Culture

When the riders set off to climb Mount Etna on the 3rd stage of Giro d'Italia today, they have definitely eaten large amounts of carbohydrates in the form of pasta, rice or potatoes during the past few days. It is well known that large amounts of carbohydrates in the diet lead to increased storage of sugar molecules inside the muscle cells called glycogen, which enables our muscles to work at a very high intensity for a long period of time.

A new Danish study from the Department of Sports Science and Clinical Biomechanics at the University of Southern Denmark recently showed, that if athletes can place their glycogen close to the structures that produce the force in the muscle cells, they can cycle for a longer time, than if their glycogen is placed elsewhere in the muscle cells.

Placement is more important than amount

In other words, the research results suggest that it is more important where the sugar is stored than how much there is:

"The better you are at placing the energy source, meaning the sugar, as close to the place of consumption as possible, the more endurance you have", explains PhD student Rasmus Jensen.

Since the sugar is stored in very small molecules called glycogen, the researchers had to use a powerful electron microscope, which makes it possible to examine the tiniest structures of only a few nanometres (one-millionth of a millimetre). In order to make these observations representative of the whole body, many muscle cells must be examined, and therefore the research team has spent more than 2,000 hours on the microscopy work in order to complete the study.

In the footsteps of August Krogh

In this way, researchers now take another step in a 100-year process of understanding the importance of carbohydrates for our endurance on the bike. At that time, Danish Nobel Prize winner August Krogh made a number of experiments with both a high-fat and a carbohydrate-rich diet in relation to cycling. Due to his world-renowned ability to build research equipment with unprecedented precision, he discovered that not only carbohydrate but also fat could be used as fuel in the muscles.

August Krogh often used himself as a trial subject and therefore also made another important finding, namely that many days on a high-fat diet caused significant tiredness during cycling at a high intensity. This was the start of a long period of intensive research into the muscles' choice of fuel between fat and carbohydrate, and a number of studies have now shown that a diet high in carbohydrates increases the glycogen content of the muscles, which can be burned faster than fat, allowing muscles to work harder and for a longer period of time.

Will examine how diet changes can optimize placement of glycogen

With the new study, we now know that it is also crucial for your endurance where the glycogen is placed within the muscle cells. It is still too early to make specific recommendations to riders and other athletes on how to place their glycogen in the best possible way.

"The potential of this finding is that the riders of the Giro d'Italia and other endurance athletes of the future will not only eat a lot of carbohydrates but also make sure to 'place' the glycogen molecules of their muscles at the best locations", says Rasmus Jensen.

The researchers have now initiated a number of experiments, some in collaboration with the government-funded initiative Team Denmark, where they will investigate how different forms of exercise combined with diet changes can optimise the placement of glycogen in the muscles and thus improve performance during prolonged hard work such as road cycling. In addition, the researchers have initiated laboratory experiments in an effort to understand why the placement of glycogen is important for the muscles' ability to work hard for a long time.

ST. LOUIS, MO -- For years, Elizabeth (Toby) Kellogg, PhD, member and Robert E. King Distinguished Investigator and other researchers at the Donald Danforth Plant Science Center (Danforth Center) drove up and down the highways of the continental United States, occasionally pulling over to the side of the road to collect small weedy plants and bring them back to the lab. The weedy grass was green millet (Setaria viridis), a small model grass with a short lifecycle that uses a carbon fixation process known as the C4 pathway, which particularly helps plants thrive in warm, arid environments. Corn and sugarcane are among the major high-yield C4 crops, as are the candidate biofuel feedstocks Miscanthus and switchgrass.

Innumerable road trips and hundreds of plants have resulted in a paper, "A genome resource for green millet Setaria viridis enables discovery of agronomically valuable loci," in Nature Biotechnology. Kellogg and her colleagues, along with researchers at the HudsonAlpha Institute for Biotechnology and the U.S. Department of Energy (DOE) Joint Genome Institute (JGI), a DOE Office of Science User Facility located at Lawrence Berkeley National Laboratory (Berkeley Lab), generated genome sequences for nearly 600 green millet plants and released a very high quality reference S. viridis genome sequence. Analysis of these plant genome sequences also led researchers to identify a gene related to seed dispersal in wild populations for the first time.

"To our knowledge, nobody has ever discovered a dispersal gene that way," said Kellogg, a senior author of the paper. "This paper is the first one to survey a huge amount of natural diversity and say, 'Yeah, there are genes out there that affect this phenotype.'"

Results from A "Massive Amount" of Sequencing

Seed dispersal is critical for plants in the wild, but it is an undesirable trait for domesticated crops because it leads to reduced harvest yields. Over thousands of years, farmers have selected for cereal plants without this shattering trait - referring to the moment when the cluster of seeds at the tip of each branch breaks apart so the seeds can disperse - so that the seeds remain atop the plant to be collected.

Association mapping led the team to identify a gene called Less Shattering 1 (SvLes1); gene editing studies led by co-first author Pu Huang confirmed that it was involved in shattering by turning it off. "It's a new shattering gene variant identified in a natural population. Not very many of these shattering genes have been discovered that let a plant go all the way to seed but prevent the seeds from falling," said JGI Plant Program head Jeremy Schmutz, who is also a HudsonAlpha Faculty Investigator. "This could be another mechanism to turn off shattering and domesticate crops." How shattering occurs varies widely between crops, Kellogg added, and shattering genes may be specific to species or groups of species.

The genome data also revealed that green millet was introduced into the United States multiple times from Eurasia. The team also identified a gene associated with leaf angle, which determines how much sunlight leaves can get and in turn serves as a predictor of yield. The gene is an ortholog of known genes, "The gene has now been mapped back in maize as involved in leaf angle," noted Schmutz. "It's a nice example of de novo discovery and then mapping back to identify candidate genes."

Through JGI's Community Science Program, sequences of several hundred green millet plant genomes were generated, though the final analyses focused on 598 individuals. Schmutz and his team assembled and annotated the genomes at HudsonAlpha. Sujan Mamidi and Adam Healey, two of the co-first authors, led the data analyses and assembled the green millet "pan-genome" (a set of 51,000 genes that represent all the genes that are present in a given species).

"This is a great example of developing a large-scale genome infrastructure with a reasonably accessible system," said Schmutz. "Building the pan-genome and accessions allow us to see presence/absence variation easily and to find genes missing in particular accessions, and to confirm phenotypes, which validate traits."

"The number of lines sequenced is not trivial, and they were all assembled de novo, which let the team look at presence/absence of whole genes," Kellogg agreed. "Getting that information is hard. There's a good reason nobody's done it; it's a heck of a lot of work. I wouldn't have done it without the contribution of Jeremy's group. It's just a massive amount of sequencing."

A Resource for Many Applications

Kellogg noted that C4 crops have gotten a lot of interest because they're very productive even in high heat while C3 crops have become less efficient at photosynthesis, a concern as extreme weather events become more frequent. "A big part of the Danforth Center's mission is to feed the hungry and improve human health. So there's a major question: how to turn a C3 crop into a C4 crop. There should be a master regulator but no one has found it," Kellogg mused. "[The S. viridis genome] is a resource for many different applications. The JGI group has been wonderful to collaborate with, and this [project] wouldn't have been possible without their involvement; it's something we wouldn't have even started."

The reference genome of Setaria viridis is available on JGI's plant portal Phytozome.

Children appear to be at greater risk of having high blood pressure when their mothers had the high blood pressure condition called preeclampsia during pregnancy--but this adverse association may be reduced or even eliminated for children who were exposed to higher levels of vitamin D in the womb, according to a study from researchers at Johns Hopkins Bloomberg School of Public Health.

The findings, based on an analysis of data on 754 mother-child pairs in Massachusetts, suggest that higher vitamin D levels in pregnancy may help protect children born to preeclamptic women from developing high blood pressure. High blood pressure in childhood is associated in turn with hypertension and heart disease in adulthood.

The study was published online October 5 in JAMA Network Open.

"There is increasing evidence that cardiovascular disease risk is, to a great extent, programmed in the womb, and we now see that it may be vitamin D that alters this programming in a beneficial fashion," says study senior author Noel Mueller, PhD, an assistant professor in the Department of Epidemiology at the Bloomberg School.

Preeclampsia, which can lead to strokes and/or organ failure, is a major cause of illness and death for pregnant women, and also is associated with a greater risk of stillbirth and preterm birth. Researchers have estimated that preeclampsia occurs in 2-8 percent of pregnancies worldwide. It is associated with maternal obesity, and the rate of severe preeclampsia in the U.S. has risen sharply since the 1980s.

At the same time, the rate of high blood pressure among children in the U.S. has risen by about 40 percent between 1988 and 2008. Studies have suggested that maternal preeclampsia may be a factor in that increase.

Studies also have linked maternal vitamin D deficiency to a higher risk of preeclampsia, and have suggested that lower levels of vitamin D in adulthood or even early in life bring a greater risk of hypertension.

"We wanted to know if vitamin D levels in the womb would modify this association between maternal preeclampsia and hypertension in childhood," says study first author Mingyu Zhang, a PhD candidate in Mueller's research group.

To investigate this question, the team analyzed data that had been gathered on 754 mother-child pairs from 1998 to 2018 in a large epidemiological study conducted at the Boston Medical Center in Massachusetts. The dataset included information on preeclampsia during pregnancy, tests on blood from the umbilical cord at birth, and the children's blood pressure from age 3 to 18.

About 62 percent of the mothers in the study group were Black, and 52 percent were overweight or obese. Previous studies suggest that mothers who were Black or overweight or obese were at higher risk for preeclampsia. Darker-skinned people living in higher latitudes also are more likely to be deficient in vitamin D--a cholesterol-derived molecule that is present in some foods but also is synthesized in skin with the help of ultraviolet light.

Roughly ten percent of the women in the study group had preeclampsia, and the analysis revealed that their children on average had higher systolic blood pressure than the children born to non-preeclamptic mothers--about 5 percentile points higher, when all the blood pressure readings were arranged on a 0 to 100 percentile scale.

Cord-blood vitamin D levels clearly modified these associations, and in a dose-related manner. Children in the lowest 25 percent range of vitamin D levels (lowest "quartile") were about 11 percentile points higher in blood pressure, on average, if their mothers had had preeclampsia, compared to children of non-preeclamptic mothers.

For children in the highest vitamin D quartile, there appeared to be no difference in average blood pressure if their mothers had had preeclampsia--in other words, the results suggest that having relatively high vitamin D levels at birth, which could be achieved through dietary supplements, may completely mitigate the risk brought by preeclampsia.

"If other epidemiological studies confirm these findings, then randomized trials would be needed to determine conclusively if higher vitamin D in mothers at risk of preeclampsia protects against childhood high blood pressure," Mueller says.

When exploring data on Washington workers during the pandemic -- demographics, working conditions, wages and benefits, and risks of exposure to disease -- the authors of a new report found that women hold two-thirds of the jobs in the harshest category of work.

"The big takeaway from our research," said David West, a co-author of the report and an analyst at the Washington Labor Education and Research Center, "is how particularly women are working under precarious conditions -- a large number of women are both facing safety risks at high-hazard jobs and are economically at risk."

The report, authored by researchers from the labor center at South Seattle College's Georgetown campus and the University of Washington's School of Public Health, initially set out to understand the risks faced by workers in jobs deemed essential by Gov. Jay Inslee as the pandemic took hold in Washington, asking people to remain in their homes and closing many businesses.

But as the state began its phased reopening, nonessential workers started returning to the workplace, and the researchers found that many of those workers also faced a high risk of exposure to disease and economic stress.

In the end, the researchers identified 55 of the 694 occupations on which they had data as both precarious -- facing economic and health care stress -- and high risk of exposure to the coronavirus. Out of a total Washington workforce of 3.3 million workers, some 900,000 fill positions in these 55 occupations. These workers, 70% in essential jobs, were not only mostly female, but also disproportionately workers of color.

"There are a lot of workers in Washington who are at increased risk for exposure to COVID-19 and still going to work. And those workers tend to also be workers who have a lack of workplace protections and are either women or workers of color," said Marissa Baker, co-author of the labor report and an assistant professor in the UW Department of Environmental & Occupational Health Sciences.

"So, we really need to ensure that there are targeted policies or regulations to help these workers, especially since we now know who they are and what occupations and industries they fall into," Baker said.

In order to determine which occupations were at higher risk of exposure to COVID-19 and to make specific recommendations related to workplace safety, the researchers looked at the importance of these "key dimensions" of a job:

Physical proximity to others

Dealings with external customers

Face-to-face discussions

Contact with others

Exposure to disease/infections

Work with a team or group

Dealings with physically aggressive people

Assisting/caring for others

Performing for/working directly with the public

Use of common or specialized safety equipment (gloves, masks, hazmat suits)

The authors list in their report a series of policies designed to address these health risks as well as the economic challenges they recommend policymakers and business leaders adopt.

Here are their key recommendations:

Airborne transmissible disease (ATD) standard: Washington should follow the lead of states such as California that have enacted ATD standards for their workplaces, instead of relying on voluntary guidance.

Workplace coronavirus disclosure, testing and tracking: Support comprehensive notification of positive workplace COVID tests, workplace testing, and prioritize workplace follow-up tracking.

Safety committees: Promote and widely enforce the Washington state requirement that workplaces with more than 11 employees have safety committees in order to involve workers in identifying and preventing COVID risk factors.

Economic security: Ensure that all Washington at-risk/precarious workers have affordable access to health insurance, hazard pay, paid leave for quarantine periods, and affordable child care to reduce stress and ensure prompt care.

"Even though this has been a devastating time for the American workforce," Baker said, "we can harness this moment and make big structural changes that can forever improve the relationship between work and health."

RIVERSIDE, Calif. -- A postdoctoral researcher at the University of California, Riverside, has discovered human papillomavirus, or HPV, vaccination mandates fall short of ensuring both higher levels of uptake and equal uptake of the vaccine across socioeconomic and racial-ethnic groups.

The findings could help facilitate equal access to and compliance with uptake of COVID-19 vaccines, once they are available.

"For the first time in history we have a safe and effective vaccine with the potential to eliminate cervical cancer -- yet uptake remains well below national targets," said researcher Andrea Polonijo, a Chancellor's Postdoctoral Fellow in the Department of Social Medicine, Population, & Public Health at the School of Medicine and the research paper's sole author.

Policies that merely aim to increase knowledge or standardize the age of uptake are not enough to facilitate equal or widespread uptake, she explained.

"Without widespread public support, surveillance, sanctions for noncompliance, incentives for uptake, or efforts to improve access, flu and COVID-19 vaccine requirements are unlikely to be successful. It will be interesting to see if the University of California's 2020-21 flu vaccine order improves uptake, given unvaccinated students, faculty, and staff are still able to work remotely without a flu vaccine."

Published in SSM - Population Health, the study found HPV vaccination mandates help reduce some differences in provider recommendations and initiation of the vaccine series. Polonijo found receiving a recommendation from a health provider greatly increased the odds that teens got their first HPV shot.

"Non-Hispanic whites and higher socioeconomic status girls tend to receive physician recommendations more often than their racial-ethnic minority and lower socioeconomic status peers," she said. "My findings suggest school-entry HPV vaccination mandates helped equalize recommendations -- likely by providing the motivation for providers to consistently recommend HPV vaccines as part of routine care."

Polonijo used 2008-09 and 2011-13 data from the National Immunization Survey-Teen, a nationally representative cross-sectional survey that identifies adolescent vaccination coverage. She was surprised to find mandates did not improve rates of HPV vaccine series completion or lead to more equal vaccine series completion across racial-ethnic and socioeconomic groups.

"HPV vaccine mandates were accompanied by pharmaceutical manufacturer lobbying, political debate, and controversial news coverage, which made them unpopular among parents who may have questioned whether compliance was in their daughter's best interest and opted them out," she said. "Mandates also did not make it any easier for teens to access HPV vaccines and there was no widely used surveillance or reminder system in place to recall teens who were due for shots."

According to Polonijo, one reason HPV vaccine mandates were unpopular is that HPV is a sexually transmitted infection that cannot be transmitted through casual contact.

"Given that flu and COVID-19 are more easily spread, people might be more willing to be vaccinated against these respiratory illnesses," she said. "Earning public trust and ensuring universal provider recommendations and easy access are crucial for the success of flu or COVID-19 vaccination programs, which need to target all individuals, regardless of socioeconomic status, race-ethnicity, gender, or life stage."

NASA's Terra satellite obtained visible imagery of Tropical Storm Chan-hom as it continued moving though the Northwestern Pacific Ocean. The imagery revealed that the center of circulation was exposed and its strongest storms were south of the center.

Tropical Depression 16W formed on Oct. 4 and strengthened into a tropical storm on Oct 5. Once it reached tropical storm strength, it was re-named Chan-hom. Laos submitted the name Chan-hom to the World Meteorological Organization list. The name is a type of tree in Laos.

NASA Satellite View: Chan-hom's Organization

The Moderate Resolution Imaging Spectroradiometer or MODIS instrument that flies aboard NASA's Terra satellite captured a visible image of Tropical Storm Chan-hom on Oct. 5 that showed a couple of things were occurring in the storm. First, bands of thunderstorms were wrapping into a partially exposed low-level circulation center. Second, there was building convection and thunderstorms occurring over the southern quadrant of the storm, giving it an appearance of a backwards letter "C" on satellite imagery. The storm is expected to strengthen over the next three days and when it does, it will likely develop a more circular shape.

The satellite imagery was created using NASA's Worldview product at NASA's Goddard Space Flight Center in Greenbelt, Md.

Chan-hom's Status on Oct. 5

At 11 a.m. EDT (1500 UTC) on Oct. 5, Chan-hom was centered near latitude 23.0 degrees north and longitude 139.2 degrees east. That is about 738 miles south of Yokosuka, Japan. Chan-hom is moving north and has maximum sustained winds of 35 knots (40 mph/64 kph).

Chan-hom's Forecast

The Joint Typhoon Warning Center noted, "Chan-hom is forecast to track generally northwestward along the southwestern periphery of a sub-tropical ridge (elongated area of high pressure) over the next three days. During this time, the system will steadily intensify to a peak intensity of 85 knots (98 mph/157 kph) by three days largely due to the continued low vertical wind shear and warm sea surface temperatures."

Closed-canopy rainforests are a vital part of the Earth's modern ecosystems, but tropical plants don't preserve well in the fossil record so it is difficult to tell how long these habitats have existed and where rainforests might have once grown. Instead, scientists look to the diets of extinct animals, which lock evidence of the vegetation they ate into their teeth. A new study led by scientists at the American Museum of Natural History finds that the paradigm used to identify closed-canopy rainforests through dietary signatures needs to be reassessed. The findings are published this week in the journal Proceedings of the National Academy of Sciences.

"The Amazon is the world's most diverse rainforest, home to one in 10 known species on Earth," said Julia Tejada-Lara, who led the study as a graduate student at the Museum and Columbia University. "Closed-canopy rainforests have been proposed to occur in this area since at least the Eocene, some 50 million years ago, but we know very little about their extent and evolution through time."

To reconstruct ancient ecosystems, including rainforests, researchers often use stable carbon isotope (δ13C) analyses on extinct and living herbivores. Stable carbon isotopes, which form in specific proportions inside plants, are preserved in the body tissues of the animals that eat those plants. Samples from the animal's bones, teeth, toenails, or other biological material can help scientists determine the kinds of plants that were consumed.

In the new study, Tejada and her colleagues analyzed specimens from the American Museum of Natural History and the Museum of Natural History in Lima representing 45 modern herbivores and 12 species of "secondary consumers" (meat-, insect-, and fish-eaters) that live in western Amazonia. The authors then compared their results with a landmark analysis of modern mammals in equatorial Africa, a generally accepted proxy used to identify past closed-canopy rainforests on all continents. The researchers also determined nitrogen isotope values from 35 Amazonian mammal species, finding greater than expected complexity in how nitrogen from macromolecules (carbohydrates, proteins, and fats [lipids]) is incorporated into body tissues in animals from different levels of the food chain.

"Up to this point, there had only been one other broad isotopic sampling--and inferences of food sources--of a tropical closed-canopy rainforest mammal community, and that was in central Africa," said co-author John Flynn, Frick Curator of Fossil Mammals in the Museum's Division of Paleontology. "So we knew that if we wanted to learn more about both modern and ancient Amazon ecosystems, we had to test whether we should expect the tropical forest conditions to be roughly the same in these two continents that separated more than 90 million years ago and have a 1,600-mile-wide ocean between them today."

The comparison reveals that Amazonian and African closed-canopy rainforests have a very similar mean dietary carbon isotopic value, and it may be representative of mammalian herbivores in any closed-canopy rainforest. Beyond this newly discovered way of recognizing ancient rainforests, Amazonian mammals in this study lacked highly negative dietary values found in a few of the African animals. These negative values are often used outright to infer closed-canopy rainforests in fossil records.

"We have found that these negative isotopic values can no longer be used as an indispensable indicator of a rainforest," Tejada said. "And further, that many of the longtime assumptions about ecological niches, feeding habits, and isotopic signatures characterizing tropical communities likely need to be reassessed."

Similarities among individuals living in the same communities can dramatically change their risk of dying by suicide, according to a new study by Indiana University researchers.

The study, published in the Proceedings of the National Academy of Sciences, examined the relationship between suicide and social "sameness" -- living in communities with other individuals who share common social characteristics, such as employment and marital status, ethnicity or place of birth.
Researchers found that social similarity reduced well-known individual risks of suicide for those younger than 45, unemployed, widowed, white, Black or not born in the United States.

But sameness was not always protective. Social similarity increased suicide risk for individuals who were born in the United States, had never married, or were Alaska Native, Native American, Hispanic or Asian, according to the study.

"This study breaks a longstanding barrier to understanding the link between individual suicide risk and community-based risk," said Bernice Pescosolido, co-author of the study and a Distinguished Professor of Sociology in the College of Arts and Sciences at IU Bloomington. "This offers new insights into how complex the relationship between suicide and cultural and social connections is. Science has been challenged to get beyond the split between looking at individuals and looking at communities in the U.S. Sameness allows us to think about the role of connectedness in new ways."

Researchers merged data from a number of sources, including the National Violence Data Reporting System and the American Community Survey, to examine whether "sameness" between individuals and where they live affected their risk of suicide in the U.S. between 2005 and 2011.

Suicide in America has been on the rise, according to the U.S. Centers for Disease Control and Prevention, pressing the need for new approaches to reduce risk. While individual suicide risks have been previously documented in individuals, the finding that those risks change depending on social geography has previously been difficult to establish in the U.S., Pescosolido said.

"These findings challenge the idea of a 'one size fits all' approach to programs trying to reduce suicide -- even for targeted groups like teens, where the increase has been great," she said. "We need to consider where they are."

Traditional treatment and prevention efforts have focused around the idea that strong social ties protect people from suicide, and those who lose or do not have those connections are thought to be more at risk of suicide.

But according to Pescosolido and her colleagues, social similarity is not always a strong lever to reduce suicide risk. For example, their findings suggest that in isolated communities or those communities where socio-economic devastation has been great, similarity can actually increase the risks of suicide.

"With the burdens that people are experiencing due to the pandemic, this study reinforces calls for fresh approaches to understanding suicide risk," Pescosolido, said. "Knowing how social context alters individual suicide risk provides a path toward personalized and tailored strategies for anti-suicide programs, policies and treatment."

Black and Hispanic people and people with low incomes are more likely to live in areas at high risk of flooding from natural disasters than white and Asian people, according to a new study led by the University of Arizona.

The study also found that certain reforms to the federal government's widely used flood insurance program could be disproportionately burdensome to the same groups of people.

The findings come amid a record-breaking 2020 Atlantic hurricane season that has pummeled the southeastern United States. Hurricane Sally, which made landfall on Sept. 16, devastated parts of Alabama and Florida. Two days later, forecasters at the National Hurricane Center ran out of the 21 storm names, following the Latin alphabet, that it had decided on for this year. Scientists turned to the Greek alphabet, for only the second time ever, to name the following storms.

The study will be published in the November issue of the Journal of Environmental Economics and Management. Laura Bakkensen, an associate professor in the School of Government and Public Policy in the College of Social and Behavioral Sciences, was the paper's lead author. Bakkensen, an environmental economist, researches policy responses to natural disasters.

"We see a lot of news reports where sometimes poorer or minority-rich communities may feel greater losses," Bakkensen said. "Understanding whether that's happening and what might be driving that is really what got me interested in this."

A Database of Homebuyers' Choices

Bakkensen and her colleague Lala Ma at the University of Kentucky looked at four years of property sales data for nearly 50,000 homes in south Florida. The area has many properties prone to flooding, which made it a strong case study, Bakkensen said.

Bakkensen's study relied on individual property sales data linked with data on homebuyer ethnicity and income, providing a much more granular picture than many previous studies. This ultimately allowed researchers to get a clear idea of what factors played into homeowners' different choices about where to buy a house - or where not to buy a house.

"Flood risk house-by-house may be very different. My neighbor across the street from me might be at low risk but maybe I'm at a lower elevation and maybe I'm at high risk," Bakkensen said. "We wanted to be really careful to disentangle what is really flood risk versus a lot of other things that might correlate with flood risk in the data," such as proximity to the coastline, which is typically considered an amenity.

The key question from the data, Bakkensen said, became: How much would somebody be willing or able to pay to avoid living in a high flood-risk zone?

The answer was different depending on homebuyers' ethnicities, researchers found. The study reports that white and Asian people with low incomes would be willing or able to pay about $710 per year on average to avoid living in an area at high risk of flooding. Because Asian people accounted for only 2.5% of all the property sales data, they could not be separated as their own category. They were combined with white people because the two groups' average incomes were similar in the study's sample.

Among Black people, that number was around $500. Hispanic people, on average, were willing or able to pay an additional $618.

Predictably, the study found that the amounts homebuyers were willing or able to pay increased with their income levels.

The study notes that other factors beyond income - such as access to information about homes' flood risk - could explain why certain groups are able or willing to pay more than others to avoid flood risk. But determining that would require further research and additional data, Bakkensen said.

Reforming Flood Insurance Through Simulations

The study also sought to find ways to improve the National Flood Insurance Program, which has long been a target of reform by both political parties in Congress, Bakkensen said.

Under federal law, most lenders require flood insurance for homebuyers who are buying properties in areas at high risk for flooding. Due to a small market of private flood insurers, the federal program is the largest and most widely used, Bakkensen said.

But the seemingly competing missions at the core of the program - provide flood insurance and make it affordable for homebuyers - have made it difficult to fund, Bakkensen said. The program regularly borrows money from the Treasury Department to cover the cost of payouts.

Using the housing data and model results, Bakkensen and Ma ran simulations that predicted how certain proposals to reform the program could affect homebuyers. In one case, the researchers simulated removing two subsidy programs that make the insurance more affordable for homeowners.

They found the change would have disparately negative effects on homeowners of certain ethnicities. Removing the subsidies would cost white and Asian homeowners with low incomes only about 0.45% of their average annual incomes, compared to 0.55% of the average annual incomes for Black homeowners and 0.7% for Hispanic homeowners.

As homeowners' incomes increase, the cost of losing the subsidies took up less of their annual income, but the disparities for people of different ethnicities remain.

Another simulation took aim at the National Flood Insurance Program's flood risk maps, which are used by homeowners and officials to determine the flood risk of neighborhoods and homes in large sections of the U.S. But many of the maps are outdated, meaning the flood risk information in those maps is unreliable.

On average, Bakkensen and Ma found that updated maps provided significant value to homeowners, especially to lower income homeowners as a fraction of their income, and the researchers were able to translate those advantages into dollar figures. But the value fluctuated based on ethnicity: For white and Asian homeowners, revised maps provided an annual value of $144; that value was $70 for Hispanic homeowners and $60 for Black homeowners.

That finding alone has already raised eyebrows at the National Flood Insurance Program, Bakkensen said, where program staff have been trying to get an idea of the value of updating the maps.

The disproportionate costs of reforming the program to Black and Hispanic people and people with low incomes, Bakkensen said, were among the findings that surprised her the most. She had no pre-conceived notions, she added, about whether she would find disparities in reform outcomes.

"It was quite a striking finding, and I think it was an important one," Bakkensen said. "It shows that even with good-intentioned policy reform, we still have to be careful and do our due diligence to make sure there aren't unintended consequences that could cause harm to communities that may already experience a lot of harm from flooding and other natural disasters."

Bakkensen plans to expand her research to other areas of the country, as well as to renters, who were not included in this study. The new findings help illustrate just how differently certain groups of people experience natural disasters, she said.

"There's a lot of complexity to who's living in harm's way, and that's why we oftentimes see very different losses, or it can be an important contributing factor," Bakkensen added. "That's quite relevant for a lot of the hurricanes we're seeing this season."

Requirements for electronic health records are greater now than ever, and that burden is exacerbating the problem of physician burnout. However, there might be a solution: the medical scribe.

New research led by Neda Laiteerapong MD, Associate Professor of Medicine at the University Chicago Medicine, indicates the real value of adding this healthcare professional to a medical practice. It gives physicians more time to treat patients, add new ones, and schedule more return visits. This research also indicates that the initial cost of employing a medical scribe can be offset in a year or less, after which the possibility of increased profit follows.

"We did an economic evaluation, a pretty common technique for healthcare administrators," Laiteerapong said. "And we did it for a total of 30 specialties, plus physician assistants and nurse practitioners." The study was published October 6, 2020, in Annals of Internal Medicine.

The research assumed that every patient visit would be reimbursed by Medicare. Based on that, Laiteerapong and her team determined the number of additional visits needed to have 90% certainty of breaking even one year after hiring a scribe. However, most practices are made up of a combination of Medicare, Medicaid and privately insured patients, making it possible to reach that break-even point even sooner.

Studies show that physicians with scribes can increase their availability by as much as 20%, which is about the same amount of time that it takes to see the two or three additional patients.

"The idea that you have to see more patients can be really scary," Laiteerapong said. "But the idea is that you're actually spending that time more focused on the patient. A scribe allows doctors to focus on thinking and talking and listening, and not on the typing and clicking and ordering. I don't know anyone who became a doctor to do those things.

"We found that an average of 1.3 new patient visits per day was required to recover the cost of a scribe at the one-year point," Laiteerapong added. "And for returning patient visits, it's two or three patients per day."

The number of new patients or return visits needed to recoup costs varies depending on the type of specialty. It is lower for those who order a lot of lab testing and radiology (assuming the revenue from these tests are recovered by those physicians), and higher for others. A scribe makes that time more efficient and increases satisfaction for doctor and patient alike.

A 2018 University of Chicago study measured physician satisfaction with the scribe program in a primary care clinic. Participants reported greater satisfaction with clinic workflow when a scribe was present and that they no longer felt rushed.

The new study was completed before the new realities imposed on medical practices by COVID-19.

"Obviously, having an extra person in the room is not something that many physicians can do these days," Laiteerapong said. "But with modern technology, there can be a device in the room listening to the conversation and transmitting it electronically. So, a scribe working in another space can still have the notes 90% done when the physician leaves the room."

What it all comes down to, she said, is improved care, financial sustainability and outcomes.

"Scribes can help a practice add up to 20% more visits, which increases patient satisfaction," she said. "That is valuable to patients, who have increased access, and to providers who are able to do what they were trained to do, which is take care of patients, not paperwork."

"The Productivity Requirements of Implementing a Medical Scribe Program" was published October 6, 2020, in Annals of Internal Medicine. Additional authors are Tyler J. Miksanek, Sandra A. Ham, Wei Wei Lee and Valerie G. Press of the University of Chicago; Marie T. Brown of Rush University Medical Center; and M. Reza Skandari of Imperial College London. The study received funding from the University of Chicago Medicine Center for Healthcare Delivery Science and Innovation and the University of Chicago Bucksbaum Institute for Clinical Excellence.

Semiconductive photocatalysts that efficiently absorb solar energy could help reduce the energy required to drive a bioelectrochemical process that converts CO2 emissions into valuable chemicals, KAUST researchers have shown.

Recycling CO2 could simultaneously reduce carbon emissions into the atmosphere while generating useful chemicals and fuels, explains Bin Bian, a Ph.D. student in Pascal Saikaly's lab, who led the research. "Microbial electrosynthesis (MES), coupled with a renewable energy supply, could be one such technology," Bian says.

MES exploits the capacity of some microbes to take up CO2 and convert it into chemicals, such as acetate. In nature, chemolithoautotroph microbes metabolize minerals as a source of energy in a process that involves the shuttling of electrons. This capability can be exploited to turn CO2 into value-added products if the microbes are supplied with a stream of electrons and protons from anodic water splitting in an electrochemical cell (see image).

In their latest work, rather than focus on the CO2-to-acetate step, the team worked on reducing the energy input for molecular oxygen (O2) production at the anode, a reaction that keeps the overall cell in balance. "In MES systems, the process that consumes the most energy is believed to be the oxygen evolution reaction (OER)," Bian explains. Researchers have used light-capturing anode materials, such as titanium dioxide, that harness energy from sunlight to help drive the OER. In their current work, the team investigated a promising alternative for the photoanode, the light-harvesting material, bismuth vanadate.

Bismuth vanadate absorbed energy from a much broader range of the solar spectrum than titanium dioxide, making the whole MES cell more efficient, the team showed. "We obtained solar-to-acetate conversion efficiency of 1.65 percent, which is the highest reported so far," Saikaly says. "This efficiency is around eight times higher than the 0.2 percent efficiency of global natural photosynthesis, which is nature's solar-powered process for converting CO2 into energy-rich molecules," Bian notes.

So far the team has kept the microbe biocatalysts supplied with a steady stream of electrons and CO2 to sustain their growth. "The next step for us is to test our system under real sunlight and monitor the resilience of the biocatalysts under an intermittent renewable energy source," Saikaly says.

BOSTON - Across the U.S., the relaxation of statewide physical distancing measures that are designed to control the COVID-19 pandemic frequently resulted in an immediate reversal of public health gains against SARS-CoV-2, the virus that causes the disease, researchers from Massachusetts General Hospital (MGH) and colleagues reported.

Looking at data from all 50 states and the District of Columbia, the researchers found a gradual but steady decline in viral transmission rates during the eight weeks immediately preceding relaxation of physical distancing rules. But almost immediately after those rules were relaxed, most states reversed course. Eight weeks after restrictions were lifted or loosened, only nine of 51 still had low rates of transmission.

"Premature relaxation of social distancing measures undermined the country's ability to control the disease burden associated with COVID-19," writes Alexander C. Tsai, MD, investigator in the Department of Psychiatry at MGH and associate professor of Psychiatry at Harvard Medical School, and colleagues in the journal Clinical Infectious Diseases.

Tsai continues: "COVID-19 is disproportionately killing so-called essential workers, poorer people, and racialized minorities. In the absence of public health leadership at the federal level, these lockdowns are the best tool we have to slow transmission. But there are real costs to these lockdowns, costs that are again inequitably borne by so-called essential workers, poorer people, and racialized minorities, as well as children in public school programs who disproportionately miss out on school. So local governments need to continue to weigh the risks and benefits of these policies, and not be convinced that once you relax, there is no turning back."

The investigators previously reported that statewide physical distancing measures were associated with a reduction in the growth rate of COVID-19 cases in the U.S. and a short-term reduction in COVID-19 related deaths. Results of that study were published August 11, 2020 in the open-access journal PLOS Medicine.

"Essentially the moment those restrictions were released, those trends reversed," says Mark J. Siedner, MD, MPH, an investigator in the Division of Infectious Diseases at MGH, an associate professor of Medicine at Harvard Medical School (HMS), and senior author of the study.

The team found that this reversal occurred regardless of the type of restriction: school closings, restaurant/bar closings, workplace rules, limiting public events, closing of outdoor recreational facilities, and limits on in-state travel.

Tsai and colleagues used data from state governments and third-party sources and regression modeling to estimate the extent to which relaxation of physical distancing measures affected control of COVID-19, expressed as a value represented by the number Rt.

"Rt is the average number of people each person with COVID-19 will infect," Siedner says. "The goal of every public health intervention should be to get the Rt down to less than one, because if each person on average infects less than one other person, ultimately the epidemic will be extinguished."

The data showed that the Rt, averaged across jurisdictions, declined by 0.012 units per day in the eight weeks leading up to relaxation of restrictions, with 46 of the 51 jurisdictions studied achieving an Rt below one while the measures were in place.

After physical distancing regulations were relaxed, the transmission rate increased by an average of 0.007 units per day. Eight weeks into the relaxation period, the average Rt was 1.16, and only nine of the 51 jurisdictions had Rt rates that remained below one.

Siedner adds: "The hope was that these measures would lead to sustained changes in behavior: mask wearing and physical distancing. These data do not give us hope. Until a vaccine is available, these measures are proving to be the most effective solutions to contain epidemic hotspots."

DALLAS, Oct. 5, 2020 -- Having a spouse in a hospital's intensive care unit (ICU) may make a person more likely to have a heart attack or cardiac-related hospitalization themselves within a few weeks of the ICU admission, according to new research published today in the American Heart Association's flagship journal Circulation.

"Spouses of ICU patients should pay attention to their own physical health, especially in terms of cardiovascular disease," said the study's senior author Hiroyuki Ohbe, M.D., M.P.H., a Ph.D. student in the department of clinical epidemiology and health economics in the School of Public Health at The University of Tokyo in Japan. "The ICU can be a stressful environment with significant caregiving burdens, and spouses may face tough decisions about continuing or ending life-sustaining treatment."

"A patient's admission to ICU puts acute psychological stress on family members, and that stress may increase the risk for cardiovascular disease particularly for the other spouse," Ohbe said.

This study is the first to suggest ICU admission of a spouse may be a risk factor for cardiovascular disease events and hospitalization in the other spouse. According to previous research, about a quarter to one-half of family members of a critically ill patient experience symptoms of post-traumatic stress, anxiety and depression, known as "post-intensive care syndrome-family." Studies about bereavement have shown an increased risk of cardiovascular diseases particularly in the early weeks and months after a loved one has died, known as broken-heart syndrome (also called stress-induced cardiomyopathy or takutsobo cardiomyopathy).

Researchers matched spouses of patients admitted to the ICU for more than two days with people randomly selected from the Japan Medical Data Center database of 6 million inpatient and outpatient health insurance claims between January 2005 and August 2018.

Among 2.1 million people (just over one million married couples), more than 7,800 spouses of patients admitted to ICUs were matched with more than 31,000 people randomly selected from the database. The average age of the spouses was 54, and 35% were men. The two groups were matched for sex, age and medical insurance status.

Researchers evaluated data for any visit for cardiovascular disease, hospitalization for cardiovascular diseases and severe cardiovascular events. Compared to people without a spouse in the ICU, those with a husband or wife in the ICU:

had increased odds of having a cardiovascular event, such as chest pain, heart attack, stroke, irregular heart rhythm, heart failure or pulmonary embolism (a blood clot in the lungs) within a month; and

were more likely to be hospitalized for cardiovascular diseases and hospitalized for severe cardiovascular events.

Because the database includes only patients with employment health insurance, it may limit the ability to generalize the findings to other populations such as older adults or those without insurance. The findings should also be applicable to U.S. adults who have health insurance.

Previous studies and the current American College of Critical Care Medicine guidelines on care for family members of ICU patients have focused mostly on mental health, researchers noted. No studies have examined the physical health risks for family members. More studies are needed to confirm the findings of this research and to explore if behavior adjustments during this stressful time, such as changes in social ties, living arrangements, eating habits, alcohol consumption and economic support, are factors.

Numerous animals may be vulnerable to SARS-CoV-2, the virus that causes Covid-19, according to a large study modelling how the virus might infect different animals' cells, led by UCL researchers.

The study, published in Scientific Reports, reports evidence that 26 animals regularly in contact with people may be susceptible to infection.

The researchers investigated how the spike protein from SARS-CoV-2 could interact with the ACE2 protein it attaches to when it infects people.

The focus of the investigation was whether mutations in the ACE2 protein in 215 different animals, that make it different from the human version, would reduce the stability of the binding complex between the virus protein and host protein. Binding to the protein enables the virus to gain entry into host cells; while it is possible the virus might be able to infect animals via another pathway, it is unlikely based on current evidence that the virus could infect an animal if it cannot form a stable binding complex with ACE2.

The researchers found that for some animals, such as sheep and great apes (chimpanzee, gorilla, orangutan, and bonobo, many of which are endangered in the wild), the proteins would be able to bind together just as strongly as they do when the virus infects people. Some of the animals, such as sheep, have not yet been studied with infection tests, so this does not confirm that the animal can indeed be infected.

Lead author Professor Christine Orengo (UCL Structural & Molecular Biology) said: "We wanted to look beyond just the animals that had been studied experimentally, to see which animals might be at risk of infection, and would warrant further investigation and possible monitoring.

"The animals we identified may be at risk of outbreaks that could threaten endangered species or harm the livelihoods of farmers. The animals might also act as reservoirs of the virus, with the potential to re-infect humans later on, as has been documented on mink farms."

The research team also performed more detailed structural analyses for certain animals, to gain a better understanding of how infection risks may differ across animal species. By comparing their findings to other experimental data, they set thresholds to predict which animals are at risk of infection, and which ones most likely cannot be infected.

They found that most birds, fish, and reptiles do not appear to be at risk of infection, but the majority of the mammals they reviewed could potentially be infected.

Professor Orengo added: "The details of host infection and severity of response are more complex than just the interactions of the spike protein with ACE2, so our research is continuing to explore interactions involving other host virus proteins."

The team's findings mostly agree with experiments conducted in living animals and with reported cases of infections. They predict possible infection in domestic cats, dogs, mink, lions, and tigers, all of which have had reported cases, as well as ferrets and macaques, which have been infected in laboratory studies.

First author, Su Datt Lam (UCL Structural & Molecular Biology and the National University of Malaysia) said: "Unlike laboratory-based experiments, the computational analyses we devised can be run automatically and rapidly. Therefore, these methods could be applied easily to future virus outbreaks that, unfortunately, are becoming more common due to human encroachment into natural habitats."

Co-author Professor Joanne Santini (UCL Structural & Molecular Biology) said: "To protect animals, as well as to protect ourselves from the risk of one day catching Covid-19 from an infected animal, we need large-scale surveillance of animals, particularly pets and farm animals, to catch cases or clusters early on while they're still manageable.

"It may also be important to employ hygiene measures when dealing with animals, similar to the behaviours we've all been learning this year to reduce transmission, and for infected people to isolate from animals as well as from other people."

PULLMAN, Wash. - Earth is not necessarily the best planet in the universe. Researchers have identified two dozen planets outside our solar system that may have conditions more suitable for life than our own. Some of these orbit stars that may be better than even our sun.

A study led by Washington State University scientist Dirk Schulze-Makuch recently published in the journal Astrobiology details characteristics of potential "superhabitable" planets, that include those that are older, a little larger, slightly warmer and possibly wetter than Earth. Life could also more easily thrive on planets that circle more slowly changing stars with longer lifespans than our sun.

The 24 top contenders for superhabitable planets are all more than 100 light years away, but Schulze-Makuch said the study could help focus future observation efforts, such as from NASA's James Web Space Telescope, the LUVIOR space observatory and the European Space Agency's PLATO space telescope.

"With the next space telescopes coming up, we will get more information, so it is important to select some targets," said Schulze-Makuch, a professor with WSU and the Technical University in Berlin. "We have to focus on certain planets that have the most promising conditions for complex life. However, we have to be careful to not get stuck looking for a second Earth because there could be planets that might be more suitable for life than ours."

For the study, Schulze-Makuch, a geobiologist with expertise in planetary habitability teamed up with astronomers Rene Heller of the Max Planck Institute for Solar System Research and Edward Guinan of Villanova University to identify superhabitability criteria and search among the 4,500 known exoplanets beyond our solar system for good candidates. Habitability does not mean these planets definitely have life, merely the conditions that would be conducive to life.

The researchers selected planet-star systems with probable terrestrial planets orbiting within the host star's liquid water habitable zone from the Kepler Object of Interest Exoplanet Archive of transiting exoplanets.

While the sun is the center of our solar system, it has a relatively short lifespan of less than 10 billion years. Since it took nearly 4 billion years before any form of complex life appeared on Earth, many similar stars to our sun, called G stars, might run out of fuel before complex life can develop.

In addition to looking at systems with cooler G stars, the researchers also looked at systems with K dwarf stars, which are somewhat cooler, less massive and less luminous than our sun. K stars have the advantage of long lifespans of 20 billion to 70 billion years. This would allow orbiting planets to be older as well as giving life more time to advance to the complexity currently found on Earth. However, to be habitable, planets should not be so old that they have exhausted their geothermal heat and lack protective geomagnetic fields. Earth is around 4.5 billion years old, but the researchers argue that the sweet spot for life is a planet that is between 5 billion to 8 billion years old.

Size and mass also matter. A planet that is 10% larger than the Earth should have more habitable land. One that is about 1.5 times Earth's mass would be expected to retain its interior heating through radioactive decay longer and would also have a stronger gravity to retain an atmosphere over a longer time period.

Water is key to life and the authors argue that a little more of it would help, especially in the form of moisture, clouds and humidity. A slightly overall warmer temperature, a mean surface temperature of about 5 degrees Celsius (or about 8 degrees Fahrenheit) greater than Earth, together with the additional moisture, would be also better for life. This warmth and moisture preference is seen on Earth with the greater biodiversity in tropical rain forests than in colder, drier areas.

Among the 24 top planet candidates none of them meet all the criteria for superhabitable planets, but one has four of the critical characteristics, making it possibly much more comfortable for life than our home planet.

"It's sometimes difficult to convey this principle of superhabitable planets because we think we have the
best planet," said Schulze-Makuch. "We have a great number of complex and diverse lifeforms, and many that can survive in extreme environments. It is good to have adaptable life, but that doesn't mean that we have the best of everything."