Culture

Boston - A new study shows that providing a non-acute care space after hospital discharge for patients with COVID-19 who are experiencing homelessness helped reduce hospitalizations and keep inpatient beds available for those requiring acute care. Published in JAMA Network Open and led by researchers at Boston Medical Center's (BMC) Grayken Center for Addiction, the study demonstrates the importance of developing innovative approaches to tackle issues facing people experiencing homelessness, including their inability to isolate, in order to mitigate additional COVID-19 exposure while simultaneously alleviating the strain on hospitals during surge situations.

Approximately nine percent of BMC patients experience homelessness, who also as a group have higher rates of mental health and substance use disorders than the general population. When diagnosed with COVID-19, people are told to isolate for a period of seven to 14 days in order to minimize exposure to others. However, for individuals experiencing homelessness and who live in a shelter or in a congregate setting, isolation is rarely an option.

"Early on in the pandemic, we recognized that we needed to be proactive in addressing the risk of COVID-19 exposure and spread among people experiencing homelessness. We also knew we had to act quickly as we saw rates of COVID-19 skyrocketing in Boston and globally," said Joshua Barocas, MD, an infectious disease physician at BMC and the study's corresponding author. In collaboration with the Commonwealth of Massachusetts, BMC established and opened the COVID Recuperation Unit (CRU) in a facility close to the hospital in early April 2020. The unit treated patients discharged from BMC who did not require acute care, providing a place to safely isolate and recover from COVID-19 in a medically supervised setting. In addition, staff on site at the CRU were also trained to help patients manage their substance use disorders, recognize medical emergencies, and address mental health concerns.

The researchers analyzed data from BMC's daily COVID-19 hospitalization census between March 1 and June 4, 2020. Between that time period, 8,864 patients were admitted to BMC (13.2 percent were people experiencing homelessness) and 226 patients were admitted to the CRU (84 percent were people experiencing homelessness). Among patients experiencing homelessness diagnosed with COVID-19, there was a 28 percent reduction in hospitalizations at BMC after the CRU opened.

"Our study indicates the need to think outside the box and develop cross-sector partnerships in order to improve public health responses in the future," added Barocas, who is also assistant professor of medicine at Boston University School of Medicine. "Our approach helped the hospital during a crucial time when space and resources were limited. Beyond that, however, we were able to engage with our patients and provide services that they needed for issues beyond COVID-19. Meeting patients where they are at is critical to improve outcomes--pandemic or no pandemic."

In previous research, ancient massacre sites found men who died while pitted in battle or discovered executions of targeted families. At other sites, evidence showed killing of members of a migrant community in conflict with previously established communities, and even murders of those who were part of religious rituals.

But a more recent discovery by a research team -- that includes two University of Wyoming faculty members -- reveals the oldest documented site of an indiscriminate mass killing 6,200 years ago in what is now Potocani, Croatia.

"The DNA, combined with the archaeological and skeletal evidence -- especially that indicating systematic violence, perhaps even execution-style -- demonstrates an indiscriminate massacre and haphazard burial of 41 individuals from an early pastoralist community in what is now eastern Croatia," says James Ahern, a UW professor in the Department of Anthropology and associate vice provost for graduate education.

Ahern was a nonsenior co-author of a paper, titled, "Genome-Wide Analysis of Nearly All the Victims of a 6,200-Year-Old Massacre," that was published March 10 in PLOS ONE. The journal accepts research in over 200 subject areas across science, engineering, medicine, and the related social sciences and humanities.

Mario Novak, a research associate with the Institute for Anthropological Research in Zagreb, Croatia, was the paper's lead author. Ivor Jankovic, a UW adjunct professor of anthropology and assistant director of the Institute for Anthropological Research, also was a nonsenior co-author of the study.

Other researchers who contributed to the paper were from the Universitat Pompeu Fabra in Barcelona, Spain; Harvard University; Archaeological Museum in Zagreb, Croatia; University of Zagreb; University of Vienna; Broad Institute of Harvard and Massachusetts Institute of Technology; and the Howard Hughes Medical Institute at Harvard Medical School.

In 2007, the Croatian site underwent a "rescue" excavation that occurred when the burial was uncovered during the construction of a garage on private land, Ahern says. Archaeologists, led by Jacqueline Balen of the Archaeological Museum in Zagreb, working nearby on a cultural resource impact assessment related to the construction of a motorway, were called in to investigate.

In 2012, Ahern and Jankovic, then a research scientist at the Institute for Anthropological Research, were invited by the archaeologists in charge of Potocani discoveries to analyze the skeletal remains. The skeletal remains needed to be cleaned and inventoried, and basic analysis -- such as estimation of age and sex, recording of preserved elements, and basic documentation of pathologies and trauma -- was conducted by Jankovic, Ahern and Zrinka Premuzic, a Ph.D. student at the University of Zagreb.

"This is the oldest known case of indiscriminate, mass killing that we know of," Ahern says. "In some ways, it goes against the conventional wisdom about early agriculturalists -- the Neolithic and Eneolithic -- who have long been thought to have lived in small villages or herding groups.

"The DNA evidence indicates just a few close relatives in such a large sample, meaning that, not only was the violence seemingly indiscriminate, it involved a subset of a much larger local population."

Prior research shows that some early farmers lived in large settlements, such as at Catalhoyuk in Western Asia; and some later Eneolithic peoples, such as those who lived at the Vucedol site in the Balkans. However, Potocani is approximately 1,000 years older than the latter settlement.

The genetic analysis revealed that 70 percent of the analyzed skeletons did not have close kin among the deceased. Additionally, there was no sex bias, as the number of males and females found at the site were almost equal in number. This indicates the massacre was not the outcome of inter-male fighting one would expect in battles, nor was the result of a reprisal event targeting individuals of a specific sex.

Cranial injuries were found on 13 of the 41 individuals massacred at the site, according to the study.

"Although we do not have evidence on the cause of death for the other individuals, their deaths were almost certainly violent," Ahern says. "Multiple radiocarbon dates, as well as the sedimentology of the burial, all indicate a single burial event.

"Furthermore, a majority of violent deaths do not leave clear evidence of trauma in the preserved skeletal remains," he continues. "Individuals could have been strangled, bludgeoned, cut or stabbed in soft-tissue areas or in manners that did not damage underlying bones."

The study also considered the potential role of climate change in the mass burial event. When climate changes, resources such as water, vegetation -- including feed for cattle and other livestock -- and game animals become less predictable. Furthermore, hazards, such as unpredictable extreme weather, become more common.

"These factors tend to disrupt human lifeways, and groups sometimes try to take over others' territories and resources," Ahern explains. "Increases in population size cause groups to overextend their local resources and require expansion into other areas. Both climate change and population increase tend to cause social disruption and violent acts, such as what happened at Potocani, that become more common as groups come into conflict with each other."

Data in the study reveal how organized violence in this period could be indiscriminate, just as indiscriminate killings have been an important feature of life in historic and modern times. The history, development and causes of human violence are crucial to our ability to understand and reduce violence in our own society, Ahern says.

"Perhaps, because of the long history of human violence and warfare and its contemporary relevance, the public is engaged by the sort of narrative about the deep human past that we've been able to recreate through our scientific research," Ahern says. "Furthermore, DNA, heredity and human ancestry are issues that touch everyone's lives. Our research also highlights UW's global engagement and research enterprise."

During the COVID-19 pandemic, people who recognize the connections they share with others are more likely to wear a mask, follow health guidelines and help people, even at a potential cost to themselves, a new University of Washington study shows.

Indeed, an identification with all humanity, as opposed to identification with a geographic area like a country or town, predicts whether someone will engage in "prosocial" behaviors particular to the pandemic, such as donating their own masks to a hospital or coming to the aid of a sick person.

The study, published March 10 in PLOS ONE, is drawn from about 2,500 responses, from more than 80 countries, to an online, international study launched last April.

Researchers say the findings could have implications for public health messaging during the pandemic: Appealing to individuals' deep sense of connectedness to others could, for example, encourage some people to get vaccinated, wear masks or follow other public health guidelines.

"We want to understand to what extent people feel connected with and identify with all humanity, and how that can be used to explain the individual differences in how people respond during the COVID-19 pandemic," said author Rodolfo Cortes Barragan, a postdoctoral researcher at the UW Institute for Learning & Brain Sciences, or I-LABS, who co-led the study with postdoctoral researcher Nigini Oliveira at the Paul G. Allen School for Computer Science and Engineering.

In psychology, "identification with all humanity" is a belief that can be measured and utilized in predicting behavior or informing policy or decision-making. Last spring, as governments around the world were imposing pandemic restrictions, a multidisciplinary team of UW researchers came together to study the implications of how people would respond to pandemic-related ethical dilemmas, and how those responses might be associated with various psychological beliefs.

Researchers designed an online study, providing different scenarios based in social psychology and game theory, for participants to consider. The team then made the study available in English and five other languages on the virtual lab LabintheWild, which co-author Katharina Reinecke, an associate professor in the Allen School, created for conducting behavioral studies with people around the world.

The scenarios presented participants with situations that could arise during the pandemic and asked people to what extent they would:

Follow the list of World Health Organization health guidelines (which mostly focused on social distancing and hygiene when the study was run between mid-April to mid-June)

Donate masks of their family's to a hospital short on masks

Drive a person exhibiting obvious symptoms of COVID-19 to the hospital

Go to a grocery store to buy food for a neighboring family

Call an ambulance and wait with a sick person for it to arrive

In addition to demographic details and information about their local pandemic restrictions, such as stay-at-home orders, participants were asked questions to get at the psychology behind their responses: about their own felt identification with their local community, their nation and humanity, in general. For instance, participants were asked, "How much would you say you care (feel upset, want to help) when bad things happen to people all over the world?"

Researchers found that an identification with "all humanity" significantly predicted answers to the five scenarios, well above identifying with country or community, and after controlling for other variables such as gender, age or education level. Its effect was stronger than any other factor, said Barragan, and popped out as a highly significant predictor of people's tendency to want to help others.

The authors noted that identifying with one's country, in fact, came in a distant third, behind identification with humanity in general and one's local community. Strong feelings toward one's nation, nationalism, can lead to behavior and policies that favor some groups of people over others.

"There is variability in how people respond to the social aspects of the pandemic. Our research reveals that a crucial aspect of one's world view - how much people feel connected to others they have never met - predicts people's cooperation with public health measures and the altruism they feel toward others during the pandemic," said co-author Andrew Meltzoff, who is co-director of I-LABS and holds the Job and Gertrud Tamaki Endowed Chair in psychology.

Since last spring, of course, much has changed. More than 2.5 million people worldwide have died of COVID-19, vaccines are being administered, and guidance from the U.S. Centers for Disease Control and Prevention, especially regarding masks, has evolved. If a new survey was launched today, Barragan said, the research group would like to include scenarios tuned to the current demands of the pandemic and the way it challenges us to care for others even while we maintain physical distancing.

While surveys, in general, can be prone to what's known as self-serving bias -- the participant answers in ways that they believe will make them "look good" -- researchers say that's not evident here. They point to the sizeable differences between responses that identify with all humanity, and those that identify with community or country, and note there would be little reason for participants to deliberately emphasize one and not the others.

The project is part of a larger multidisciplinary effort by this same UW research team to bring together computer scientists and psychologists interested in decision-making in different cultural contexts, which could inform our understanding of human and machine learning.

An eventual aim of the study is to use tools from artificial intelligence research and online interactions with humans around the world to understand how one's culture influences social and moral decision-making.

"This project is a wonderful example of how the tools of computer science can be combined with psychological science to understand human moral behaviors, revealing new information for the public good," said co-author Rajesh Rao, the Hwang Endowed Professor of Computer Science and Engineering at the UW.

For COVID-19 and future humanitarian crises, the ethical dilemmas presented in the study can offer insight into what propels people to help, which can, in turn, inform policy and outreach.

"While it is true that many people don't seem to be exhibiting helpful behaviors during this pandemic, what our study shows is that there are specific characteristics that predict who is especially likely to engage in such behavior," Barragan said. "Future work could help people to feel a stronger connection to others, and this could promote more helpful behavior during pandemics."

Images

As far back as the Greek historian Herodotus, a group of people called the Scythians were considered highly mobile warrior nomads.

Scythian-era people lived across Eurasia from about 700 BCE to 200 BCE, and have long been considered highly mobile warriors who ranged widely across the steppe grasslands. Herodotus describes Scythian populations as living in wagons and engaging in raiding and warfare, and this view has persisted throughout history--supported by archeologists' observations of similar styles of horse harnesses, weapons, burial mounds and animal style motifs throughout what is now Ukraine.

Because of this, history has lumped the diverse cultures and periods of people in this region as a single "Scythian" identity, even calling it an "empire." But a study including University of Michigan research reveals what previously was considered one group was likely a set of diverse peoples with varied diets.

Mamai-Gora Mirror.pngBy analyzing human bone and tooth enamel, the international team of researchers found that, rather than being wide-ranging warriors, people in this region more likely lived in urban locales, growing millet and raising livestock in mixed economic systems. The team's results are published in the journal PLOS ONE.

"Our study demonstrates overall low levels of human mobility in the vicinity of key urban locales of the Scythian era, in contrast to previous stereotypes of highly nomadic populations," said Alicia Ventresca Miller, lead author of the study and U-M assistant professor of anthropology. "While long-distance mobility increased during the Scythian era relative to preceding periods, it was limited to a small percentage of individuals."

Ventresca Miller, formerly of the Max Planck Institute for the Science of Human History, and her team took samples of bone and tooth enamel from 56 human skeletons at three burial sites--Bel'sk, Mamai-Gora and Medvin--in modern-day Ukraine. The team examined these samples using isotope analysis. This kind of analysis examines isotopes of elements--in this study, strontium, oxygen, nitrogen and carbon--deposited in human tissues through eating and drinking. This allows researchers to determine where an individual traveled and lived based on the unique isotope composition in their tissue.

Together, these analyses showed that urban locales were places of social and economic diversity where people farmed millet and raised livestock. These findings suggest people largely stayed where they farmed and raised livestock--though they did tend to move around more than previous eras.

"The Scythian epoch was clearly a period of contradictions, with strong evidence for complex interactions between agro-pastoralists and pastoralists that contributed to population aggregation in urban locales," said Ventresca Miller, who is also assistant curator of Asian archeology at the U-M Museum of Anthropological Archaeology. "This study highlights the potential use of using isotopic analysis to directly assess prevailing models of economies and mobilities during the Scythian era."

In the future, researchers hope to provide further insights into how people moved between site types, such as urban centers versus rural settings, as well as between individuals with different grave goods and apparent social status.

"In this way, we can move further away from assumed stereotypes of migration and nomadism toward dynamic and complex insights into globalized Scythian societies," Ventresca Miller said.

The legalization of cannabis and the arrival of nonmedical fentanyl are fundamentally changing drug markets in North America. A large part of these changes relates to the ability to produce large quantities of the drugs at low costs, which has slashed wholesale prices for both drugs and retail prices for cannabis. A new analysis explores the effects of these changes on use. The analysis concludes that sharp declines in production costs for cannabis and opioids could dramatically reduce the price per dose for consumers in ways that alter patterns of use and dependence.

The analysis, by a researcher at Carnegie Mellon University (CMU), is published in the International Journal of Drug Policy.

"Historical analogies suggest that very large declines in price can have effects on use that go beyond just expanding traditional patterns of consumption," explains Jonathan Caulkins, professor of operations research and public policy at CMU's Heinz College, who wrote the analysis. "The overall situation with cannabis and fentanyl may look more different in 2040 compared to today--just as today looks different compared to 2000."

Caulkins focused on the motivations for use of these drugs, factors that appear ready to change. He also considered market factors, noting that basic relationships among production costs, prices, and consumption have held up in markets over centuries. And he looked at wild cards--cultural, sociological, and political changes that could be equally influential.

Caulkins started with two key economic ideas: First, prices in competitive markets fall to match the marginal cost of production. For example, North American cannabis production costs have decreased as much as 95 percent. Second, when prices fall, consumption rises. This has occurred with cannabis, although as yet, there is no indication that fentanyl production has reduced retail opioid prices--but monitoring retail opioid prices is difficult.

Therefore, falling prices affect consumption, but the effects of precipitous declines may not be simply a larger version of the effects of modest price declines. Among other factors to consider is elasticity of demand, including how the degree of responsiveness to price changes varies from one setting to the next and from one outcome to the next. In short, for many products used widely by society (e.g., lighting and electricity, computers, cigarettes), Caulkins explains, their meaning changed when production costs fell radically.

"Liberalization of cannabis policy and reduced production costs may fundamentally change the place of cannabis in society," Caulkins notes. Consider, for example, that cannabis operations are listed on the NASDAQ and Toronto stock exchanges, legalization has led to a wide range of products such as edibles and vaping, and advertising for the product has soared. More changes are likely, he suggests.

Significant declines in wholesale opioid prices could also have far-reaching and unexpected effects, Caulkins predicts. Among them: reducing the value of criminal organizations' cross-border smuggling, making distribution less violent.

"We don't know what the future holds," he adds, "but I predict that if someone in 2040 lists the major changes in drug markets, use, and dependence that occurred since 2020, there will be items on that list that pertain to the declines in production costs brought about by cannabis legalization and the spread of synthetic opioids."

Based on this prediction, Caulkins concludes: "It's not too soon to invest more in monitoring markets to stay abreast of the diverse ramifications that may flow from these radical reductions in production costs."

One of the most classic algorithmic problems deals with calculating the shortest path between two points. A more complicated variant of the problem is when the route traverses a changing network--whether this be a road network or the internet. For 40 years, an algorithm has been sought to provide an optimal solution to this problem. Now, computer scientist Christian Wulff-Nilsen of the University of Copenhagen and two research colleagues have come up with a recipe.

When heading somewhere new, most of us leave it to computer algorithms to help us find the best route, whether by using a car's GPS, or public transport and map apps on their phone. Still, there are times when a proposed route doesn't quite align with reality. This is because road networks, public transportation networks and other networks aren't static. The best route can suddenly be the slowest, e.g. because a queue has formed due to roadworks or an accident.

People probably don't think about the complicated math behind routing suggestions in these types of situations. The software being used is trying to solve a variant for the classic algorithmic "shortest path" problem, the shortest path in a dynamic network. For 40 years, researchers have been working to find an algorithm that can optimally solve this mathematical conundrum. Now, Christian Wulff-Nilsen of the University of Copenhagen's Department of Computer Science has succeeded in cracking the nut along with two colleagues.

"We have developed an algorithm, for which we now have mathematical proof, that it is better than every other algorithm up to now--and the closest thing to optimal that will ever be, even if we look 1000 years into the future," says Associate Professor Wulff-Nilsen. The results were presented at the prestigious FOCS 2020 conference.

Optimally, in this context, refers to an algorithm that spends as little time and as little computer memory as possible to calculate the best route in a given network.
This is not just true of road and transportation networks, but also the internet or any other type of network.

Networks as graphs

The researchers represent a network as a so-called dynamic graph". In this context, a graph is an abstract representation of a network consisting of edges, roads for example, and nodes, representing intersections, for example. When a graph is dynamic, it means that it can change over time. The new algorithm handles changes consisting of deleted edges--for example, if the equivalent of a stretch of a road suddenly becomes inaccessible due to roadworks.

"The tremendous advantage of seeing a network as an abstract graph is that it can be used to represent any type of network. It could be the internet, where you want to send data via as short a route as possible, a human brain or the network of friendship relations on Facebook. This makes graph algorithms applicable in a wide variety of contexts," explains Christian Wulff-Nilsen.

Traditional algorithms assume that a graph is static, which is rarely true in the real world. When these kinds of algorithms are used in a dynamic network, they need to be rerun every time a small change occurs in the graph--which wastes time.

More data necessitates better algorithms

Finding better algorithms is not just useful when travelling. It is necessary in virtually any area where data is produced, as Christian Wulff-Nilsen points out:

"We are living in a time when volumes of data grow at a tremendous rate and the development of hardware simply can't keep up. In order to manage all of the data we produce, we need to develop smarter software that requires less running time and memory. That's why we need smarter algorithms," he says.

He hopes that it will be possible to use this algorithm or some of the techniques behind it in practice, but stresses that this is theoretical evidence and first requires experimentation.

NASA's Perseverance Rover recently made a successful landing on Mars, embarking on a two-year mission to seek signs of ancient life and collect samples. Because Mars is extremely cold -- nighttime temperatures can drop below -112 F -- heaters are required to keep the rover's battery system from freezing. Now, researchers reporting in ACS' Nano Letters have 3D printed porous carbon aerogels for electrodes in ultralow-temperature supercapacitors, reducing heating needs for future space and polar missions.

Jennifer Lu, Yat Li and colleagues wanted to develop an energy storage system that could operate at very low temperatures without heating units, which add weight and energy requirements to instruments and machinery, such as the Mars rovers. So the researchers 3D printed a porous carbon aerogel using cellulose nanocrystal-based ink, and then freeze-dried it and further treated the surface. The resulting material had multiple levels of pores, from the 500-μm pores in the lattice-like structure, to nanometer-sized pores within the bars of the lattice. This multiscale porous network preserved adequate ion diffusion and charge transfer through an electrode at -94 F, achieving higher energy storage capacitance than previously reported low-temperature supercapacitors. The team will collaborate with NASA scientists to further characterize the device's low-temperature performance.

The slowdown in global warming that was observed at the end of last century was reflected by a decrease in malaria transmission in the Ethiopian highlands, according to a study led by the Barcelona Institute for Global Health (ISGlobal), an institution supported by "la Caixa" Foundation, and the University of Chicago. The results, published in Nature Communications, underscore the close connection between climate and health.

For several years there has been a heated debate on the impact of global warming on malaria incidence. It is believed that the largest effect could occur in the highlands, where lower temperatures limit vector abundance, leading to intermittent and seasonal disease outbreaks. "We see that malaria epidemiology in these areas is strongly under climate control at all scales (months, years and even decades), which settles once and for all the debate on whether climate change is affecting or not the dynamics of malaria in Africa", says Xavier Rodó, Head of the Climate and Health Programme at ISGlobal and first author of the study.

At the turn of the century, a clear decrease in malaria incidence was observed in East Africa. This decline could be simply the result of disease control measures, or could reflect the temporary slowdown in increase in global mean surface temperature, a phenomenon that was observed between 1998 and 2005.

To answer this question, Rodó and colleagues focused on the region of Oromia in Ethiopia, a densely populated highland between 1,600 and 2,500 m above sea level. This region presents the advantage of having complete records of annual cases of malaria caused by both P. falciparum and P. vivax parasites between 1968 and 2007, and that public health interventions to control the disease were not reinforced in the region until 2004. This allows to separate the effect of climate from the effect of disease control measures for two parasites that are known to respond differently to climate.

Using mathematical modelling, the research team analysed the association between malaria cases, regional climate (local temperatures and rainfall) and global climate (in particular the effect of El Niño and the Pacific Decadal Oscillation on the Pacific Ocean). The results show that the variation in malaria cases correlates extremely well with changes in regional temperatures: the regional decline in temperatures linked to the slowdown in climate change coincided with the reduction in malaria cases observed from 2000, five years before disease control measures were reinforced. This decline in cases coincided with the slowdown in the increase of global surface temperature, as a result of the El Niño and the Pacific Decadal Oscillation. The analysis shows there is a "chain of effects" from global climate variability to regional temperature variations in East Africa, which translates into new malaria cases in the Ethiopian highlands.

"The coupling between disease dynamics and climate conditions is so strong that it is evident at multiple temporal scales, from seasonality to multiannual cycles to decadal trends. Malaria incidence not only tracked changes in temperature, which we had demonstrated before, but also in the decrease at the turn of the century, the focus of this work," says Mercedes Pascual, researcher at the University of Chicago and last author of the study.

For Rodó, "the evidence that the slowdown in warming influenced malaria transmission demonstrates the strong coupling between disease and climate". These results also emphasise the value of considering climate conditions when evaluating public health interventions aimed at disease control, and of integrating them into early warning systems.

Researchers from University of Texas-Arlington, University of Virginia, Sun Yat-Sen University, and University of Washington published a new paper in the Journal of Marketing that seeks to advance the discipline of avatar-based marketing.

The study, forthcoming in the Journal of Marketing, is titled "An Emerging Theory of Avatar Marketing" and is authored by Fred Miao, Irina Kozlenkova, Haizhong Wang, Tao Xie, and Robert Palmatier.

In 2020, Samsung's Star Labs brought digital avatars to CES 2020. However, this promotion was burned by its own fanfare. The avatars looked realistic and successfully answered some questions, but only when they were heavily controlled. As this example illustrates, avatar-based marketing is still in its nascent stage.

A pressing question is "How to design effective avatars?" Given the considerable amount of ambiguity about the definition of avatar, the researchers first identify and evaluate key conceptual elements of the term avatar and offer this definition: digital entities with anthropomorphic appearance, controlled by a human or software, that have an ability to interact.

Based on this definition, they present a typology of avatar design to isolate elements that academics and managers can leverage to ensure avatars' effectiveness for achieving specific goals (e.g., providing standard vs. personalized solutions). Design elements affect avatars' form realism and behavioral realism. Form realism refers to the extent to which the avatar's shape appears human, while behavioral realism captures the degree to which it behaves as a human would in the physical world. Form realism includes design elements such as spatial dimension (2D/3D), movement (static vs. dynamic), and human characteristics (e.g., name, gender), whereas behavioral realism captures the avatar's communication modality (e.g., verbal), response type (scripted vs. natural response), social content, and its controlling entity.

The study reveals a key limitation in avatar design: lack of consideration of the alignment between form and behavioral realism of avatars. As Miao explains, "If the levels of form and behavioral realism are mismatched, the consequences for avatars' effectiveness may be profound and can help explain inconsistent avatar performance."

Integrating form and behavioral realism, the study features a 2 x 2 avatar taxonomy that identifies four distinct categories of avatars: simplistic, superficial, intelligent unrealistic, and digital human avatars. A simplistic avatar has an unrealistic human appearance (e.g., 2D, visually static, cartoonish image) and engages in low intelligence behaviors (e.g., scripted, only task-specific communication). For example, in the Netherlands, ING Bank's 2D, cartoonish-looking avatar Inge responds to simple customer inquiries from a set of predetermined answers. In contrast, a superficial avatar has a realistic anthropomorphic appearance (e.g., 3D, visually dynamic, photorealistic image), such as Natwest Bank's Cora, but low behavioral realism in that it is only able to offer preprogrammed answers to specific questions. An intelligent unrealistic avatar (e.g., REA) is characterized by humanlike cognitive and emotional intelligence, but exhibits an unrealistic (e.g., cartoonish) human image. These avatars can engage customers in real-time, complex transactions without being mistaken for human agents. Finally, a digital human avatar such as SK-II's YUMI is the most advanced category of avatars, characterized by both a highly realistic anthropomorphic appearance and humanlike cognitive and emotional intelligence, and is designed to provide the highest degree of realism during interactions with human users.

Based on observations of relative effectiveness of these avatars in practice, the researchers present propositions that predict outcomes of avatar marketing. In particular:

-As the form realism of an avatar increases, so do customers' expectations for its behavioral realism.

-Differences between the avatar's form and behavioral realism have asymmetric effects, such that customers experience positive (negative) disconfirmation when an avatar's behavioral realism is greater (less) than its form realism.

Recall the avatar of Samsung's Star Labs, which is high in form realism but low in behavioral realism. Kozlenkova says that "Our analysis indicates that Samsung's avatar sets audience expectations too high, which may have led to a negative disconfirmation, thereby resulting in an unfavorable customer experience."

Avatars' effectiveness may be highly contingent on the level of perceived uncertainty users experience during their interactions with avatars as well as choice of media channel (e.g., smartphones vs. desktops). Finally, design efforts should take the customer relationship phase into account because the relative effects of customers' cognitive, affective, and social responses differ across relationship stages.

The framework generates practical implications that urge firms to consider five interrelated areas: (1) when to deploy avatars, (2) avatar form realism, (3) avatar behavioral realism, (4) form-behavioral realism alignment, and (5) avatar contingency effects for optimal avatar-based marketing applications.

Armando Collazo Garcia III got more than he expected from a graduate course he took last spring. He developed a new understanding of the physics of transonic shocks produced across a laminar flow airfoil with boundary-layer suction and added a published paper to his resume.

"When I got the assignment to do a research project, I realized I already had a good data set from my master's thesis that I could use in a new way," Collazo Garcia said. "I was able to apply linear algebra techniques to manipulate the flow field data and decompose the information into modes. The modes provided a snapshot of various aspects of the flow and were ranked by their energy contribution, with the higher-ranking modes showing the most important characteristics of the flow. The beauty of this technique is it takes out all of the random noise--all of the uncertainty associated with the data--and identifies the modes that are most important so we can more efficiently study the process."

The paper was developed for the course AE 598 - Modal Analysis of Fluid Flow taught by Theresa Saxton-Fox, assistant professor in the Department of Aerospace Engineering at the University of Illinois Urbana-Champaign.

"From the class, I learned how to use modal analysis techniques, in particular, proper orthogonal decomposition, and how the technique can help me understand the dominant modes and dominant features in the flow in question," Collazo Garcia said. "In doing the analysis, I learned how considering a reduced order model using the dominant modes allowed me to understand the dynamics and the important physics of the process without unsteadiness and noise that is present in the data."

For his master's thesis, Collazo Garcia assessed the aerodynamic performance and associated flow characteristics of a Griffith-type laminar flow airfoil in the transonic environment. Because the airfoil was designed to operate in the presence of active boundary-layer suction to assist the pressure increase across the trailing-edge region, the airfoil aerodynamic performance was hindered when this suction was not applied. A highly unsteady shock oscillation process was also observed in the absence of suction due to a complex flow interaction process. It was observed that applying suction mitigated this large variability in the shock position and unsteady motion. The work he began in Saxton-Fox's class allowed him to use modal analysis to expand on the knowledge on this oscillatory shock process.

"We obtained the associated frequencies of each mode and were able to create a reconstruction of the process and capture the important physics by removing all the associated unsteadiness and noise in the data," Collazo Garcia said. "We observed the Mach wave build up, which leads to the fully developed shock. After oscillation, it dissipates and then we see again the process forming."

Collazo Garcia said the reconstruction, which assumed a single Fourier mode for each proper orthogonal decomposition mode, is a very simple technique that can be applied to other flows and other data sets with the intent of understanding the underlying physics, the most important characteristics in an unsteady process.

Women with polycystic ovary syndrome (PCOS) are at a significantly increased risk of contracting COVID-19 than women without the condition, new research led by the University of Birmingham has revealed.

Researchers are now calling for healthcare policy to specifically encourage women with PCOS to adhere to COVID-19 infection control measures while the global pandemic continues.

Polycystic ovary syndrome (PCOS) is a common condition affecting around one in 10 women in the UK. The three main symptoms are irregular periods, high levels of "male" hormones which may cause physical signs such as excess facial or body hair, and a cystic appearance on an ultrasound or MRI scan of the ovaries which is caused by follicles becoming increasingly fluid filled as they fail to develop and release an egg normally to be ready for fertilisation within a women's menstrual cycle.

Women with PCOS have an increased risk of cardiometabolic disease, such as type 2 diabetes, non-alcoholic fatty liver disease, and high blood pressure, all of which have been identified as risk factors for COVID-19.

To investigate whether the increased metabolic risk in PCOS translates into an increased risk of COVID-19 infection, the team carried out a population-based closed cohort study in the UK during the first wave of the pandemic between January and July 2020.

Using UK GP patient records, the study included 21,292 women with PCOS and 78,310 female 'controls' without PCOS matched for age and general practice location.

Results revealed a 51% increased risk of contracting COVID-19 in women with PCOS, compared to those of the same age and background of those without PCOS.

A 26% increased susceptibility to COVID-19 infection in the PCOS cohort persisted - even after adjustment for individual cardio-metabolic risk factors known to cluster within PCOS, which have recently been directly linked to increased COVID-19 susceptibility, including obesity, impaired glucose regulation and hypertension.

The research, published in the European Journal of Endocrinology, showed that incidence of COVID-19 in women with PCOS was almost twice the rate than in women without PCOS (18.1 cases per 1,000 person years in women with PCOS, compared to 11.9 cases per 1,000 person years in women without PCOS).

First author Anuradhaa Subramanian, of the University of Birmingham, said: "Given the high prevalence of PCOS, these findings need to be considered when designing public health policy and advice as our understanding of COVID-19 evolves."

Joint senior author Dr Krish Nirantharakumar, of the University of Birmingham's Institute of Applied Health Research, said that COVID-19 shielding strategies for women with PCOS should also carefully consider the need to protect mental health.

"The risk of mental health problems including low self-esteem, anxiety and depression is significantly higher in women with PCOS, and advice on strict adherence to social distancing needs to be tempered by the associated risk of exacerbating these underlying problems," he adds.

Co-author Dr Michael O'Reilly, of the Royal College of Surgeons of Ireland, explains: "Before the onset of the COVID-19 pandemic, women with PCOS consistently report fragmented care, delayed diagnosis and a perception of poor clinician understanding of their condition.

"Women suffering from this condition may fear, with some degree of justification, that an enhanced risk of COVID-19 infection will further compromise timely access to healthcare and serve to increase the sense of disenfranchisement currently experienced by many patients."

Joint senior author Professor Wiebke Arlt, Director of the University of Birmingham's Institute of Metabolism and Systems Research, said: "The pandemic has already dramatically altered our current healthcare delivery models, and although the increased rollout of virtual consultations and methods of delivering remote healthcare have been commendable, for many patients with PCOS these will not be an appropriate substitute for the traditional clinician-patient live consultation."

Professor Arlt, who leads DAISy-PCOS - a large Wellcome Trust-funded research programme on metabolic health and "male" hormones in women with PCOS - adds: "Women with PCOS have recently been highlighted as an overlooked and potentially high risk population for contracting COVID-19.

"However, our study does not provide information on the risk of a severe course of the COVID-19 infection or on the risk of COVID-19 related long-term complications of COVID-19 and further research is required."

People with unhealthy heart structures and poorer functioning hearts have a significantly higher risk of being diagnosed with COVID-19 infection, according to research by Queen Mary University of London, in collaboration with the Medical Research Council Lifecourse Epidemiology Unit (The University of Southampton).

The researchers made use of the comprehensive and internationally unique UK Biobank database, which includes health and genetic information from over half a million participants from across the UK, including detailed magnetic resonance imaging (MRI) of their hearts as well as linkages to COVID-19 test results from Public Health England.

The team investigated records from 310 Biobank participants to see whether pre-existing features of the heart anatomy and function, as demonstrated on heart MRI scans, were linked to having a positive COVID-19 test result.

The findings, published in the journal of Aging Clinical and Experimental Research, demonstrate that people with pre-existing unhealthy heart structures and poorer heart function were more likely to test positive for COVID-19. These relationships appeared important even after accounting for possible predisposing factors such as age, sex, ethnicity, deprivation, diabetes, high blood pressure, high cholesterol, and previous heart attack.

Dr Zahra Raisi-Estabragh, BHF Clinical Research Training Fellow at Queen Mary University of London and lead researcher, said: "In this research, we've discovered that poorer heart structure and function is linked to a higher risk of subsequent COVID-19. This is important because some studies have suggested that COVID-19 may cause structural damage to the heart. However, these studies only use heart scans from people after infection, so they cannot be certain whether the poor heart structures pre-existed COVID-19.

"In our study, we used imaging data obtained before COVID-19, and showed that many of these abnormalities likely pre-exist and predispose people to COVID-19, rather than occur as a result of infection. This is a very important distinction for guiding our management of patients with COVID-19."

Professor Steffen Petersen, Professor of Cardiology at Queen Mary University of London who supervised the project said: "There is currently a lot of uncertainty around the relationships between the heart and COVID-19. Our work adds a new perspective to this issue, helping to inform patient care and public health strategies. However, further studies in diverse populations and settings are required to definitively answer these questions."

Professor Nick Harvey, Professor of Rheumatology and Clinical Epidemiology at the MRC LEU, University of Southampton, who co-supervised the work added "This national collaboration and the wealth of information available in the UK Biobank database permitted a highly detailed analysis, providing novel and unique insights into the complex interactions between the heart and COVID-19. It illustrates the importance for the University of Southampton and the MRC LEU of our ongoing contribution to the leadership of the large, state-of-the-art, multidisciplinary Imaging Study as part of the unique world-leading UK Biobank resource."

The researchers have received funding from the British Heart Foundation, National Institute for Health Research (NIHR), the European Union's Horizon 2020 programme, EPSRC,
UK Medical Research Council and the Medical College of Saint Bartholomew's Hospital Trust.

New international research published in Anaesthesia (a journal of the Association of Anaesthetists) concludes that surgery should be delayed for seven weeks after a patient tests positive for SARS-CoV-2, since the data show that surgery that takes place between 0 and 6 weeks after diagnosis is associated with increased mortality.

The study is by the COVIDSurg Collaborative: a global collaboration of over 15,000 surgeons working together to collect a range of data on the COVID-19 pandemic. This study's lead authors are Dr Dmitri Nepogodiev (Public Health) and Dr Aneel Bhangu (Surgeon) of the University of Birmingham, UK.

While it is known that infection with SARS-CoV-2 during surgery increases mortality and international guidelines recommend surgery should be delayed for patients testing positive for COVID-19, there is little evidence regarding the optimal duration of delay.

This international multicentre study included 140,231 patients (1,674 hospitals, 116 countries)* undergoing surgery in October 2020. Participating hospitals included all patients undergoing a surgical procedure. The number of co-authors (more than 15,000) makes this the largest collaborative surgery study ever undertaken globally.

Patients who became infected with SARS-CoV-2 after their surgery were excluded from the study. The primary outcome measure was 30-day postoperative death. Statistical modelling was used to adjust for patient, disease, and operation variables and calculate adjusted 30-day mortality rates for different time periods from SARS-CoV-2 diagnosis to surgery.

The time from SARS-CoV-2 diagnosis to surgery was 0-2 weeks in 1,144 (0.8%) patients, 3-4 weeks in 461 (0.3%), 5-6 weeks in 327 (0.2%), 7 weeks or more in 1,205 (0.9%), and 137,590 (97.8%) patients did not have SARS-CoV-2 infection. Adjusted 30-day mortality in patients who did not have SARS-CoV-2 infection was 1.5%. This was increased in patients operated at 0-2 weeks (4.0%), 3-4 weeks (4.0%), and at 5-6 weeks (3.6%), but not at 7-8 weeks (1.5%) after SARS-CoV-2 diagnosis.

These findings were consistent across age groups, patient fitness levels, urgency (elective versus emergency) of surgery, and grade (minor versus major) of surgery. Following a delay of 7 weeks or more, patients with ongoing COVID-19 symptoms (6.0%) had higher mortality than patients whose symptoms had resolved (2.4%) or who had been asymptomatic (1.3%).

Dr Dmitri Nepogodiev says: "We found that patients operated 0-6 weeks after SARS-CoV-2 infection diagnosis are at increased risk of postoperative death, as were patients with ongoing symptoms at the time of surgery. We recommend that whenever possible surgery should be delayed for at least 7 weeks after a positive SARS-CoV-2 test result, or until symptoms resolve if patients have ongoing symptoms for 7 weeks or more after diagnosis."

Dr Aneel Bhangu adds: "Decisions regarding delaying surgery should be tailored for each patient, since the possible advantages of delaying surgery for at least 7 weeks following SARS-CoV-2 diagnosis must be balanced against the potential risks of delay. For some urgent surgeries, for example for advanced tumours, surgeons and patients may decide that the risks of delay are not justified."

Dr Mike Nathanson, President of the Association of Anaesthetists, said "This paper provides important information to patients and their carers and will help them determine the right time for surgery after a COVID-19 infection. Of the millions of patients now waiting for surgery, many will have had COVID-19 and they will want to be informed about the risks. COVID-19 will be with us for many years and the number of patients with a previous infection will continue to increase."

Scientists have pinpointed the location of an essential enzyme in plant cells involved in photosynthesis, according to a study published today in eLife.

The findings overturn conventional thinking about where the enzyme resides in plant cells and suggest a probable role in regulating energy processes as plants adapt from dark to light conditions.

During photosynthesis, plants convert carbon into energy stores through 'electron transport', involving an enzyme called ferredoxin:NADP(H) oxidoreductase, or FNR.

Plants can switch rapidly between two types of electron transport - linear electron flow (LEF) and cyclic electron flow (CEF) in response to environmental conditions. The transfer of FNR between membrane structures in the chloroplast, where photosynthesis takes place, has been linked to this switch.

"Current dogma states that FNR carries out its function in the soluble compartment of the chloroplast, but evidence suggests that the activity of FNR increases when it is attached to an internal membrane," explains first author Manuela Kramer, a PhD student at the School of Biological and Chemical Sciences, Queen Mary University of London, UK. "We needed to find out precisely where FNR is located in the chloroplast, how it interacts with other proteins, and how this affects its activity in order to understand its role in switching between electron transport processes."

The researchers used immuno-gold staining to pinpoint FNR in more than 300 chloroplasts from 18 individual Arabidopsis plants. The staining density of FNR was five times higher in the internal membrane system of the chloroplast (thylakoids) than in the soluble compartment (stroma), where it did not rise above background levels. This significantly higher labelling in the membrane proved that chloroplasts contain little soluble FNR, and confirmed for the first time where the enzyme is located.

To understand more about FNR's location, the team generated plants where the enzyme is specifically bound to different proteins called 'tether proteins'. In Arabidopsis plants with decreased FNR content, they substituted three versions of FNR from maize, each with a different capacity for binding to the tether proteins TROL and Tic62. They found that rescue with maize FNR types that strongly bound to the Tic62 tether protein resulted in much higher density of gold FNR labelling in specific, lamellar membrane regions of the thylakoids. This suggests that the distribution of FNR throughout the chloroplast in plant cells is dependent on binding to the tether proteins.

Finally, the team tested how FNR location affects electron transport, by comparing electron flow rates when plants were adapted to the dark with electron flow after their acclimatisation to light. In normal dark-adapted plants, a short exposure to light resulted in a switch to higher CEF activity. However, this was not seen in plants lacking strong interaction between FNR and the tether proteins, suggesting these plants lack the ability to switch on CEF. After light acclimatisation, both the wild-type and mutant plants had similar, decreased CEF activity, suggesting that the impact of FNR is related to light-dependent changes in the interactions between the enzyme and tether proteins.

"Our results show a link between the interaction of FNR with different proteins and the activity of an alternative photosynthetic electron transport pathway," concludes senior author Guy Hanke, Senior Lecturer in Plant Cell and Molecular Biology at the School of Biological and Chemical Sciences, Queen Mary University of London. "This supports a role for FNR location in regulating photosynthetic electron flow during the transition of plants from dark to light."

The annually occurring algal spring blooms play an important role for our climate, as they remove large amounts of carbon dioxide from the atmosphere. However, they are an ephemeral phenomenon. Most of the carbon is released into the water once the algae die. There, bacteria are already waiting to finish them off and consume the algal remains.

Previous studies have shown that in these blooms, different algae can come out on top each year. However, within the bacteria subsequently degrading the algae, the same specialised groups prevail year after year. Apparently not the algae themselves but rather their components - above all chains of sugar molecules, the so-called polysaccharides - determine which bacteria will thrive. However, the details of the bacterial response to the algal feast are still not fully understood.

Metaproteomics: Studying bacterial proteins in bulk

Therefore, Ben Francis together with colleagues from the Max Planck Institute for Marine Microbiology, the University of Greifswald and the MARUM - Center for Marine Environmental Sciences at the University of Bremen now took a closer look at the bacterial insides. "We decided to center on a method called metaproteomics, which involves studying all proteins in a microbial community, in our case in the seawater", Francis explains. "In particular, we looked at transporter proteins, whose activity is critical in understanding the uptake of algal sugars into bacterial cells." In the metaproteomic data, the scientists saw that these transporter proteins distinctly changed over time. "We saw a pronounced shift in the abundance of transporter proteins predicted to be involved in uptake of different types of polysaccharide", Francis continues. "This indicates that the bacteria start off by mostly focusing on the 'easy to degrade' substrates, such as laminarin and starch. Then later on they move on and attack the 'harder to degrade' polymers composed of mannose and xylose."

One sugar after the other

In other words, the bacteria take the easy road first, and only when the treats have been consumed, they aim for the chewy bits. When does this shift happen? Ben Francis and his colleagues see two possible triggers: It could either take place when competition for the easy food sources gets more intense, because the bacteria reproduce quickly in this lush environment and thus cell numbers increase. Or, alternatively, it depends more on the algae: Once the algal bloom breaks down and more algae have died, more of the hard substrates accumulate and they become a viable food source at that point.

Even though the scientists from Bremen and Greifswald have studied the dynamics of algal and bacterial blooms in the North Sea for a long time, this temporal course was something that had so far gone undetected. "Combining state-of-the-art proteomics techniques with sample preparation methods, which specifically consider the high complexity of these very challenging samples, enabled us to establish one of the most comprehensive proteome data set with more than 20 000 protein groups. These data revealed that substrate specificities of transporter proteins change over time. These changes were not visible in the corresponding metagenomic data set used to investigate bacterial diversity", says Dörte Becher from the University of Greifswald. "It clearly shows that we need to dig very deep to understand the underlying ecological processes that govern marine carbon cycling." Quantifying transporter proteins could indeed become an important piece in solving the highly complex puzzle of marine carbon cycling.

Combination of methods allows new insights

"This detailed 'meta-proteogenomic' study combines the exceptional expertise of the University of Greifswald in the identification and quantification of proteins in complex environmental samples with our expertise in molecular microbial ecology", says Rudolf Amann, co-author on the study and director of the Max Planck Institute for Marine Microbiology in Bremen. "Our results indicate that the complex heterotrophic microbiome of the North Sea reacts to phytoplankton blooms not only in substrate-driven successions of recurrent bacterial species, but also in distinct changes of the expression of transporter proteins and degradative enzymes." Ultimately, it will be the combination of various methods that will advance our knowledge of the molecules, enzymatic reactions, and rates underlying the marine carbon cycle, which is a prerequisite for predicting and managing atmospheric carbon dioxide levels.