Culture

More than half of all in-hospital deaths due to COVID-19 during the first six months of 2020 were among Black and Hispanic patients, according to a new study led by researchers at the Stanford University School of Medicine and Duke University.

The researchers did not find any racial or ethnic differences in mortality rates among people hospitalized with the disease. Yet a disproportionate number of Black and Hispanic people became sick enough to require hospitalization, and they made up 53% of inpatient deaths.

Fatima Rodriguez, MD, assistant professor of cardiovascular medicine at Stanford, is the lead author of the study, which was published Nov. 17 in Circulation. Tracy Wang, MD, professor of medicine at Duke University, is the senior author.

"The COVID-19 pandemic has shown a spotlight on racial and ethnic disparities in health care that have been happening for years," said Rodriguez, an expert in health disparities in cardiovascular medicine. "Our study shows an over-representation of Black and Hispanic patients in terms of morbidity and mortality that needs to be addressed upstream before hospitalization."

Researchers examined a sample of 7,868 patients hospitalized with the coronavirus at 88 hospitals across the country between Jan. 17 and July 22. The data was collected from the American Heart Association's COVID-19 Cardiovascular Disease Registry. The average mortality rate for all patients was 18.4%.

The researchers found that white patients accounted for 35.2% of the sample, Hispanic patients for 33%, Black patients for 25.5% and Asian patients for 6.3%.

The U.S. Census Bureau estimates that white people make up 60% of the nation's population, Hispanic people 18.5%, Black people 13.4% and Asian people 5.9%.

Hospitals, not race and ethnicity, tied to mortality rate

"Interestingly, more of the variations in mortality were explained by the site of the care than by race or ethnicity," Rodriguez said. "We need to understand more about differences between hospitals. Is it different treatment protocols that are rapidly evolving during the pandemic? Or perhaps minority-serving hospitals have different resources? This is an active area of research within the registry used for this study as we enroll more sites across the country."

The study also found that Black and Hispanic patients were significantly younger than others, with an average age of 57 and 60, respectively, compared with 69 for white patients and 64 for Asian patients. In addition, Black and Hispanic patients had more underlying health conditions. Black patients had the highest prevalence of obesity, hypertension and diabetes. They also had the highest rates of mechanical ventilation and renal replacement therapy and the lowest rates of remdesivir use at 6.1%. The antiviral medication was the first treatment approved for COVID-19.

Somewhat surprisingly, heart problems occurred infrequently among all patients, Rodriguez said.

"Asian patients showed higher rates of cardiorespiratory disease severity when they arrived at the hospital," she said. "That was an interesting finding. They tended to be older and to come to the hospital later in the disease progression."

The study had some limitations, Rodriguez said, including an overrepresentation of urban and large academic teaching hospitals in the data sample, but the findings remain startling.

"My work focuses on preventing chronic disease before patients are hospitalized," Rodriguez said. "We need to invest in communities to increase opportunity for healthy lifestyles and good health care. Structural racism, we know, is a major roadblock for preventing good health."

Boston, MA -- Despite being known risk factors for poor cardiovascular outcomes, blood pressure and low-density lipoprotein (LDL) cholesterol remain undertreated among a large proportion of patients. To address this gap, a team from Brigham and Women's Hospital and Mass General Brigham Health System, led by Brigham cardiologist Benjamin Scirica, MD, MPH, developed a program that provides an end-to-end solution to improve blood pressure and cholesterol levels across a broad population of patients at high cardiovascular risk. Developed before the COVID-19 pandemic, the disease management program leverages task shifting, standardized treatment algorithms, and digital solutions such as home blood pressure cuffs to adjust medications based on how a patient is doing. The program relies on a team of navigators and pharmacists to help deliver personalized care remotely, without the need for in-person visits or physician involvement in every treatment decision. The new approach improved clinical outcomes for patients and may provide a model for expanding remote health care. Scirica presented results during the American Heart Association Scientific Sessions 2020, with simultaneous publication in the journal Circulation.

"Our program demonstrates that we can remotely improve cardiovascular health through cholesterol and blood pressure control faster, more efficiently and with greater personalization than standard practice," said Scirica. "And we see this as a transferable program -- one that could be adopted in other health care settings. It could be applied to a broad range of clinical scenarios across our system and across the world, especially in places where health care resources may be scarce."

This report summarized the interim results of the first 5,000 Mass General Brigham patients with uncontrolled LDL cholesterol, blood pressure or both, who were enrolled between Jan. 1, 2018 and May 21, 2020. Patients were mostly prescribed lower-cost generic drugs through the program. Pharmacists initiated and adjusted prescriptions for individuals based on clinical algorithms, prescribing more intensive medications if a patient needed them or adjusting a dosage if a patient was initially intolerant to a medication.

Non-licensed navigators served as the face of the program. They communicated directly with patients, providing treatment recommendation and education until treatment goals were met. Digital tools helped support the workflow and clinical decisions for the navigators and pharmacists. The program was supervised by specialists, and primary care physicians were updated on all treatment changes.

Of the 3,939 patients in the Lipid program, 1,343 had achieved their goal LDL cholesterol level by the time of this report, with the average decrease in LDL cholesterol being 52 mg/dl (42 percent). An overall drop in cholesterol levels of 24 mg/dl (18 percent) was seen in all patients, including those still being actively managed. Of the 1,437 patients enrolled in the high blood pressure group, blood pressure levels dropped by an average of 14/6mmHg (systolic/diastolic) in the 556 who had completed the program by the time of this report.

"These reductions are clinically meaningful. From decades of studies, we know that reductions of this magnitude in blood pressure and cholesterol result in fewer heart attacks, strokes and other cardiovascular events," said Scirica.

Scirica notes that there are challenges in a program like this one, especially around keeping participants engaged. He also acknowledges that virtual care can amplify inequities in care. The team is working on multiple solutions to try to increase access, including low-tech solutions that rely on phone calls rather than video. They also continue to update and enhance the program as guidelines continue to evolve.

Still, the team hopes the work provides a foundation for future broadly delivered population health initiatives.

"I'm especially excited for the future of disease management programs that can help at the intersection of diseases," said Scirica. "We've started with lipids and hypertension first, but our interests expand to heart failure, diabetes, mental health -- all of which overlap -- and it motivates us to look into a fully integrated system for remote chronic care management."

American College of Rheumatology Calls the Bipartisan Legislation a "Win-Win" for All Medical Specialties

ATLANTA - Today, more than 60 healthcare stakeholders, representing Medicare providers, signed a letter urging congressional leaders to support bipartisan legislation that would implement the Centers for Medicare and Medicaid Service's (CMS) Calendar Year 2021 Medicare Physician Fee Schedule (MPFS) final rule as written, and provide for a one-year waiver of budget neutrality adjustments to avoid payment reductions to providers during the COVID-19 public health emergency.

If enacted, H.R. 8505 , which was introduced by Representatives Michael Burgess (R-TX) and Bobby Rush (D-IL), would ensure that long overdue rate increases for evaluation and management (E/M) services provided by rheumatologists, neurologists, and other cognitive specialists under Medicare - as finalized by CMS in its final rule - would not lead to rate cuts to other medical specialties or to physical and occupational therapists, many of which are an integral part of the rheumatology patient care team. This is a legislative solution that meets the needs of all stakeholders by allowing CMS to implement the final rule, on schedule, while funding offsets to the reimbursement reductions using funds allotted for provider support during the public health emergency.

"H.R. 8505 is a win-win solution for all medical specialties, and we encourage congressional leaders to swiftly pass this legislation," said David Karp, MD, PhD president of the American College of Rheumatology (ACR), the group leading the letter. "Current E/M reimbursement rates suppress patient access to diagnosis, treatment, and health maintenance at a time when demand for care is increasing. If this dire situation is not addressed as planned in the MPFS, then patient access to care will continue to decline."

In 2018, CMS proposed a code collapse that would have resulted in significant cuts to rheumatology care provided to Medicare beneficiaries. But after hearing the concerns raised by the patient and specialty provider community, CMS finalized a new proposal that reflects the recommendations of the American Medical Association, the ACR and over 170 other specialty societies and state medical associations. When enacted, the new rule will provide long overdue updates to Medicare reimbursement for time-intensive healthcare services including examinations, disease diagnosis, risk assessments and care coordination.

"The E/M improvements that will go into effect in January 2021 are critical to the continued delivery of high-quality rheumatology care for millions of Medicare beneficiaries," said Karp. "Budget neutrality via H.R. 8505 is a fair and reasonable approach to ensure these needed updates are not made at the expense of other specialties."

TROY, N.Y. -- Despite additional costs, increased restrictions, and issues stemming from compliance directives, government-mandated stress tests are effective in strengthening the overall health of the multi-trillion-dollar American banking industry.

According to research recently published in the Journal of Banking and Finance by Raffi E. García, an assistant professor in the Lally School of Management at Rensselaer Polytechnic Institute, stress tests strengthen the industry by reducing a bank's risk and increasing its lending capital.

"The perception has been that stress tests are a drag on banks," García said. "It is believed that complying with the additional regulations of these bank stress tests is costly and that only the biggest banks should take on these expenses. This research finds otherwise."

Bank stress tests are analyses of bank performance under a range of hypothetical situations. They have been used by the banking industry since the 2008 global financial crisis revealed the vulnerabilities of many financial institutions.

García used a regression discontinuity design that studied all publicly traded banks and bank holding companies with $10 billion or more in assets between 2011 and 2016 and found that stress tests reduce the percentage of risky investment by banks.

He also found that investors perceive stress-tested banks as having a higher probability of earning expected gains. Those investors put more money into such banks, making it easier and cheaper for them to raise capital.

Furthermore, García found that the increase in regulatory oversight and stricter requirements do not induce stress-tested banks to manipulate their bank size just to avoid compliance. The findings have implications for legislators, banking executives, and every American taxpayer.

"Right now, these stress tests are mandatory only for the very largest banks," García said. "Most of us have our money in banks that aren't being stress-tested. If you include more banks that comply with these type of transparency requirements, it would be beneficial in protecting taxpayers from future losses."

CHAPEL HILL, NC - In a controlled study of smokers, nonsmokers, and e-cigarette users, University of North Carolina School of Medicine researchers found that e-cigarette users exhibited significantly altered immune responses to a model of influenza virus infection, suggesting increased susceptibility to disease.

The findings, published in the American Journal of Respiratory Cell and Molecular Biology, show that vaping changes the expression of genes and production of proteins in respiratory cells, as well as altering virus-specific antibody production.

"In many of the study participants, we observed more changes to the immune response in e-cigarette users than we did in smokers," said first author Meghan Rebuli, PhD, assistant professor in the UNC Department of Pediatrics and member of the UNC Center for Environmental Medicine, Asthma, and Lung Biology. "All of these factors have the potential to adversely affect response to a virus and immunity post-infection. While we used influenza as a model, this suggests that e-cigarette users are likely more susceptible to respiratory viruses than are non-smokers, and this likely includes SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19)."

The main reason to avoid smoking is the risk of cancer, heart disease, emphysema, stroke, diabetes, chronic obstructive pulmonary disorder, and other lung diseases. For these reasons, researchers also have been studying the potential effects of electronic cigarettes, which are composed of thousands of chemicals many of which are FDA-approved for ingestion, but not inhalation.

But for many years, inhalation of tobacco smoke has also been linked to increased risk of viral infection, such as influenza. Inhalation of e-cigarette aerosols has also been linked to immune suppression within the respiratory tract, specifically the protective mucosal layer lining the inside the nasal cavity.

Rebuli, senior author Ilona Jaspers, PhD, and colleagues, thought that changes in the nasal mucosal immune response could modify antiviral host defense responses in e-cigarette users. This is important because viruses, including the flu and SARS-CoV-2, have been shown to infect nasal cavities where they can replicate in cells, spread throughout the respiratory system, and be transmitted to other people. Jaspers, the director of the UNC Center for Environmental Medicine, Asthma, and Lung Biology, has led previous experiments showing that vaping altered hundreds of genes in epithelial cells involved in the body's natural immune defense. For the current study, the researchers wanted to study what happens when e-cigarette users are exposed to a respiratory virus.

For the study, non-smokers, cigarette smokers, and e-cigarette users, age 18-40, were inoculated with live attenuated influenza virus (LAIV) vaccine - a well-established model of influenza infection in the Jaspers lab- to safely examine innate immune response. Pre- and post-inoculation, the researchers collected nasal epithelial lining fluid, nasal lavage fluid, nasal scrape biopsies, urine, and blood. The scientists examined cytokines and chemokines, influenza-specific Immunoglobulin A (IgA), immune gene expression, and markers of viral load.

The researchers found that though the amount of markers of viral load did not differ among the three groups, expected increases in nasal epithelial lining fluid anti-LAIV IgA - which is a potential indicator of developed immunity post-infection - did not occur in e-cigarette users and cigarette smokers. Further, LAIV-induced gene expression changes in nasal biopsies differed in cigarette smokers and e-cigarette users as compared to non-smokers, with a greater number of genes changed in e-cigarette users, mostly resulting in decreased expression of immune genes critical for defense against viruses and generation of immune memory.

"This is not good," Jaspers said. "We want to see IgA levels increase during infection. It's the body's natural way to defend against an invader. Here we saw that both smoking and e-cigarette use hampers IgA levels. The suppressed expression of important immune genes is also concerning and in line with an overall suppression of appropriate immune responses."

Moreover, altered immune response in e-cigarette users and cigarette smokers could make vaccines less effective in these groups.

"We don't know for sure if people who vape are more susceptible to COVID-19, or if vaccines would be less effective for them," Rebuli said. "But we know we never want to see suppression of genes, proteins, and antibodies involved in our immune response. And this is what we see in our data related to smoking and e-cigarette use."

Arlington, Va. (November 16, 2020) -- A variety of ticks that carry the bacteria causing the deadly disease Rocky Mountain spotted fever (RMSF) are more than twice as likely to shift their feeding preference from dogs to humans when temperatures rise, a sign that climate change could expand and intensify human disease risks, according to a new study presented today at the Annual Meeting of the American Society of Tropical Medicine and Hygiene (ASTMH).

"Our work indicates that when the weather gets hot, we should be much more vigilant for infections of RMSF in humans," said Laura Backus, MPH, DVM, who led the study at the University of California, Davis School of Veterinary Medicine (UC-Davis). "We found that when temperatures rose from about 74 to 100 degrees Fahrenheit, brown dog ticks that carry the disease were 2.5 times more likely to prefer humans over dogs."

Cases of RMSF and related diseases, collectively known as spotted fever rickettsiosis, have risen dramatically over the last 20 years. The disease is treatable with antibiotics if detected in the first week of infection, but once an infection takes hold, the fatality rate for RMSF victims can exceed 20%. Complications can include damaged blood vessels; inflammation of the heart, lungs or brain; and kidney failure. Over the last 10 years, public health authorities have been particularly alarmed by a rash of deadly RMSF outbreaks among indigenous communities in Arizona and northern Mexico.

Backus said there have been indications from earlier work that brown dog ticks, which are found throughout the continental United States, may be more aggressive toward humans in hot weather. And scientists warn that climate change is greatly expanding areas of the country experiencing multiple days when temperatures top 100 degrees Fahrenheit, or about 38 degrees Celsius. Backus and her colleagues at UC-Davis wanted to gain more definitive insights into how rising temperatures might elevate the risk of RMSF infections.

For their experiment, they constructed two large wooden boxes measuring about 3 feet tall and 2 feet wide, which were then connected to each other by a clear plastic tube. They conducted a series of tests that involved putting a human in one box, a dog in the other and ticks in the clear plastic tube between them. The researchers then observed, over 20-minute intervals, whether the ticks, which seek out hosts to feed on based on smell, preferred dogs or humans--first at temperatures of around 74 degrees Fahrenheit (23.3 degrees Celsius) and then at 100 degrees Fahrenheit (37.8 degrees Celsius).

Backus said that at the higher temperature, one type of brown dog tick, known as the tropical lineage tick, was especially decisive in shifting its preferences from dogs to humans. Currently, tropical lineage brown dog ticks are found across the southern regions of the United States, in places like Arizona, Florida, southern California and southern Georgia. However, Backus said that their range is expected to move northward as climate change causes average temperatures to rise.

Brown dog ticks belonging to another lineage, the temperate lineage, are found throughout the lower 48 states and may also carry RMSF. Backus said that while the temperate ticks showed only a slight increase in preference for humans over dogs in the higher temperature test, they exhibited a pronounced decrease in their preference for dogs. Many ticks simply shifted from clearly pro-dog to neutral--they did not move toward either subject.

"We believe that this decreased preference for dogs--combined with a slight increase in preference for humans--suggests that hot temperatures may also elevate risks of RMSF in areas where the temperate ticks are more common," Backus said.

She added that it's important to identify conditions that can increase infection risks--and put health officials on higher alert--because symptoms in the crucial early phase of RMSF, when it's relatively easy to treat, can be mistaken for a number of more common ailments. They include headache, fever and muscle aches. Backus said there is also a need for better diagnostic tests since the existing test is time-consuming and may produce false negatives.

"The findings from the use of this simple but effective laboratory experiment to gauge how rising temperatures might lead to more human infections with a very dangerous tick-borne pathogen adds to the growing evidence of the increasing connection between climate change and its impact on health," said ASTMH President Joel Breman, MD, DTPH, FASTM. "Climate change is moving so quickly that it is critical to keep pace with the many ways it may alter and intensify the risk of a wide range of infectious diseases so we are better prepared to diagnose, treat and prevent them."

DALLAS, November 16, 2020 -- Adults with the healthiest sleep patterns had a 42% lower risk of heart failure regardless of other risk factors compared to adults with unhealthy sleep patterns, according to new research published today in the American Heart Association's flagship journal Circulation. Healthy sleep patterns are rising in the morning, sleeping 7-8 hours a day and having no frequent insomnia, snoring or excessive daytime sleepiness.

Heart failure affects more than 26 million people, and emerging evidence indicates sleep problems may play a role in the development of heart failure.

This observational study examined the relationship between healthy sleep patterns and heart failure and included data on 408,802 UK Biobank participants, ages 37 to 73 at the time of recruitment (2006-2010). Incidence of heart failure was collected until April 1, 2019. Researchers recorded 5,221 cases of heart failure during a median follow-up of 10 years.

Researchers analyzed sleep quality as well as overall sleep patterns. The measures of sleep quality included sleep duration, insomnia and snoring and other sleep-related features, such as whether the participant was an early bird or night owl and if they had any daytime sleepiness (likely to unintentionally doze off or fall asleep during the daytime).

"The healthy sleep score we created was based on the scoring of these five sleep behaviors," said Lu Qi, M.D., Ph.D., corresponding author and professor of epidemiology and director of the Obesity Research Center at Tulane University in New Orleans. "Our findings highlight the importance of improving overall sleep patterns to help prevent heart failure."

Sleep behaviors were collected through touchscreen questionnaires. Sleep duration was defined into three groups: short, or less than 7 hours a day; recommended, or 7 to 8 hours a day; and prolonged, or 9 hours or more a day.

After adjusting for diabetes, hypertension, medication use, genetic variations and other covariates, participants with the healthiest sleep pattern had a 42% reduction in the risk of heart failure compared to people with an unhealthy sleep pattern.

They also found the risk of heart failure was independently associated and:

8% lower in early risers;

12% lower in those who slept 7 to 8 hours daily;

17% lower in those who did not have frequent insomnia; and

34% lower in those reporting no daytime sleepiness.

Participant sleep behaviors were self-reported, and the information on changes in sleep behaviors during follow-up were not available. The researchers noted other unmeasured or unknown adjustments may have also influenced the findings.

Qi also noted that the study's strengths include its novelty, prospective study design and large sample size.

First-author is Xiang Li, Ph.D.; other co-authors are Qiaochu Xue, M.P.H.; Mengying Wang, M.P.H.; Tao Zhou, Ph.D.; Hao Ma, Ph.D.; and Yoriko Heianza, Ph.D. Author disclosures are detailed in the manuscript.

Darwin's theory of evolution should be expanded to include consideration of a DNA stability "energy code" - so-called "molecular Darwinism" - to further account for the long-term survival of species' characteristics on Earth, according to Rutgers scientists.

The iconic genetic code can be viewed as an "energy code" that evolved by following the laws of thermodynamics (flow of energy), causing its evolution to culminate in a nearly singular code for all living species, according to the Rutgers co-authored study in the journal Quarterly Reviews of Biophysics.

"These revelations matter because they provide entirely new ways of analyzing the human genome and the genome of any living species, the blueprints of life," said senior author Kenneth J. Breslauer, Linus C. Pauling Distinguished University Professor in the Department of Chemistry and Chemical Biology in the School of Arts and Sciences at Rutgers University-New Brunswick. He is also affiliated with the Rutgers Cancer Institute of New Jersey. "The origins of the evolution of the DNA genetic code and the evolution of all living species are embedded in the different energy profiles of their molecular DNA blueprints. Under the influence of the laws of thermodynamics, this energy code evolved, out of an astronomical number of alternative possibilities, into a nearly singular code across all living species."

Scientists investigated this so-called "universal enigma," probing the origins of the astounding observation that the genetic code evolved into a nearly uniform blueprint that arose from trillions of possibilities.

The scientists expanded the underpinnings of the landmark "survival of the fittest" Darwinian evolutionary theory to include "molecular Darwinism." Darwin's revolutionary theory is based on the generational persistence of a species' physical features that allow it to survive in a given environment through "natural selection." Molecular Darwinism refers to physical characteristics that persist through generations because the regions of the molecular DNA that code for those traits are unusually stable.

Different DNA regions can exhibit differential energy signatures that may favor physical structures in organisms that enable specific biological functions, Breslauer said.

Next steps include recasting and mapping the human genome chemical sequence into an "energy genome," so DNA regions with different energy stabilities can be correlated with physical structures and biological functions. That would enable better selection of DNA targets for molecular-based therapeutics.

Population-wide screening for genetic variants linked to hereditary breast and ovarian cancer may be cost effective in women between the ages of 20 and 35, according to a study published in JAMA Network Open.

However, screening for older women was not cost-effective, the researchers found, since the majority of risk-reducing mastectomies and salpingo-oophorectomies occur before age 50 and the majority of hereditary breast and ovarian cancers occur after 50. Older women who learn they are at risk have a smaller window of time to take action.

The study is a product of the RISE (Rational Integration of clinical SEquencing) consortium, which seeks to estimate the long-term clinical and economic value of genetic screening scenarios. Consortium members include Vanderbilt University Medical Center, the University of Washington in Seattle and Geisinger Health.

Josh Peterson, MD, MPH, professor of Medicine and Biomedical Informatics, is one of four Vanderbilt co-authors of the study and a principal investigator for RISE, which is supported with funding from the National Human Genome Research Institute.

"Screening for genetic conditions and risks has become common for the perinatal period, but whether to do so for adults is still debated. This study adds to the growing literature that testing for common genetic risks, such as hereditary breast and ovarian cancer, early in adult life is beneficial to patients and cost-effective from a societal perspective," Peterson said.

David Veenstra, PharmD, PhD, professor of Pharmacy at the University of Washington, a principal investigator for RISE and associate director of Comparative Health Outcomes, Policy and Economics (CHOICE), is the corresponding author for the study, and Gregory Guzauskas, MSPH, PhD, a senior research scientist with CHOICE, is the first author.

The researchers developed a decision-analytic model to compare population screening for hereditary breast and ovarian cancer in an unselected population of previously undiagnosed women versus no screening. They then modeled clinical events in the decision tree. The risk variants included BRCA1, BRCA2, ATM, CHEK2, MSH6, PALB2, RAD51C AND TP53. Estimates were based on extrapolated data from the Geisinger MyCode Community Health Initiative and other published sources.

The results indicated that population screening of 30-year-old women resulted in 75 fewer cancer cases per 100,000 women. With 45-year-old women, the benefit decreased sharply with only 24 fewer cancer cases per 100,000 women. The researchers also analyzed quality-adjusted-life-years (QALYs) with the two scenarios and found that 288 QALYs were gained for women age 30 compared to 97 QALYs for women age 45.

The researchers also sought to determine if "cascade" benefits occurred when women identified at risk shared the information with relatives. They did not find that cascade screening fundamentally impacted clinical and economical values. Although 70% of carriers informed family members, only 20% of those relatives were assumed to undergo testing, which reflects the low rates of cascade testing uptake in practice. The researchers did, however, recommend that cascade testing be implemented where feasible.

The researchers noted that additional research is warranted on the potential impact on women who test negative for genetic risk variants to determine if these noncarriers follow through with recommended screenings for all women. They also noted that a limitation of their study is that it did not evaluate the impacts of patient diversity and disparity and said that "underserved populations such as African Americans represent an important follow-up opportunity."

Genomic screening for hereditary breast and ovarian cancer is a matter of ongoing debate and analysis. Although the U.S. Centers for Disease Control and Prevention lists this genetic syndrome as a Tier 1 genomic application with "significant potential for positive impact on public health," the U.S. Preventive Services Task Force guidelines for BRCA1/2 testing recommend against routine risk assessment for women without personal or family medical histories that suggest a genetic carrier status.

November 16, 2020 - The Center for Justice Research (CJR) at Texas Southern University supports innovative, data-driven solutions for the creation of an equitable criminal justice system. CJR is the premier criminal justice research center located on the campus of a historically Black college or university. Our researchers offer an important voice at this crucial time. A Police Reform Action Brief released today focuses on the chokehold crisis. This is the first in a series of action briefs on police reform that will assist in the reimagination of policing.

Key Observation: National standards are necessary to ensure protection against excessive use of force, including chokeholds. However, states and local jurisdictions cannot wait on Congress to implement reforms that protect their citizens and hold police accountable. Police reform will require support at all levels of government.

The first in the series, Reimagination of Policing Action Brief: Banning Chokeholds, highlights the extensive history of police officer use of chokeholds and similar tactics that often result in unconsciousness, and even death. The May 25, 2020 death of George Floyd under the knee of a Minneapolis police officer has shaken the nation's conscience. Americans are demanding change. The brief's authors, the Center for Justice Research at Texas Southern University, provides support for a zero-tolerance approach to police chokeholds. A chokehold ban will help move this country further toward the elimination of racially-motivated police violence and the longstanding tensions/distrust between minority communities and the police.

George Floyd's murder was egregious but not unique. Many police agencies hold the position that they don't train officers to use chokeholds, but they are continuously used by officers to regain compliance. In fact, when a New York City police officer applied a chokehold that ultimately killed Eric Garner in 2014, they had already been banned some 21 years earlier. In Minneapolis, it is estimated that between 2015 and 2020, some form of a neck restraint was administered 237 times by police officers, with almost 20% of them resulting in unconsciousness.

The Justice Act, put forth by Senator Tim Scott, seeks to discourage chokeholds by way of withholding federal funds to those departments that continue their use or refuse to provide accurate data on their department's use. The George Floyd Justice in Policing Act, passed by the U.S. House, sets federal standards that prohibit the use of deadly force --including chokeholds -- by federal officers except as a last resort to prevent imminent and serious bodily injury following de-escalation techniques. If passed, officers who use chokeholds will be subject to prosecution under federal statute.

The brief concludes with comprehensive recommendations for key stakeholders, at all levels, to consider in the advancement of police reform in their respective jurisdictions.

Find out more here: Reimagination of Policing Action Brief: Banning Chokeholds

Director Dr. Howard Henderson and other criminal justice reform experts at Texas Southern University's Center for Justice Research are available to discuss how they can advise on evidence-supported, police reform policies and practices on the local, state and national levels - concrete steps that law enforcement can take to bridge the racial divide. They can be reached at justice.research@tsu.edu or 713-313-6843.

COLUMBUS, Ohio - After a major corporate fraud case hits a city, financially motivated neighborhood crimes like robbery and theft increase in the area, a new study suggests.

Researchers from The Ohio State University and Indiana University found that the revelation of corporate accounting misconduct is linked to about a 2.3 percent increase in local financially motivated crimes in the following year.

Corporate fraud had the strongest effect on local crimes in smaller cities with fewer job opportunities and higher income inequality.

The researchers confirmed the finding using several different methods and showed the link applied only to financial crimes and not violent offenses like murder or rape.

"Our results suggest that big corporate fraud scandals can have community implications well beyond the firm itself," said Eric Holzman, co-author of the study and assistant professor of accounting at Ohio State's Fisher College of Business.

"The effect is strongest in smaller cities where the economic impact of the fraud is most severe."

Holzman conducted the study with Brian Miller and Brian Williams at Indiana University. It was published yesterday (Nov. 14, 2020) in the journal Contemporary Accounting Research.

The researchers analyzed FBI data on 255 cases of corporate accounting misconduct between 1996 and 2013. They then examined crime rates in the cities where the firms were headquartered.

The 2.3 percent increase in financially motivated crimes was found even after accounting for a variety of other factors, including local unemployment rates at the time of the fraud, poverty rates, and crime rates before the accounting fraud was revealed. The link between the accounting fraud and local crime lasted about three years before it faded.

The findings were strongest when the fraud was associated with a larger drop in the company's stock price and when it received more media attention.

Several of the results suggest crime increased the most in cities where the fraud had the biggest economic impact on the community.

For example, larger impacts occurred when the corporation had to lay off a higher number of employees, when it occurred in smaller cities with fewer job opportunities, and where there were larger income gaps between the rich and poor.

These results didn't surprise Holzman, who spent nine years as a forensic accountant in Washington, D.C., investigating corporate fraud cases.

"I would go to some of these smaller towns and you could see the economic devastation that happened when the big local employer got involved in accounting misconduct and had to close or lay off a lot of employees," he said.

The researchers did several other analyses to confirm their findings. In one, they matched 88 of the cities where fraud occurred to similar cities where there was no corporate malfeasance. They found no similar increases in financially motivated crimes in the cities that had not experienced fraud.

In another analysis, they looked at what would happen if they imagined corporate fraud scandals happening at random times in random cities. Would they still find many cities experiencing increases in financially related crimes the following year?

After running this scenario 10,000 times, they found increases in crime similar to their real findings only 1.7 percent of the time - suggesting their results were unlikely to be random chance.

While the findings are intriguing, Holzman cautioned against drawing too firm a conclusion about why this is happening.

"It doesn't necessarily mean that people who lose their jobs are turning to a life of crime, or that they see this fraud and think it is now OK to steal. It may be something else, like an increase in teen delinquency due to added stress at home linked to the adverse economic conditions brought by the fraud," he said.

"We found a strong association in our study using multiple research designs, but we need different kinds of studies to determine a causal mechanism."

Theories on how the Milky Way formed are set to be rewritten following discoveries about the behaviour of some of its oldest stars.

An investigation into the orbits of the Galaxy's metal-poor stars - assumed to be among the most ancient in existence - has found that some of them travel in previously unpredicted patterns.

"Metal-poor stars - containing less than one-thousandth the amount of iron found in the Sun - are some of the rarest objects in the galaxy," said Professor Gary Da Costa from Australia's ARC Centre of Excellence in All Sky Astrophysics in 3 Dimensions (ASTRO 3D) and the Australian National University.

"We've studied 475 of them and found that about 11 per cent orbit in the almost flat plane that is the Milky Way's disc.

"They follow an almost circular path - very much like the Sun. That was unexpected, so astronomers are going to have to rethink some of our basic ideas."

Previous studies had shown that metal-poor stars were almost exclusively confined to the Galaxy's halo and bulge, but this study revealed a significant number orbiting the disk itself.

The Sun also orbits within the disk, which is why it manifests as the comparatively thin, ribbon-like structure easily visible from Earth in the night sky. In effect, we are seeing it edge-on.

"In the last year our view of the Milky Way has dramatically changed," said lead author Giacomo Cordoni from the University of Padova in Italy, who performed the bulk of the study while on a recent study placement at the ANU, funded by the European Research Council's GALFOR Project.

"This discovery is not consistent with the previous Galaxy formation scenario and adds a new piece to the puzzle that is the Milky Way. Their orbits are very much like that of the Sun, even though they contain just a tiny fraction of its iron. Understanding why they move in the way that they do will likely prompt a significant reassessment of how the Milky Way developed over many billions of years."

The ancient stars were identified using three very high-tech pieces of kit: ANU's SkyMapper and 2.3-metre telescopes, and the European Space Agency's Gaia satellite.

The low metal content was identified by the telescopes, and the satellite was then used to determine their orbits.

The results - crunched by researchers from Australia, Italy, Sweden, the United States and Germany - found that the orbits of ancient stars fell into a number of different patterns, all but one of which matched previous predictions and observations.

As expected, many of the stars had largely spherical orbits, clustering around the Galaxy's "stellar halo" - a structure thought to be at least 10 billion years old.

Others had uneven and "wobbly" paths assumed to be the result of two cataclysmic collisions with smaller galaxies that occurred in the distant past - creating structures known as the Gaia Sausage and the Gaia Sequoia.

Some stars were orbiting retrograde - effectively going the wrong way around the Galaxy - and a few, about five per cent, appeared to be in the process of leaving the Milky Way altogether.

And then there were the remaining 50 or so, with orbits that aligned with the Galaxy's disk.

"I think this work is full of important and new results, but if I had to choose one that would be the discovery of this population of extremely metal-poor disk stars," said Cordoni.

"Future scenarios for the formation of our Galaxy will have to account for this finding - which will change our ideas quite dramatically."

Cordoni's team included scientists from Italy's Centre of Studies and Activities for Space, the Max Planck Institutes for Astrophysics and Astronomy in Germany, the Massachusetts Institute of Technology in the US, Sweden's Uppsala and Stockholm universities, and Australia's Monash University, University of New South Wales and ANU.

The team included Australia's Brian Schmidt, winner of the 2011 Nobel Prize in Physics.

An advance version of the study is now available in the Monthly Notices of the Royal Astronomical Society.

ROCHESTER, Minn. -- In a retrospective case study, Mayo Clinic researchers have found that antibiotics administered to children younger than 2 are associated with several ongoing illnesses or conditions, ranging from allergies to obesity. The findings appear in Mayo Clinic Proceedings.

Using health record data from the Rochester Epidemiology Project, a population-based research collaboration in Minnesota and Wisconsin, researchers analyzed data from over 14,500 children. About 70% of the children had received at least one treatment with antibiotics for illness before age 2. Children receiving multiple antibiotic treatments were more likely to have multiple illnesses or conditions later in childhood.

Types and frequency of illness varied depending on age, type of medication, dose and number of doses. There also were some differences between boys and girls. Conditions associated with early use of antibiotics included asthma, allergic rhinitis, weight issues and obesity, food allergies, attention deficit hyperactivity disorder, celiac disease, and atopic dermatitis. The authors speculate that even though antibiotics may only transiently affect the microbiome, the collection of microbes in the body, this may have long-term health consequences.

"We want to emphasize that this study shows association ? not causation ? of these conditions," says Nathan LeBrasseur, Ph.D., a researcher at Mayo Clinic's Robert and Arlene Kogod Center on Aging and the study's senior author. "These findings offer the opportunity to target future research to determine more reliable and safer approaches to timing, dosing and types of antibiotics for children in this age group."

While recent data show an increase in some of the childhood conditions involved in the study, experts are not sure why. Other than the issue of multidrug resistance, antibiotics have been presumed safe by most pediatricians.

Researchers also say the ultimate goal is to provide practical guidelines for physicians on the safest way to use antibiotics early in life.

A team of researchers at the Medical University of South Carolina (MUSC) has found that the molecule lysyl oxidase (LOX) plays a number of important roles in promoting skin and organ fibrosis in scleroderma, a connective tissue disorder. The researchers have also shown that LOX can be useful in assessing how well an antifibrotic treatment works, suggesting that it may have potential as a biomarker of fibrosis progression or regression.

The team was led by noted fibrosis researcher Carol Feghali-Bostwick, Ph.D., the SmartState and Kitty Trask Holt Endowed Chair for Scleroderma and professor in the Department of Medicine at MUSC, and graduate student Xinh Xinh Nguyen. They report their findings in an article published online ahead of print in the American Journal of Physiology Lung Cellular and Molecular Physiology.

Scleroderma is a connective tissue disease that causes fibrosis, or thickening, of organs such as the lungs, kidneys and heart, along with the skin. In fibrosis, excess connective tissue progressively accumulates around the cells in organs, causing them to lose function and eventually fail. Historically, the only treatment available to these patients has been lung transplantation, which is very invasive and does not stop fibrosis from progressing in other organs. Recently, the Food and Drug Administration approved two new drugs for lung fibrosis, but their usefulness is limited in patients with scleroderma.

"These drugs merely slow the progression of the disease," said Feghali-Bostwick. "They don't stop it. They don't reverse it. New drug targets are urgently needed."

In the study, Feghali-Bostwick and Nguyen assessed whether LOX might be such a target. They were able to show that LOX plays multiple roles, known as "moonlighting," in the development and progression of fibrosis in scleroderma. They did so using a preclinical model of lung fibrosis, cells derived from lung and skin tissue samples of patients with scleroderma, and human lung and skin tissue cores. These cores more realistically mimic the physiologic conditions of living human tissue than just growing cells in a petri dish.

Their findings are important because previous research had only shown that LOX increases fibrosis by crosslinking connective tissue. The MUSC team demonstrated that LOX plays additional roles in the progression of fibrosis by stimulating excess production of connective tissue and increasing interleukin 6 (IL-6), an inflammatory molecule.

The research team showed that LOX expression increased 2.8-fold at 10 days following the initiation of lung fibrosis in the preclinical model. The research team also showed that LOX levels and activity were diminished in the lung fibrosis model, almost to baseline levels observed in the control, after administration of an antifibrotic peptide (E4) that is soon to enter a phase 1 clinical trial. These findings suggest that measuring LOX activity in the blood could be a promising biomarker for monitoring treatment response in patients with scleroderma and other fibrotic diseases.

"LOX has a direct role in fibrosis, and measuring circulating LOX levels is useful in monitoring the response to antifibrotic therapies," said Nguyen, who is a TL1 translational research trainee. The TL1 translational research training program, of which Feghali-Bostwick is the associate director, is funded by the South Carolina Clinical & Translational Research Institute.

Feghali-Bostwick reiterated how important such a biomarker of fibrosis would be.

"It's exciting that LOX is a biomarker that goes up when we induce lung fibrosis in the mice and goes down when we improve the fibrosis," she said. "Having a good biomarker of fibrosis would be invaluable because it would allow us to monitor the response to therapy in patients."

The MUSC team is currently investigating how the E4 peptide reduces fibrosis, not just in the skin and lungs but in other organs as well. Fibrosis is the end-stage of many fibroproliferative diseases that result in organ damage. These include cirrhosis, macular degeneration and cardiovascular disease. If the E4 peptide proves effective at reducing fibrosis in organs beyond the lungs and the skin, it could have potential as an antifibrotic therapy in those patients as well.

This research project was launched by Tetsuya Nishimoto, Ph.D., a postdoctoral fellow in the Feghali-Bostwick laboratory who, in 2016, passed away unexpectedly. Thanks to Nguyen's efforts, the Feghali-Bostwick laboratory was able to see his project to the end.

A metabolic engineering research group at KAIST has developed an engineered Corynebacterium glutamicum strain capable of producing high-level glutaric acid without byproducts from glucose. This new strategy will be useful for developing engineered microorganisms for the bio-based production of value-added chemicals.

Glutaric acid, also known as pentanedioic acid, is a carboxylic acid that is widely used for various applications including the production of polyesters, polyamides, polyurethanes, glutaric anhydride, 1,5-pentanediol, and 5-hydroxyvaleric acid. Glutaric acid has been produced using various petroleum-based chemical methods, relying on non-renewable and toxic starting materials. Thus, various approaches have been taken to biologically produce glutaric acid from renewable resources. Previously, the development of the first glutaric acid producing Escherichia coli by introducing Pseudomonas putida genes was reported by a research group from KAIST, but the titer was low. Glutaric acid production by metabolically engineered Corynebacterium glutamicum has also been reported in several studies, but further improvements in glutaric acid production seemed possible since C. glutamicum has the capability of producing more than 130 g/L of L-lysine.

A research group comprised of Taehee Han, Gi Bae Kim, and Distinguished Professor Sang Yup Lee of the Department of Chemical and Biomolecular Engineering addressed this issue. Their research paper "Glutaric acid production by systems metabolic engineering of an L-lysine-overproducing Corynebacterium glutamicum" was published online in PNAS on November 16, 2020.

This research reports the development of a metabolically engineered C. glutamicum strain capable of efficiently producing glutaric acid, starting from an L-lysine overproducer. The following novel strategies and approaches to achieve high-level glutaric acid production were employed. First, metabolic pathways in C. glutamicum were reconstituted for glutaric acid production by introducing P. putida genes. Then, multi-omics analyses including genome, transcriptome, and fluxome were conducted to understand the phenotype of the L-lysine overproducer strain. In addition to systematic understanding of the host strain, gene manipulation targets were predicted by omics analyses and applied for engineering C. glutamicum, which resulted in the development of an engineered strain capable of efficiently producing glutaric acid. Furthermore, the new glutaric acid exporter was discovered for the first time, which was used to further increase glutaric acid production through enhancing product excretion. Last but not least, culture conditions were optimized for high-level glutaric acid production. As a result, the final engineered strain was able to produce 105.3 g/L glutaric acid, the highest titer ever reported, in 69 hours by fed-batch fermentation.

Professor Sang Yup Lee said, "It is meaningful that we were able to develop a highly efficient glutaric acid producer capable of producing glutaric acid at the world's highest titer without any byproducts from renewable carbon sources. This will further accelerate the bio-based production of valuable chemicals in pharmaceutical/medical/chemical industries."