Culture

Dr. Irina Arzhantseva and Professor Heinrich Haerke from the Centre for Classical and Oriental Archaeology (IKVIA, Faculty of Humanities, HSE University) have been involved in the discovery of the earliest domestic cat yet found in northern Eurasia.

Since 2011, the abandoned town of Dzhankent, located near Kazalinsk and Baikonur (Kazakhstan), has been the object of international research and expeditions led by the two HSE archaeologists, together with Kazakh colleagues from Korkyt-Ata State University of Kyzylorda. Last year, the sharp-eyed archaeozoologist on the team, Dr. Ashleigh Haruda from Martin Luther University Halle-Wittenberg (Germany), while looking through the masses of animal bones from the excavation, spotted the bones of a feline and immediately realized the significance of the find.

She assembled an international and interdisciplinary team to study all aspects of this cat, and obtain all possible information from the largely complete skeleton. As a result, we now have an astonishingly detailed picture of a tomcat that lived and died in the late 8th century AD in a large village on the Syr-Darya river, not far from the Aral Sea (as it was then). X-rays, 3D imaging and close inspection of the bones revealed a number of serious fractures that had healed, meaning that humans must have looked after the animal while he was unable to hunt. In fact, he was looked after quite well: in spite of his disabilities, he reached an age well over one year, probably several years. Also, stable isotope analysis showed that this tomcat most likely fed on fish, an observation which would also fit the local environment.

But even more intriguing is what this high-calibre scientific study says about the relationship between humans and pets at the time. We know from 10th century Arab geographers that Yengi-kent (as Dzhankent was called then) was a town where the ruler of the Turkic Oguz nomads had his winter quarters. But not only is this two centuries after the time when the tomcat lived here: we also know from ethnographic studies that nomads do not keep cats - or rather, cats may temporarily live in nomad camps, but they do not follow the movements of the nomads with their herds. Cats thrive on small rodents which are attracted by human food stores, mostly grain, and nomads do not have large grain stores; such stores are typical of villages and towns, and that is where the history of cats and cat-keeping started.

So the presence of Dzhanik (as the archaeologists have begun to call him) at this place implies that this was a reasonably large settlement with a sedentary population even 200 years before it was surrounded by big walls and was called a town. This fits the provisional ideas of the archaeologists about the origins of Dzhankent: the later town of the 10th century grew out of a large fishing village which, as early as the 7th/8th centuries, had trading links to the south, to the Iranian civilization of Khorezm on the Amu-Darya river. Khorezmian traders should have been interested in the location of Dzhankent on the Syr-Darya, the river which around that time became the route of the Northern Silk Road, connecting Central Asia (and ultimately, China) to the Volga, the Caspian and Black Seas and the Mediterranean. And it is along one of these trade routes that domestic cats must have reached Dzhankent, perhaps with a caravan or more likely on a river boat or sailing ship. Because Dzhanik was not a captured, tame wildcat which had lived in the Aral Sea region: ancient DNA has proven that he was most likely a true representative of the Felis catus L. species, the kind of modern domestic cat. And this makes him the earliest domestic mouser in Eurasia north of Central Asia and east of China, about 1200 years ago.

While multiple recent studies have provided evidence of the benefits of case management, primary care teams have struggled to implement and sustain its use in their clinical practices. In this systematic review, researchers examine barriers to case management, as well as factors facilitating its implementation. Researchers conducted a comprehensive literature review of studies that address comprehensive case management from a primary care perspective. A thematic analysis revealed nine barriers and/or facilitators that emerge across different studies, representing the perspectives of diverse health care professionals across six countries. The nine categories are family context; policy and available resources; physician buy-in and understanding of the case manager role; relationship building; team communication practices; autonomy of case manager; training in technology; relationships with patients; and time pressure and workload. Moreover, the framework situates these barriers and facilitators relative to each other. The authors believe their results may be of interest to policymakers, health care professionals and researchers who may use this study as a starting point for further investigation.

Effectively Communicating with Older Adults Who Have Hearing Loss During COVID-19

Media Contact: Waun'Shae Blount, wblount1@jhmi.edu

The COVID-19 pandemic has caused a variety of challenges for older adults with hearing trouble across different health care settings, including the inpatient hospital setting and nursing homes, assisted living facilities and home environments. Research from Johns Hopkins suggests that nearly half of adults over age 60 have hearing loss, which indicates a significant portion of the population may be experiencing these challenges as a result of COVID-19.

During the COVID-19 pandemic, those with hearing difficulties who are accustomed to reading lips may face challenges because they cannot read the lips of people wearing a face mask. Additionally, following the 6 foot physical distancing recommendation can make communicating by sign language more difficult. To address these communication barriers, Johns Hopkins researchers have developed a checklist for clinicians to use while treating patients with hearing loss. Published online in the June 17, 2020, issue of the Journal of the American Geriatrics Society, the checklist provides recommendations for both inpatient and telehealth visits, such as using hand-held devices and telephones that enable the older adult to see and hear the provider clearly. The checklist also includes tips for the patient's environment, including decreasing background noise, improving lighting, and ensuring providers effectively communicate via verbal and nonverbal ways such as speaking slowly or wearing a clear mask when permissible.

Nicholas Reed, Au.D., assistant professor of audiology in the Department of Otolaryngology-Head and Neck Surgery at the Johns Hopkins University School of Medicine, and of epidemiology at the Johns Hopkins Bloomberg School of Public Health, is available for comment.

Universal Testing May Help Reduce COVID-19 Infections, Deaths in Long-Term Care Facilities

Media Contact: Michael E. Newman, mnewma25@jhmi.edu

Throughout the COVID-19 pandemic, residents in long-term care facilities -- including nursing homes and assisted living centers -- have been at particularly high risk of infection by and spread of SARS-CoV-2 (the virus that causes COVID-19), and with a disproportionally tragic outcome. According to estimates in an article in The New York Times, although only 10% of COVID-19 cases in the United States have occurred in long-term care facilities, they are responsible for 42% of deaths from the disease.

However, a team of infectious disease experts at Johns Hopkins Medicine believes the actual number of COVID-19 infections nationally in long-term care facilities may be much higher because health care providers are missing asymptomatic cases. This discrepancy, they warn in a new study published July 14 in JAMA Internal Medicine, may make it more difficult to reduce or prevent the spread of COVID-19 in the very susceptible population living in these centers.

In their study, the researchers performed "universal testing" for SARS-CoV-2 among all 893 men and women living at 11 long-term care facilities in Maryland. Previously, only residents who showed symptoms of COVID-19 had been "target tested" by local health departments.

Among the 893 universally tested, 354 people -- nearly 40% --were found to be positive for SARS-CoV-2 RNA, compared with 153 (17%) identified in earlier target testing based on symptoms. The universal screening, therefore, raised the number of COVID-19 cases among the residents in the state's long-term care facilities from 153 to 507 (57%), a 231% increase. Of those who tested positive, the researchers report that 281 (55%) were asymptomatic.

"These results underscore the importance of universal testing, as symptom-based approaches may miss a substantial number of cases in long-term care facilities," says Benjamin Bigelow, a fourth-year medical student at the Johns Hopkins University School of Medicine and the study's lead author. "Unrecognized asymptomatic cases among residents can severely hinder preventive strategies and increase the risk of the virus dangerously spreading."

"More testing resources are urgently needed to identify the true burden of COVID-19 in long-term care facilities, so that we can be more successful in curbing infection and mortality in one of the disease's major hot spots," adds Morgan Katz, M.D., M.H.S., assistant professor of medicine at the Johns Hopkins University School of Medicine and senior author of the study.

Study Says Twitter Effectively Communicates Pediatric Critical Care Info during a Pandemic

Media Contact: Michael E. Newman, mnewma25@jhmi.edu

Ever since the microblogging and social networking platform Twitter emerged in 2006, it has consistently ranked among the top ways that people around the world communicate with one another, with some 500 million tweets sent per day. According to the Twitter monitoring company, Tweet Binder, the COVID-19 pandemic has dominated the Twitterverse with about 600 million tweets alone using the hashtag #COVID19, #coronavirus or something similar between February and May of this year.

Among the massive volume of COVID-19 tweets posted during that time were ones teamed with a second hashtag, #PedsICU -- a social media designation created long before the pandemic to foster international collaboration, rapidly disseminate information and keep the lines of professional communication flowing among members of the pediatric critical care community. How effectively this hashtag twinning actually "spreads the word" about COVID-19 to those serving in pediatric intensive care units (PICUs) worldwide is the subject of a recent study posted online May 27 in the journal Pediatric Critical Care Medicine.

"We wanted to determine if leveraging social media, specifically Twitter, was a solid strategy for keeping PICUs across the globe connected and informed on the most current information during a pandemic," says Sapna Kudchadkar, M.D., Ph.D., associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine and co-investigator for the study.

To conduct their study, Kudchadkar and co-investigator Christopher Carroll, M.D., M.S., research director of pediatric critical care at the Connecticut Children's Medical Center, collected data on all tweets posted worldwide from Feb. 1 to May 2 that contained the hashtag #PedsICU, along with those containing both #PedsICU and a recognizable COVID-19 hashtag.

During that span, there were 49,865 #PedsICU tweets, with 21,538 (43%) of them also including a COVID-19 hashtag. Of the latter, #COVID19 was the most commonly used pandemic-related tag (69%). Geographic distribution for tweeters using the tandem hashtags spanned six continents, with the majority of tweets coming from North America and Australia.

There was a sharp rise in tweets with both hashtags around mid-March, which coincided with the World Health Organization raising COVID-19 to pandemic status. Since then, more than two-thirds of #PedsICU tweets were about the disease. About a third of the tweeters were physicians, but the researchers note there also was "robust engagement" from other PICU team members, including nurses, nurse practitioners, respiratory therapists and pharmacists.

One example of social media quickly disseminating COVID-19 news globally occurred April 26, when clinicians in the United Kingdom first recognized multisystem inflammatory syndrome in children (MIS-C) was potentially related to COVID-19. Tweets on this announcement with the hashtags #PedsICU and #COVID19 received some 3,500 shares within a few hours of the initial post.

The most popular tweets during the study period, the researchers say, were links to medical literature, reviews, educational videos and other open-access resources.

"Our study demonstrates that during a pandemic such as COVID-19, targeted use of #PedsICU combined with a specific disease-related hashtag significantly helps combat misinformation, quickly spreads useful data and news, and optimizes the reach of pediatric critical care stakeholders to others around the world," says Kudchadkar, who is available for interviews.

Stoke-on-Trent faces an increased threat of poverty and destitution due to the COVID-19 crisis, a new report reveals.

The research has been carried out by Staffordshire University Business School for the Stoke-on-Trent Hardship Commission and highlights the considerable work to be still done by central government to 'level-up' the Stoke-on-Trent economy.

Following the raft of measures introduced by the Chancellor in last week's mini budget, lead author Professor David Etherington believes that much more is needed to 'kickstart' opportunities for the residents of the city.

He said: "Government Rescue packages are insufficient to guarantee a safety net for those who will have to rely on benefits and other forms of social protection. As well as raising the level of benefits, cancelling out benefit delays and stopping the implementation of benefit sanctions is also important."

Key findings from the report reveal that:

Stoke's economy and labour market is vulnerable to the coronavirus crisis - it is estimated that around 27,000 jobs could be lost.

There has been a substantial increase in claims for Universal Credit - over 13,000 in May with a monthly increase of 24.1%.

The basic rate of Universal Credit is worth around a sixth of average weekly pay (17 per cent). On top of years of benefit cuts and delays this will force thousands into destitution.

Foodbanks are now a key source of welfare support and there has been a dramatic increase in use by over 23% in Stoke-on-Trent

Steve Wyn Williams, Chair of the Hardship Commission commented: "This report is a vital addition and update to the Hardship Commission Report we produced last year (2019) and, in particular, underlines the threats of the current COVID crisis on poverty and destitution in the city. We welcome the proposals in the report for more proactive and comprehensive policies to tackle unemployment."

Professor Etherington suggests that a more pro-active and inclusive approach to employment policy is urgently needed. This should include social dialogue and enhanced role of partnerships which involve trade unions and community organisations; job and training guarantees for all long term unemployed people and a job rotation and skills investment model for workers to promote growth and productivity.

JUPITER, Fla.--JULY 14, 2020--Some individuals love meeting new people, while others abhor the idea. For individuals with conditions such as autism, unfamiliar social interactions can produce negative emotions such as fear and anxiety. A new study from Scripps Research reveals how two key neural circuits dictate the choice between social approach and avoidance.

Neuroscientists who study autism have sought to define the brain circuits underlying these challenges, to enable more precise diagnosis, and to develop protocols for testing the effectiveness of therapeutic interventions. Brain mapping efforts have implicated multiple areas, including the emotional center of the brain and the region responsible for coordinating thoughts and actions. Assigning cause and effect to changes in these regions to the symptoms of autism, however, has been challenging.

The study, from the lab of neuroscientist Damon Page, PhD, uses a variety of innovative techniques to address this challenge, finding two specific circuits capable of independently controlling social preference in mice. Both link the areas of higher-level thought and decision-making in the prefrontal cortex to the emotional regulation center of the brain, the amygdala.

Sociable animals like mice - and humans - generally seek out social engagement, which produces benefits including increased resilience to stress, Page explains. But in conditions such as autism, schizophrenia and others that feature social impairments, an unexpected social encounter may produce a negative emotional reaction. Difficulty communicating and interacting with others is a hallmark of autism spectrum disorders, which now affect 1 in 34 U.S. boys and 1 in 54 girls age 8, according to the National Institutes of Mental Health.

"To understand something properly, you need to know where to look. It's a needle-in-the-haystack problem," Page says. "Understanding how this circuit works normally enables us to now ask the questions, 'How is this wiring changed in a condition like autism? How do therapeutic interventions impact the function of this circuit?'"

The group found that one neural circuit connecting the mouse infralimbic cortex to the basolateral amygdala impairs social behavior if its activity is dialed down. The other key circuit connects the prelimbic cortex to the basolateral amygdala. Dialing up activity of that circuit produced similarly impaired social behavior, says Aya Zucca, the study's co-first author.

Zucca notes that both mice and humans use corresponding brain regions to process social information, so the mouse model is a good one for studying these issues.

"Using a technique called optogenetics in mice, we controlled the neurons that were active during negative experiences at the precise time of social engagement. This manipulation of the circuit resulted in them avoiding social interaction. It's a bit like when you see a friendly face, but then have a flashback of a negative experience that's strong enough to make you decide to walk the other way."

With this social preference circuitry now identified, other questions can be addressed, such as, how this circuitry is wired during development, and whether genetic or environmental risk factors for autism cause mis-wiring of this circuitry, Page says.

"The brain circuitry underlying the social symptoms of autism is almost certainly highly complex and we're just beginning to map it," Page says. "But this study adds an important landmark to that map."

Over the past few decades, San (Bushmen) communities in southern Africa, former hunter-gatherers, have developed new adaptive strategies to cope with climate change, the presence of other groups on their land, and the impacts of globalization. While San have likely lived in southern Africa for 20,000 to 40,000 years, they remain politically and economically marginalized in relation to other social groups. Such forms of marginalization have been attributed to governance regimes that have dispossessed San groups from their land and livelihoods. According to a newly published article in the Journal of Anthropological Research, San communities face unprecedented challenges in the era of globalization, as cash-based economies continue to become more prevalent and resource-sharing at the communal level decreases.

In "The Plight of the Kalahari San: Hunter-Gatherers in a Globalized World," author Robert K. Hitchcock describes how challenges faced by San communities are connected to national-level and international-level legal and developmental frameworks. In particular, the legal status of San communities varies substantially across three different southern African countries: Botswana, Namibia, and Zimbabwe. In Botswana, where the largest number of San resides, San are not classified as an indigenous ethnic group vis-à-vis other ethnic groups; instead, they are categorized as Remote Area Dwellers, and a Remote Area Development Program (RADP) for these communities exist. Nevertheless, San livelihoods in Botswana continue to be at risk, because land tenure protections remain weak. In Namibia, the San are recognized as a distinct indigenous group, and a national-level San Development Office dedicated for San welfare was established by the Namibian government in 2007. They are now considered 'marginalized communities' along with Himba and Ovatue by the Namibian government. In Zimbabwe, no specific government agency is dedicated to the welfare of the San or other groups, though the Zimbabwe Constitution does recognize people that are defined as 'Koisan.'

Since the 1970s, Botswana, Zimbabwe, and Namibia have all instituted reforms to land tenure, which resulted in large portions of former tribal lands to be allocated to non-San groups and individuals. As a result, San communities have been displaced from their land in all three countries. Although some San communities have returned to their ancestral lands after court case victories, as occurred in Botswana San livelihoods continue to be vulnerable after the Botswana government criminalized subsistence hunting in 2014. Hunting rights were restored in 2019 but only for private, citizen and foreign safari hunters.

In Namibia, San groups have been involved in conservancies as a form of community-based natural resources management since 1996. In particular, San communities have enrolled as members of state-sanctioned conservancies, such as the Nyae Nyae Conservancy. These conservancies allow members to share revenues derived from safari hunting and tourism. Nyae Nyae, Namibia is the only area left in Africa, besides the Hadza area near Lake Eyasi, Tanzania, where local people have the right to hunt for subsistence as long as they use traditional weapons. The funds that have been made available to Ju/'hoan and !Kung communities have been used to develop gardens and protection facilities for water points. There is also a village schools program that provides San students with mother-tongue language education at the pre-school and primary school levels.

In the past few decades, San communities have gradually reclaimed their ways of life in southern Africa through legal victories at the national level. By mobilizing support for legal advocacy on behalf of San communities, local non-government organizations continue to play crucial roles among the San. Nevertheless, these community-led San organizations continue to face difficulties in obtaining adequate financing. The author of this article admits that "that it is not inexpensive to engage in international and local human rights efforts" San communities continue to call upon their governments and international organizations to recognize their human rights and protect their welfare.

AURORA, Colo. (July 14, 2020) - A study published earlier this year claiming the coronavirus may have jumped from dogs to humans is scientifically flawed, offering no direct evidence to support its conclusions, according to a collaborative group of international researchers, including scientists at the University of Colorado Anschutz Medical Campus.

"During this time of Covid-19 we are seeing people publish things that make wild leaps to conclusions that are not justified by the evidence," said David Pollock, PhD, professor of biochemistry and molecular genetics at the University of Colorado School of Medicine. "And this seems to be one of them."

Pollock and CU Anschutz alumnus Todd Castoe, an associate professor of biology at the University of Texas Arlington, are lead authors of an academic letter published this week in Molecular Biology and Evolution aimed at refuting the earlier study published in the same journal.

Pollock and his co-authors, including PhD student Kristen Wade and colleague Elizabeth Carlton, PhD, MPH, an assistant professor at the Colorado School of Public Health at CU Anschutz, took issue with the April 2020 study by biology Professor Xuhua Xia of the University of Ottawa in Canada.

Many scientists are interested in the origins of the novel coronavirus. The want to know which host the SARS-CoV-2 virus, responsible for Covid-19, came from before making the leap from animal to human.

The classic way to address this is by finding viruses with similar genome sequences in a particular animal host. Xia, however, focused on a feature of the coronavirus genome known as CpG content, and found that a distantly-related dog coronavirus had similar CpG content as SARS-CoV-2. Because this distant virus replicated well in the dog's digestive tract, he concluded that a dog's intestines were the ideal place to have affected the ancestral SARS-CoV-2's CpG content.

"However, there is no evidence for the logical premise of Xia's argument, considering that all mammals have digestive tracts," the researchers wrote.

They showed that dogs aren't special in their content of ZAP and ABOBEC3G proteins, which help safeguard humans from viruses and can interact with viral CpG content.

"Additionally, a recent inoculation study found that while other domesticated mammalian hosts are highly susceptible to SARS-CoV-2, canines exhibited low susceptibility, and no traces of viral RNA were detectable in any dog organs," the scientists wrote.

Pollock and his colleagues said that although the recent origin of SARS-CoV-2 is uncertain, the best current evidence makes it likely that it was passed to humans by horseshoe bats or possibly pangolins, a kind of spiny anteater in China. There is strong evidence that the virus has recently jumped between humans and these animals or other intermediate hosts.

Bat and pangolin viruses also have CpG content similar to human SARS-CoV-2, so the environment that affected viral CpGs must have happened long ago and possibly in one of these two mammals. They noted that there are signs of prior recombination events among divergent viruses. That suggests that over the years relatives of coronaviruses found in bats and pangolins mixed and mutated to give rise to SARS-CoV-2.

The proposition that dogs were likely recent ancestors of SARS-CoV-2 is not justified by the available evidence, the researchers concluded.

"Xia did not demonstrate that the low CpG frequency in the SARS- CoV-2 genome was driven by a unique selective environment in dog digestive tracts," the authors wrote. "Dogs are not more plausible than most other potential host species, and based on current data, far less plausible than bats or pangolins."

Pollock said determining how the virus jumped from animals to humans is critical in preparing for the next pandemic.

Even so, he said, in the midst of a pandemic scientific results can be over-interpreted and misused, leading to misappropriation of resources and effort. Rather than promote the speculations of a study based on weak evidence, he noted, it is better to admit uncertainty. If not, the scientific community has an obligation to respond.

"Considering the ramifications, scientists need to be particularly careful in interpreting findings, and avoid rushing to conclusions that are not well supported by solid evidence" co-lead author Castoe said. "We need to get this right."

A new study has narrowed down the region of the genome that drives the black color in throat and face of warblers by studying the hybrid offspring produced when two species mate. The hybrids of golden-winged and blue-winged warblers have a mix of coloration from the parent species, which allows researchers to identify which regions of the genome are associated with which color patterns. The study, led by researchers at Penn State, also reveals a more complex basis for the amount of yellow in warbler bellies and raises concerns about how hybrids of these species are classified.

Their results appear online in the journal The Auk: Ornithological Advances.

"The distinct plumage of these otherwise very similar birds has perplexed ornithologists for more than a hundred years," said Marcella Baiz, postdoctoral researcher at Penn State and first author of the paper. "Our research team previously compared the genomes of golden-winged and blue-winged warblers and identified 6 regions that differed between them, some of which may control color. In this study, we used hybrid birds of these species, which mix and match the features of their parent species, to help identify which regions of the genome are associated with which color patterns."

Color is an important cue for warblers and is prominently displayed during mating and other behaviors. Blue-winged warblers have yellow throats and bellies, while golden-winged warblers have white bellies and a black throat patch and face mask. Hybrids of these species vary in amounts of yellow and whether they have a black face mask and throat, and these characteristics are commonly used to categorize birds into different classes of hybrids.

The research team rated hybrid birds based on their plumage color and genetic likeness to the two parental species. They found that the amount of yellow in hybrids, which is produced by pigments called carotenoids, is not directly related to a bird's genetic likeness to the parent species--for example, hybrids with more yellow were not genetically closer to blue-winged warblers. Additionally, the extent of yellow in hybrids re-captured in subsequent years appeared to decline over time.

"Some researchers have hoped that the extent of yellow could indicate how many generations a hybrid is removed from the parent species," said David Toews, assistant professor of biology at Penn State and leader of the research team. "Our results indicate that it isn't quite so straightforward, and that classifying hybrids into groups based on the amount of yellow can be misleading."

The inheritance of a black throat patch and face mask, however, appears to be much more straightforward. The research team previously identified a genetic region related to black coloration in warblers. In the current study, the team used a rarer type of hybrid to narrow that to a region about five times smaller.

"This one type of very rare hybrid looks almost entirely like a blue-winged warbler, with a yellow body but with a black throat patch and face mask, like a golden-winged warbler," said Baiz. "By comparing its genome to that of blue-wing warblers, we were able to identify a much smaller genetic region where the birds differed, which we believe drives the black coloration."

The genetic region is located near the Agouti-signaling protein (ASIP) gene, which is thought to regulate production of the pigment melanin in some birds. Next, the research team would like to confirm that this section of the genome affects expression of the ASIP protein in warblers and underlies differences in their black plumage patches.

"We plan to continue to study the evolution of color across the 110 species of warblers, which have incredibly diverse plumage," said Toews. "Now that we have identified a starting point, this narrowed down genetic region, we won't be stabbing in the dark."

Cleveland - Researchers at Case Western Reserve University reviewed national data from the U.S. Census bureau and found associations between states' voting patterns in the 2016 presidential elections and decreases in the number of adults 18 to 64 years of age without health insurance coverage.

"Following the implementation of the Affordable Care Act (ACA), we observed sharp decreases in the number of uninsured Americans nationwide," said Uriel Kim, lead author on the study and an MD candidate at the Case Western Reserve University School of Medicine. "However, since the 2016 presidential election, these gains are reversing in so-called 'red' states, and 'purple' states that flipped from blue to red."

The paper State Voting Patterns in the 2016 Presidential Election and Uninsured Rates in Non-elderly Adults was recently published in the Journal of General Internal Medicine.

Kim and colleagues at the medical school defined states based on voting patterns in the 2016 general election, categorizing them as Blue (21 states and Washington, D.C.), Red (24), or Purple (6)--states that switched from Blue to Red in the 2016 election. (No Red states switched to Blue.)

"The implementation of Medicaid expansion and the marketplaces has varied across states, at least partially explaining our study findings," Kim said. "For example, of the 14 states that have not expanded Medicaid, most are red or purple states. Additionally, while all Americans have access to the insurance marketplaces, the degree to which states invest in outreach and navigation programs for marketplace insurance generally varies along party lines."

In the years 2014 through 2016 (compared to 2013, before key provisions of the ACA were implemented), the data showed that the number of uninsured adults age 18 to 64 decreased by 15.8 million nationwide.

Blue states saw a decrease in the uninsured of over 7.6 million.

Purple states saw a decrease in the uninsured of nearly 3 million.

Red states saw a decrease in the uninsured of nearly 5.2 million.

While the number of uninsured Americans reached record lows in 2016, over 23.5 million remained uninsured.

From 2017-18, following the presidential election, the number of uninsured individuals increased by more than 850,000 nationwide, reversing the positive trends.

Blue states saw a negligible decrease in the number of uninsured.

Purple states saw the number of uninsured grow by 240,000.

Red states saw the uninsured grow by 620,000

Over 24.3 million were still uninsured by 2018, with the majority living in Red states.

Tables and the full study are available in the paper here. Data from 2019 and 2020 were not yet available for the researchers to review.

The ACA expanded coverage with two approaches: the expansion of Medicaid (in some states) to individuals with higher incomes and the creation of "marketplaces" (in all states) that allow individuals to purchase health insurance for themselves and their families. Individuals purchasing insurance on the marketplace receive sliding-scale subsidies based on their income.

The study's senior author, Siran Koroukian, an associate professor in the Department of Population and Quantitative Health Sciences in the medical school, added that the study highlights the importance of policies to enable health care access, which has particular relevance during the COVID-19 pandemic and the resulting economic fallout.

"Since the majority of Americans receive insurance through their employer," said Koroukian, "the rise in unemployment following COVID-19 could mean that millions of people could be left without any insurance coverage, especially in states with less robust Medicaid programs or insurance marketplaces. This is problematic when the ability to access care is essential."

Depressed mood or anxiety exhibited in COVID-19 patients may possibly be a sign the virus affects the central nervous system, according to an international study led by a University of Cincinnati College of Medicine researcher.

These two psychological symptoms were most closely associated with a loss of smell and taste rather than the more severe indicators of the novel coronavirus such as shortness of breath, cough or fever, according to the study.

"If you had asked me why would I be depressed or anxious when I am COVID positive, I would say it is because my symptoms are severe and I have shortness of breath or I can't breathe or I have symptoms such as cough or high fever," says Ahmad Sedaghat, MD, PhD, an associate professor and director of rhinology, allergy and anterior skull base surgery, in the UC College of Medicine's Department of Otolaryngology-Head and Neck Surgery.

"None of these symptoms that portended morbidity or mortality was associated with how depressed or anxious these patients were," explains Sedaghat, also a UC Health physician specializing in diseases of the nose and sinuses. "The only element of COVID-19 that was associated with depressed mood and anxiety was the severity of patients' loss of smell and taste. This is an unexpected and shocking result."

Sedaghat conducted a prospective, cross-sectional telephone questionnaire study which examined characteristics and symptoms of 114 patients who were diagnosed with COVID-19 over a six-week period at Kantonsspital Aarau in Aarau, Switzerland. Severity of the loss of smell or taste, nasal obstruction, excessive mucus production, fever, cough and shortness of breath during COVID-19 were assessed. The findings of the study are available online in The Laryngoscope.

First author of the study is Marlene M. Speth, MD, and other co-authors include Thirza Singer-Cornelius, MD; Michael Oberle, PhD; Isabelle Gengler, MD; and Steffi Brockmeier, MD.

At the time of enrollment in the study, when participants were experiencing COVID-19, 47.4% of participants reported at least several days of depressed mood per week while 21.1% reported depressed mood nearly every day. In terms of severity, 44.7% of participants reported expressing mild anxiety while 10.5% reported severe anxiety.

"The unexpected finding that the potentially least worrisome symptoms of COVID-19 may be causing the greatest degree of psychological distress could potentially tell us something about the disease," says Sedaghat. "We think our findings suggest the possibility that psychological distress in the form of depressed mood or anxiety may reflect the penetration of SARS-CoV-2, the virus that causes COVID-19, into the central nervous system."

Sedaghat says researchers have long thought that the olfactory tract may be the primary way that coronaviruses enter the central nervous system. There was evidence of this with SARS, or severe acute respiratory syndrome, a viral illness that first emerged in China in November 2002 and spread through international travel to 29 countries. Studies using mouse models of that virus have shown that the olfactory tract, or the pathway for communication of odors from the nose to the brain, was a gateway into the central nervous system and infection of the brain.

"These symptoms of psychological distress, such as depressed mood and anxiety are central nervous system symptoms if they are associated only with how diminished is your sense of smell," says Sedaghat. "This may indicate that the virus is infecting olfactory neurons, decreasing the sense of smell, and then using the olfactory tract to enter the central nervous symptom."

Infrequent but severe central nervous system symptoms of COVID-19 such as seizures or altered mental status have been described, but depressed mood and anxiety may be the considerably more common but milder central nervous symptom of COVID-19, explains Sedaghat.

"There may be more central nervous system penetration of the virus than we think based on the prevalence of olfaction-associated depressed mood and anxiety and this really opens up doors for future investigations to look at how the virus may interact with the central nervous system," says Sedaghat.

ITHACA, N.Y. - In the midst of the COVID-19 crisis, it's common to feel stress levels rise every time we hear the word "virus." But new Cornell-led research reveals that the sound of the word itself was likely to raise your blood pressure - even before "corona" was added to it.

The study, "Affective Arousal Links Sound to Meaning," published July 14 in the journal Psychological Science, shows that some sound combinations, like those in the word "virus," elicit more emotionally intense responses than others. This may play a role in both children's language acquisition and how we might have evolved language in the first place.

The research also explains why, when people are presented with a spiky shape and a rounded shape and asked to guess which is called "bouba" and which "kiki," the majority call the spiky shape "kiki" and the rounded one "bouba." This well-studied psychological "matching" effect holds across age and cultural backgrounds, though scholars have disagreed about the reason.

The study's authors were Morten Christiansen, the William R. Kenan, Jr. Professor of Psychology and co-director of Cornell's Cognitive Science Program; Arash Aryani, a researcher at Freie Universität Berlin; and Erin Isbilen, a graduate student in psychology and a member of Christiansen's Cognitive Neuroscience Lab.

The new study shows that the level of emotional intensity, or "arousal," we feel when seeing objects or hearing sounds might provide the missing link that connects spikiness to "kiki" and roundedness to "bouba."

"For most words," the authors wrote, "the relationship between sound and meaning appears arbitrary: The sound of a word does not typically tell us what it means. A growing body of work, however, has shown that the sounds of words can carry subtle cues about what they refer to."

The researchers first asked study participants to rate the level of arousal experienced for the visual and auditory stimuli from eight previous studies of the matching effect, and found that the level of arousal can explain the matching preferences. They found that spiky shapes and kiki-like nonwords are indeed emotionally stimulating - similar to the word "virus" - whereas rounded shapes and bouba-like nonwords are calming.

These results were confirmed in a second experiment, using an acoustic model generated from the arousal ratings for more than 900 unrelated nonsense words. Their final experiment asked participants to match a subset of these nonsense words that varied in their level of arousal to the visual stimuli from the eight prior studies. Once again, they found that spiky shapes were chosen for high-arousal words, rounded shapes for low-arousal words.

According to the researchers, these findings suggest that many of the mappings in our vocabulary between sound and meaning are driven by our emotional responses to the auditory and visual input.

"Our emotional states may thus help children map sound to meaning when learning new words," Christiansen said. "The arousal link between sound and meaning may also have allowed early humans to get language off the ground in the first place, by making it easy to associate a word with its meaning."

According to the researchers, the study highlights the previously underappreciated role that human emotion may play in the emergence of language, both developmentally and evolutionarily, by grounding associations between abstract concepts (like shapes) and linguistic signs (like spoken words) in the affective system.

It also shows how the sounds of words might affect our emotional states independently of what they mean.

New research, based on earlier results in mice, suggests that our brains are never at rest, even when we are not learning anything about the world around us.

Our brains are often likened to computers, with learned skills and memories stored in the activity patterns of billions of nerve cells. However, new research shows that memories of specific events and experiences may never settle down. Instead, the activity patterns that store information can continually change, even when we are not learning anything new.

Why does this not cause the brain to forget what it has learned? The study, from the University of Cambridge, Harvard Medical School and Stanford University, reveals how the brain can reliably access stored information despite drastic changes in the brain signals that represent it.

The research, led by Dr Timothy O'Leary from Cambridge's Department of Engineering, shows that different parts of our brain may need to relearn and keep track of information in other parts of the brain as it moves around. Their study, published in the open access journal eLife, provides some of the first evidence that constant changes in neural activity are compatible with long term memories of learned skills.

The researchers came to this conclusion through modelling and analysis of data taken from an experiment in which mice were trained to associate a visual cue at the start of a 4.5-metre-long virtual reality maze with turning left or right at a T-junction, before navigating to a reward. The results of the 2017 study showed that single nerve cells in the brain continually changed the information they encoded about this learned task, even though the behaviour of the mice remained stable over time.

The experimental data consisted of activity patterns from hundreds of nerve cells recorded simultaneously in a part of the brain that controls and plans movement, recorded at a resolution that is not yet possible in humans.

"Finding coherent patterns in this large assembly of cells is challenging, much like trying to determine the behaviour of a swarm of insects by watching a random sample of individuals," said O'Leary. "However, in some respects the brain itself needs to solve a similar task, because other brain areas need to extract and process information from this same population."

Nerve cells connect to hundreds or even thousands of their neighbours and extract information by weighting and pooling it. This has a direct analogy with the methods used by pollsters in the run up to an election: survey results from multiple sources are collected and 'weighted' according to their consistency. In this way a steady pattern can emerge even when individual measurements vary wildly.

The Cambridge group used this principle to construct a decoding algorithm that extracted consistent, hidden patterns within the complex activity of hundreds of cells. They found two things. First, that there was indeed a consistent hidden pattern that could accurately predict the animal's behaviour. Second, this consistent pattern itself gradually changes over time, but not so drastically that the decoding algorithm couldn't keep up. This suggests that the brain continually modifies the internal code that relays information between different internal circuits.

Science fiction explores the possibility of transferring our memories and experiences into hardware devices directly from our brains. If future technology eventually allows us to upload and download our thoughts and memories, we may find that our brain cannot interpret its own activity patterns if they are replayed many years later. The concept of an apple - its colour, flavour, taste and the memories associated with it - may remain consistent, but the patterns of activity it evokes in the brain may change completely over time.

Such conundra will likely remain speculative for the immediate future, but experimental technology that achieves a limited version of such mind reading is already a reality, as this study shows. Brain-machine interfaces are a rapidly maturing technology, and human neural interfaces that can control prosthetics and external hardware have been in clinical use for over a decade. The work from the Cambridge group highlights a major open challenge in extracting reliable information from the brain.

"Even though we can now monitor brain activity and relate it directly to memories and experiences, the activity patterns themselves continually change over a period of several days," said O'Leary, who is a Lecturer in Information Engineering and Medical Neuroscience. "Our study shows that in spite of this change, we can construct and maintain a relatively stable 'dictionary' to read out what an animal is thinking as it navigates a familiar environment.

"The work suggests that our brains are never at rest, even when we are not learning anything about the external world. This has major implications for our understanding of the brain and for brain-machine interfaces and neural prosthetics."

Educators could use the COVID-19 outbreak to help middle-schoolers better understand the world, according to new research from faculty at Binghamton University, State University of New York.

In the field of middle-grades education (grade 4-9), the COVID-19 pandemic may offer educators a perfect real-world scenario that invites students to critically examine how our global community's actions impact one another, according to Bogum Yoon, associate professor of literacy education at Binghamton University.

"The outbreak of the coronavirus has affected individuals' lives and education around the world, including the United States," said Yoon. "This phenomenon invites educators to work with students for deepening their understanding about the interconnected world as global citizens."

In her new paper, Yoon provides instructional suggestions on how educators can use the pandemic crisis as an authentic world-learning opportunity. The suggestions could naturally tie into several content areas: English language arts (e.g., reading about the virus and discussing it; critiquing news media content on the coronavirus); science (e.g., the nature of the coronavirus and its impact for individuals' health; discussing the impact of masks for their own and others' health); social studies (e.g., virus impact to different ethnic and SES groups; the restriction of individuals' rights and freedom under a ban); and mathematics (e.g., comparing U.S. death rates with other countries through graphs; reviewing the statistics on the shortage of essential goods in a given country and comparing them with other countries). Although Yoon focused on middle grade education, these instructional suggestions can be applied to any grade level.

"The topic of the novel disease provides an excellent opportunity to recognize the global issue, extend school curriculum, and examine the role of the world," said Yoon. "Through the process of learning about the world, students can better understand their own identities, ideologies and situations."

The paper, "The Global Pandemic as Learning Opportunities about the World: Extending School Curriculum," was published in Middle Grades Review.

Young gay sexual minority men - especially Black and Latino youth - have their first sexual experiences at younger ages, emphasizing a need for comprehensive and inclusive sex education, according to Rutgers researchers.

The study, published in the Journal of Sex Research, examined consensual sex behaviors to better understand same-sex sexual debut, or the age at which people first engage in sexual behaviors.

The researchers, part of the Rutgers School of Public Health's Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), found that 19 percent of participants had their first sexual experience before the age of 13.

The researchers also found that same-sex sexual encounters first happen, on average, at 14.5 years, with Hispanic/Latinx and Black non-Hispanic participants reporting a younger age for their first time performing oral sex or engaging in anal sex, compared to their peers.

Earlier age of sexual debut among sexual minority men is associated with a range of sexual and health risk behaviors, including increased likelihood of condomless sex; tobacco, alcohol, and other substance use; psychological distress; suicidality; and earlier age of HIV diagnosis.

According to the researchers, health care providers, including pediatricians and behavioral health therapists, can help reduce potential harms of these behaviors by having candid conversations about sex; not assuming the sexual identities or behaviors of their young patients; actively inquiring about sexual behaviors with partners of all genders; providing appropriate counseling about all sexual behaviors and their associated risks for HIV and other STIs; and speaking with adolescent patients in private - without parents/guardians present - whenever legally and ethically possible.

Providers working with young gay men of all ages should also consider beginning routine testing for HIV and other sexually transmitted diseases at earlier ages than previously indicated, particularly among youth of color.

"Our results suggest that health care providers can play an active role in mitigating sexual and health behaviors that are associated with the early onset of same-sex sexual behaviors; to date the medical profession is ill equipped to address the needs of LGBTQ+ people," said Perry N. Halkitis, dean of the Rutgers School of Public Health.

Comprehensive sexuality education, which is inclusive of sexual and gender minority populations and all types of sexual behaviors, may not only empower sexual and gender minority youth to make informed choices about their sexual health and behavior, but may also improve school climate through educating non-LGBTQ peers.

"As many schools are forced to redesign their classrooms and curricula to accommodate socially distanced or remote learning for COVID-19, this may be the perfect time to consider implementing comprehensive sex education programming to provide age-appropriate sexual health education for people of all genders and sexual orientations," said Caleb LoSchiavo, doctoral student at the Rutgers School of Public Health and co-author.

Vertical farms with their soil-free, computer-controlled environments may sound like sci-fi. But there is a growing environmental and economic case for them, according to new research laying out radical ways of putting food on our plates.

The interdisciplinary study combining biology and engineering sets down steps towards accelerating the growth of this branch of precision agriculture, including the use of aeroponics which uses nutrient-enriched aerosols in place of soil.

Carried out by the John Innes Centre, the University of Bristol and the aeroponic technology provider LettUs Grow, the study identifies future research areas needed to accelerate the sustainable growth of vertical farming using aeroponic systems.

Dr Antony Dodd, a group leader at the John Innes Centre and senior author of the study, says: "By bringing fundamental biological insights into the context of the physics of growing plants in an aerosol, we can help the vertical farming business become more productive more quickly, while producing healthier food with less environmental impact."

Jack Farmer, Chief Scientific Officer at LettUs Grow and one of the authors of the study, adds: "Climate change is only going to increase the demand for this technology. Projected changes in regional weather patterns and water availability are likely to impact agricultural productivity soon. Vertical farming offers the ability to grow high value nutritious crops in a climate resilient manner all year round, proving a reliable income stream for growers."

Vertical farming is a type of indoor agriculture where crops are cultivated in stacked systems with water, lighting and nutrient sources carefully controlled.

It is part of a rapidly growing sector supported by artificial intelligence in which machines are taught to manage day to day horticultural tasks. The industry is set to grow annually by 21% by 2025 according to one commercial forecast (Grand View Research, 2019).

Green benefits include better use of space because vertical farms can be sited in urban locations, fewer food miles, isolation from pathogens, reduction in soil degradation and nutrient and water recapturing and recycling.

Vertical farms also allow product consistency, price stabilization, and cultivation at latitudes incompatible with certain crops such as the desert or arctic.

"Vertical systems allow us to extend the latitude range on which crops can be grown on the planet, from the deserts of Dubai to the 4-hour winter days of Iceland. In fact, if you were growing crops on Mars you would need to use this kind of technology because there is no soil," says Dr Dodd.

The study, which appears in the journal New Phytologist, lays out seven steps - strategic areas of future research needed to underpin increased productivity and sustainability of aeroponic vertical farms.

These seek to understand:

Why aeroponic cultivation can be more productive than hydroponic or soil cultivation.

The relationship between aeroponic cultivation and 24-hour circadian rhythms of plants.

Root development of a range of crops in aeroponic conditions.

The relationship between aerosol droplet size and deposition and plant performance.

How we can establish frameworks for comparing vertical farming technologies for a range of crops.

How aeroponic methods affect microbial interactions with plant roots.

The nature of recycling of root exudates (fluids secreted by the roots of plants) within the nutrient solutions of closed aeroponic systems.

The report argues that a driver of technological innovation in vertical farms is minimizing operation costs whilst maximizing productivity - and that investment in fundamental biological research has a significant role.

Dr Dodd's research area covers circadian rhythms - biological clocks which align plant physiology and molecular processes to the day to day cycle of light and dark. He recently completed a year-long Royal Society Industry Fellowship with LettUs Grow.

This involved combining Dr Dodd's expertise in circadian rhythms and plant physiology with the work of LettUs Grow's team of biologists and engineers to design optimal aeroponic cultivation regimens. This is a key area of investigation as these molecular internal timers will perform differently in vertical farms.

Aeroponic platforms are often used to grow high value crops such as salads, pak choi, herbs, small brassica crops, pea shoots and bean shoots. LettUs Grow are also working on growth regimens for fruiting and rooting crops such as strawberries and carrots, as well as aeroponic propagation of trees for both fruit and forestry.

John Innes Centre researchers have bred a line of broccoli adapted to grow indoors for a major supermarket and one of the aims of research will be to test how we can genetically tune more crops to grow in the controlled space of vertical farms.

Bethany Eldridge, a researcher at the University of Bristol studying root-environment interactions and first author of the study adds: "Given that 80% of agricultural land worldwide is reported to have moderate or severe erosion, the ability to grow crops in a soilless system with minimal fertilizers and pesticides is advantageous because it provides an opportunity to grow crops in areas facing soil erosion or other environmental issues such as algal blooms in local water bodies that may have been driven by traditional, soil-based, agriculture."

Lilly Manzoni, Head of Research and Development at LettUs Grow and one the authors of the study says, "This paper is unique because it is broader than a typical plant research paper, it combines the expertise of engineers, aerosol scientists, plant biologists and horticulturalists. The wonderful thing about controlled environment agriculture and aeroponics is that it is truly interdisciplinary"