Culture

Study published in the American Journal of Kidney Diseases (AJKD) projects that prevalence of patients receiving dialysis in China will increase from 384.4 patients per million (PPM) in 2017 to 629.7 PMP in 2025 with a predicted 874,373 patients receiving dialysis in 2025.

The national prevalence of dialysis in China has not been well studied due to its large population and limited resources. Insurance claims data provide a unique opportunity to understand the burden of kidney failure and have been used to characterize dialysis patients in the United States. Using a large nationwide claims database, the age-and sex-standardized prevalence of kidney disease treated with dialysis in China was estimated between 2013 and 2017. In addition, researchers predicted the prevalence trend over time to estimate the rising prevalence through 2025. Kidney failure has become a major public health problem in China. It is imperative to develop prevention and control strategies to reduce the escalating burden of advanced kidney disease.

Researchers at University of California San Diego School of Medicine, in collaboration with Dutch scientists, have found that certain metabolites -- small molecules produced by the process of metabolism -- may be predictive indicators for persons at risk for recurrent major depressive disorder.

The findings were published in the January 11, 2021 online issue of Translational Psychiatry.

"This is evidence for a mitochondrial nexus at the heart of depression," said senior author Robert K. Naviaux, MD, PhD, professor of medicine, pediatrics and pathology at UC San Diego School of Medicine. "It's a small study, but it is the first to show the potential of using metabolic markers as predictive clinical indicators of patients at greatest risk -- and lower risk -- for recurring bouts of major depressive symptoms."

Recurrent major depressive disorder (in lay terms, clinical depression) is a mood disorder characterized by multiple symptoms in combination: feelings of sadness or hopelessness, anger or frustration, loss of interest, sleep disturbances, anxiety, slowed or difficulty thinking, suicidal thoughts and unexplained physical problems, such as back pain or headaches.

Major depressive disorder (MDD) is among the most common mental illnesses in the United States, with an estimated lifetime prevalence of 20.6 percent, meaning one in five Americans will suffer at least one episode during their lives. For patients who have recurrent MDD (rMDD), the five-year recurrence risk is up to 80 percent.

For their study, Naviaux and colleagues in The Netherlands recruited 68 subjects (45 females, 23 males) with rMDD who were in antidepressant-free remission and 59 age- and gender-matched controls. After collecting blood from patients who were in remission, the patients were followed prospectively for two-and-a-half years.

Results showed that a metabolic signature found when patients were well could predict which patients were most likely to relapse up to two-and-a-half years in the future. The accuracy of this prediction was more than 90 percent. Analysis of the most predictive chemicals found they belong to certain kinds of lipids (fats that included eicosanoids and sphingolipids) and purines.

Purines are made from molecules, such as ATP and ADP -- the major chemicals used for energy storage in cells, but which also play a role in communications used by cells under stress, known as purinergic signaling.

The researchers found that in subjects with rMDD, changes in specific metabolites in six identified metabolic pathways resulted in fundamental alterations of important cellular activities.

"The findings revealed an underlying biochemical signature in remitted rMDD that set diagnosed patients apart from healthy controls," said Naviaux. "These differences are not visible through ordinary clinical assessment, but suggest that the use of metabolomics -- the biological study of metabolites -- could be a new tool for predicting which patients are most vulnerable to a recurrence of depressive symptoms."

The authors noted that their initial findings require validation in a larger study of at least 198 females and 198 males (99 cases and 99 controls each).

The most distant quasar known has been discovered. The quasar, observed just 670 million years after the Big Bang, is 1000 times more luminous than the Milky Way. It is powered by the earliest known supermassive black hole, which weighs in at more than 1.6 billion times the mass of the Sun. Seen more than 13 billion years ago, this fully formed distant quasar is also the earliest yet discovered, providing astronomers with insight into the formation of massive galaxies in the early Universe. The result was released today at the January 2021 meeting of the American Astronomical Society.

Quasars, which are powered by the feeding frenzies of colossal supermassive black holes, are the most energetic objects in the Universe. They occur when gas in the superheated accretion disk around a supermassive black hole is inexorably drawn inwards, shedding energy across the electromagnetic spectrum. The amount of electromagnetic radiation emitted by quasars is enormous, with the most massive examples easily outshining entire galaxies. Today, an international team of astronomers has announced the discovery of J0313-1806, the most distant quasar known to date.[1]

"The most distant quasars are crucial for understanding how the earliest black holes formed and for understanding cosmic reionization -- the last major phase transition of our Universe," said Xiaohui Fan, study co-author and Regents Professor of Astronomy at the University of Arizona.[2]

J0313-1806 is seen more than 13 billion years ago. As the most distant quasar known, it is also the earliest, being fully formed only about 670 million years after the Big Bang. The new quasar is more than ten trillion times as luminous as our Sun -- meaning that it pours out one thousand times more energy than the entire Milky Way Galaxy. The source of this quasar's power is a supermassive black hole 1.6 billion times as massive as the Sun -- the earliest black hole currently known to exist in the Universe.[3]

The presence of such a massive black hole so early in the Universe's history challenges theories of black hole formation as astronomers need to explain how it came into existence when it barely had the time to do so. Feige Wang, NASA Hubble fellow at the University of Arizona and lead author of the research paper, explains: "Black holes created by the very first massive stars could not have grown this large in only a few hundred million years."

The observations that led to this discovery were made using a variety of telescopes, including three National Science Foundation NOIRLab facilities -- the Víctor M. Blanco 4-meter Telescope at Cerro Tololo Inter-American Observatory, Gemini South, and Gemini North. Data from the Blanco Telescope, taken as part of the DESI Legacy Imaging Surveys, which are served to the astronomical community via the Astro Data Lab at NOIRLab's Community Science and Data Center (CSDC), helped to first identify J0313-1806, while Gemini South observations were used to confirm its identity as a quasar. High-quality spectra from two Maunakea observatories in Hawai'i -- Gemini North and W. M. Keck Observatory -- were used to measure the mass of the central supermassive black hole.

"The most distant quasars and earliest black holes are important markers in the history of the Universe," said Program Director Martin Still of the National Science Foundation. "The researchers combined several of NSF's NOIRLab facilities to make this discovery."

As well as weighing the monster black hole, the Gemini North and Keck Observatory observations uncovered an extremely fast outflow emanating from the quasar in the form of a high-velocity wind, which is traveling at 20% of the speed of light. "The energy released by such an extreme high-velocity outflow is large enough to impact the star formation in the entire quasar host galaxy," said Jinyi Yang, Peter A. Strittmatter postdoctoral fellow of Steward Observatory at the University of Arizona. This is the earliest known example of a quasar sculpting the growth of its host galaxy, making J0313-1806 a promising target for future observations.

The galaxy hosting J0313-1806 is undergoing a spurt of star formation, producing new stars 200 times faster than the Milky Way. The combination of this intense star formation, the luminous quasar, and the high-velocity outflow make J0313-1806 and its host galaxy a promising natural laboratory for understanding the growth of supermassive black holes and their host galaxies in the early Universe.

"This would be a great target to investigate the formation of the earliest supermassive black holes," concluded Feige Wang. "We also hope to learn more about the effect of quasar outflows on their host galaxy -- as well as to learn how the most massive galaxies formed in the early Universe."

Curiosity has been found to play a role in our learning and emotional well-being, but due to the open-ended nature of how curiosity is actually practiced, measuring it is challenging. Psychological studies have attempted to gauge participants' curiosity through their engagement in specific activities, such as asking questions, playing trivia games, and gossiping. However, such methods focus on quantifying a person's curiosity rather than understanding the different ways it can be expressed.

Efforts to better understand what curiosity actually looks like for different people have underappreciated roots in the field of philosophy. Varying styles have been described with loose archetypes, like "hunter" and "busybody" -- evocative, but hard to objectively measure when it comes to studying how people collect new information.

A new study led by researchers at the University of Pennsylvania's School of Engineering and Applied Science, the Annenberg School for Communication, and the Department of Philosophy and Religion at American University, uses Wikipedia browsing as a method for describing curiosity styles. Using a branch of mathematics known as graph theory, their analysis of curiosity opens doors for using it as a tool to improve learning and life satisfaction.

The interdisciplinary study, published in Nature Human Behavior, was undertaken by Danielle Bassett, J. Peter Skirkanich Professor in Penn Engineering's Departments of Bioengineering and Electrical and Systems Engineering, David Lydon-Staley, then a postdoctoral fellow in her lab and now an assistant professor in the Annenberg School of Communication, two members of Bassett's Complex Systems Lab: graduate student Dale Zhou and postdoctoral fellow Ann Sizemore Blevins, and Perry Zurn, assistant professor from American University's Department of Philosophy.

"The reason this paper exists is because of the participation of many people from different fields," says Lydon-Staley. "Perry has been researching curiosity in novel ways that show the spectrum of curious practice and Dani has been using networks to describe form and function in many different systems. My background in human behavior allowed me to design and conduct a study linking the styles of curiosity to a measurable activity: Wikipedia searches."

Zurn's research on how different people express curiosity provided a framework for the study.

"Each curiosity style has its own 'kinesthetic signature' that describes how a person naturally searches for information," says Zurn. "For example, the 'hunter' style is characterized by the seeking of closely related information, aiming to dive deeply into a certain topic, while the 'busybody' jumps from topic to topic, collecting loosely connected information."

The study was comprised of 149 participants, who were instructed to browse Wikipedia for 15 minutes a day over the course of 21 days. With no further instructions on what pages to visit, the participants' paths through the site revealed the kinesthetic signatures of their curiosity styles.

"Wikipedia allowed both introverts and extroverts to have equal opportunity in curious practice, a limitation in other studies of curiosity, while the ad-free search engine allowed individuals to truly be captains of their own curiosity ships," says Bassett.

While browsing, data was recorded as knowledge networks where each unique Wikipedia page visited became a node and the relatedness between Wikipedia pages, determined by text similarity between two pages, created the thickness of the edges between the nodes.

Participants with the hunter curiosity style exhibited a tight network with relatively high clustering of nodes, thick edges, and short overall path lengths. Those with the busybody curiosity style exhibited a looser network with nodes further separated by thin connecting edges and longer path lengths.

The signatures of a participant's curiosity style were not written in stone, however.

"We found that people are curious in their own ways and fall in and out of different styles, shown by changes in the knowledge network structures over time. We then wanted to understand the drivers of these changes," says Bassett.

To better understand the factors that influence which curiosity style a person might use, the researchers surveyed the participants on indicators of well-being in a laboratory visit before their Wikipedia browsing began. These indicators included "deprivation sensitivity," or the tendency to seek information in order to fill knowledge gaps, and "sensation seeking," or the tendency to seek novel and exciting information. Other factors recorded participants' tendencies to browse topics for fun, seek out social interaction, and tolerate stress. The information from these surveys was incorporated in the models of the knowledge networks, allowing the team to assess the mechanisms behind curiosity styles.

"We hypothesize that a switch from hunter to busybody style might arise due to sensation seeking, or the craving for novelty and new information during the day," says Bassett.

"By measuring a person's level of sensation seeking before each Wikipedia browsing session, we found that people tended to take larger steps between nodes when the tendency to seek new information was high," says Lydon-Staley, creating a loose knowledge network.

The participants who originally scored higher in deprivation sensitivity tended to form tighter networks as they sought information to fill knowledge gaps. This network structure indicated the hunter style of information seeking. For example, one participant searched for "History of the Jews in Germany," "Hep-Hep riots," "Zionism," "Nathan Birnbaum," and "Theodor Herzl," all centralized around Jewish history.

On the other end of the spectrum, participants who reported lower deprivation sensitivity exhibited a knowledge network characterized by thinner links, more loosely connected topics, and longer overall network paths. An example of this style is a Wikipedia search for "Physical chemistry," "Me Too movement," "The Partridge Family," "Harborne Primary School," "HIP 79431," and "Tom Bigelow."

"With this method, we can now quantify the kind of information or resources we store. Resources affect well-being, and this research complicates, in a good way, how resources affect well-being," says Lydon-Staley.

Bassett adds that, "while there may be different motivators behind each curiosity style, each style has a purpose."

In addition to the importance of each style, our ability to learn and our emotional well-being may be more related to the connection of information rather than the information itself.

"Curiosity is edgework. It is more about building structures of information than about acquiring separate informational units. This can motivate us, as educators, to ask how we can help students not only understand existing knowledge connections but get excited about building new ones," says Zurn.

As to whether we should be directing curiosity to improve education, Lydon-Staley says, "We need more data to know how to use this information in the classroom, but I hope it discourages the idea that there are curious and incurious people."

"Curiosity should be encouraged and expectations of certain types of curiosity to be exhibited by certain types of students is limiting. We should value and respect each style of curious practice while being less prescriptive for how to accomplish a task," says Bassett.

Some real-world applications that align with this understanding of curiosity are using projects that students can tune to their own curiosity, supporting quieter students to express their curiosity in less boisterous ways, and realizing that students may be able to solve problems in ways unimaginable to the teacher.

"By visualizing these networks, we can begin to see not only the spectrum of hunter and busybody styles, but the incredible flexibility that characterizes curiosity and the knowledge networks it builds. Appreciating the diversity of curious practice can be really empowering for students, especially those who are otherwise socially marginalized or underserved. Rather than asking 'am I curious or not?,' they can ask 'which style or styles do I have?' and 'what can I do with it?'," says Zurn.

It is clear that curiosity is important for our well-being and the visualization of these knowledge networks may help to pinpoint where curiosity reflects emotional state and vice versa. Recent research from the same team showed that when we maintain a consistent level of curiosity throughout the day, we are more likely to experience increased feelings of life satisfaction and decreased symptoms of depression. Their work suggests that engaging in curiosity more often and having an open mind about what curiosity looks like may improve well-being, a link the team plans to test using interventions in future work.

In a time when human interaction is stinted and our natural curiosity is interrupted by ads and algorithms, curiosity examined through a network perspective helps us see how we can use curiosity to increase life satisfaction and communication with others. While a clear benefit of this study is its potential future applications in education and emotional well-being, its network approach and interdisciplinary research design also promotes collaborative scientific studies. This interdisciplinary approach allows us to learn from many perspectives and propose many applications for knowledge networks as tools to enhance our well-being beyond education.

Crowdsourced Responses from Dermatologists on Twitter Found to be as Effective as Formal Telemedicine

At the start of the pandemic, many doctors on the front lines turned to Twitter and other social media platforms to find guidance and solace directly from their peers. In early 2020, information on COVID-19 had yet to be studied and published in peer-reviewed journals or printed in medical textbooks. Since then, social media has been characterized as both a boon to medical communities seeking real time information and a major driver of misinformation on the virus and its spread. A new study from researchers at the University of Paris provides support for social media as a potentially useful tool in the doctor's diagnostic toolkit and a way for general practitioners with questions to connect to specialists who may have the answers.

In France, some general practitioners have turned to social media for help diagnosing common dermatological conditions. They post a deidentified photo of a skin condition to Twitter or MedPics, a private social networking site for doctors, and other clinicians can respond with their diagnosis. In a retrospective observational study, researchers compared the accuracy of using social media to crowdsource a dermatological diagnosis to the accuracy of asking a dermatologist using more traditional telemedicine methods. Researchers found that diagnoses suggested by doctors on social media generally agreed with teledermatology results, and diagnoses were even more strongly aligned when dermatologists were active in the crowdsourced response. When the images posted to social media were reviewed by an expert committee of dermatologists, the researcher found that primary diagnoses from social media were accurate about 60% of the time, whereas teledermatology consultations were correct about 55% of the time, with no significant difference between the two studied methods.

These results suggest that social media can be as useful as teledermatology services for doctors when diagnosing common and minor dermatological conditions, but consultation with an expert dermatologist may still be necessary. The authors acknowledge that social media is less secure than standard medical communications technologies and that Twitter and other public platforms do not take the same measures to protect patients' privacy.

Diagnostic Agreement Between Telemedicine on Social Networks and Teledermatology Centers

Alexandre Malmartel, MD and Sophia Serhrouchni, MD
University of Paris, Department of General Medicine, Paris, France
https://www.annfammed.org/content/19/1/24

Black and Hispanic Californians Face Health Care Discrimination at Higher Rates and Are Less Trusting of Health Care Providers

A recent statewide survey of Californians uncovered that 30% of Black adults and 13% of Hispanic adults felt that they have been judged or treated differently by a health care provider because of their race/ethnicity or language. One out of six Black and Latino Californians were more likely to report strong mistrust of their health care providers. Researchers at the Charles R. Drew University in Los Angeles analyzed data from more than 2,300 White, Hispanic, and non-Hispanic Black adults who asked to report on perceived discrimination due to race, ethnicity, language, income, and insurance status or type. Black and Hispanic adults reported higher rates of discrimination across the board, including income and insurance-based discrimination. Black and Hispanic adults reported higher rates of discrimination, including income and insurance-based discrimination. In addition, 20% and 10% of Black and Latino adults stated that they could not get health care services they needed because of racial/ethnic or language discrimination, respectively.

The analysis also found a link between having a consistent primary care physician and overall medical trust. Adults who did not have a usual source of primary care were much more likely to report mistrust of healthcare providers. The research team discusses the link between medical mistrust, racial and ethnic discrimination in health care, and roots in institutionalized racism, declaring that "resolving mistrust requires addressing systemic bias and prejudice in the medical system," echoing recent sentiments expressed by the American Medical Association.

Discrimination and Medical Mistrust in a Racially and Ethnically Diverse Sample of California Adults

Mohsen Bazargan, PhD, et al
Charles R. Drew University of Medicine and Science, Los Angeles, California
https://www.annfammed.org/content/19/1/4

Editors of 10 Medical Journals Commit to Equity and Justice in Primary Care Research

Today there is a renewed call to action for all medical researchers to confront systemic racism, write the editors of 10 North American primary care and family medicine journals. Racism is a pervasive and systemic issue that has profound adverse effects on health. The editors have issued a joint statement that amplifies calls to action from antiracist and Black Lives Matter movements in the pursuit of health equity. The statement also outlines immediate steps the journals will take to address equity, justice and systemic racism in primary care research.

The statement, published by the major North American medical journals for family medicine, including peer-reviewed publications from the American Academy of Family Physicians and the College of Family Physicians of Canada, places deliberate attention on the role of systemic racism in creating inequalities in health and the need to make immediate changes within the academic medical community to further equity and racial justice.

Systemic Racism and Health Disparities: A Statement From Editors of Family Medicine Journals

Sumi Sexton, MD, et al
Georgetown University, Washington, DC
https://www.annfammed.org/content/19/1/2

Healing the Pain of Systemic Racism: How One Community Clinic in Minneapolis Will Rebuild

The uprisings for racial justice in Minneapolis resulted in damage to a neighborhood family medicine clinic. In this essay, physicians from that practice witness the pain of their community manifested in damage to their clinic and reflect on how medicine can begin to heal the pain of systemic racism. COVID-19 health disparities and the murder of George Floyd are cultural milestones with the same root causes: lack of access to quality health care, discrimination, and sustained inequities perpetuated by multiple systems, including health care. They argue that family medicine, and medicine in general must begin to heal at the community level through direct and organized action to address social, structural and political factors that influence health. The authors recognize that "you can't heal what you don't reveal" and issue a call to family medicine, a specialty that began as a countercultural movement within medicine, to train future family physicians in community engagement and policy advocacy to heal communities.

Family Medicine, Community, and Race: A Minneapolis Practice Reflects

Shailendra Prasad, MBBS, MPH, et al
University of Minnesota, Department of Family Medicine & Community Health, Minneapolis, Minnesota
https://www.annfammed.org/content/19/1/69

Pregnant Women in North Carolina Gain Access to More Comprehensive Coverage Through Simplified Full Medicaid Enrollment

North Carolina did not expand Medicaid eligibility under the Affordable Care Act, which continued to put many low income women at risk for losing health care coverage post partum. The state did comply with ACA standards for simplifying Medicaid enrollment, automating the process and removing a stringent and often cumbersome financial assessment process. Analysis from researchers at Duke University found that these reforms enabled more low-income women to qualify for full Medicaid and reduced the number of women who instead qualified for more limited benefits under the state's Medicaid for Pregnant Women program. Researchers examined Medicaid claims and vital statistics in North Carolina from 2011 to 2017 and determined that, after changing the full Medicaid enrollment process in 2013 to adhere to the ACA standards, enrollment in full Medicaid during pregnancy doubled and Medicaid for Pregnant Women fell. Full Medicaid does not expire after 60 days and allows women access to crucial preventative health services that include primary care and contraception.

Pregnancy Medicaid Improvements in a Nonexpansion State After the Affordable Care Act

Jonas J. Swartz, MD, MPH, et al
Duke University, Department of Obstetrics and Gynecology, Durham, North Carolina
https://www.annfammed.org/content/19/1/38

Dear White People: Do Your Part to Actively Engage in Anti-Racist Education and Policy Change

Members of the Society of Teachers of Family Medicine Minority and Multicultural Health Collaborative write an open letter to their white colleagues, as reflected in this essay. They discuss their experiences of being educated in unbalanced and biased academic systems, including medical schools. They also share how they have had to carry disproportionately higher financial debt due to student loans. And while physicians of color produce essential research highlighting gaps in care for underserved communities--and tools to address those gaps--they are undervalued, underpaid, denied career advancement, and experience daily micro- and macro-aggressions. As medical doctors who are also people of color, they write that they have had to bear the exhaustive burden of a minority tax, including assuming the responsibility of explaining and then fixing racism and associated inequities of racism in medicine while also balancing the complexities of "white fragility." The authors provide a list of specific actions that their white counterparts can follow to support and elevate the voices of all people of color to break down structural and systemic policies and practices that enforce a culture of racism, inequity, and bias.

Dear White People

Krys E. Foster, MD, MPH, FAAFP, et al
Thomas Jefferson University, Department of Family and Community Medicine, Philadelphia, Pennsylvania
https://www.annfammed.org/content/19/1/66

One Biracial Psychiatrist Describes Her Experiences of Nuanced Racism

Emma Lo, MD, Assistant Professor of Psychiatry at Yale University School of Medicine, writes a first-person narrative of how she, as a biracial, female resident and early-career psychiatrist, has experienced marginalizing incidents in her practice. She also draws attention to the oversimplified categories that fail to consider racial nuances and the resulting culture that excludes and devalues biracial or multiracial health care clinicians. Lo writes about the emotions she feels in interacting with her colleagues who do nothing to stop the perpetuation of patients' racist views; her frustration about her inability to speak out against and confront the microaggressions she experiences for fear of awkwardness; and shame for her own perceived propagation of racist viewpoints. Lo hopes that her essay illuminates the ambiguity necessary in dialogues about race and enriches literature about racism in medicine. "Until the medical community appreciates a nuanced view of race, biracial and multiracial people should not be forced to choose a checkbox or a side; nor are we a sum of our parts," she writes.

What Are You? A Biracial Physician on Nuanced Racism

Emma Lo, MD
Yale University, School of Medicine and Connecticut Mental Health Center, New Haven, Connecticut
https://www.annfammed.org/content/19/1/72

How One Dutch City and Its Family Physicians Responded to the COVID-19 Pandemic

Family physicians play a central role in providing the first point of access for health care in the Dutch health system. Researchers studied the changes in presented health problems and the demand for primary care during the initial COVID-19 crisis in Nijmegen, a city in the Netherlands. They analyzed data from 25 family physicians and more than 26,000 patients in and around the city. Specifically, researchers examined the most prominent symptoms of COVID-19 including COVID-19 itself as a reason for the family practitioner visit, comparing February through May of 2019 with 2020. In March of 2020 more people presented with respiratory tract symptoms than in March of 2019. COVID-19 became the most common respiratory tract-related reason for contacting a family physician. However, from April to May 2020, presented symptoms dropped to levels lower than in 2019. Due to the pandemic, the demand for primary care changed rapidly. Acute and chronic health problems, and prevention visits, decreased, while mental health visits did not change. Study findings stress the importance of securing care for all health problems in a primary care's preparations for a major epidemic and to avoid the collateral damage of a health system's single-minded focus on an epidemic.

The Covid-19 Pandemic in Nijmegen, the Netherlands: Changes in Presented Health Problems and Demand for Primary Care

Henk Schers, PhD, et al
Radboud University Medical Center, Nijmegen, The Netherlands
https://www.annfammed.org/content/19/1/44

Reviewing the Evidence for Cloth Mask Use Among Health Care Workers

A rapid, evidence-based review summarizes the effectiveness of cloth masks in protecting health care clinicians from respiratory viral infections, such as COVID-19. Nine studies were included in the review, and all but one were conducted prior to the COVID-19 pandemic. The only randomized trial of cloth face masks published at the time of this review compared the infection rates of influenza-like illness among groups of health care professionals who wore cloth masks, medical masks, or inconsistent mask use in the hospital setting. That study reported wide-ranging confidence intervals when comparing groups, but overall, they conclude that cloth mask use was associated with significantly higher viral infections than exclusive use of medical masks.

A majority of studies were conducted in laboratory settings and evaluated either cloth face mask fit and airflow when compared to other kinds of mask or the filtration abilities of cloth material and masks. All filtration studies tested aerosolized particles including noncoronavirus, bacteria, and simulated biologic particles, and results were highly variable but suggested some level of participle filtration. Notably, available filtration studies did not specifically test COVID-19 transmission or respiratory droplet transmission. The lab studies all conclude that cloth masks provided an inferior fit and were less effective at filtering viral particles compared to standard medical or N95 masks. Conclusions of this qualitative review align with current Center for Disease Control and Prevention guidelines that recommend use of an N95 respirator for care of patients with COVID-19. The authors also recommend that for health care professionals without access to medical masks, a cloth mask should be paired with the plastic face shield, with frequent cloth mask changes to reduce the risk of moisture retention.

The Potential for Cloth Masks to Protect Health Care Clinicians From SARS-CoV-2: A Rapid Review

Ariel Kiyomi Daoud et al
University of Colorado School of Medicine, Aurora, Colorado
https://www.annfammed.org/content/19/1/55

Primary Care Plays Key Role in Managing COVID-19 in Three Asian Cities

Despite having some of the densest living spaces and the highest number of international visitors, Hong Kong, Singapore, and Beijing have utilized their respective primary health care systems to keep their COVID-19 cases and deaths relatively low. Researchers studied the primary health care systems in the three cities to identify features of each system that other cities can use as examples to prepare for and prevent deaths in future health crises. Wong et al write that all three cities have made use of primary care in performing public health surveillance and primary care functions, underscoring their assertion that primary care is an indispensable part of any health system and can play an important role in addressing future infectious disease outbreaks when it is supported, engaged, and integrated with other parts of a health system.

A Tale Of 3 Asian Cities: How is Primary Care Responding to COVID-19 in Hong Kong, Singapore, and Beijing?

Samuel Y.S. Wong MD, MPH, et al
Chinese University of Hong Kong, Jockey Club School of Public Health and Primary Care, Hong Kong
https://www.annfammed.org/content/19/1/44

Becoming a Virtual-First Doctor and the Promises of Telehealth

The COVID-19 pandemic offers a glimpse into a world where virtual medical visits and telehealth could become the norm. In this essay, Ben Kaplan, a fourth-year medical student at the University of North Carolina, shares his experience providing all-virtual care for two at-risk patient populations. Kaplan is among a generation of doctors-in-training who have stepped up to provide virtual front line care during the coronavirus pandemic, all through expanded telephone and video-call based care. The author's experience making check-in calls for high-risk community members and providing video-based gender-affirming care experiences have led Kaplan to see telehealth as a bridge between the health care system and individuals who lacked access to consistent, high-quality care long before the pandemic. Kaplan recognizes some of the major limitations of virtual care, but ultimately calls for expanded access to telehealth and mixed virtual and in-person "hybrid" clinical care.

He discusses the American Academy of Family Physicians and other medical associations' endorsement of health insurance reforms that would achieve "telehealth parity," providing standardized reimbursement for telephone and video-based care on par with in-person visits. In order to ensure that telehealth reaches those who might need it most, Kaplan also argues for expanded access to broadband internet and investing in digital literacy skills as a social determinant of health. He writes, "Telehealth is not a one-stop solution to our nation's vast structural inequities, and its limitations with respect to in-person care merit serious consideration. However, if my brief experience is any indication, telehealth may continue to be a crucial resource for some of our most marginalized patients long after this national state of emergency has resolved."

Access, Equity, and Neutral Space: Telehealth Beyond the Pandemic

Ben Kaplan, MPH
University of North Carolina, Chapel Hill, School of Medicine, Chapel Hill, North Carolina
https://www.annfammed.org/content/19/1/75

Bonus: Visual Abstract at https://umich.box.com/s/fesdz33vuefzcvge6qzb0nyefq42e8w6

US Pandemic Response Highlights Urgent Need for Health Care Reforms to Reduce Health Disparities

The US health care system has responded to the disruption caused by COVID-19 with short-term measures that do not fix the underlying problems with the current system. This approach underscores the ways in which that system fails low-income people, racial and ethnic minorities, and other vulnerable populations that have been hit particularly hard by the pandemic. Marshall H. Chin, MD, a physician at the University of Chicago, stresses the urgency of addressing the underlying structural problems that perpetuate health disparities now. He presents three keys to developing lasting equity-specific reforms to the health care system: greater implementation of already successful interventions (e.g., expanding health coverage, implementing interventions that attack drivers of disparities, addressing social factors); creating a business case to reduce disparities; and engaging in "hard conversations about whether we truly value the opportunity for everyone to have a healthy life."

Cherry Blossoms, COVID-19, and the Opportunity for a Healthy Life

Marshall H. Chin, MD, MPH
University of Chicago, Section of General Internal Medicine, Chicago, Illinois
https://www.annfammed.org/content/19/1/63

Treatment for Chronic Pain Must Address Both Physical and Social Pain

Physical pain and social pain may be more closely related than previously thought. Social pain, which typically results from interpersonal rejection or abuse, has been viewed as a non-medical response to external factors. However, recent research suggests that some physical and social stress responses may arise because of shared processing in the brain. Long-term usage of opioid medications could perpetuate a cycle of experiencing both physical and social pain and may increase risk of addiction. The authors, both of whom prescribe opioid medications, caution, "We must recognize that when physical and social pain coexist, long-term opioid therapy is more likely to harm than help." They advocate a move "toward chronic pain care models that do not separate physical pain (as a medical issue) from social pain (as a non-medical issue)."

When Physical and Social Pain Coexist: Insights Into Opioid Therapy

Mark D. Sullivan, MD, PhD and Jane C. Ballantyne, MD
University of Washington, Seattle, Washington
https://www.annfammed.org/content/19/1/63

Fewer Patient Encounters Drive Decline in Total Primary Care Office Visits

Despite seeing gains in insurance coverage for preventive health services under the Affordable Care Act, the US has seen a declining rate of primary care visits over the past fifteen years. Are fewer individuals seeing primary care physicians. The authors of this study compared two factors that contribute to that decline to determine whether it was the number of primary care patients or the frequency of their clinical visits that contributed most to the overall decline. Over a fifteen year period from 2002 to 2017, both the number of unique patients seeing PCPs and the number of visits per patient declined. At the start of their analysis in 2002, most Americans saw a primary care physician about 4.3 times in a two-year span. By the end of the study in 2016, frequency of contact dropped to about 3.7 visits. Additionally, the total number of unique patients who had contact with a primary care physician decreased by 2.5% over 15 years and declined across all age groups at varying rates. Applying the rates to adjusted population estimates, the authors conclude that less frequent visits by the average American makes up a larger proportion of the primary care decline compared to the number of primary care patients overall.

Decreasing Use of Primary Care: A Repeated Cross-Sectional Study of MEPS 2007-2017

Michael E. Johansen, MD, MS and Joshua D. Niforatos, MD, MTS
OhioHealth, Grant Family Medicine, Columbus, Ohio and The Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
https://www.annfammed.org/content/19/1/41

Consent Forms Design Influences Patient Willingness to Share Personal Health Information

Patients are sometimes asked to share their personal health information for research purposes. Informed consent and trust are critical components in a patient's decision to participate in research. Researchers at the University of Florida conducted a three-arm randomized controlled trial to compare the effects on patient experiences of three electronic consent (e-consent) designs that asked them to share PHI for research purposes. Participants were randomized to a standard e-consent form (standard); an e-consent that contained standard information plus hyperlinks to additional interactive details (interactive); or an e-consent that contained standard information, interactive hyperlinks, and factual messages about data protections and researcher training (trust-enhanced). Researchers found no differences in preferences at one-week follow up. However, after six months, participants expressed the most satisfaction and subjective understanding with the trust-enhanced e-consent. The authors write that research institutions should consider developing and further validating e-consents that deliver information interactively, beyond that which is required by federal regulations, including facts that may enhance patient-informed consent and trust in research.

An Electronic Tool to Support Patient-Centered Broad Consent: A Multi-Arm Randomized Clinical Trial in Family Medicine

Elizabeth H. Golembiewski, PhD, MPH, et al
Mayo Clinic, Rochester, Minnesota
https://www.annfammed.org/content/19/1/16

Medical Practice Patterns Vary Between Physicians More Than They Vary Within an Individual Physician's Practice Over Time

Harmful medical practices, like inappropriate prescribing of opioids and racial and income-based discrimination in clinical settings, can vary across medical practices and individuals. Patients may find that even common primary care health services, like getting a chest x-rays or a referral to a heart or lung specialist, can differ widely depending on your doctor or clinic location. These variations in medical practice can have serious consequences for the quality, equity and cost of one's health care; however, it's unclear whether these disparities can be attributed to individual differences, from one doctor to another or to changes in your doctor's individual practice over time, perhaps in response to shifts in clinical guidelines or advancements in diagnostic technologists. Is it person-to-person variation or variation over time? A group of Israeli researchers sought to answer this question in a retrospective cohort study using a decade of data from the largest health care provider in southern Israel. This study shows variations between physicians' practice patterns to be significantly more pronounced than variations within an individual physician's practice patterns over a decade. Researchers assessed the medical practice patterns of 251 primary care physicians, including their rates of imaging tests, cardiac tests, laboratory tests, and specialist visits. After adjusting for different patient and clinic characteristics, practice pattern variations remain high, while individual physicians' patterns over time appear stable. The authors propose that medical practitioners' personal behavioral characteristics might help explain variations across practice patterns.

Medical Practice Variation Among Primary Care Physicians: 1 Decade, 14 Health Services, 3,238,498 Patient-Years

Victor Novack, MD, PhD, et al
Ben-Gurion University of the Negev, Soroka University Medical Center, Be'er-Sheva, Israel
https://www.annfammed.org/content/19/1/30

Innovations in Primary Care

Innovations in Primary Care are brief one-page articles that describe novel innovations from health care's front lines. In this issue:

House Calls Without Walls: Street Medicine Delivers Primary Care to Unsheltered Persons Experiencing Homelessness--A "street medicine" team brings full-spectrum primary care on location to unsheltered homeless individuals in Los Angeles, part of an emerging model of "reality-based medicine."
https://www.annfammed.org/content/19/1/84

A Community Partnership to Improve Access to Buprenorphine in a Homeless Population--A new mobile health service formed through a community partnership in Chicago has improved access to medical treatment for opioid use disorder for individuals experiencing homelessness during the COVID-19 pandemic.
https://www.annfammed.org/content/19/1/85

Targeted Inpatient Screening Mammogram Program to Reduce Disparities in Breast Cancer Screening Rates--A program targeting disparities in breast cancer screening demonstrates the feasibility of performing targeted inpatient screening mammograms to improve screening rates among Medicaid and dual-eligible patients.
https://www.annfammed.org/content/19/1/83

A recent statewide survey of Californians uncovered that 30% of Black adults and 13% of Hispanic adults felt that they have been judged or treated differently by a health care provider because of their race/ethnicity or language. One out of six Black and Latino Californians were more likely to report strong mistrust of their health care providers. Researchers at the Charles R. Drew University in Los Angeles analyzed data from more than 2,300 White, Hispanic, and non-Hispanic Black adults who asked to report on perceived discrimination due to race, ethnicity, language, income, and insurance status or type. Black and Hispanic adults reported higher rates of discrimination across the board, including income and insurance-based discrimination. Black and Hispanic adults reported higher rates of discrimination, including income and insurance-based discrimination. In addition, 20% and 10% of Black and Latino adults stated that they could not get health care services they needed because of racial/ethnic or language discrimination, respectively.

The analysis also found a link between having a consistent primary care physician and overall medical trust. Adults who did not have a usual source of primary care were much more likely to report mistrust of healthcare providers. The research team discusses the link between medical mistrust, racial and ethnic discrimination in health care, and roots in institutionalized racism, declaring that "resolving mistrust requires addressing systemic bias and prejudice in the medical system," echoing recent sentiments expressed by the American Medical Association.

Traditional gendered patterns of child care persisted during the COVID-19 shutdown, with more than a third of couples relying on women to provide most or all of it, according to a study from University of Georgia researcher Kristen Shockley.

Some previous research has found that typical familial patterns may get upended during crises, but that's not what Shockley and her colleagues found in the early months of the COVID-19 shutdown.

"Most people have never undergone anything like this before, where all of a sudden they can't rely on their normal child care, and most people's work situation has changed too," said Shockley, associate professor of psychology in the Franklin College of Arts and Sciences. "We thought this would be a chance for men to step in and partake equally in child care, but for many couples we didn't see that happen."

In mid-March, as schools and day cares closed and many shifted to remote work, Shockley and her colleagues quickly created a survey targeting dual-earner couples with at least one child under age 6.

"My son was 15 months old when this all started, and I know firsthand that you can't just plop younger kids in front of a TV or expect them to do their schoolwork," she said. "We were particularly interested in people who really had to provide active child care."

The team initially surveyed 274 couples, conducting a follow-up survey with 133 of the same couples in May. The study, which will appear Journal of Applied Psychology, assessed marital tension, health and job performance in addition to child care strategies.

"When the wife does it all, not surprisingly, the outcomes are bad for the couple," Shockley said. "It's not just bad for the wife, it's also bad for the husband, including in terms of job performance although his work role presumably hasn't changed. When one person's doing it all, there's a lot of tension in the relationship, and it's probably spilling over into the husband's ability to focus at work."

Though 36.6% of couples relied on the wife to provide most or all child care, 44.5% used more egalitarian strategies, and 18.9% used strategies that were not clearly gendered or egalitarian.

Egalitarian strategies included alternating work days, planning daily mini shifts that included both work and child care for husband and wife, and alternating shifts that changed day to day based on the couple's work needs.

"When you look at the more egalitarian strategies, we found the best outcomes for people who were able to alternate working days," Shockley said. "The boundaries are clear. When you're working, you can really focus on work, and when you're taking care of the kids, you can really focus on the kids. But not everybody has jobs amenable to that."

When both people were working at home, planned mini shifts and needs-based alternation had similar well-being outcomes for the couple, but job performance was higher for couples who used needs-based alternation, according to Shockley.

"I think that's due to the communication that comes with it, and the flexibility within your dyad at home," she said. "For couples who are continuing to work remotely, I would say needs-based alternation with night-before communication about work needs is probably better than having fixed shifts."

Although the paper doesn't include qualitative quotes, Shockley remembers the participants' comments quite clearly.

"People were saying, 'I'm at my breaking point,' and this was just two weeks in. A lot of people said, 'I'm just not sleeping.' You could feel people's struggle, and there was a lot of resentment, particularly when the wife was doing it all," she said.

"This really highlights some infrastructure issues we have with the way we think about child care in this country. The default becomes, 'Oh well, the wife is going to pick up the slack.' It's not a long-term solution."

Shockley also noted that the couples surveyed have relatively high incomes.

"Compared to the country, the household income of our study is pretty high," she said. "This might look different in lower-income samples. We might see totally different strategies emerging, particularly if there's less possibility for remote work."

A rapid, evidence-based review summarizes the effectiveness of cloth masks in protecting health care clinicians from respiratory viral infections, such as COVID-19. Nine studies were included in the review, and all but one were conducted prior to the COVID-19 pandemic. The only randomized trial of cloth face masks published at the time of this review compared the infection rates of influenza-like illness among groups of health care professionals who wore cloth masks, medical masks, or inconsistent mask use in the hospital setting. That study reported wide-ranging confidence intervals when comparing groups, but overall, they conclude that cloth mask use was associated with significantly higher viral infections than exclusive use of medical masks.

A majority of studies were conducted in laboratory settings and evaluated either cloth face mask fit and airflow when compared to other kinds of mask or the filtration abilities of cloth material and masks. All filtration studies tested aerosolized particles including noncoronavirus, bacteria, and simulated biologic particles, and results were highly variable but suggested some level of participle filtration. Notably, available filtration studies did not specifically test COVID-19 transmission or respiratory droplet transmission. The lab studies all conclude that cloth masks provided an inferior fit and were less effective at filtering viral particles compared to standard medical or N95 masks. Conclusions of this qualitative review align with current Center for Disease Control and Prevention guidelines that recommend use of an N95 respirator for care of patients with COVID-19. The authors also recommend that for health care professionals without access to medical masks, a cloth mask should be paired with the plastic face shield, with frequent cloth mask changes to reduce the risk of moisture retention.

Despite having some of the densest living spaces and the highest number of international visitors, Hong Kong, Singapore, and Beijing have utilized their respective primary health care systems to keep their COVID-19 cases and deaths relatively low. Researchers studied the primary health care systems in the three cities to identify features of each system that other cities can use as examples to prepare for and prevent deaths in future health crises. Wong et al write that all three cities have made use of primary care in performing public health surveillance and primary care functions, underscoring their assertion that primary care is an indispensable part of any health system and can play an important role in addressing future infectious disease outbreaks when it is supported, engaged, and integrated with other parts of a health system.

URBANA, Ill. - Soil erosion is a major challenge in agricultural production. It affects soil quality and carries nutrient sediments that pollute waterways. While soil erosion is a naturally occurring process, agricultural activities such as conventional tilling exacerbate it. Farmers implementing no-till practices can significantly reduce soil erosion rates, a new University of Illinois study shows.

Completely shifting to no-till would reduce soil loss and sediment yield by more than 70%, says Sanghyun Lee, doctoral student in the Department of Agricultural and Biological Engineering at U of I and lead author on the study, published in Journal of Environmental Management.

But even a partial change in tilling practices could have significant results, he adds.

"If we focus on the most vulnerable area in terms of soil erosion, then only 40% no-till shows almost the same reduction as 100% no-till implementation," Lee says.

The study used physical data and computer modeling to estimate soil erosion in the Drummer Creek watershed, which is part of the Upper Sangamon River watershed in Central Illinois. The area's main crops are corn and soybeans, and tillage is a predominant agricultural practice.

"The rate of soil erosion is increased and accelerated by unsustainable agricultural production. One of the main reasons is conventional tillage in the field," Lee says. "Our model provides a tool to estimate the impacts of tilling on soil erosion across the watershed."

Lee and co-authors Maria Chu, Jorge Guzman, and Alejandra Botero-Acosta developed the modeling framework, coupling a hydrological model (MIKE SHE) with the Water Erosion Prediction Project (WEPP) to examine the impacts of no-till practice in the watershed. The WEPP model provided the sediment sources from the agricultural fields under different tillage practices and the hydrologic model simulated sediment transport across the watershed.

The researchers included historical data on climate, soil properties, sediment sample data, and other relevant measures, then used the coupled model to predict how different management practices affect soil erosion rates.

"Farmers may prefer tilling because wet climate conditions cause compacted soil," Lee says. "However, soil erosion removes topsoil, which contains lots of nutrients, and this may reduce yield in the long term. Soil erosion also affects water quality, both locally over time and at a distance.

"Therefore, farmers need to weigh the benefits of tilling with the consequences of soil erosion and choose the best management strategies."

The modeling framework can help identify the most vulnerable areas, so producers can implement sustainable management practices where it matters most, Lee notes.

Harmful medical practices, like inappropriate prescribing of opioids and racial and income-based discrimination in clinical settings, can vary across medical practices and individuals. Patients may find that even common primary care health services, like getting a chest x-rays or a referral to a heart or lung specialist, can differ widely depending on your doctor or clinic location. These variations in medical practice can have serious consequences for the quality, equity and cost of one's health care; however, it's unclear whether these disparities can be attributed to individual differences, from one doctor to another or to changes in your doctor's individual practice over time, perhaps in response to shifts in clinical guidelines or advancements in diagnostic technologists. Is it person-to-person variation or variation over time? A group of Israeli researchers sought to answer this question in a retrospective cohort study using a decade of data from the largest health care provider in southern Israel. This study shows variations between physicians' practice patterns to be significantly more pronounced than variations within an individual physician's practice patterns over a decade. Researchers assessed the medical practice patterns of 251 primary care physicians, including their rates of imaging tests, cardiac tests, laboratory tests, and specialist visits. After adjusting for different patient and clinic characteristics, practice pattern variations remain high, while individual physicians' patterns over time appear stable. The authors propose that medical practitioners' personal behavioral characteristics might help explain variations across practice patterns.

Irvine, Calif., Jan. 5, 2021 -- Scientists at the University of California, Irvine have developed a new deep-learning framework that predicts gene regulation at the single-cell level.

Deep learning, a family of machine-learning methods based on artificial neural networks, has revolutionized applications such as image interpretation, natural language processing and autonomous driving. In a study published recently in Science Advances, UCI researchers describe how the technique can also be successfully used to observe gene regulation at the cellular level. Until now, that process had been limited to tissue-level analysis.

According to co-senior author Xiaohui Xie, UCI professor of computer science, the framework enables the study of transcription factor binding at the cellular level, which was previously impossible due to the intrinsic noise and sparsity of single-cell data. A transcription factor is a protein that controls the translation of genetic information from DNA to RNA; TFs regulate genes to ensure they're expressed in proper sequence and at the right time in cells.

"The breakthrough was in realizing that we could leverage deep learning and massive datasets of tissue-level TF binding profiles to understand how TFs regulate target genes in individual cells through specific signals," Xie said.

By training a neural network on large-scale genomic and epigenetic datasets, and by drawing on the expertise of collaborators across three departments, the researchers were able to identify novel gene regulations for individual cells or cell types.

"Our capability of predicting whether certain transcriptional factors are binding to DNA in a specific cell or cell type at a particular time provides a new way to tease out small populations of cells that could be critical to understanding and treating diseases," said co-senior author Qing Nie, UCI Chancellor's Professor of mathematics and director of the campus's National Science Foundation-Simons Center for Multiscale Cell Fate Research, which supported the project.

He said that scientists can use the deep-learning framework to identify key signals in cancer stem cells - a small cell population that is difficult to specifically target in treatment or even quantify.

"This interdisciplinary project is a prime example of how researchers with different areas of expertise can work together to solve complex biological questions through machine-learning techniques," Nie added.

Through the centuries, scientists and non-scientists alike have looked at the night sky and felt excitement, intrigue, and overwhelming mystery while pondering questions about how our universe came to be, and how humanity developed and thrived in this exact place and time. Early astronomers painstakingly studied stars' subtle movements in the night sky to try and determine how our planet moves in relation to other celestial bodies. As technology has increased, so too has our understanding of how the universe works and our relative position within it.

What remains a mystery, however, is a more detailed understanding of how stars and planets formed in the first place. Astrophysicists and cosmologists understand that the movement of materials across the interstellar medium (ISM) helped form planets and stars, but how this complex mixture of gas and dust--the fuel for star formation--moves across the universe is even more mysterious.

To help better understand this mystery, researchers have turned to the power of high-performance computing (HPC) to develop high-resolution recreations of phenomena in the galaxy. Much like several terrestrial challenges in engineering and fluid dynamics research, astrophysicists are focused on developing a better understanding of the role of turbulence in helping shape our universe.

Over the last several years, a multi-institution collaboration being led by Australian National University Associate Professor Christoph Federrath and Heidelberg University Professor Ralf Klessen has been using HPC resources at the Leibniz Supercomputing Centre (LRZ) in Garching near Munich to study turbulence's influence on galaxy formation. The team recently revealed the so-called "sonic scale" of astrophysical turbulence--marking the transition moving from supersonic to subsonic speeds (faster or slower than the speed of sound, respectively)--creating the largest-ever simulation of supersonic turbulence in the process. The team published its research in Nature Astronomy.

Many scales in a simulation

To simulate turbulence in their research, Federrath and his collaborators needed to solve the complex equations of gas dynamics representing a wide variety of scales. Specifically, the team needed to simulate turbulent dynamics on both sides of the sonic scale in the complex, gaseous mixture travelling across the ISM. This meant having a sufficiently large simulation to capture these large-scale phenomena happening faster than the speed of sound, while also advancing the simulation slowly and with enough detail to accurately model the smaller, slower dynamics taking place at subsonic speeds.

"Turbulent flows only occur on scales far away from the energy source that drives on large scales, and also far away from the so-called dissipation (where the kinetic energy of the turbulence turns into heat) on small scales" Federrath said. "For our particular simulation, in which we want to resolve both the supersonic and the subsonic cascade of turbulence with the sonic scale in between, this requires at least 4 orders of magnitude in spatial scales to be resolved."

In addition to scale, the complexity of the simulations is another major computational challenge. While turbulence on Earth is one of the last major unsolved mysteries of physics, researchers who are studying terrestrial turbulence have one major advantage--the majority of these fluids are incompressible or only mildly compressible, meaning that the density of terrestrial fluids stays close to constant. In the ISM, though, the gaseous mix of elements is highly compressible, meaning researchers not only have to account for the large range of scales that influences turbulence, they also have to solve equations throughout the simulation to know the gases' density before proceeding.

Understanding the influence that density near the sonic scale plays in star formation is important for Federrath and his collaborators, because modern theories of star formation suggest that the sonic scale itself serves as a "Goldilocks zone" for star formation. Astrophysicists have long used similar terms to discuss how a planet's proximity to a star determines its ability to host life, but for star formation itself, the sonic scale strikes a balance between the forces of turbulence and gravity, creating the conditions for stars to more easily form. Scales larger than the sonic scale tend to have too much turbulence, leading to sparse star formation, while in smaller, subsonic regions, gravity wins the day and leads to localized clusters of stars forming.

In order to accurately simulate the sonic scale and the supersonic and subsonic scales on either side, the team worked with LRZ to scale its application to more than 65,000 compute cores on the SuperMUC HPC system. Having so many compute cores available allowed the team to create a simulation with more than 1 trillion resolution elements, making it the largest-ever simulation of its kind.

"With this simulation, we were able to resolve the sonic scale for the first time," Federrath said. "We found its location was close to theoretical predictions, but with certain modifications that will hopefully lead to more refined star formation models and more accurate predictions of star formation rates of molecular clouds in the universe. The formation of stars powers the evolution of galaxies on large scales and sets the initial conditions for planet formation on small scales, and turbulence is playing a big role in all of this. We ultimately hope that this simulation advances our understanding of the different types of turbulence on Earth and in space."

Cosmological collaborations and computational advancements

While the team is proud of its record-breaking simulation, it is already turning its attention to adding more details into its simulations, leading toward an even more accurate picture of star formation. Federrath indicated that the team planned to start incorporating the effects of magnetic fields on the simulation, leading to a substantial increase in memory for a simulation that already requires significant memory and computing power as well as multiple petabytes of storage--the current simulation requires 131 terabytes of memory and 23 terabytes of disk space per snapshot, with the whole simulation consisting of more than 100 snapshots.

Since he was working on his doctoral degree at the University of Heidelberg, Federrath has collaborated with staff at LRZ's AstroLab to help scale his simulations to take full advantage of modern HPC systems. Running the largest-ever simulation of its type serves as validation of the merits of this long-running collaboration. During this period, Federrath has worked closely with LRZ's Dr. Luigi Iapichino, Head of LRZ's AstroLab, who was a co-author on the Nature Astronomy publication.

"I see our mission as being the interface between the ever-increasing complexity of the HPC architectures, which is a burden on the application developers, and the scientists, which don't always have the right skill set for using HPC resource in the most effective way," Iapichino said. "From this viewpoint, collaborating with Christoph was quite simple because he is very skilled in programming for HPC performance. I am glad that in this kind of collaborations, application specialists are often full-fledged partners of researchers, because it stresses the key role centres' staffs play in the evolving HPC framework."

A shadow over the promising inhaled interferon beta COVID-19 therapy has been cleared with the discovery that although it appears to increase levels of ACE2 protein - coronavirus' key entry point into nose and lung cells - it predominantly increases levels of a short version of that protein, which the virus cannot bind to.

The virus that causes COVID-19, known as SARS-CoV-2, enters nose and lung cells through binding of its spike protein to the cell surface protein angiotensin converting enzyme 2 (ACE2).

Now a new, short, form of ACE2 has been identified by Professor Jane Lucas, Professor Donna Davies, Dr Gabrielle Wheway and Dr Vito Mennella at the University of Southampton and University Hospital Southampton NHS Foundation Trust.

The study, published in Nature Genetics, shows that as well as the longer form of ACE2 used by SARS-CoV-2, a shorter form of ACE2 exists that lacks the SARS-CoV-2 binding site.

Naturally occurring antiviral proteins called interferons have shown promise in treating COVID-19. However, previous studies have shown that interferons increase levels of ACE2 - casting doubts over the potential for such treatments, with the possibility that increased ACE2 could see these drugs actually worsen COVID-19 impacts.

But this latest research shows that it is predominantly the short ACE2, which lacks the viral binding site, that is increased in response to interferons. Since levels of the longer form of ACE2 remain unchanged, interferons do not appear to boost entry points for the virus, supporting their use in treating COVID-19 patients.

This helps to explain the hugely promising results for a trial of an inhaled interferon beta treatment for COVID-19 patients, developed in Southampton by a team led by Professor Tom Wilkinson of the University of Southampton.

This research gives a new insight into this short form of ACE2, and shows how it has a very different role to the longer form of ACE2 that acts as entry point for SARS-CoV-2.

Short ACE2 lacks the binding site for SARS-CoV-2, so it cannot be used as an entry point for the virus. Instead, its regulation by interferons suggests it may be involved in the body's anti-viral response.

As the researchers showed that short ACE2 does not increase in response to SARS-CoV-2 infection, it is unlikely to be involved in the body's immune response to COVID-19, but it did increase in response to another common respiratory virus.

These results will enable researchers to distinguish between these two forms of ACE2, knowledge which could prove invaluable for developing more sophisticated treatments for COVID-19 patients.

Professor Jane Lucas, Professor of Paediatric Respiratory Medicine at the University of Southampton and Honorary Consultant Paediatric Respiratory Medicine at University Hospital Southampton and one of the lead authors for the study, said:

"We were excited to discover a new form of ACE2, and became even more interested when we realised that may be protective against SARS-CoV-2 in the airways rather than an entry site for infection. We believe this may have important implications for managing COVID-19 infection and we are starting further studies to investigate this further."

CAMBRIDGE, MA -- Engineers at MIT and Imperial College London have developed a new way to generate tough, functional materials using a mixture of bacteria and yeast similar to the "kombucha mother" used to ferment tea.

Using this mixture, also called a SCOBY (symbiotic culture of bacteria and yeast), the researchers were able to produce cellulose embedded with enzymes that can perform a variety of functions, such as sensing environmental pollutants. They also showed that they could incorporate yeast directly into the material, creating "living materials" that could be used to purify water or to make "smart" packaging materials that can detect damage.

"We foresee a future where diverse materials could be grown at home or in local production facilities, using biology rather than resource-intensive centralized manufacturing," says Timothy Lu, an MIT associate professor of electrical engineering and computer science and of biological engineering.

Lu and Tom Ellis, a professor of bioengineering at Imperial College London, are the senior authors of the paper, which appears today in Nature Materials. The paper's lead authors are MIT graduate student Tzu-Chieh Tang and Cambridge University postdoc Charlie Gilbert.

Division of labor

Several years ago, Lu's lab developed a way to use E. coli to generate biofilms embedded with materials such as gold nanowires. However, those films are very small and thin, making them difficult to use in most large-scale applications. In the new study, the researchers set out to find a way to use microbes to generate larger quantities of more substantial materials.

They thought of creating a microbe population similar to a kombucha mother, which is a mixture of certain types of bacteria and yeast. These fermentation factories, which usually contain one species of bacteria and one or more yeast species, produce ethanol, cellulose, and acetic acid, which gives kombucha tea its distinctive flavor.

Most of the wild yeast strains used for fermentation are difficult to genetically modify, so the researchers replaced them with a strain of laboratory yeast called Saccharomyces cerevisiae. They combined the yeast with a type of bacteria called Komagataeibacter rhaeticus, which their collaborators at Imperial College London had previously isolated from a kombucha mother. This species can produce large quantities of cellulose.

Because the researchers used a laboratory strain of yeast, they could engineer the cells to do any of the things that lab yeast can do -- for example, producing enzymes that glow in the dark, or sensing pollutants in the environment. The yeast can also be programmed so that they can break down pollutants after detecting them.

Meanwhile, the bacteria in the culture produce large-scale quantities of tough cellulose to serve as a scaffold. The researchers designed their system so that they can control whether the yeast themselves, or just the enzymes that they produce, are incorporated into the cellulose structure. It takes only a few days to grow the material, and if left long enough, it can thicken to occupy a space as large as a bathtub.

"We think this is a good system that is very cheap and very easy to make in very large quantities," Tang says. "It's at least a thousand times more material than the E.coli system."

Just add tea

To demonstrate the potential of their microbe culture, which they call "Syn-SCOBY," the researchers created a material incorporating yeast that senses estradiol, which is sometimes found as an environmental pollutant. In another version, they used a strain of yeast that produces a glowing protein called luciferase when exposed to blue light. These yeasts could be swapped out for other strains that detect other pollutants, metals, or pathogens.

The culture can be grown in normal yeast culture medium, which the researchers used for most of their studies, but they have also shown that it can grow in tea with sugar. The researchers envision that the cultures could be customized for people to use at home for growing water filters or other useful materials.

"Pretty much everyone can do this in their kitchen or at home," Tang says. "You don't have to be an expert. You just need sugar, you need tea to provide the nutrients, and you need a piece of Syn-SCOBY mother."