Culture

Are we "Waiting for Godot"- A Metaphor for Covid-19 "Waiting for Godot", one of the greatest works of the Theater of the Absurd is used to illustrate the dystopic nature of our approach to COVID-19. The continued use of a lab test to inappropriately define a "case" and the use of that measure to define the health impacts of the pandemic is discussed. Given the broad variability in COVID-19 tests and their characteristics, coupled with the estimated prevalence of the disease further clouds the validity of conclusions drawn from testing to date. The continued unqualified reporting of this statistic does little to guide appropriate intervention policies but does continue to fuel the levels of public fear. Much of the conflict over appropriate policies revolves around waiting for a vaccine that, like Godot, may never arrive. The contribution of Herd Immunity in decreasing the transmission rate is also addressed as is the concept of individual risk.

Going forward we not only have to accept the fact that we are war with the virus but also the fact that war generates casualties. The most prevalent casualties of this conflict have become the 55 million K-12 school children who are, ironically, essentially immune. To continue this travesty on what might be an illusion of hope is akin to systematic child abuse.

A new study led by NorthShore University HealthSystem (NorthShore) and the University of Chicago took a novel approach to identifying SNPs influencing the risk of neuropsychiatric disorders like schizophrenia, bipolar and major depressive disorder, the institutions announced today. The findings, published in the current issue of Science, significantly advance understanding of the genetics of neuropsychiatric disorders and offer a path to translating genetic discoveries into novel disease biology and better clinical treatments.

Current approaches to genome-wide association studies (GWAS) in neuropsychiatry have advanced the identification of many single-base pair changes in the DNA (single nucleotide polymorphisms, or SNPs) associated with an increased risk of developing a psychiatric condition. However, these studies don't necessarily determine which of these SNPs are linked to functional changes in gene expression, and which might actually play a role in the disease.

In this study, the researchers were interested in identifying SNPs that directly affected how readily available DNA is for gene expression (chromatin accessibility). To find these candidates, they first identified SNPs that were heterozygous in their patient samples -- that is, they had one variant of the SNP from their mother and a different copy from their father. SNPs that were differentially accessible were dubbed "allele-specific open chromatin" or ASoC, variants.

The study was led by Jubao Duan, PhD, the Charles R. Walgreen Research Chair and director of functional genomics of psychiatry at NorthShore, who is also an associate professor of psychiatry and behavioral neuroscience at the University of Chicago.

"Much like a mixed jar of peanut butter and plain M&M's that look alike but taste very different, functional disease variants in DNA appear similar and novel approaches are required to identify them," said first author Siwei Zhang, PhD, a research scientist at NorthShore. "Since we can't taste DNA the way we do M&M's, we had to find other ways to separate the functional SNPs from the non-functional. We reasoned that the presence of risk alleles might change the local accessibility of chromatin, and they did."

Investigators used human blood samples to create induced pluripotent stem cells (iPSCs) and turned those iPSCs into different kinds of neuronal cells that model developing human brain cells. They then took a look at chromatin accessibility of DNA sequences in the neurons.

Profiling the ASoC variants identified thousands of potentially functional SNPs, a large fraction of which were associated with changes in the expression of nearby genes. The majority of these ASoC SNPs were found in closed chromatin regions of post-mortem brains, thus highlighting the unique value of using iPSC-derived neurons as a neurodevelopmental cellular model to link a functional SNP to psychiatric disease.

Further analysis demonstrated that these ASoC variants are more likely to be causally linked to a range of neuropsychiatric traits, allowing the researchers to prioritize the study of specific SNPs in genomic regions associated with schizophrenia risk.

"Using ASoC to identify functional SNP has some advantages over other, more conventional approaches," said Xin He, PhD, an assistant professor of human genetics at the University of Chicago, who co-led the computational analysis in the study. "This is because ASoC SNPs likely affect chromatin accessibility directly, while many traditionally identified SNPs associated with gene expression aren't necessarily functional. Compared with potentially functional SNPs identified with other methods, our ASoC SNPs showed much stronger enrichment for psychiatric disease risk variants."

In a proof-of-principle experiment, the scientists were also able to edit the genome of their iPSCs using CRISPR and determined that editing an ASoC SNP frequently led to changes in nearby gene expression. This led the researchers to nominate putative causal genes in several schizophrenia disease regions, which can be explored in future studies for their role in causing the neuropsychiatric illness.

"Although schizophrenia and other neuropsychiatric disorders involve multiple risk genes that each have a small effect on disease risk and likely act in gene networks, our findings offer important insights that may advance an area of medicine with tremendous potential," said Dr. Duan. "We hope to continue harnessing multi-dimension genomic datasets and stem cell models to unravel how these devastating disorders are caused by genes and interactions with environmental factors such as stress or infection during early neurodevelopment."

How hard is it to pick the next Usain Bolt, Ian Thorpe or Anna Meares? Finding a world champion often falls to talent scouts and involves years of hard work, but could it be as simple as a 35-second body scan?

A new paper by University of South Australia sports scientist Professor Grant Tomkinson analyses how a $7500 3D portable whole-body scanner can identify sporting talent for particular codes and monitor body changes in athletes to ensure they are performing at their peak.

Prof Tomkinson, an adjunct researcher at UniSA based in the United States, has tested the reliability of a 3D whole-body scanner to measure athletes' shape and composition, comparing it with X-rays, MRIs and manual tests, which involve bone calipers and girth tapes.

Anthropometry has been used for decades to identify talent, improve sports performance and health, but manual assessments and x-rays have their drawbacks, Prof Tomkinson says.

"3D scanning is less invasive than manual tests, and because it is fast, large samples can be easily measured, there is no need for physical contact, it doesn't require a lot of expertise and it can measure body surface areas and volumes," he says. "And, unlike x-rays, it doesn't emit any potentially harmful radiation."

Prof Tomkinson and a team from the University of North Dakota scanned 49 athletes (30 women and 19 men), subjecting them to a series of 35-second scans, extracting millions of measurements within 2 mm accuracy.

All that is required is a 3D camera, a turntable and measurement extraction software.

"3D scans measure both cross-sectional areas and volumes and surface areas so they are generally better predictors of sporting success than manual tests," he says.

In a few seconds a 3D body scan can measure the length of an arm and leg, the circumference of a thigh, or a body girth, as well as detect any asymmetries, such as scoliosis, or different leg lengths, which can affect the body's musculature.

One of the main ways to select athletes for specific sports is to compare their body size and shape with the general population. For example, 3D body scans of elite rowers show that the best male rowers have much larger chests than the general population and elite female rowers have larger thighs than most women.

Similarly, marathon runners have a very defined physique - they are shorter, lighter, have longer legs relative to their torso and are leaner than the average person.

3D whole-body scanning has recently been used in several large anthropometric surveys of military personnel and the general population, but there is scant reliable anthropometric data on athletes beyond traditional manual measures, Prof Tomkinson says.

"Tracking changes in whole body and lean mass using 3D scanning would be an inexpensive and safer alternative to x-rays and magnetic resonance imaging (MRI) and could potentially be used to identify talent earlier and refine training to improve performance," Prof Tomkinson says.

The rate of COVID-19 transmission in New South Wales (NSW) educational settings was extremely limited during the first wave of COVID-19, research findings published today in The Lancet Child and Adolescent Health have shown.

Researchers from the National Centre for Immunisation Research and Surveillance (NCIRS) and the University of Sydney released their preliminary findings from this work from January to April 2020.

The Lancet publication today contains detailed analysis on COVID-19 spread in 25 educational settings (15 schools and 10 childcare settings) in Term 1. Additional data from Term 2 and 3 are also available today.

Lead author Professor Kristine Macartney said the study showed transmission rates in NSW schools and early childhood education and care (ECEC) services were minimal, particularly between children and from children to adults.

"This is the first comprehensive population-based assessment of coronavirus transmission in educational settings worldwide," Professor Macartney said.

"COVID-19 transmission in schools appears to be considerably less than that seen for other respiratory viruses, such as influenza.

"This supports the previous findings that COVID-19 transmission in educational settings can be kept low and manageable in the context of an effective pandemic response that includes contact tracing and quarantine, and temporary school closures for cleaning if someone is found to be infected.

"It is also consistent with other data that show lower rates, and generally milder disease, in children than in adults.

"However, it is important to view these findings in the context of the NSW outbreak. Higher rates of transmission may occur in areas with higher levels of virus transmission in the community or with less rigorous public health and community response."

In Term 1 and 2 there have been 33 initial cases of COVID-19 confirmed at 31 of NSW's 7700 schools and ECEC services, with 25 sites in Term 1 and six during Term 2 affected.

In Term 1 and 2, a total of 16 students and 17 adult staff were the first cases who tested positive for the virus.

Out of 1333 close contacts in primary and high schools, just five (0.4%) possible secondary infections were recorded across Terms 1 and 2: one primary student, two high school students, one primary teacher and one high school teacher.

Initial cases were also seen in 11 ECEC services across Term 1 and 2, with 13 possible secondary infections recorded out of 636 close contacts.

All 13 secondary cases (7 children and 6 staff) were linked to an outbreak at a single ECEC service early in Term 1 that started initially in staff members. No secondary cases were identified in the other 10 ECEC services.

This observational study is continuing in Term 3 in NSW (July - September). Data for Term 3 is preliminary but as at 3 August, there have been 11 cases (3 staff members and 8 students) with two secondary infections being recorded in one primary school and one ECEC service.

"We know anyone of any age can be infected and potentially spread the virus," Prof Macartney said.

"But understanding how the virus spreads in our context will assist modellers, policymakers, healthcare providers, and the public to understand the risk of COVID-19 in educational settings and help in decision making around school closures and re-openings."

Memory loss among older Australians is on the rise as the Baby Boomer generation enters retirement - but a new technique tested by Flinders University researchers that investigates cognitive skills through eye-tracking technology may be used to help incorporate all older people's preferences into aged care policy and practice.

Current estimates indicate that up to 20% of people in developed countries aged 65 and over have mild cognitive impairment (MCI), with these percentages predicted to rise markedly by 2050. This greatly compromises their ability to communicate efficiently - particularly when it comes to filing official forms.

Researchers from Flinders University have used eye-tracking technology to investigate the information processes adopted by older people with and without MCI.

Outpatients at Adelaide memory clinics July 2017 and June 2018 were asked to read the same materials, involving written choices about their preferences for alternative states of quality of life. These were designed to mirror the types of official forms issued to aged-care patients when assessing quality of care and quality of life outcomes. Misunderstanding such materials could potentially lock out people with dementia, MCI or poor memory from making best-informed decisions about their care.

Eye-tracking technology was used to map how each person focused as they read, which can represent good and poor cognition.

The eye tracking technology identified the relationships between cognitive capacity, task complexity and the extent of is the tendency for participants to simplify the choice situation by overlooking or ignoring one or more of the attributes presented. This tactic to take short-cuts to cope with cognitive demands is referred to as attribute non-attendance (ANA).

"This exploratory study provided important insights into the information processes adopted by older people with varying levels of cognitive functioning," says lead researcher Kaiying Wang. "It also helped our team to identify those who needed more help in formulating their decisions."

Recent advances in econometric modelling of health valuation data have demonstrated the added value of capturing ANA information, especially to help data analysis and improve the precision of model estimates.

The researchers have found that eye-tracking technology can usefully inform the design, conduct and econometric modelling of quality of life assessments, which will help to guide health and aged care policy and practice in determining where resources should be targeted to maximise quality of life benefits for older people.

"This new eye tracking technology will help us to find new ways to drive the inclusivity of older people with cognitive impairment and dementia in these important assessments", says Professor Julie Ratcliffe of Flinders University's College of Nursing and Health Sciences.

"It is very important that older people's preferences about quality of care and quality of life are used to inform economic evaluation of policy and practice in health and aged care."

To improve our understanding of the physical mechanisms involved and provide an observational basis for model validation, Dr. Licheng Feng (National Marine Environmental Forecasting Center) and colleagues set out to diagnose the atmospheric and oceanic factors that could have been responsible for the second-year cooling in the 2017/18 La Niña event. They have had their findings published in Advances of Atmospheric Sciences (https://doi.org/10.1007/s00376-020-0028-4).

"ENSO [El Niño-Southern Oscillation] is the major mode of interannual variability in the tropical Pacific climate system," explains Dr Feng, "and its influences are not limited to regional climate; they can induce worldwide climatic, ecological and societal anomalies. Accurate prediction of ENSO can provide a physical basis for short-term climate prediction. However, real-time prediction of ENSO remains problematic and challenging, with most models failing to predict the Niño3.4 SST cooling when initialized from early-mid 2017. Thus, it is important to study the factors determining the cooling in 2017, and understand the processes involved."

By using the ERA5 and GODAS (Global Ocean Data Assimilation System) products, atmospheric and oceanic factors were examined that could have been responsible for the second-year cooling, including surface wind and the subsurface thermal state. A time sequence is described to demonstrate how the cold SSTAs were produced in the central-eastern tropical Pacific in late 2017. Both the wind stress anomalies and the subsurface cold anomalies played an important role in the second-year cooling of the 2017/18 La Niña event.

"Compared with the 2011/12 La Niña event, the 2017/18 La Niña event shows three differences," says Dr Feng. "First, the effects of the western Pacific warm waters were weak; secondly, the negative SSTAs first emerged in the far-eastern equatorial Pacific in fall 2017; and lastly cold anomalies on both sides of the equator played the same role during the 2017/18 La Niña event. These differences show the diversity of La Niña events," concludes Dr. Feng.

"Future work may be needed to diagnose more reanalysis data to confirm the results," he adds.

Researchers from The Ohio State University published a new paper in the Journal of Marketing that examines whether to focus sharing economy marketing communications on the platform or on the provider.

The study, forthcoming in the the Journal of Marketing, is titled "Providers vs. Platforms: Marketing Communications in the Sharing Economy" and is authored by John Costello and Rebecca Walker Reczek.

Over the past decade, a growing number of firms have found success using a peer-to-peer (P2P) business model (e.g., Uber, Lyft, Airbnb, and TaskRabbit). P2P brands are expected to drive much of the sharing economy's future growth, with experts projecting a market size of $335 billion by 2025 for the overall sharing economy, up from $14 billion in 2014. Marketing communications represent the company's "voice" to consumers and offer a key way to shift consumers' purchase perceptions and behaviors. Although P2P brands face many important decisions about their marketing communications, a new study in the Journal of Marketing explores one specific, but consequential, decision for P2P marketers: whether to focus on the platform or on the provider in marketing communications. Both strategies are used among P2P brands in the marketplace, but existing research offers no insight into whether platform- or provider-focused communications are more effective and why.

Consumers interact with two distinct entities in a P2P purchase. The first is the platform, typically a for-profit firm that acts as an intermediary for exchange between consumers and providers of goods and services. The second is a peer provider, an individual who offers a good or service and connects with the consumer through the platform. We find the P2P model leads consumers to perceive high provider-firm independence where providers are viewed as relatively independent from the platform(s) on which they offer goods/services. Given the perceived independence of the provider and firm for P2P firms, P2P marketing managers may choose to focus on either entity in their marketing communications.

Through experiments and a field study conducted in collaboration with a real P2P company, the research team demonstrates that when P2P brands use provider-focused marketing communications versus platform-focused marketing communications, consumers perceive a purchase as helping an individual provider to a greater extent. This mental shift increases consumers' likelihood of purchase and app download as well as willingness to pay (WTP). Costello explains that "This is because provider-focused marketing communications in this context lead consumers to think about their purchase from the provider's perspective. We call this tendency an empathy lens, which is being aware of another person's internal state or putting oneself in the place of another. We also show that our effects do not extend to traditional firms because consumers do not view these purchases through an empathy lens."

These findings have practical implications for marketing managers of P2P brands, public policymakers, and consumers. From a managerial perspective, they identify the importance of provider-focused marketing communications as a way to drive important brand outcomes and should be particularly helpful for marketers at start-up P2P brands. These new brands face increased spending from established P2P brands and a relatively high failure rate, thus making informed decisions about marketing communications particularly important.

The research also suggests that there may be an opportunity for policymakers to educate consumers about how their perceptions about P2P purchases may be influenced by firm actions like marketing communications, and thus may not match economic reality. Reczek says that "Our studies show that consumers often view purchases from for-profit P2Ps as helping an individual provider. However, this perception could have negative consequences for providers. For example, if consumers already believe they are helping through their purchases, they may be less willing to support regulations that help protect these individuals financially or may be less willing to provide other support such as tipping." This point is particularly timely as experts recently reported that the threat of COVID-19 has dramatically decreased the usage of popular peer-to-peer (P2P) brands like Uber and Lyft, leaving many P2P providers in a difficult financial position. While some P2P brands are pivoting to services like food delivery to keep drivers active, consumers should remember that perceptions of helping do not always match reality.

New results achieved by combining big data captured by the Subaru Telescope and the power of machine learning have discovered a galaxy with an extremely low oxygen abundance of 1.6% solar abundance, breaking the previous record of the lowest oxygen abundance. The measured oxygen abundance suggests that most of the stars in this galaxy formed very recently.

To understand galaxy evolution, astronomers need to study galaxies in various stages of formation and evolution. Most of the galaxies in the modern Universe are mature galaxies, but standard cosmology predicts that there may still be a few galaxies in the early formation stage in the modern Universe. Because these early-stage galaxies are rare, an international research team searched for them in wide-field imaging data taken with the Subaru Telescope. "To find the very faint, rare galaxies, deep, wide-field data taken with the Subaru Telescope was indispensable," emphasizes Dr. Takashi Kojima, the leader of the team.

However, it was difficult to find galaxies in the early stage of galaxy formation from the data because the wide-field data includes as many as 40 million objects. So the research team developed a new machine learning method to find such galaxies from the vast amount of data. They had a computer repeatedly learn the galaxy colors expected from theoretical models, and then let the computer select only galaxies in the early stage of galaxy formation.

The research team then performed follow-up observations to determine the elemental abundance ratios of 4 of the 27 candidates selected by the computer. They have found that one galaxy (HSC J1631+4426), located 430 million light-years away in the constellation Hercules, has an oxygen abundance only 1.6 percent of that of the Sun. This is the lowest values ever reported for a galaxy. The measured oxygen abundance suggests that most of the stars in this galaxy formed very recently. In other words, this galaxy is undergoing an early stage of the galaxy evolution.

"What is surprising is that the stellar mass of the HSC J1631+4426 galaxy is very small, 0.8 million solar masses. This stellar mass is only about 1/100,000 of our Milky Way galaxy, and comparable to the mass of a star cluster in our Milky Way," said Prof. Ouchi of the National Astronomical Observatory of Japan and the University of Tokyo. This small mass also supports the primordial nature of the HSC J1631+4426 galaxy.

The research team thinks that there are two interesting indications from this discovery. First, this is the evidence about a galaxy at such an early stage of galaxy evolution existing today. In the framework of the standard cosmology, new galaxies are thought to be born in the present universe. The discovery of the HSC J1631+4426 galaxy backs up the picture of the standard cosmology. Second, we may witness a new-born galaxy at the latest epoch of the cosmic history. The standard cosmology suggests that the matter density of the universe rapidly drops in our universe whose expansion accelerates. In the future universe with the rapid expansion, matter does not assemble by gravity, and new galaxies won't be born. The HSC J1631+4426 galaxy may be the last generation galaxy in the long cosmic history.

Maunakea, Hawaii - Astronomers using two Maunakea Observatories - Subaru Telescope and W. M. Keck Observatory - combined with the power of machine learning, have discovered a nearby galaxy that has broken the record for having the lowest level of oxygen ever seen. The researchers measured its oxygen abundance at only 1.6 percent that of the Sun, suggesting the galaxy, named HSC J1631+4426, only recently started making stars.

The study will be published in the August 3, 2020 issue of The Astrophysical Journal and is available in preprint format on arXiv.org.

Young galaxies like HSC J1631+4426 are rare; most galaxies in the modern universe are already mature. Standard Cosmology predicts there may still be a few star-forming galaxies today, but they are difficult to detect.

"To find these very faint, rare galaxies, deep, wide-field imaging data taken with the Subaru Telescope was indispensable," said Takashi Kojima of the University of Tokyo Institute for Cosmic Ray Research and lead author of the study.

However, the wide-field data detected 40 million objects. To comb through the vast amount of data and zero in on galaxies that are just beginning to form stars, the research team developed a new machine learning method. They 'taught' a computer to repeatedly learn the galaxy colors expected from theoretical models and select only galaxies in the early stage of galaxy formation.

The computer identified 27 candidates; the research team performed follow-up observations on four of them, using Keck Observatory's DEep Imaging and Multi-Object Spectrograph (DEIMOS) as well as Subaru Telescope's Faint Object Camera and Spectrograph (FOCAS) to determine the candidate galaxies' elemental abundance ratios, distances, and mass.

The spectroscopic data revealed that one of them, HSC J1631+4426, is an extremely metal-poor galaxy with the lowest oxygen abundance ever reported. The researchers also determined its location to be relatively close - just 430 million light-years away in the constellation Hercules - and that the galaxy is tiny.

"What's surprising is the stellar mass of the HSC J1631+4426 galaxy is very small, 0.8 million solar masses, which is only about 1/100,000 of our Milky Way, and comparable to the mass of a star cluster in our galaxy," said co-author Masami Ouchi, a professor at the National Astronomical Observatory of Japan and the University of Tokyo.

"Low-mass, young, metal-poor galaxies found near us are important because they resemble primordial galaxies, making HSC J1631+4426 one of the best local labs for studying in detail what the first galaxies were like in the early universe, shortly after the Big Bang," said John O'Meara, chief scientist at Keck Observatory.

The Big Bang created two main elements: hydrogen and helium. As such, the earliest galaxies are expected to have few 'metals' like oxygen (in astronomy, elements heavier than hydrogen and helium are called 'metals'). Oxygen-poor galaxies found today serve as analogs for galaxies born shortly after the Big Bang, thus helping astronomers better understand how galaxies formed and evolved in the early universe.

The research team finds two interesting indications from the discovery of HSC J1631+4426. First, it provides evidence supporting the Standard Cosmology prediction that young, star-forming galaxies do in fact exist in the present universe.

Second, the study indicates this could be the latest epoch of the cosmic history where we may witness a newborn galaxy. The Standard Cosmology suggests the density of matter drops as the expansion of the universe accelerates. This would lead to a future universe where matter does not assemble by gravity, and new galaxies won't be born. Thus, HSC J1631+4426 may be the last generation galaxy of its kind in the long cosmic history.

This news release has been revised and republished by the University of Bristol Press Office on Aug. 12, 2020. Please see the revised version here.

BOSTON - New research indicates that at the peak of the COVID-19 pandemic in the U.S. and the U.K., frontline healthcare workers--particularly those from Black, Asian, and minority ethnic backgrounds--faced much higher risks of testing positive for COVID-19 than individuals in the general community. The study, which was conducted by a team led by researchers at Massachusetts General Hospital (MGH), is published in The Lancet Public Health.

Among 2,035,395 individuals in the community and 99,795 frontline healthcare workers who voluntarily used the COVID Symptom Study smartphone app developed by Zoe Global Ltd with scientific input from MGH and Kings College London, 5,545 new reports of a positive COVID-19 test were documented between March 24 and April 23, 2020.

Frontline healthcare workers had at least a threefold increased risk of COVID-19, after accounting for differences in testing frequency between frontline healthcare workers and the general community. Black, Asian, and minority ethnic healthcare workers appeared to be disproportionately affected, with a nearly twofold higher risk compared with white healthcare workers.

Also, frontline healthcare workers who reported inadequate availability of personal protective equipment (PPE) such as masks, gloves, and gowns, had an especially elevated risk; however, adequate availability of PPE did not seem to completely reduce risk among healthcare workers caring for patients with COVID-19.

"Although it is clear that healthcare workers on the front line of the fight against COVID-19 have an increased risk of infection, our country continues to face vexing shortages of PPE," said senior author Andrew T. Chan, MD, PhD, chief of the Clinical and Translational Epidemiology Unit at MGH and director of Cancer Epidemiology at the MGH Cancer Center. "Our results underscore the importance of providing adequate access to PPE and also suggest that systemic racism associated with inequalities to access to PPE likely contribute to the disproportionate risk of infection among minority frontline healthcare workers."

Dr. Chan hopes the study's findings bring greater awareness to the importance of ensuring an equitable supply chain of PPE and of developing additional strategies to protect all frontline healthcare workers. "This study demonstrates how the two major crises that the U.S. faces-- the COVID-19 pandemic and systemic racism--are inextricably linked and need immediate attention," he added.

Lugano, Switzerland - 31 July 2020. An ESMO interdisciplinary expert consensus paper on how to manage cancer patients during the COVID-19 pandemic has been published today in Annals of Oncology, encouraging medical oncologists worldwide not to discontinue or delay any type of anti-cancer treatment that may potentially impact on overall survival (1). The experts also urge to stop labelling all cancer patients as vulnerable to coronavirus infection since this may lead to inappropriate care and potential negative outcomes.

Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus in humans (SARS-CoV-2) for which there is no proven therapy yet (2). Since its outbreak in December 2019, over 16 million cases have been reported worldwide, including more than 600,000 deaths (3).

The COVID-19 emergency is still challenging oncology experts to continue delivering quality cancer care while protecting patients from the risk of being exposed to the coronavirus. Earlier this year, ESMO developed adapted guidelines for prioritising the various aspects of cancer care across different tumour types, with the aim to mitigate the negative effects of the pandemic on the management of cancer patients (4).

An international consortium was established by ESMO to discuss current clinical evidence from cohort studies and to provide expert advice on significant clinical open questions, from diagnosis to surgery related to cancer management in the COVID-19 era. The interdisciplinary expert panel, consisting of 64 experts and one voting patient advocate, agreed on 28 statements.

"The general advice is that whenever an anti-cancer treatment can impact overall survival of the patient it should not be discontinued or delayed," explains first author of the consensus paper Prof. Giuseppe Curigliano, European Institute of Oncology (IEO), Milan, Italy, commenting on the recommendations about safety and risks of delivering cancer care in the pandemic era. The recommendation relies on the lack of convincing evidence that using immune checkpoint inhibitors, non-cytotoxic targeted therapies and some types of adjuvant or neoadjuvant systemic therapies is detrimental or, in principle, associated to a higher risk of complications or mortality. "Of course, case-by-case discussions run by multidisciplinary teams remain pivotal to balance the risk of being infected against tumour control, as stated in our previous work," says Curigliano.

In the consensus paper, the interdisciplinary expert panel also warns against labelling all cancer patients as vulnerable to COVID-19 irrespectively of age, gender, tumour (sub)-type and stage. In fact, despite the fact that during the early days of the pandemic (5-7) cancer patients were reported to be at increased risk of contracting the coronavirus infection and developing a more severe disease, evidences collected up to today suggest that many patients with solid tumours are not more vulnerable to COVID-19 severe outcomes than the general population. (8,9)

"Although it was reasonable to adopt over-protective measures for our patients at the outbreak of a novel infective disease which was not previously observed in humans, we now need to step away from the assumption that all cancer patients are vulnerable to COVID-19," continues Curigliano. "The implications have been important, because for some patients treatment was delayed or interrupted over the last few months, and I believe that we will see the impact of this over-precautionary approach in the next future."

Responding to the critical question about who are cancer patients really at high risk related to the COVID-19 virus and its consequences, Curigliano concludes: "Based on current evidence, only patients who are elderly, with multiple comorbidities and receiving chemotherapy are vulnerable to the infection. In this population, before starting any treatment, we recommend to test patients for COVID-19 with a real-time RT-PCR (reverse transcription polymerase chain reaction), the current gold standard for diagnosis, in order to exclude that the patient is infected by the coronavirus."

The set of statements published in the ESMO's flagship journal has been designed to serve as a dynamic knowledge repository that will be better informed by accumulating further data on the SARS CoV-2 biology, the pandemic characteristics, the risk of cancer patients for COVID-19 and its modulating factors and, finally, on optimal cancer care in the presence of the virus.

A new study published today in Lancet Public Health has found that front-line healthcare workers with adequate personal protective equipment (PPE) have a three-fold increased risk of a positive SARS-CoV-2 test, compared to the general population. Those with inadequate PPE had a further increase in risk. The study also found that healthcare workers from Black, Asian and minority ethnic (BAME) backgrounds were more likely to test positive.

Using the COVID Symptom Tracker App, researchers from King's College London and Harvard looked at data from 2,035,395 individuals and 99,795 front-line health-care workers in the UK and US. The prevalence of SARS-CoV-2 was 2747 cases per 100,000 front-line health-care workers compared with 242 cases per 100,000 people in the general community. A little over 20 percent of front-line health-care workers reported at least one symptom associated with SARS-CoV-2 infection compared with 14·4 percent of the general population; fatigue, loss of smell or taste, and hoarse voice were especially frequent.

BAME health-care workers were at an especially high risk of SARS-CoV-2 infection, with at least a fivefold increased risk of infection compared with the non-Hispanic white general community.

Professor Sebastien Ourselin, senior author from King's College London said: "The findings of our study have tremendous impact for healthcare workers and hospitals. The data is clear in revealing that there is still an elevated risk of SARS-CoV-2 infection despite availability of PPE.

"In particular we note that that the BAME community experience elevated risk of infection and in some cases lack access to adequate PPE, or frequently reuse equipment."

Researchers say their study not only shows the importance of adequate availability and use of PPE, but also the crucial need for additional strategies to protect healthcare workers, such as ensuring correct application and removal of PPE and avoiding reuse which was associated with increased risk.

Differences were also noted in PPE adequacy according to race and ethnicity, with non- Hispanic white health-care workers more frequently reporting reuse of or inadequate access to PPE, even after adjusting for exposure to patients with COVID-19.

Joint first author Dr Mark Graham from King's College London said: "The work is important in the context of the widely reported higher death rates amongst healthcare workers from BAME backgrounds. Hopefully a better understanding of the factors contributing to these disparities will inform efforts to better protect workers."

Dr Claire Steves, lead clinical researcher from King's College London said: "I'm very pleased we have now introduced masks and social distancing where possible for all interactions in hospitals - to protect ourselves and the population we serve. We need to ensure this is reinforced and sustained throughout the health service - including in health care settings outside hospitals, for example in care homes.

"Additional protective strategies are equally as important, such as implementing social distancing among healthcare staff. Stricter protocols for socialising among healthcare staff also need to be considered."

Fast facts

An international team of researchers, hosted and supported by NYU Abu Dhabi, have found that small, bottom-dwelling reef fishes on the world's hottest coral reefs in the southern Arabian Gulf are much less diverse and abundant than on nearby reefs with less extreme temperatures

The paper, published in Nature Communications, examines 'cryptobenthic' fishes in the Arabian Gulf and the Sea of Oman, linking the reduced diversity and productivity of communities in the Arabian Gulf to energetic deficits that preclude the existence of many species

Abu Dhabi, UAE, July 31, 2020: As global warming continues to escalate, there are lasting implications to consider, including the changes to biological communities in vital habitats such as coral reefs. A team of researchers, led by Simon Brandl (currently at the Centre de Recherches Insulaires et Observatoire de l'Environnement, CRIOBE, France) and Jacob Johansen, an Assistant Research Professor at Hawai'i Institute of Marine Biology (and previously a research scientist at NYU Abu Dhabi's Marine Biology Lab), recently studied cryptobenthic reef fishes (small, bottom-dwelling fish that are at the base of coral reef food webs) in the Arabian Gulf and the Sea of Oman and found that the more thermally extreme coral reef habitat in the Arabian Gulf adversely impacted the diversity and productivity of these important fishes.

In the paper, Extreme environmental conditions reduce coral reef fish biodiversity and productivity, published in the journal Nature Communications, the researchers use a variety of techniques to compare organismal traits, diversity, and productivity of cryptobenthic reef fish in the environmentally extreme Arabian Gulf with those in the Sea of Oman.

"The Arabian Gulf is the world's hottest sea each summer with temperatures well beyond those experienced by fishes elsewhere in the tropics, while the adjacent Sea of Oman is considerably more benign. This makes this region a useful natural laboratory for understanding how climate extremes affect fish function and diversity", said senior author Associate Professor of Biology at NYU Abu Dhabi John Burt.

Fish communities in the Arabian Gulf were found to be half as diverse and less than 25 percent as abundant as those in the Gulf of Oman, despite broad similarities in the amount of live coral. Surprisingly, this does not seem to be related to absolute temperature tolerances of cryptobenthic fishes.

"We expected to see much lower temperature tolerances in species that occur in the Sea of Oman, but not in the southern Arabian Gulf," said Johansen. "Yet, the critical thermal tolerances of all species found in the Sea of Oman were, in theory, sufficient to survive even the maximum summer temperatures of 36°C in the southern Arabian Gulf."

Instead, differences in prey eaten and body condition in the species present at both locations suggest that the thermal extremes of the Arabian Gulf are an energetically challenging environment for these smallest marine vertebrates. While hotter waters require more energy, a distinct, less diverse set of prey items in the Arabian Gulf may make it difficult for these small-bodied fishes to satisfy their energetic demands.

Importantly, the reduced diversity and abundance of cryptobenthic fishes greatly impairs the unique functional role of these animals. "These tiny fishes normally feed a lot of the larger, predatory animals on coral reefs by growing and dying rapidly, while constantly replenishing their populations," explains Brandl, "But on reefs in the southern Arabian Gulf, cryptobenthic fish communities provide only a fraction of the fish flesh that they can produce in more benign environments."

"Our findings highlight an imminent threat to cryptobenthic reef fishes and their essential role for coral reef functioning. These smallest marine ectotherms may struggle to compensate for increasing costs of growth and maintenance as they adapt to more extreme temperatures," said Johansen. "Extreme environmental conditions, as predicted for the end of the 21st century, could, therefore, disrupt the community structure and productivity of coral reefs in the Arabian Gulf and beyond."

[Oakland, CA] As the western United States enters the 2020 wildfire season with anticipated above normal significant fire potential, a new report from Physicians, Scientists, and Engineers for Healthy Energy (PSE) provides the most expansive synthesis to date on the public health dimensions of wildfire and California's approaches to wildfire prevention and the mitigation of wildfire-related impacts.

Since the beginning of 2020 California has seen more than 78,000 acres burned as a result of at least 5,200 fires across the state. To prevent wildfire and to mitigate wildfire impacts, California agencies and utility providers have adopted approaches such as prescribed burns, wood biomass utilization for energy production, chemical fire suppression, and most recently, the widespread de-energization of electrical lines through public safety power shutoffs (PSPS). While each of these approaches are important pillars of wildfire management, the near- and long-term public health implications of these strategies had not been thoroughly characterized.

In the new report, 'The Public Health Dimensions of California Wildfire and Wildfire Prevention, Mitigation and Suppression', researchers synthesize the public health dimensions of wildfire prevention, mitigation and suppression strategies, including a detailed review of the impacts from the 2019 California public safety power shutoffs (PSPS). "Continuity of electricity is fundamental to supporting critical health-protective services, such as indoor air filtration, air conditioning and refrigeration during wildfires and other natural disasters," said lead researcher Lee Ann Hill, MPH, Senior Scientist at PSE. "Distributed clean energy resources can be strategically deployed to provide backup power that can support critical services during wildfires, public safety power shutoffs, and other natural disasters and grid outages."

In contrast to diesel generators commonly used for backup power, distributed energy resources, such as solar and battery storage, can provide simultaneous climate and air quality benefits in communities that may be particularly vulnerable to wildfire, PSPS and other natural disasters.

In the report, the authors also outline policies and strategies aimed to reduce public health risks associated with wildfire itself and with approaches to wildfire prevention and mitigation. "Public health data should be central to decision-making regarding wildfire management. The need for public health perspectives is further amplified by the COVID-19 pandemic, which presents additional challenges related to wildfire preparedness and response," said Hill.

Negative air quality impacts from wildfire smoke like those seen in recent years may also hold further implications for respiratory health conditions associated with COVID-19, the report found. "The air quality impacts associated with large wildfire events can be widespread, impacting air quality in neighboring regions and states," explained Hill. "Evaluating air quality data across the state, we observed a strong relationship between active wildfire and exceedance of regional levels of particulate matter." Exposure to wildfire smoke may worsen COVID-19 symptoms, according to the Centers for Disease Control and Prevention (CDC). Long-term exposure to particulate matter, a primary constituent of wildfire smoke, has been associated with an increased risk of death from COVID-19 in the United States.

Amid the COVID-19 pandemic, the researchers highlight that typical wildfire response activities do not align with COVID-19 social distancing measures. Evacuations involve transporting and sheltering displaced people to indoor environments where large numbers of individuals may come into contact. Additionally, clean air spaces -- public spaces promoted to provide access to filtered air during days with heavy wildfire smoke -- also bring populations together in enclosed, indoor spaces that could increase the risk of COVID-19 spread in communities, adds Hill. The researchers conclude that these actions and health interventions may need to be reevaluated and adapted amid the COVID-19 global pandemic, an effort that is currently underway in California.

"Preparedness is key. State and regional agencies and the general public should be aware of the intersection of public health risks posed by wildfires, PSPS, and COVID-19," concludes Hill.