicians in the county.

The most frequent reason given, found in 79 responses to the survey, was the UK had lost control to the EU, and there was need to regain it.

Immigration was mentioned 77 times, very often paired with concerns about pressure on public services and loss of control over law-making. Comments included "uncontrolled immigration, loss of sovereignty" or 'being told by the EU how to run our country", "the costs of being part of the EU - could be better used in this country, immigration". People mentioned wanting a "strong" Britain, 16 of the 21 people that raised the issue of public services, also mentioned immigration, or a need to control borders.

However only six people said immigration was a problem in Cornwall, and only five said the issue was important to themselves and their families. These numbers doubled when people were asked about the impact on the UK, and 41 people gave it as a reason why they voted to Leave the EU.

The research was carried out as part of an Economic and Social Research Council Impact Accelerator project to understand why regions with high levels of European Union Structural Funding support voted disproportionately to Leave.

Dr Joanie Willett, from the University of Exeter carried out carried out three focus groups with 15 participants, as well as nine one-to-one interviews, and a questionnaire seven to ten months after the referendum, to understand the key factors behind the result. All participants had voted Leave.

The qualitative survey, which had largely open questions, was shared on social media, and email lists of business, local government, and cultural organisations. It was open for a 4-week period, and received 186 responses from Leave voters.

Dr Willett said: "Our research indicates people voted to Leave the EU because they felt like they were supporting their nation, and that would protect them, rather than a desire for stronger say in what happens in their communities. People didn't ask for political decision making to be more decentralised, but this could be a useful response to the concerns people had about having more control."

Only three survey responses mentioned voting Leave because it would allow more local control over decision-making.

Democracy was mentioned in 44 responses, membership of the EU being a waste of money in 43, wanting to create a strong Britain in 35, sovereignty in 18, the economy in 13, fishing and farming in 10, and freedom/independence/autonomy in 8. The European Court of Justice received six mentions, two people made reference to Germany and World War Two.

A total of 47 people used highly emotive language, for example: "sovereignty - not to be elected by an unelected foreign elite", but most people described their decision to vote Leave in more restrained terms. This included comments such as "Europe had too much hold on legislation"

Dr Willett said: "Many people who took part in the study wanted a strong affective economy, good public services and accessible jobs. They seem to have linked a Leave vote with expressing concerns about the association between immigration and the economy. These issues don't appear to be grounded in people's daily experiences."

INFORMS Journal Information Systems Research Study Key Takeaways:

In real-time feedback the relationship source (peer, subordinate or supervisor) plays a role: the feedback tends to be more critical when it is from supervisors.

Favoritism and retribution are impacted in real-time feedback: Supervisors adopt tit-for-tat strategies, but peers do not.

Men rate women higher than men, and women rate men and women similar to how men rate men.

Positive real-time feedback has a stronger effect on future ratings than negative feedback.

CATONSVILLE, MD, May 20, 2021 - To deliver real-time feedback to support employee development and rapid innovation, many companies are replacing formal, review-based performance management with systems that enable frequent and continuous employee evaluation. New research in the INFORMS journal Information Systems Research examines the role of these applications to understand the effects on employee performance appraisals.

The study, "Are Traditional Performance Reviews Outdated? An Empirical Analysis on Continuous, Real-time Feedback in the Workplace," was conducted by Michael Rivera and Subodha Kumar from Temple University and Liangfei Qiu from the University of Florida. The authors found that the relationship source (peer, subordinate or supervisor) impacts real-time feedback, which tends to be more critical when it comes from supervisors.

"What is more interesting is the effect of favoritism and retribution in real-time feedback: Supervisors adopt tit-for-tat strategies, but peers do not," said Kumar, a professor in the Fox School of Business at Temple. "We also uncover that men rate women higher than men, and that women rate men and women similar to how men rate men."

In addition, positive real-time feedback has a stronger effect on future ratings than negative feedback.

Real-time feedback applications enable supervisors and employees to give, seek and receive competency-based feedback using their computers, smartphones or other devices.

The authors used data from five different organizations using the platform DevelapMe. The organizations spanned several industries including pharmaceutical, healthcare, interior design and payment processing. The data consisted of around 5,000 instances of feedback.

"Our findings have direct implications for the design and implementation of performance management systems," said Kumar. "We highlight how companies can use information systems to create an innovative human resource operation that delivers flexibility and agility."

Oysters live and grow in saltwater. However, the saltiness of their habitat can change dramatically, especially where the mighty Mississippi River flows into the Gulf of Mexico. Louisiana oysters from the northern Gulf of Mexico may experience some of the lowest salinity in the world due to the influx of fresh water from the Mississippi River. In addition, increased rainfall and large-scale river diversions for coastal protection will bring more fresh water that does not bode well for the eastern oyster. New research led by Louisiana State University (LSU) alumna Joanna Griffiths from Portland, Oregon, and her faculty advisor LSU Department of Biological Sciences Associate Professor Morgan Kelly reveals new information on why some oysters may be more resilient to freshwater than others. Their findings published this week have a significant impact on this commercially important marine species.

"Oysters are known to be tolerant to a wide breadth of salinity. That's generally true of a lot of oysters because they can close up their shell. But as larvae, they don't have that shell structure to protect them," said Griffiths, who is now a postdoctoral researcher at U.C. Davis.

She conducted an extensive study as part of her doctoral dissertation on oyster larvae survival and growth. She investigated whether having parents who have lived in environments with low salinity will produce offspring that are more resistant to low salinity based on a concept called transgenerational plasticity that would suggest one generation's flexibility is passed on to the next generation.

To test this hypothesis, the researchers spawned and raised oysters at the Louisiana Department of Wildlife and Fisheries Michael C. Voisin Oyster Hatchery in Grand Isle in 2016. They transplanted 240 of these oysters into coastal waters at two different locations -- a low salinity site by the Louisiana University Marine Consortium, or LUMCON, in Chauvin, and a medium salinity site by the Louisiana Sea Grant Oyster Research and Demonstration Farm in Grand Isle. After two years, the researchers collected the oysters and found the oysters at the saltier site in Grand Isle were 40 percent larger than the ones from LUMCON thus showing that environment can affect development. Then, the researchers spawned the next generation to see what flexibility characteristics could be passed down from parent to offspring.

Griffiths meticulously cross-bred oysters from both sites and produced 240 oyster families. She and four colleagues tended to the oyster larvae around-the-clock.

"This type of experiment that Joanna did is a lot of work," Kelly said. "It is a lot of record-keeping. You have to be ready at every developmental stage of the baby oysters. A little bit like having a human baby, you have to be up in the middle of the night sometimes getting ready for the next stage of the oyster larvae life cycle. There are a lot of sleepless nights breeding oysters."

Catastrophically, the breeding experiment failed and no oyster larvae survived. Griffiths repeated the experiment and again it failed.

"It was hard to put in a lot of work and get absolutely nothing from it," she said.

But on the third try, she succeeded.

Of the 240 oyster families, about 60 families of larvae survived after five days.

Griffiths measured the larvae and found that the offspring of the parents who had lived at the low salinity site by LUMCON were not more resilient to low salinity. She used size as a measure of success because the larger an oyster larva is, the less time they need to spend in the water column where they are vulnerable to predators before metamorphosizing and settling onto a reef.

She found that some families of oysters do well under low salinity and some families do poorly. The oysters that do well have some variation of a gene that helps them grow well no matter what environment.

"We were surprised how much genetic variation they have and how heritable the resilient trait is," Griffiths said.

These results suggest that selective breeding in hatchery management practices may be an effective way of increasing resiliency for low salinity tolerance in eastern oysters.

"I've experienced a lot of failures during my Ph.D., but I think they have made me a better scientist. I might be studying the resilience of oysters to stress, but it's this project that has made me more resilient as a scientist. I know I can deal with difficult and tough circumstances and I'm now grateful for those failures!"

During the pandemic, the old waiting room phrase "the doctor will see you now" has taken on a new meaning. So has the waiting room. Our kitchen table or living room couch is where many people do work lately, and that includes visits to the doctor. New research from Syracuse University's Falk College indicates this method of health care will continue even after COVID numbers are (hopefully) reduced.

"I was surprised by the results," said the study's lead author Bhavneet Walia, assistant professor of public health at Syracuse University. "I initially thought that, because of the challenges of telehealth, physicians would not be in favor of continuing post-pandemic. It turns out they do. But make no mistake, there are challenges." Among them is the technology itself. Internet connectivity along with software and hardware require money and training. And this is just on the side of the physician (a future study will probe patient relationships with telehealth). "We saw training went up for physicians during our survey period," which Walia said was from July to September of 2020. Findings of the study can be found in JMIR Human Factors.

In order to develop the survey, Walia collaborated with two physicians from the Syracuse Veterans Administration hospital. Between them they created a series of questions that could provide in depth answers, all while being mindful of a physician's limited time. 148 physicians responded from around the United States and according to Walia many were in favor of continuing with telehealth. "In the U.S. we talk about this iron triangle of healthcare which is quality, access and cost. The results of this survey show that physicians who practice internal medicine are in favor, more than 40%, say they would continue with telehealth. This is great in terms of achieving the iron triangle."

But there are concerns, mostly centered around the technology itself. Not only among physicians who must purchase and use the software. Public health officials are worried about the possibility of market concentration involving the companies that produce the technology.

Market concentration is an outcome in which a market is dominated by a small number of companies.

"As consumers we want competition which reduces the price and increases the quality," said Walia. "On one hand, from this survey I believe telehealth can increase access. On the other hand as a health economist I worry that market concentration will reduce access. As a researcher my goal is to understand the problem and anticipate future problems. This could be one. The goal of advancing telehealth is to increase access, and market concentration can make things work backwards. We cannot ignore this, if this is going to be the next big thing. Let's make sure, as policy makers, that we don't allow market concentration to happen."

So it appears the 21st century version of the house call, talking to your family doctor from the comforts of home, will continue. Professor Walia wants to be certain it continues with the healthcare consumer in mind.

At the start of the COVID-19 outbreak, a University of Illinois Chicago researcher conducted a survey asking respondents if they experienced health care delays because of the pandemic. In addition to learning about the types of delays, the study also presented a unique opportunity to capture a historic moment at the pandemic's beginning. 

Elizabeth Papautsky, UIC assistant professor of biomedical and health information sciences, is first author on "Characterizing Healthcare Delays and Interruptions in the U.S. During the COVID-19 Pandemic Using Data from an Internet-Based Cross-Sectional Survey," published in the Journal of Medical Internet Research.  

The study was conducted through an internet survey from April 5-May 5, 2020, and over 2,500 people responded. The results showed 48% of respondents experienced delayed health care, with the three most common delays being dental (38%), preventative (29%) and diagnostic (16%). 

Fear of COVID-19 infection, health care provider discouragement, and the feeling that their health care concerns weren't as important as others were the top reasons people listed for delaying care, according to the study. 

The study's results are not surprising, but worrisome as implications may include long-term health care decline, Papautsky said. For example, due to COVID-19's impact on preventive and diagnostic care, an uptick in cancer diagnoses and at higher stages is expected, she added. 

Despite a convenience sample, which is often frowned upon in research, Papautsky said, important lessons can be learned. 

"We captured a fleeting moment in time," she said. "This is an opportunity to learn how to do research in very dynamic situations. What lessons can we learn for when there are other situations where you need to get a survey out quickly and how can we do that better." 

One surprising thing about the study was the number of respondents: 2,570 people, invited via social media, completed the 40-minute survey. 

"People really cared about it. That shows the power of social media and the power of asking questions that people are concerned about," Papautsky said. 

While the conditions for this study cannot be replicated, the methodological lessons learned can serve as a sort of "pilot study" for future crises, creating more diverse and inclusive research that drives health equity forward, the study reports. 

"There is an urgent need for sharing lessons learned, disseminating effective strategies for reaching more diverse populations, and encouraging the research community to employ and improve upon these strategies in future research," Papautsky said. 

Environmental quality is associated with advanced-stage prostate cancer at diagnosis, according to a new study by University of Illinois Chicago researchers. 

Prostate cancer is up to 57% heritable, with the remainder attributed to environmental exposures. However, studies on those environmental factors and prostate cancer aggressiveness have previously been limited. For their study, "Association between environmental quality and prostate cancer at diagnosis," published in the journal Prostate Cancer and Prostatic Disease, researchers paired data from the environmental quality index, or EQI, and the Surveillance, Epidemiology and End Results Program, or SEER. 

Study co-author Dr. Michael Abern, associate professor and director of urologic oncology at University of Illinois College of Medicine, said by combining the data from SEER and EQI, researchers found that lower environmental quality was associated with advanced-stage prostate cancer diagnosis.  

The EQI combines data from multiple sources and reports an overall quality index, as well as five subdomains: air, water, land, built and sociodemographic. The data is collected from sources such as Environmental Protection Agency air quality monitoring. 

"When we drilled down further into the subdomains of the EQI, we found that some of the associations were stronger than others. Specifically, the land, water and sociodemographic domains seem to be driving the association more than air or built domains," Abern said. 

Additionally, areas with low-quality land, water and sociodemographic variables showed the strongest association with prostate cancer being diagnosed at a later stage, which can mean poorer treatment outcomes. 

The study also found that race was an independent predictor of metastatic prostate cancer -- cancer that has spread -- at diagnosis, with Black men at higher risk. That risk is elevated more when coupled with living in an area with low environmental quality.  

According to the study, there were more than 174,000 newly diagnosed prostate cancer cases and more than 31,000 prostate cancer deaths in the United States in 2019, making it the most common non-cutaneous (skin) malignancy in men. When diagnosed early, prostate cancer has a nearly 100% five-year survival rate.  

Though there have been other studies that explore environmental exposures, they often compare a single agent and individual exposure. Using the EQI and SEER offers a more comprehensive ecologic analysis to better represent environmental exposures and the relationship to advanced prostate cancer, the study states. Because the EQI also looks at sociodemographic variables, it takes health equity into account.

"They are actually measuring infrastructure and barriers to getting healthcare," Abern said. 

Abern said the study provides the ability to make hypotheses as to why late-state prostate cancer diagnoses are higher in certain areas, and then drill down into the components of the environmental variables to try to find solutions such as environmental policy changes. 

It is well established that age and Black race are risk factors to develop prostate cancer in addition to genetic risk factors including family history. An important distinction can be drawn between incidence and aggressiveness, Abern said, and this study focuses on the aggressiveness of prostate cancer. 

"When I see a patient with prostate cancer, they assume maybe they got it because of something they did. It is probably not. Not a lot is known about personal lifestyle choices that lead to prostate cancer. Diet, exercise and smoking have never had a very strong association with prostate cancer," Abern said. "Seeing a doctor and getting screened is still the most important thing about getting diagnosed."