Culture

As schools prepare to reopen and more people are heading back to their offices and shared work spaces, Syracuse University Professor Jianshun "Jensen" Zhang offers a three-step plan to improve indoor air quality (IAQ) and help prevent the spread of COVID indoors.

Zhang's plan is detailed in a recent editorial published in the journal "Science and Technology for the Built Environment" called "Integrating IAQ control strategies to reduce the risk of asymptomatic SARS CoV-2 infections in classrooms and open plan offices."

"Classrooms and open-space offices present a special challenge because of their relatively large occupant density, which can lead to a higher chance of person-to-person cross infection in the space via airborne transmission as well as through direct or indirect contacts," Zhang says. "As schools and businesses are making plans to reopen, how can the risk of such cross infection be minimized or prevented?"

The coronavirus disease is a respiratory illness that can spread from person to person. The virus that causes COVID-19 spreads, typically through respiratory droplets from coughing, sneezing, or talking. Some people without symptoms are able to spread the disease without knowing that they have it.

Dr. Zhang, a professor in the Department of Mechanical and Aerospace Engineering and Director of the Building Energy and Environmental Systems Laboratory, writes that source control, ventilation and air cleaning - and combinations of all three - can offer important tools in preventing the spread of COVID within indoor spaces.

Here's a look at his three-step plan:

Source Control

Source control is the first and most important among all IAQ strategies. For preventing the spread of the coronavirus, that means detecting, tracking, and isolating infected persons; and preventing transmission from asymptomatic virus carriers.

"The latter is more challenging in open space office or classroom settings in which air is typically well mixed," Zhang writes. "To reduce the number of virus-containing aerosols emitted to the space from any possible virus carriers present, universal face masking, as well as hand sanitizing before entering the space is essential."

Ventilation

The next step in air quality is ventilation with a focus on supplying enough clean outdoor air to rooms and offices and effectively diluting the concentration of pollutants.

"Mechanically ventilated classrooms and offices typically have about 20 percent of their air supplied from outdoors, and the rest is recirculated air. This is done to save heating and cooling energy while maintaining acceptable levels of IAQ," Zhang says. "To reduce the risk of the SARS CoV-2 virus infection, the outdoor ventilation rate should be increased to the maximum operational capacity of the building ventilation system, which can be two or more times of that under the normal operation mode per the existing standard."

He also writes that any recirculated air needs to be filtered with HEPA filters or MERV 14 filters, to minimize cross-contamination.

Zhang says that proper air distribution is essential for making sure the filtered air is reaching the people where they are. He says, "this is an area so far has been largely neglected in existing guidelines or recommended practices for reducing the SARS CoV-2 virus infection."

He points out that most classrooms and open plan offices in the United States use mixing ventilation (MV) for fresh air delivery. Air diffusers in MV are typically located close to the ceiling level, but Zhang recommends that air supply should be brought in through ground ventilation. The difference is that filtered air from the ceiling mixes with the exhaled breath of people who could be asymptomatic carriers of COVID.

He said to prevent filtered air becoming contaminated, it should be pumped into a room through ground-level vents. Zhang recommends using "displacement ventilation," which simply delivers the air supply at the floor level but exhausts it through vents in the ceiling.

Air cleaning

Air cleaning strategies involve applying air filtration or purification within a building, rooms, or at a personal level, such as a properly worn mask. But among all three, there must be high efficiency filters and sufficient airflow, writes Zhang.

At the building level, high efficiency particulate (HEPA) filters in the recirculated or mixed air duct can reduce the cross contamination between rooms and increase the total clean air delivery rate (outdoor plus filtered air) for diluting the virus concentration in the ventilated space.

Standalone room air cleaners with HEPA filters can also be used as a supplementary measure to further reduce the concentration of virus in the occupied space. Research has shown a range of clean air delivery rate (CADR) from 170 to 800?m3/h (or 100 to 470 CFM) with a median cost of $361 based on a comprehensive survey of off-the-shelf air cleaners available from the most popular online shopping sites. The results were consistent with an earlier laboratory study in which 6 portable air cleaners were tested for both particulate and volatile organic compounds removal performance. Zhang says that an air cleaner with a CADR of 722?m3/h (425 CFM) can double the clean air supply for 25 people in a classroom or open plan office.

Zhang says this can be considered as a cost-effective supplementary measure for rooms where total ventilation airflow rate is insufficient. However, for spaces with displacement ventilation (DV), a room air cleaner should only be used with caution so that the desirable airflow pattern of DV is not disturbed.

Conclusion

Zhang writes that these IAQ strategies can be used and implemented across multiple scales from an entire building to a room to an individual's cubicle or personal space. In his editorial, Dr. Zhang also includes a table that shows the efficiency of different combinations of IAQ strategies and the associated costs.

DALLAS, July 29, 2020 -- After decades of progress in reducing overall, premature cardiac death rates in the U.S., a county-by-county population study has found the decline began slowing in 2011, according to new research published today in the Journal of the American Heart Association, an open access journal of the American Heart Association.

Researchers in China and the U.S. accessed multiple databases to analyze county-by-county data on nearly 1.6 million premature cardiac deaths in the U.S. that occurred between 1999 and 2017, among individuals between 35 and 74 years of age. While rates declined between 1999 and 2017, since 2010 the pace of the decline has slowed significantly.

"From the 1960s to 2010s, the United States experienced remarkable decline in cardiovascular disease mortality that was coined as one of the major public health accomplishments of the 20th century," said lead investigator Zhi-Jie Zheng, M.D., Ph.D., a University Endowed Distinguished Professor and chair of the department of global health at Peking University in Beijing, China, who leads studies analyzing global and country-specific trends in diseases of major global health importance. Zheng previously served as a lead epidemiologist at the U.S. Centers for Disease Control and Prevention in Atlanta and a supervisory medical epidemiologist at the National Heart, Lung, and Blood Institute of the National Institutes of Health in Bethesda, Maryland.

"Increasing numbers of out-of-hospital deaths and fatal heart attacks in younger age groups, coupled with a steady widening of disparity of socioeconomic and health environment factors affecting health care at the county level, appear to be the key drivers of the slowdown we have seen since 2010."

The study is one of the first national analyses on factors related to disparities in premature cardiac death rates among U.S. counties.

In 2012, all United Nations-member countries including the U.S. committed to achieving a 25% reduction in premature death from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases by the year 2025, as proposed by World Health Organization (WHO). In addition, The Global Cardiovascular Disease Taskforce, which includes the American Heart Association, American College of Cardiology Foundation and other organizations, set a goal to reducing premature deaths from cardiovascular diseases and stroke (The Heart of 25 by 25).

In this study, premature cardiac death was defined as any death that occurred between ages 35 and 74 attributed to heart disease. Among the key findings:

Of nearly 1.6 million premature cardiac deaths from 1999 to 2017, about 61% occurred outside of a hospital.
Although overall premature cardiac death rates fell, the proportion of out-of-hospital deaths rose from 58.3% to 61.5% in 2017.
Twice as many premature cardiac deaths occurred in men compared to women.
Premature death rates were 3.4 times higher among African Americans than Asians or Pacific Islanders.
"Our findings suggest a need for health care policy changes and programs that can identify high-risk, young populations prone to premature cardiac death and support improved cardiac health," Zheng said.

"The decline in the reduction of premature deaths attributable to heart disease is disheartening and is an urgent call to action," said American Heart Association President Mitchell S. V. Elkind, M.D., M.S., FAHA, FAAN, professor of neurology and epidemiology at Columbia University New York and attending neurologist at Columbia University Irving Medical Center of the NewYork-Presbyterian Hospital. "We must invest and focus public and private efforts to address the disparities in risk factors, access to care and other factors slowing the progress in heart disease so that we can increase the opportunity for all Americans to live longer and healthier lives."

"Heart attacks can occur at any age, not just in older persons," Zheng said. "The slower decline in out-of-hospital rates is alarming and warrants more precision targeting and sustained efforts to integrate lifestyle and behavioral interventions that increase heart health and reduce the risk of premature cardiac death."

Disparities were largely associated with demographic composition and socioeconomic status. Demographic composition, which included population size, rural living, sex, age, racial/ethnic and foreign-born as factors, accounted for just over a third of out-of-hospital and in-hospital premature cardiac deaths.

Differences in socioeconomic factors, which included median household income, unemployment, school enrollment and number of violent crimes per 100,000 population, accounted for about 20% of deaths.

Health care environment, which included density of primary care physicians; diabetic, Medicare enrollees who had diabetes confirmed by an HbA1c test; access to places for physical activity; and access to healthy foods, accounted for 18.6% of out-of-hospital and 13.9% of in-hospital deaths. While population health status, which included scoring according to the cardiovascular disease risk index derived from a set of major cardiovascular risk factors, self-rated poor/fair health and total Medicare reimbursements per enrollee (a measure of health care utilization as a proxy for illness), accounted for 23.7% of out-of-hospital death and 30.2% in-hospital deaths.

The study had several limitations including potential errors in the reporting of cause of death, which is reliant on county-level, government health department data.

Once found in bottles, food containers, cash register receipts and electronics, bisphenol A (BPA) has been phased out of many products because of health concerns and government regulations. As a result, the production and use of BPA analogs, which are unregulated and poorly understood, have increased. Now, by analyzing urine samples and wastewater, researchers report in ACS' Environmental Science & Technology how human exposure to bisphenols has changed over time in an Australian population.

BPA is used in the manufacture of polycarbonate plastics and epoxy resins. An endocrine disruptor, the compound readily leaches from these products, and high levels have been linked to health problems in humans and laboratory animals. With increasing regulation and unfavorable public opinion, BPA is being replaced with similar compounds, such as bisphenol S (BPS), bisphenol F (BPF), bisphenol B (BPB) and bisphenol AF (BP-AF). However, these compounds have not been well studied, and despite their similar chemical structures to BPA, they are largely unregulated. Chang He and colleagues wanted to use pooled urine samples and wastewater collected from South East Queensland, Australia, to estimate exposure to various bisphenols over a 6-year period.

Between 2012 and 2017, the team collected urine samples from a pathology lab and wastewater samples from three wastewater treatment plants. For each 2-year period, they pooled urine samples from the lab by age and sex so that they could determine average levels of bisphenol exposure. Using liquid chromatography/tandem mass spectrometry, the researchers detected BPA in all pooled urine samples, and BPS in 97% of samples, whereas BPB, BPF and BP-AF were not found in any samples. Over the years, urinary levels of BPA decreased, while BPS increased. Higher levels of BPA were measured in younger age groups, which might reflect the presence of BPA in many children's products, such as bottles and toys, manufactured in Australia before 2010. In wastewater, BPA and BPS were detected in all samples, and BPF in 29% of samples. The levels of these bisphenols in wastewater were much higher than predicted from urinary excretion, indicating that most of the compounds arose from leaching from plastic products, industrial input or other sources.

WASHINGTON--COVID-19 may increase the risk of blot cots in women who are pregnant or taking estrogen with birth control or hormone replacement therapy, according to a new manuscript published in the Endocrine Society's journal, Endocrinology.

One of the many complications of COVID-19 is the formation of blood clots in previously healthy people. Estrogen increases the chance of blood clots during pregnancy and in women taking birth control pills or hormone replacement therapy. If infected with COVID-19, these women's risk of blood clotting could be even higher, and they may need to undergo anticoagulation therapy or to discontinue their estrogen medicines.

"During this pandemic, we need additional research to determine if women who become infected with the coronavirus during pregnancy should receive anticoagulation therapy or if women taking birth control pills or hormone replacement therapy should discontinue them," said the study's corresponding author, Daniel I. Spratt, M.D., of Maine Medical Center in Portland, Maine, and Tufts University School of Medicine in Boston, Mass. "Research that helps us understand how the coronavirus causes blood clots may also provide us with new knowledge regarding how blood clots form in other settings and how to prevent them."

Researching and understanding the cause of blood clotting in COVID-19, including the intersecting effects of estrogen therapy or pregnancy, has several hurdles and will require innovative animal and tissue models.

Conversations between clinicians and basic researchers and between endocrinologists and hematologists are necessary to explore potential interactions between SARS-CoV-2--the virus that causes COVID-19--and pregnancy or estrogen therapy that could guide clinical management.

Like the legendary falling apple that hit Isaac Newton and led to his groundbreaking insight on the nature of gravity, COVID-19 could provide unintended glimpses into how complex Earth systems operate, according to a new Stanford-led paper. The perspective, published July 29 in Nature Reviews Earth & Environment, hypothesizes outcomes of unprecedented changes in human activity wrought by worldwide sheltering orders, and outlines research priorities for understanding their short and long-term implications. Getting it right could revolutionize how we think about issues as broad as greenhouse gas emissions, regional air quality, and the global economy's connection to poverty, food security and deforestation, according to the researchers. It could also help ensure an economically, socially and environmentally sustainable recovery from the coronavirus pandemic while helping prevent future crises.

"Without distracting from the most important priority - which is clearly the health and well-being of people and communities - the current easing of the human footprint is providing a unique window into the impacts of humans on the environment, including a number of questions that are critical for effective public policy," said lead author Noah Diffenbaugh, the Kara J Foundation Professor at Stanford's School of Earth, Energy & Environmental Sciences.

For example, the question of how much electrifying the vehicle fleet will improve air quality has until now relied heavily on theoretical arguments and computer models. The scale of recent emissions reductions, however, provides an opportunity to use atmospheric observations to check just how accurate those models are in simulating the impact of pollution-reduction interventions such as electric vehicle incentives.

Predicting pandemic outcomes

The researchers note that although many of the initial impacts of COVID sheltering, such as clear skies resulting from reduced pollutant emissions, could be perceived as beneficial to the environment, the longer-term impacts - particularly related to the economic recession - are less clear. To understand the impacts across both short and long timescales, they propose focusing on cascading effects along two pathways: (1) energy, emissions, climate and air quality; and (2) poverty, globalization, food and biodiversity.

Given the complex interactions along these pathways, the researchers emphasize the need for techniques that can bring together multiple lines of evidence to reveal causes and effects. This includes bolstering and expanding coordinated efforts to study the impacts of the pandemic, including safe deployment of environmental sensors that can track changing conditions, computer models that simulate Earth's response to the sheltering measures and solutions-oriented research trials that lend insight into human behavior and decision making. The authors also call for a coordinated data repository where many different kinds of data can be made openly available to the public in a uniform format.

"Almost overnight, people across the world had to change the way they live, the way they work - with many facing loss of income - commute, buy food, educate their children and other energy-consuming behaviors," said Inês Azevedo, an associate professor of energy resources engineering in Stanford's School of Earth, Energy & Environmental Sciences. "It's critical for us to better understand how future societal disruptions and catastrophes could affect interactions among energy systems and other systems that serve society."

Understanding the human response

A key factor in understanding how the pandemic's effects play out is its influence on human behavior and decision making.

"Human behavior contributes to, but is also affected by, changes in the Earth system, and COVID-19 is creating new challenges for ensuring people and corporations act to protect the planet," said co-author Margaret Levi, the Sara Miller McCune Director of Stanford's Center for Advanced Study in the Behavioral Sciences and a professor of political science. "While government was not a central focus in this paper, it clarifies the roles that laws, regulations and investments play in the safety of the food supply and food workers, emissions controls and many other aspects of the health of the Earth and its inhabitants."

Some of the pandemic's most lasting impacts on climate and air quality could occur via insights it provides into the calculation of policy parameters that measure the value that individuals and society place on different environmental trade-offs. The COVID-19 crisis is making these tradeoffs more explicit, the researchers point out. This is because governments, communities and individuals are making historic decisions reflecting underlying preferences for current and future consumption, as well as the tradeoff between different types of economic activity and individual and collective risk.

These decisions can help quantify the parameters that are routinely used in environmental policymaking (such as the cost of human lives lost to air pollution or of climate change associated with carbon dioxide emissions). As those updated parameters are incorporated into actual policy decisions, they will have lasting effects on the regulations that impact the long-term trajectory of climate and air quality.

Studying policy interventions designed to prevent socio-environmental damage - such as the role of poverty in driving deforestation - could also help vulnerable people weather poverty shocks from COVID-19 by providing a deeper understanding of how and where poverty and environmental degradation are most tightly linked. The researchers propose using the kinds of solution-oriented research trials that were awarded this year's Nobel Prize in Economics to study whether interventions such as payments for protection of natural resources are effective in staving off deforestation, over-fishing and other environmental damages.

"COVID-19 poses some of the biggest challenges we have faced in the last century," said paper co-author Chris Field, the Perry L. McCarty Director of the Stanford Woods Institute for the Environment and Melvin and Joan Lane Professor for Interdisciplinary Environmental Studies. "With every challenge, there are opportunities for learning, and this paper provides a map for expanding the set of opportunities."

WASHINGTON, D.C. and SAN DIEGO, CA -- People of color are far more likely to worry about their ability to pay for healthcare if diagnosed with COVID-19 than their White counterparts, according to a new survey from nonprofit West Health and Gallup. By a margin of almost two to one (58% vs. 32%), non-White adults report that they are either "extremely concerned" or "concerned" about the potential cost of care. That concern is three times higher among lower-income versus higher-income households (60% vs. 20%).

The data come from the West Health/Gallup U.S. Healthcare Study, an ongoing survey about Americans' experiences with and attitudes about the healthcare system. The latest findings are based on a nationally representative sample of 1,017 U.S. adults interviewed between June 8 and June 30.

Additionally, the survey finds a disturbing trend when it comes to medication insecurity. Overall, 24% of U.S. adults say they lacked money to pay for at least one prescribed medicine in the past 12 months, an increase from 19% in early 2019. Among non-White Americans, the burden is growing even more quickly. Medication insecurity jumped 10 percentage points, from 21% to 31%, compared with a statistically insignificant three-point increase among White Americans (17% to 20%).

"We're seeing a significant and increasing racial and socioeconomic divide when it comes to Americans' views on the cost of healthcare and its impact on their daily lives," said Tim Lash, chief strategy officer for West Health. "When we started polling in early 2019, close to 1 in 5 Americans were unable to pay for prescribed medication in the last 12 months. Today it's 1 in 4, and disparities between race and income are growing and will continue to grow without more action from providers and policymakers."

"The statistically significant rise in Americans experiencing medication insecurity is by itself a noticeable shift," said Dan Witters, Gallup senior researcher. "The 10-percentage-point increase among non-White Americans between early 2019 and today serves as strong evidence that the situation is worsening more acutely for those who are already most at risk."

Non-White Workers Twice as Likely to Report Staying in Unwanted Job

Amid broad concern about paying for the cost of COVID-19 or other medical expenses, health insurance benefits are likely more important than ever to U.S. workers. The West Health/Gallup survey finds that 12% of workers are staying in a job they want to leave because they are afraid of losing healthcare benefits, a sentiment that is about twice as likely to be held by non-White workers versus White workers (17% vs. 9%).

High Public Support for Government Negotiation and for Banning Political Contributions from Pharma

Americans step across racial lines in their overwhelming support for disallowing political contributions by pharmaceutical companies and for government intervention in setting price limits for government-sponsored research and a COVID vaccine.

Nearly 9 in 10 U.S. adults (89%) think the federal government should be able to negotiate the cost of a COVID-19 vaccine while only 10% say the drug company itself should set the price. Similarly, 86% of U.S. adults say there should be limits on the price of drugs that government-funded research helped develop. Regarding the influence of pharmaceutical companies on the political process, 78% of U.S. adults say political campaigns should not be allowed to accept donations from pharmaceutical companies during the coronavirus pandemic.

In the case of an infection, the SARS-CoV-2 virus must overcome various defense mechanisms of the human body, including its non-specific or innate immune defense. During this process, infected body cells release messenger substances known as type 1 interferons. These attract natural killer cells, which kill the infected cells.

One of the reasons the SARS-CoV-2 virus is so successful - and thus dangerous - is that it can suppress the non-specific immune response. In addition, it lets the human cell produce the viral protein PLpro (papain-like protease). PLpro has two functions: It plays a role in the maturation and release of new viral particles, and it suppresses the development of type 1 interferons. The German and Dutch researchers have now been able to monitor these processes in cell culture experiments. Moreover, if they blocked PLpro, virus production was inhibited and the innate immune response of the human cells was strengthened at the same time.

Professor Ivan Dikic, Director of the Institute of Biochemistry II at University Hospital Frankfurt and last author of the paper, explains: "We used the compound GRL-0617, a non-covalent inhibitor of PLpro, and examined its mode of action very closely in terms of biochemistry, structure and function. We concluded that inhibiting PLpro is a very promising double-hit therapeutic strategy against COVID-19. The further development of PLpro-inhibiting substance classes for use in clinical trials is now a key challenge for this therapeutic approach."

Another important finding from this work is that the viral protein PLpro of SARS-CoV-2 cleaves off ISG-15 (interferon-stimulated gene 15) from cellular proteins with a higher level of activity than the SARS equivalent, which leads to greater inhibition of type I interferon production. This is concordant with recent clinical observations which show that COVID-19 exhibits a reduced interferon response in comparison to other respiratory viruses such as influenza and SARS.

To understand in detail how inhibiting PLpro stops the virus, researchers in Frankfurt, Munich, Mainz, Freiburg and Leiden have worked closely together and pooled their biochemical, structural, IT and virological expertise.

Donghyuk Shin, postdoctoral researcher and first author of the paper, says: "Personally, I would like to underline the significance of science and research and in particular emphasize the potential generated by a culture of collaboration. When I saw our joint results, I was immensely grateful for being a researcher."

Professor Sandra Ciesek, Director of the Institute of Medical Virology at University Hospital Frankfurt, explains that the papain-like protease is an extremely attractive anti-viral goal for her as a physician because its inhibition would be a "double strike" against SARS-CoV-2. She highlights the excellent collaboration between the two institutes: "Especially when investigating a new clinical picture, everyone profits from interdisciplinary collaboration as well as different experiences and viewpoints."

Researchers have shown how a blend of old tyres and building rubble could be used as a sustainable road-making material, in a zero-waste solution to boost recycling and support the circular economy.

Construction, renovation and demolition account for about half the waste produced annually worldwide, while around 1 billion scrap tyres are generated globally each year.

The new material, developed by researchers at RMIT University in Melbourne, Australia, is the first to combine recycled rubble and rubber in a mix that is precisely optimised to meet road engineering safety standards.

Designed to be used for base layers, the recycled blend is more flexible than standard materials, making roads less prone to cracking.

Lead researcher Dr Mohammad Boroujeni said the rubble-rubber mix could deliver both environmental and engineering benefits.

"Traditional road bases are made of unsustainable virgin materials - quarried rock and natural sand," Boroujeni said.

"Our blended material is a 100% recycled alternative that offers a new way to reuse tyre and building waste, while performing strongly on key criteria like flexibility, strength and permanent deformation.

"As we push towards a circular economy that can eliminate waste and support the continual use of resources, our recycled blend is the right choice for better roads and a better environment."

In Australia, only 16% of scrap tyres are domestically recycled. About 3.15 million tons of processed building rubble - known as recycled concrete aggregate (RCA) - is added to stockpiles each year rather than being reused.

In 2019, federal and state governments agreed to ban the export of certain waste materials, with the aim of building Australia's capacity to generate high value recycled commodities and associated demand. As part of the agreement, whole used tyres will be banned from export by December 2021.

On the road to a circular economy

Roads are made of four layers - a subgrade, base and sub-base, with asphalt on top.

All the layers must be strong enough to withstand the pressures of heavy vehicles, while being flexible enough to allow the right amount of movement so a road doesn't easily crack.

RCA can potentially be used on its own for road base layers, but adding recycled rubber can significantly enhance the finished product.

In previous research, the RMIT School of Engineering team has shown their rubble-rubber blend performs well when tested for stress, acid and water resistance, as well as strength, deformation and dynamic properties. Its low shrinkage and good flexibility reduce the risk of cracking.

The new study published in Construction and Building Materials looked at how the mix would withstand the pressures of being driven over by countless vehicles over its lifetime.

Researchers used special machinery to assess the blended material's performance under frictional force, or shear stress, and compared different types of crumb rubber (fine and coarse) mixed into the RCA at different ratios.

The team identified an optimal mixture - 0.5% fine crumb rubber to 99.5% RCA - that delivered on shear strength while maintaining good cohesion between the two materials.

Chief investigator Professor Jie Li said while the recycling of construction waste and scrap tyres was growing, both industries continued to produce significantly more waste than is currently reused.

"Solutions to our waste problems will come not only from reducing how much goes to landfill and increasing how much we recycle; developing new and innovative uses for our recycled materials is absolutely vital," Li said.

'An experimental study on the shear behaviour of recycled concrete aggregate incorporating recycled tyre waste' is published in Construction and Building Materials (DOI: 10.1016/j.conbuildmat.2020.120266).

A team of researchers investigating how a certain type of drugs can kill cells has discovered that these drugs can do more harm than good when used in combination with other cancer treatments.

The researchers wanted to know more about how the drugs, which are called pan-Bcl-2 or Bcl-xL-specific inhibitors, help encourage cell death, specifically cells that have damaged RNA, DNA or proteins.

They had a hunch that chemical and physical factors that damage the DNA, RNA or proteins of otherwise healthy cells -- such as cancer treatments like radiation -- might also predispose formerly healthy cells to die if they were exposed to the pan-Bcl-2 or Bcl-xL-specific inhibitor drugs. A number of cancer treatments use combinations of drugs and other treatments to try to combat cancers that have become resistant to single drug treatments.

It turns out that their hunch was correct.

"Our study explains why clinical trials with 31 drug combinations with Bcl-2 inhibitors have been terminated, withdrawn or suspended," said Denis E. Kainov, the senior author of the new study, which has been published in MDPI Cancers.

Kainov is an associate professor at the Norwegian University of Science and Technology's (NTNU) Department of Clinical and Molecular Medicine.

Kainov specifically identified trials with the pan-Bcl-2 drug navitoclax plus bendamustine and rituximab in patients with relapsed diffuse large B cell lymphoma, and navitoclax plus abiraterone acetate with or without hydroxychloroquine in patients with progressive metastatic castrate refractory prostate cancer (NCT02471391, NCT01423539).

"We think that clinicians and patients should be aware of adverse effects of certain drugs like navitoclax," said Aleksandr Ianevski, the first author of the study, and a PhD candidate at NTNU. "This information has the potential to save lives and improve care of cancer patients."

The researchers tested their idea by exposing healthy small roundworms (C. elegans) to a DNA-damaging substance plus a Bcl-xl specific inhibitor.

The roundworms that were treated with the two substances died faster than those that had been given only one or no substances. They also found reproductive and developmental defects in the roundworms given the combination treatment.

They also tested the toxicity of the combined treatment on healthy, non-malignant human, monkey and dog cells, and found that the treatment killed all the cells. A similar test on malignant cells also showed that the combined treatment would kill these cells, too. But since the goal of a successful cancer treatment is to kill the cancer cells while leaving healthy cells alone, the combination doesn't meet that goal.

When cells are infected by a virus, the virus inserts its own RNA or DNA into the cell and turns the cell into a virus-making factory.

The pan-Bcl-2 or Bcl-xL-specific inhibitors can cause these infected cells to die.

Kainov said that the pan-Bcl-2 or Bcl-xL-specific inhibitors could have adverse effects because cancer patients could be infected with different viruses (such as herpes, coronavirus or influenza).

Safety new medical providers can substantially increase their telemedicine services with modest investments in new staff and technology, a move that can help them expand patients' access to specialized medical care, according to a new RAND Corporation study.

But sustaining gains created by expanded telemedicine will require more-generous reimbursement policies from payers or ongoing revenue from other sources such as government grants, according to researchers.

While the study focused on the experiences of nine community health centers in California that provided telemedicine access to medical specialists from their primary care clinics, the findings have implications about how to sustain the rapid expansion of telemedicine that has been prompted by the social distancing efforts triggered by the novel coronavirus pandemic.

"We found that telemedicine services can extend care for services such as psychiatry and diabetic retinopathy screening in settings that reach underserved populations," said Lori Uscher-Pines, lead author of the study and a senior policy researcher at RAND, a nonprofit research organization. "But in order to sustain such improvements, the federal government and others who pay for medical care need to increase their long-term support for telemedicine services."

There are about 1,400 community health centers across the nation that serve 29 million patients who are mostly low-income. The federally supported centers provide comprehensive primary care to medically underserved populations, regardless of their insurance status or ability to pay for services.

RAND researchers examined the experiences of clinics enrolled in the Sustainable Models of Telehealth in the Safety Net, which was funded by the California Health Care Foundation from 2017 to 2020. The project's goal was to help transform participating health centers from low-volume to high-volume telemedicine providers that are dedicated to improving access to specialty care through technology.

The nine community health centers in the project operated health clinics mostly in rural areas of California.

On average, the health centers had experienced a slight downward trend in telemedicine use prior to the start of the initiative. But there was a large and significant increase in telemedicine volume at the beginning of the initiative, which continued to increase over time.

The majority of participating health centers contracted with third parties (typically a
telemedicine vendor or independent group of specialists) for telemedicine services. In this model, a patient visits the health center where they typically receive primary care and is connected to a remotely located specialist who is employed by another organization.

Two of the health centers primarily used their own clinicians to provide telemedicine services. In this model, multisite health centers that employ specialists such as mental health providers connect patients -- via telemedicine -- at clinics that do not have the specialists.

The community health centers spent between $4,400 and about $250,000 to establish expanded telemedicine programs, with most of the money going to new equipment. During the project, telemedicine volume at the clinics ranged from fewer than 500 visits per year to more than 7,000 per year.

Nearly half of the telemedicine visits were with a behavioral health provider, while another quarter were for eye care. Other common specialists providing telemedicine care included endocrinologists, rheumatologists and dermatologists.

Staff from most health centers reported that the telemedicine services were likely permanent, but that financial factors would determine the scope of services. Administrators at all of the clinics said that telemedicine was a cost center for their organizations and identified several factors that make it difficult for health centers to break even on telemedicine.

Barriers that increased costs include a high no-show rate, limited connectivity, restrictions that do not allow some providers to provide telemedicine services, telemedicine visits taking up space that could be used for more-profitable visits, and the costs associated with switching telemedicine providers.

The RAND evaluation recommends that clinics hire a telemedicine coordinator to head their efforts and that they consider offering telemedicine services to patients from their homes.

The home model, which has been widely implemented during the COVID-19 pandemic, allows health centers to serve patients who live farther away and may be more sustainable because it uses less physical clinic space and can allow salaried providers employed by a clinic to work at full capacity.

"Most community health centers involved in the project were committed to sustaining telemedicine programs, regardless of profitability, in order to provide their patients access to medical specialists," Uscher-Pines said. "Nevertheless, during and after the COVID-19 pandemic, new reimbursement policies could allow for greater flexibility in the type of visits that qualify for reimbursement, which could increase revenue for these visits."

In addition to overall findings, RAND researchers prepared companion reports that provide in-depth recommendations about how to expand telemedicine services. Those reports cover the ideal duties for a telemedicine coordinator, promising practices for adoption of telemedicine and a detailed analysis of the financial costs of expanding telemedicine.

CLEVELAND, Ohio (July 29, 2020)--For menopausal women who have difficulty sleeping, it might be because of chemicals in the environment. A new study based on data from the Midlife Women's Health Study suggests that exposure to various chemicals, such as phthalates, found in hundreds of products used daily, is associated with sleep disruptions in midlife women. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

Up to 60% of women in the menopause transition experience sleep difficulties. Women who have trouble falling asleep are at greater risk of developing persistent depression that can lead to worse health outcomes, may require more medical care, and increase absenteeism.

Earlier studies have shown that such sleep disruption is the result of decreasing hormone levels. Exposure to endocrine-disrupting chemicals (EDCs), however, is one largely unexplored area that may help to explain the increased prevalence of sleep difficulties in midlife women. Phthalates are common EDCs that are found in industrial plasticizers and chemical stabilizers. Phthalates increase the performance of everything from food packaging and clothing to cosmetics and children's toys. Personal care products, in particular, represent a major area of exposure.

Although everyone is exposed to phthalates, they appear to concentrate more in women than men. A previous study suggested that increased exposure to phthalates from personal care products significantly increased the risk of hot flashes. Other studies have demonstrated associations between phthalate exposure and the likelihood of waking up at night, as well as the risk of suffering from depression.

Since phthalates are known to modulate the hormones associated with sleep and depression, researchers in this latest study surmised that they may be directly or indirectly associated with sleep in midlife women. This study, based on data gathered from more than 760 premenopausal and perimenopausal women, suggests that the frequency of sleep disruptions is associated with urinary concentrations of phthalates. It is the first known study to document this association. The relationship, however, appears complex, because other variables, such as smoking status, have been shown to influence the effect. More research is warranted to fully understand this association, as well as the underlying mechanisms of how hormones and EDC exposure influence sleep, particularly in midlife women.

Study results appear in the article "Associations of phthalate exposure and endogenous hormones with self-reported sleep disruptions: results from the Midlife Women's Health Study."

"This study raises concerns and additional questions about a possible contribution of phthalates to sleep disturbances in premenopausal and perimenopausal women. Additional research into these endocrine-disrupting chemicals and their interactions with hormones, sleep, and mood in midlife women is needed," says Dr. Stephanie Faubion, NAMS medical director.

Many living creatures live in soil. Though their sizes range from microscopic soil microbes to larger animals like gopher turtles, they all call soil their "home." Included in these ground-dwelling species are bees - vital in the pollination cycle of about 90% of plant life.

Rebecca Lybrand and her team at Oregon State University are studying the interaction between the bees and soil in agricultural settings.

According to the recently-published paper, bees contribute $15 billion to crop value annually. They pollinate about three-quarters of the fruits, vegetables, and nuts within the United States alone. Declines in honeybee colonies are a critical threat to agriculture and the global food supply.

"Growers who are interested in attracting alternative pollinators, such as wild bees, face a major challenge," says Lybrand. "There are not many studies about what habitats are best for these wild bees."

Pollinators are widely affected by human land use. Creating buildings, parking lots and other "anthropogenic changes" disrupt the natural habitats of animals and plants. Agricultural disturbance also affects bee communities. Interestingly, above-ground bee species are nine times more affected by agricultural intensification than ground-dwelling species.

In some cases, growers have been able to build "bee beds" in their farm setting. In the 1950s, they started to design moist, salty soil areas to attract ground-nesting bees that helped increase alfalfa yields in Washington state.

Lybrand's study looked at physical and chemical properties of soils collected from active bee and sand nest wasp sites in the Willamette Valley of western Oregon. They compared soil properties among seven farm sites to identify similarities and differences.

The Willamette Valley has wet winters with warm, hot summers. The team first found agricultural sites that contained ground-nesting bees. They collaborated with farmers who observed ground-nesting bee activity around their fields.

The nests are only identified by rather small holes (only 3-5mm). The team only collected data if they observed bees entering the nest. Nests and holes can remain even after the bees leave. At the study site, they specified the type of bee to the family level (i.e. "bee" versus "genus" and "species".) But they also collected some bees to bring back to the lab for further identification.

The data the team collected in the field included soil temperature, pH, and soil texture. They also collected soil samples to bring back to the lab for analysis.

Findings from the study included that active nesting sites were present in locations with little to no rock cover and low vegetation. Nesting sites were found in areas with low organic matter coverage. The slope of the land didn't seem to have any influence, nor did a north/south-facing aspect.

"One of our observations confirmed that active emergence holes remained open throughout the year," says Lybrand. "They didn't swell shut during the wetter, cooler seasons - despite having clay in the soils that might cause shrinking and swelling."

An interesting finding from the research is that the team found lipids in the soil nest linings. The lipids may provide a type of waterproofing for the nests and their inhabitants.

"Because the large majority of wild bee species nest in the soil, studies about how to best attract them to farms are important," says Lybrand. "Soil scientists and entomologists can partner with growers to identify soil habitats that support and attract more of these pollinators to agricultural lands. Improving our understanding of the connections between agriculture and the soils that bees, crops, and living organisms rely on to survive is important. Our research also provided a framework for studying ground-nesting organisms - an area of soil science that is underrepresented."

Looking to the future, Lybrand says, "future research should also integrate methods that identify bees and/or wasps to the species level. That would allow for interpretations of the results from an ecological point of view. Another question to follow up on could be the nature and purpose of the lipids found in the soil nest linings, to confirm their actual role."

Whether returning to a school building, online learning or a hybrid school environment, it is normal for children and adolescents to have some stress or anxiety about going back to school. This year, fears of getting sick, school safety protocols for COVID-19 or heightened tensions around racism may make the transition even more difficult.

"There are a range of mental health concerns that children can face in school from minor stressors such as nerves about an upcoming tests or dynamics in peer relationships, all the way to some of the common mental health disorders, such as learning disorders, ADHD, anxiety and depression," said Samanta Boddapati, PhD, child clinical psychologist and prevention coordinator at Big Lots Behavioral Health Services at Nationwide Children's Hospital. "A number of factors within the school environment can promote or hinder mental health and might influence how children react. For example, positive student relationships and strong social emotional programming within schools can promote mental health, whereas issues like bullying, or teasing and challenges with peer relationships might hinder mental wellness."

In a recent survey of school-aged parents conducted by Nationwide Children's, 2 out of 5 parents said that they had concerns about their child's social and emotional wellbeing as they head back to school. Concerns about transitioning back to school will be different depending on the age of a child.

Experts say very young children may have separation anxiety or general stress and concerns about being away from family and being in new environments with new people. For younger children who have a hard time saying goodbye, consider making a special goodbye part of your routine that you can do together, such as a special handshake or a statement that you and your child can make to one another, and remind your child when you might see each other again. Some small children also like a transitional object, like a small item that reminds them of a caregiver while they are separated and that they can "keep safe" while apart.

For older children who have been communicating with teachers primarily through online learning or social media, face-to-face communication might feel uncomfortable at first. As kids get older, they have more stress related to social access, bullying, and grades, but also other anxiety related to changes in the structure of their day.

"Maintaining a routine is important, especially for families who are continuing to do online learning full-time. Create a part of your child's day that is structured and a part of their day that has some flexibility," said Parker Huston, PhD, clinical director of On Our Sleeves® and pediatric psychologist for Big Lots Behavioral Health Services at Nationwide Children's.

Experts say no matter the age of your child, the best thing you can do to help your child's mental health as they go back to school this year is to start having conversations early and often. Additional tips for parents and caregivers from the behavioral health experts at Nationwide Children's include:

* Admit to your child there are a lot of unknowns, but that you are there to support them. Remind them of other adults in their life who are there to help them and that they can always talk to you and them.
* Discuss possible scenarios or fears with children, as well as talking through different options and alternatives. This can help increase children's flexibility, thinking and problem-solving abilities. Asking them what they are nervous about does not increase their anxious thinking so long as the conversation is focused on problem-solving.
* Model appropriate coping skills for children, showing kids how to respond to future unknowns and building resilience. For example, reach out to your own social support about your anxieties and use that as an example with your child of how you sought help and how they can do the same.
* Demystify some of the procedures that may be in place in schools such as mask-wearing and temperature checks by talking about them and practicing them at home. For example, wear masks for short times during the day at home while playing or reading to simulate what it will be like in school. Make sure they are compliant with having their temperature taken using an external thermometer as well.
* Reach out to your school to see what resources are available for your child, such as social-emotional programming or school counseling.

More free educational resources about supporting the mental health of your child as they transition back-to-school online or in-person can be found at OnOurSleeves.org. This blog post provides advice for helping kids get used to seeing and wearing masks. This blog post focuses on helping children with special needs during COVID-19.

"A certain amount of stress is normal, but parents, caregivers and educators should look out for drastic changes in functioning or behavior," said Dr. Huston. "Sleep changes, mood changes, inability to engage with social environments or friends, increased anxiety about things that they maybe weren't nervous about in the past are changes you want to talk to your child's pediatrician about."

Mountain gorillas that live in oversized groups may have to limit the number of strong social relationships they form, new research suggests.

Scientists from the Dian Fossey Gorilla Fund (Fossey Fund) and University of Exeter identified up to seven categories of relationship between gorillas - ranging from close mother-offspring ties to "weak" associations.

Mountain gorillas usually live in groups of 12 to 20, and the study found the richest range of relationships in groups of this size.

When groups were smaller or larger - sometimes up to 65 gorillas - the scientists found less diversity of social relationships.

"It is often assumed that animals living in larger groups will have more diverse and complex social lives," said Dr Robin Morrison, of the Fossey Fund and Exeter's Centre for Research in Animal Behaviour.

"However, our study suggests that social diversity is lower in very large groups where gorillas must maintain a larger number of relationships - with most relationships falling into the weakest category.

"Strong social relationships still exist in the big groups, but they seem to make up a smaller proportion of the total relationships.

"We cannot say for certain why this is, but it may be that gorillas only have enough time and mental energy to maintain a certain number of relationships at a given strength.

"So they keep their key relationships and simply maintain weak ties with all the other gorillas in the group."

Dr Morrison added: "Living in a social group requires mental effort.

"Indeed, one of the big ideas in social evolution is that humans developed large brains and language to deal with social complexity."

The research team used 12 years of data on 13 gorilla groups monitored by the Fossey Fund in Volcanoes National Park, Rwanda.

Mountain gorilla numbers in the park have risen in recent years, which may explain why unusually large groups have formed.

The gorillas live in stable social groups, moving and feeding together in the day and nesting together at night.

The study used proximity data - how much time individuals spent close together - to measure social relationships.

"In many primates, social interaction can be measured by how much time individuals spend grooming each other," Dr Morrison said.

"However, gorillas spend less time grooming than most other primates.

"Instead, a lot of gorilla society is about who individuals choose to sit next to, and who they move away from."

The relationship categories identified by the scientists relate to different patterns of interaction revealed by the data.

These represent a scale of from close to weak associations, but the categories cannot be simply expressed in human terms such as best friends, close friends, etc.

Lauren Brent, Associate Professor at the University of Exeter, said: "Not only were groups above a certain size not more socially diverse, but individuals living in the same group had variable levels of social complexity - some gorillas had a greater diversity of social relationships than others.

"This adds to a rich body of evidence that shows that, whether you are a human, gorilla or another type of social animal, not everyone experiences their social world in the same way."

The researchers found that the diversity of social relationships experienced by individual gorillas varied by age and sex.

Both males and females experience a diverse range of relationships as youngsters, but this changes as they age.

While females maintain a relatively consistent diversity of relationships through adolescence and adulthood, this declines rapidly in males as they enter adolescence, reaching the lowest levels at around 14.

At this age, males show many characteristics of sexual maturity but are still several years from full sexual maturity.

This is also the period when males are most likely to decide whether to leave the group they were born into - so they may be socially distancing themselves in the lead up to this departure.

If they choose to remain, as roughly half do, they then gradually build up a diverse set of relationships through adulthood as they take on key social roles protecting the group and fathering and caring for offspring.

The research findings could be useful for gorilla conservation, including efforts to limit the spread of disease.

"By better understanding these social relationships, we can better understand how diseases would spread through these social groups," said Dr Tara Stoinski, President and CEO of the Dian Fossey Gorilla Fund and one of the study co-authors.

"This is really important right now for mountain gorillas because disease is one of the major threats to their conservation.

"They catch many of the same diseases as humans, including Ebola, and it's extremely likely they would also catch COVID-19 if they were exposed to it.

"Long-term monitoring and protection of endangered mountain gorillas is crucial, not only for their conservation but also for what we can learn from this intelligent and highly social species about how complex social behaviour, such as our own, has evolved."

Many reports illustrate that Coagulation factor XIIIa (FXIIIa) has diverse and crucial functions in thrombus for¬mation and stability. However, it is difficult to obtain large amounts of FXIII in the market. Therefore, obtaining large quantities of FXIIIa through genetic engineering technology is important for both clinical treatment and mechanism of protein expression.

The expression, purification and identification of recombinant human coagulation factor XIIIa in Pichia pastoris (a species of methylotrophic yeast) shows that it has biological activity, suggests a study conducted by a team of researchers at the Zhejiang Chinese Medical University led by Xu et al.

Recombinant pPICZαC-FXIIIa was expressed in Pichia pastoris, purified and then tested for biological activity by reacting it with plasma samples.

In this study, FXIIIa fragments in human placenta tissue was taken and inserted in an expression vector under the control of a yeast promoter for AOX1, which was constructed and expressed in Pichia pastoris (Figure 1). The findings suggest that the FXIIIa fragment of 2250 bp was inserted successfully into the pPICZαC vector. The expression and purification products about 83 kDa (the same molecular weight as human FXIIIa) were obtained, which solidified significantly when reacted with human plasma. The work shown that the expression and purification products were successful, with sufficient biological activity, which can be used as a candidate FXIIIa hemostatic agent in genetic engineering.

This study is significant as is reports an efficient expression system for the production of FXIIIa. This will not only facilitate further studies of FXIIIa, but also pave the way for possible large-scale production of biologically active FXIIIa. The researchers note that more work on recombinant FXIIIa production with higher purity and more activity would be investigated, to improve upon current results.