Culture

A new paper in the JNCI Cancer Spectrum, published by Oxford University Press, finds that the mortality rates for complex cancer procedures differ greatly between one-star hospitals (10.4%) and five-star hospitals (6.4%).

The safety of complex cancer surgeries varies widely across hospitals in the United States, with as much as a four-fold difference in hospital mortality rates, volume of patients, hospital experience, and surgeon training. Researchers have previously suggested that a large-scale shift of patients away from high-risk hospitals could meaningfully reduce mortality rates for complex cancer surgeries. Yet there are numerous challenges to matching patients with hospitals that are best suited to perform a specific procedure. In particular, hospital volumes and surgery-specific performance data are not readily available to patients and providers.

Researchers examined the Center for Medicare and Medicaid Services' "Star Rating" system, which serves as a guide for patients to compare the quality of each hospital's care (one-star = lowest to five-star= highest). This system is based on 62 measurements (e.g. mortality, readmissions, patient experience), but is not specific to any medical operation or patient population. Despite this fact, researchers found that the ratings correlate with quality and safety across many patient care scenarios, including the risk of mortality after complex cancer surgery.

A total of 105,823 patients underwent complex cancer procedures at 3,146 hospitals between 2013 and 2016. Eligible patients were over 65 years old with a diagnosis of cancer of the lung, colon, stomach, esophagus, or pancreas. This group captures an estimated 80% of all high-risk cancer surgeries.

The mortality rating over a 90-day period correlated with the star system, with the greatest difference observed between the 1-star (10.4%) and 5-star (6.4%) hospitals. However, these rates varied by surgery type.

These findings are consistent with prior studies that have found that the Center for Medicare and Medicaid Services' star rating system correlates with surgical mortality. And yet, the overall effectiveness of this system in choosing hospitals for complex cancer surgeries appears to be modest (84 lives per year), relative to other proposed strategies.

"For complex cancer care, choosing the right hospital may be as important as choosing the right treatment.," said Daniel Boffa. "In order for patients to select the best hospital for their situation, they need access to understandable information regarding the safety and quality of hospital care. Unfortunately, the CMS star-rating system, while clear and easy to access, does not appear to distinguish the safest from the least safe hospitals with enough separation to reliably guide cancer patient choice for complex surgical care."

(LOS ANGELES) - When a person has a heart attack, the person's coronary artery is blocked, cutting off the flow of blood and oxygen to that portion of the person's heart. The surrounding heart muscle may be damaged to an extent depending on the size of the blocked area and the time between the attack and treatment. Upon recovery, the heart muscle starts to heal, and like a skin wound, it may form a scar. The size and location of the scar can vary greatly, and there is a possibility to develop additional complications or even death.

Although there are potential problems associated with cardiac scarring, little is known about the factors involved in regulating cardiac scar size after a heart attack. An understanding and demonstration of the role such factors play in the scarring process may result in new medical treatments.

As recently published in the journal Cell, a collaborative group including Ali Khademhosseini, Ph.D. and Samad Ahadian, Ph.D., of the Terasaki Institute for Biomedical Innovation (TIBI), has identified such a factor: collagen V. Collagen is the most abundant protein in the human body and is found in bones, tendons, muscles, skin and various internal organs. It provides structure and strength and holds the body together. It is also a component of scar tissue, which can be formed in various places throughout the body.

Within a healthy heart, there are different types of collagen, but collagen V is found in only small quantities. However, the group observed that large quantities of collagen V were found in cardiac injury scars. Previous independent studies of animals, genetically deficient for the production of collagen V, had shown increased cardiac scar tissue. These observations suggested that collagen V might somehow be involved in scar formation.

The group prepared mice that were completely deficient in producing collagen V and performed several experiments on them to test the effects of collagen V. Their findings indicate that upon cardiac injury equivalent to a heart attack, the genetic activity of the collagen V-deficient mice favored the formation of larger and more irregularly-constructed cardiac scars than that of normal control mice. In addition, fibroblasts, specialized cells that produce collagen and are part of the matrix that makes up scar tissue, exhibited different behavioral and mechanical properties in the collagen V-deficient mice compared to normal mice. During the normal healing process following cardiac injury, cardiac fibroblasts exert forces upon cardiac scars and cause them to shrink.

The team hypothesized that since the cardiac scar tissue without collagen V is larger, more stiff, and irregularly structured, the forces exerted by its fibroblasts would also be less. In order to test the hypothesis, the team made two separate scaffold preparations, consisting of a collagen hydrogel mixed with cardiac injury fibroblasts from either a normal or collagen V-deficient mouse. The scaffolds were then attached to two silicon-based posts and observed for the displacement of the posts due to fibroblast contraction. It was found that there was significantly less displacement of the posts with the collagen V-deficient fibroblasts than the normal fibroblasts, thus confirming their hypothesis and providing evidence for larger scar formation without collagen V. "By being able to fabricate and characterize microtissues, we could measure mechanical forces of heart tissues in a dish. Similar approaches can be used for human studies in a personalized manner," said Samad Ahadian, Ph.D., lead investigator of the Terasaki Institute team. As collagen V expression can vary among individuals, the elucidation of the feedback mechanisms and interactions of collagen V in scar formation may have profound implications for cardiac patients who suffer from the various heart ailments associated with cardiac injury scars.

Such knowledge may also have an even broader influence beyond mitigating cardiac ailments. Individuals with Ehlers Danlos Syndrome have genetic mutations that leave them deficient in collagen V production, and they exhibit abnormalities in the connective tissues of their joints, skin, and other tissues. They also exhibit abnormal wound healing with increased scar sizes. Experiments have shown that fibroblasts from individuals with this syndrome have increased expression of a protein called integrin, due to their lack of collagen V production; these individuals could possibly benefit from therapies involving inhibitors of integrin signaling.

"Understanding biological mechanisms that control tissue behavior is crucial for developing personalized therapeutics.?The work here demonstrates the importance of matrix molecules in cardiac tissue regeneration and scar formation," said Khademhosseini, Director and CEO of Terasaki Institute. "Therefore, this work is of considerable significance in developing approaches that induce tissue healing. As such, this work synergizes with a number of Platforms at the Terasaki Institute, which aim to leverage our ability to find personalized solutions for patients."

GALVESTON, Texas - A multidisciplinary team from The University of Texas Medical Branch at Galveston has uncovered a new mechanism for designing antiviral drugs for dengue virus. The study is currently available in Proceedings of the National Academy of Sciences.

Dengue virus is a very important mosquito-transmitted viral pathogen, causing 390 million human infections each year. Dengue is common in more than 100 countries and forty percent of the world's population is at risk of infection. When someone becomes ill with dengue, symptoms that can range from mild to severe may include fever, nausea/vomiting, rash and muscle/bone/joint aches. Despite this, there are no clinically approved drugs currently available to people who become infected.

In this study, the UTMB team has solved the co-crystal structure of the dengue capsid protein, which forms the interior of virus, in complex with an inhibitor. The co-crystal structure has provided atomic details of how the inhibitor binds the capsid protein and blocks its normal function, leading to the inhibition of viral infection. The structural information has opened new avenues to rationally design inhibitors for antiviral development.

"There are four types of dengue virus, all of which can cause epidemics and disease in humans. The current inhibitor does not inhibit all types of dengue virus. Our co-crystal structure explains why this is the case," said Pei-Yong Shi, I.H. Kempner professor of Human Genetics at UTMB. "Using this new information, we will be able to design new drugs that can inhibit all types of dengue virus. In addition, the structural information will also enable us to make compounds with improved potency and drug-like properties."

"The inhibitor binds four capsid molecules to form a tetramer. Such capsid tetramers are assembled into dengue virus," said Mark White, Associate Professor at UTMB who co-senior authored the study. "However, such a tetramer-containing virus is not able to productively infect new cells. Our study also explains how resistance emerges when dengue virus is treated with the inhibitor. A resistant virus emerges through one amino acid change that weakens the compound binding to the viral capsid protein."

"The World Health Organization lists dengue virus as one of the top ten public health threats and as such requires the urgent development of effective vaccine and therapeutics," said Hongjie Xia, UTMB postdoctoral fellow and lead author of the study. "Although we are currently coping with COVID-19 pandemic, Singapore and other regions are experiencing a record number of dengue human cases. This motivates our team to develop clinical treatments for this devasting disease."

Extremely preterm children have very low birth weights, underdeveloped organs, and risks of long-term problems or disabilities.

Antenatal treatment -- therapy given before birth -- can improve outcomes in preterm children.

Statistical analysis of medical records can tell clinicians which antenatal treatments can best protect against severe neurodevelopmental impairment or death.

Read this story at http://www.uab.edu/news

The UAB News Studio is available for live or taped interviews with UAB experts.

BIRMINGHAM, Ala. - Tiny infants known as extremely preterm children have very low birth weights, underdeveloped organs, and risks of long-term problems or disabilities. Antenatal treatment of the mother and fetus -- therapy given before birth -- offers an opportunity to improve outcomes in preterm children.

Antenatal magnesium sulfate or antenatal corticosteroids have known benefits to reduce problems like cerebral palsy, death, respiratory distress syndrome or necrotizing enterocolitis, and both treatments are recommended for infants born between 24 and 33 weeks of gestation. The effect of both of them combined in extremely premature children, versus either alone or none, has not been studied, though both are often given in routine care.

Now researchers, led by Samuel Gentle, M.D., assistant professor of pediatrics in the University of Alabama at Birmingham School of Medicine, report that antenatal treatment with both magnesium sulfate and corticosteroids together yields an increased benefit for children born at 22 to 26 weeks of gestation, compared to no antenatal treatment or with either therapy alone. This multi-center, prospective observational study included six universities, a nonprofit research institute and the National Institutes of Health Neonatal Research Network. Researchers did a statistical analysis of medical records for 3,093 children born 2011 through 2014, which included comprehensive neurodevelopmental follow-ups at 18 to 26 months of corrected age. The children had an average birth weight of 1 pound, 9 ounces.

Children exposed to both antenatal corticosteroids and magnesium sulfate had a 36.3 percent rate of severe neurodevelopmental impairment or death, compared to 44.3 percent for those exposed to antenatal corticosteroids alone, 53 percent for those exposed to magnesium sulfate alone and 48.2 percent for those who had neither therapy.

Similarly, children exposed to both antenatal corticosteroids and magnesium sulfate had a lower rate of death compared with either or neither therapy. However, the rate of severe neurodevelopmental impairment among survivors did not differ among exposure groups.

The research is published in the journal Obstetrics & Gynecology, and Gentle discusses the importance of these findings for clinical practice in a recent "Editors Picks" podcast: "You might say, 'Why do we need to look at this if there is data to support the practice for both?' In this cohort, around 75 percent of infants were exposed to magnesium sulfate, whereas nearly 90 percent were exposed to antenatal corticosteroids. If there's time to get one therapy, it seems as though there would be time to be exposed to both."

"This national research is a very important study of two of the most effective maternal medications in periviability," said one of the co-authors, Waldemar Carlo, M.D., the Edwin M. Dixon Professor of Pediatrics and director of the UAB Division of Neonatology and Newborn Nurseries.

Emergency room visits for domestic violence incidents in California more than tripled during the Great Recession compared to the years before, signaling a need to prepare for similar and more prolonged effects during the COVID-19 financial crisis, suggest University of California, Davis, researchers.

Conducting one of the first studies to date examining the impact of a modern recession on hospital and emergency room visits, researchers found that physical abuse in adults increased substantially between the time periods, with Black and Native American people being disproportionately affected. Violence against children did not show a marked increase. The results were published in Preventive Medicine in June.

"The results from our study shine a spotlight on the importance of domestic-violence-related screening, prevention and response during the next several months of the COVID-19 financial effects," said the study's primary author, Alvaro Medel-Herrero, project scientist for the UC Davis Center for Health and the Environment. "Notably, domestic violence is grossly under-reported, and cases that end up in the emergency room or result in a hospital stay are only the most egregious examples. This tells us there may be an even larger problem than the numbers can show."

The study's co-authors included Suzette Smiley-Jewel, of the UC Davis School of Veterinary Medicine; Martha Shumway, Department of Psychiatry, University of California, San Francisco; Amy Bonomi, Michigan State University; and Dennis Reidy, School of Public Health, Georgia State University.

Study looked at 53,000 domestic violence episodes

The study's authors looked at more than 53,000 domestic-violence-related episodes, composed of both intimate partner violence as well as violence against elders and children, between 2000 and 2015. The numbers were drawn from California's Office of Statewide Health Planning and Development, or OSHPD, and then broken down between the years during, before and after the Great Recession. While the Great Recession officially lasted less than two years, from December 2007 to June 2009, during which the gross domestic product contracted, the economic crisis produced long-lasting consequences for individuals as well as society as a whole, researchers said.

"Proactive outreach is especially needed for minoritized people, who may be especially isolated, experiencing disconnections from services, and facing extreme financial stress," said one of the co-authors, Bonomi, of Michigan State University.

Blacks more than three times more likely to be victims

Time series for the study were divided into pre-recession (January 2000-November 2007) and recession/post-recession (December 2007-September 2015) periods. Blacks were more than three times more likely to suffer domestic violence during the recessionary period when compared with other segments of the California population, according to the data. Statistics showed that there were 3.58 emergency room visits per 100,000 population compared to 10.42 emergency visits per 100,000 people for Blacks. Hospitalization rates remained relatively similar from the pre-recession as compared to the recession/post-recession period except for Native Americans, which nearly doubled.

Emergency visits vastly exceeded hospitalizations during the 2007-2015 time period.

Additionally, the number of California police calls for weapon-involved domestic violence episodes steadily increased from 2008 (65,219) to 2014 (75,102).

Costs associated with domestic violence

For the period analyzed (2000-2015), the estimated total charge for all analyzed domestic violence hospitalizations was more than $1 billion (data was not available for emergency department costs).

Length of hospital stays slightly increased during the recession/post-recession period as compared to the pre-recession period, yet the inflation-adjusted charge per hospitalization dramatically increased over time, according to the study.

Domestic violence rate does not correspond with other hospital visits

It is important to note that the described increase in domestic-violence-related hospitalizations during the recession does not correspond to a general trend in health care in California. For example, California cancer hospital rates dropped during the Great Recession, according to OSHPD data. However, an increasing demand for emergency care during the recession and post-recession period has been reported and may reflect limitations in accessing care in other parts of the health care system, researchers said.

The authors' research will continue.

COLUMBUS, Ohio - A new study by researchers at The Ohio State University Wexner Medical Center and The Ohio State University College of Medicine documents a clear link between the stress hormone cortisol and higher blood sugar levels in people with type 2 diabetes.

The study published online in the journal Psychoneuroendocrinology.

"In healthy people, cortisol fluctuates naturally throughout the day, spiking in the morning and falling at night," said Dr. Joshua J. Joseph, an endocrinologist and researcher at The Ohio State Wexner Medical Center's Diabetes and Metabolism Research Center who led the study. "But in participants with type 2 diabetes, cortisol profiles that were flatter throughout the day, had higher glucose levels."

Previous research has shown that stress and depression are two of the major causes of a flatter cortisol profile. These sustained levels of cortisol make it much more difficult to control blood sugar and manage the disease, which is why it is so important for those with type 2 diabetes to find ways to reduce stress.

"We have begun a new trial to examine if mindfulness practices can lower blood sugar in those with type 2 diabetes," said Joseph, an assistant professor in the College of Medicine. "But this isn't the only effective form of stress relief. It's important to find something you enjoy and make it a part of your everyday routine."

The relationship of cortisol with glucose levels was only observed in those with diabetes. However, Dr. Joseph and his team believe the stress hormone likely plays an important role in diabetes prevention and they continue to research the connection between cortisol and the development of diabetes and cardiovascular disease.

More than 30 million Americans have Type 2 diabetes, according to the Centers for Disease Control and Prevention. With Type 2 diabetes, your body doesn't use insulin properly. Some people can manage their blood sugar levels with healthy eating and exercise, while others may need medication or insulin to help manage it.

"Most people with Type 2 diabetes know the importance of exercising regularly, eating a healthy diet, and getting plenty of rest. But stress relief is a crucial and often forgotten component of diabetes management," Joseph said. "Whether it's a yoga class, taking a walk or reading a book, finding ways to lower your stress levels is important to everyone's overall health, especially for those with type 2 diabetes."

Researchers from the MDC have developed a new tool that makes it easier to maximize the power of deep learning for studying genomics. They describe the new approach, Janggu, in the journal Nature Communications.

Imagine that before you could make dinner, you first had to rebuild the kitchen, specifically designed for each recipe. You'd spend way more time on preparation, than actually cooking. For computational biologists, it's been a similar time-consuming process for analyzing genomics data. Before they can even begin their analysis, they spend a lot of valuable time formatting and preparing huge data sets to feed into deep learning models.

To streamline this process, researchers from the Max Delbrueck Center for Molecular Medicine in the Helmholtz Association (MDC) developed a universal programming tool that converts a wide variety of genomics data into the required format for analysis by deep learning models. "Before, you ended up wasting a lot of time on the technical aspect, rather than focusing on the biological question you were trying to answer," says Dr. Wolfgang Kopp, a scientist in the Bioinformatics and Omics Data Science research group at MDC's Berlin Institute of Medical Systems Biology ?(BIMSB), and first author of the paper. "With Janggu, we are aiming to relieve some of that technical burden and make it accessible to as many people as possible."

Unique name, universal solution

Janggu is named after a traditional Korean drum shaped like an hourglass turned on its side. The two large sections of the hourglass represent the areas Janggu is focused: pre-processing of genomics data, results visualization and model evaluation. The narrow connector in the middle represents a placeholder for any type of deep learning model researchers wish to use.

Deep learning models involve algorithms sorting through massive amounts data and finding relevant features or patterns. While deep learning is a very powerful tool, its use in genomics has been limited. Most published models tend to only work with fixed types of data, able to answer only one specific question. Swapping out or adding new data often requires starting over from scratch and extensive programming efforts.

Janggu converts different genomics data types into a universal format that can be plugged into any machine learning or deep learning model that uses python, a widely-used programming language.

"What makes our approach special is that you can easily use any genomic data set for your deep learning problem, anything goes in any format," Dr. Altuna Akalin, who heads the Bioinformatics and Omics Data Science research group.

Separation is key

Akalin's research group has a dual mission: developing new machine learning tools, and using them to investigate questions in biology and medicine. During their own research efforts, they were continually frustrated by how much time was spent formatting data. They realized part of the problem was each deep learning model included its own data pre-processing. By separating the data extraction and formatting from the analysis, it provides a much easier way to interchange, combine or reuse sections of data. It's kind of like having all the kitchen tools and ingredients at your fingertips ready to try out a new recipe.

"The difficulty was finding the right balance between flexibility and usability," Kopp says. "If it is too flexible, people will be drowned in different options and it will be difficult to get started."

Kopp has prepared several tutorials to help others begin using Janggu, along with example datasets and case studies. The Nature Communications paper demonstrates Janggu's versatility in handling very large volumes of data, combining data streams, and answering different types of questions, such as predicting binding sites from DNA sequences and/or chromatin accessibility, as well as for classification and regression tasks.

Endless applications

While most of Janggu's benefit is on the front end, the researchers wanted to provide a complete solution for deep learning. Janggu also includes visualization of results after the deep learning analysis, and evaluates what the model has learned. Notably, the team incorporated "higher-order sequence encoding" into the package, which allows to capture correlations between neighboring nucleotides. This helped to increase accuracy of some analyses. By making deep learning easier and more user-friendly, Janggu helps throw open the door to answering all kinds of biological questions.

"One of the most interesting applications is predicting the effect of mutations on gene regulation," Akalin says. "This is exciting because now we can start understanding individual genomes, for instance, we can pinpoint genetic variants that cause regulatory changes, or we can interpret regulatory mutations occurring in tumors."

Black women are often less likely to be associated with the concept of a "typical woman" and are viewed as more similar to Black men than to white women, which may lead to some anti-racist and feminist movements failing to advocate for the rights of Black women, according to new research published by the American Psychological Association.

"Black women are often overlooked in people's conversations about racism and sexism even though they face a unique combination of both of these forms of discrimination simultaneously," said lead researcher Stewart Coles, a PhD candidate at the University of Michigan's Department of Communication and Media. "This 'intersectional invisibility' means that movements that are supposed to help Black women may be contributing to their marginalization."

The research was published online in the APA journal Translational Issues in Psychological Science. The study was conducted online with more than 1,000 participants from the United States who were asked whether 41 positive or negative stereotypical attributes (such as hostile, sexually promiscuous or determined) were associated with different races or genders. Participants were told that their responses were not an admission that they believed these stereotypes so they would answer honestly.

Some participants were asked about stereotypical attributes just for men and women or for Black people or white people. Then other groups were asked about a combination of race and gender (Black women, Black men, white women and white men). The clustering of the responses showed how Black women were viewed in relation to the other groups. The typical woman was considered to be much more similar to a typical white woman than a typical Black woman. Black women and Black men also were considered to be more similar to each other than to white women or white men.

"The operative word in defining how similar to other groups Black women are is more 'Black' and less 'women,'" the journal article noted.

The underdifferentiation of Black women from Black men may help explain why Black women face similar rates of racial disparities in traffic stops and arrests, but anti-racist movements often focus on Black men in the fight against police brutality, said Josh Pasek, PhD, one of the researchers on the study and associate professor of communication studies and faculty associate in the Center for Political Studies at the University of Michigan.

"This is reflected both in terms of the victims of brutality who are highlighted and whose voices receive the most attention," said Pasek. "In this moment, we can see how much more attention has been paid to the murders of Ahmaud Arbery and George Floyd than the murder of Breonna Taylor."

Arbery, a 25-year-old Black man, was shot dead in February after being chased by three white men as he jogged through a neighborhood in Brunswick, Georgia. Taylor, a 26-year-old Black woman, was shot and killed by police in her Louisville, Kentucky, apartment in March. Floyd, a 46-year-old Black man, was killed during an arrest in Minneapolis in May. His death set off protests across the country.

Previous research has found that Blackness is associated with masculinity, leading to errors when categorizing Black women's gender or recognizing Black women's faces. Other studies have found that Black women and girls are more associated with threat and danger than are white women and girls.

Feminist movements that focus only on issues that predominantly affect white women without addressing racialized sexism ignore the needs of Black women, who face higher rates of police abuses, including sexual violence, Coles said. Previous research also has found that Black women experience much higher rates of domestic and sexual abuse from partners than white women, and Black women are less likely to report this violence than white women.

Feminist and anti-racist movements should include Black women in leadership roles and advocate for the rights of Black women, Coles said.

"The key often starts with listening to Black women about their concerns and what their needs are and then delivering accordingly," he said.

Three out of four study participants were white, while 8% were Black, 8% were Hispanic and 5% were Asian. The responses weren't analyzed based on the ethnicity or gender of the participants because the study wasn't examining whether the participants endorsed specific stereotypes themselves.

"Previous research suggests that members of marginalized groups are aware of stereotypes of their groups," Coles said. "Thus, they would likely report the same awareness of stereotypes as would members of other groups."

Two drug policy experts have identified gaps and challenges in New Zealand's proposal for legalizing recreational cannabis. In advance of a widely-watched national referendum vote to be held this September, Associate Professor Chris Wilkins and Dr. Marta Rychert of Massey University argue in the pages of Addiction that New Zealand's Cannabis Legislation and Control Bill (CLCB) needs to be strengthened in two critical areas:

Set a formal minimum price for cannabis: The legalization of cannabis in other jurisdictions has resulted in significant declines in the legal price of cannabis. Minimum unit pricing has been shown to be effective at reducing alcohol consumption levels and related harms. The CLCB includes a discretionary power to raise the excise tax for cannabis for a maximum of 12 months if the price of cannabis drops below the level consistent with purposes of the Act. This discretionary power lacks clear criteria for activation and thus falls short of a clear minimum price provision.

Lower the potency cap for cannabis products: High potency cannabis is associated with increasing first-time cannabis treatment admissions, transition to daily use, cannabis dependence and higher risk of psychosis and psychosis relapse. The CLCB's maximum potency levels for cannabis plant (15% THC) appears to be at the higher end of those currently found in the black market in New Zealand. Potency levels for edibles and extracts are expressed as milligrams "per unit" and "per package" without defining what constitutes a unit or package. (Edibles and concentrates will not initially be sold but they are included in the CLCB for future approval.)

Wilkins and Rychert also identify two public health objectives of the CLCB that will be difficult to achieve:

Difficulties reducing cannabis use over time via a commercial market: The CLCB largely proposes a commercial cannabis market with provisions for non-commercial and not-for-profit supply. The CLCB objective of lowering cannabis use over time appears at odds with the proposed commercial cannabis sector, which will focus on expanding sales. Non-commercial or not-for-profit operators can provide legal access to cannabis while avoiding profit driven commercial companies.

Difficulties taxing products by THC potency: The CLCB proposes a progressive product excise tax based on THC potency and weight. Considerable work will be required to implement a potency-based tax, including consistent sampling procedures, certified testing facilities, and effective auditing to prevent producers gaming the system. Also, the reliability and replicability of testing THC is problematic. A weight-based tax (similar to the taxation of tobacco) may be a more practical alternative for now.

Dr Wilkins says: "The New Zealand referendum vote will be the first time a country will have the opportunity to vote on a comprehensive regulatory framework to legalise cannabis rather than a general question asking whether cannabis should be legal or not. It's therefore important that New Zealand voters clearly understand the strengths and weaknesses of the proposed CLCB."

Wilkins and Rychert provided feedback on the first draft of the CLCB to the New Zealand Ministry of Justice Cannabis Referendum Team, along with a number of other anonymous experts and public commentators. The authors received no financial or non-financial remuneration for these comments.

COLUMBUS, Ohio - Here's a good way to make sure a friend hates a gift from you: Say it will save him money.

In a series of studies, researchers found that people reacted negatively to gifts that they were told - or that they inferred - were given to help them save money.

Receiving this kind of present makes a person feel inferior to the gift-giver, the research found. People are more receptive to gifts that are intended to save them time.

"Most of us have this belief that any gift we give is going to be appreciated - but the way a gift is presented can influence how people feel about it," said Grant Donnelly, co-author of the study and assistant professor of marketing at The Ohio State University's Fisher College of Business.

The study was published recently in the Journal of the Association for Consumer Research.

While money-saving gifts often miss the mark, gifts intended to save people time are seen as a compliment, Donnelly said.

"When you don't have time, you're perceived as busy and in high demand. There's something high-status about that, compared to not having enough money, which is seen as low status," he said.

In one study, the researchers asked 405 people recruited online to recall recently receiving a gift that they thought was intended by the gift-giver to save them either time or money.

They were asked to write a few sentences about how they felt about the gift and then completed various measures assessing their impression of the gift and gift-giver.

Results showed that those who received the gift intended to save them money were more likely to say the gift made them feel embarrassed, ashamed and bad, compared to those who recalled the time-saving gift.

The reason? Those who received the money-saving gift reported that they believed the gift-giver perceived their own status as higher than the recipient's.

"They thought the gift-giver was implying they couldn't take care of themselves and were incompetent because they needed money," Donnelly said.

The results held true in a real-world situation, too. The researchers provided 200 college students with a $5 Starbucks gift card to give to a friend. Half of the gift cards included the message "I know you've been stressed for money lately. I hope you'll enjoy this gift card in hopes that it will save you some money."

The other half had a message that was identical except the message was that it would save them time, rather than money.

All gift cards had a survey for the gift recipients to return to the researchers.

Results were identical to the first study: Those who received gift cards intended to save them money had more negative emotions than those who received the cards intended to save them time. In addition, those who received the money-saving cards said they thought the gift-givers believed they were higher-status than themselves.

If there was any bright spot for the people who sent the money-saving gift card, it was that their friends were just as likely to redeem the card as those who received it as a time-saver, Donnelly said.

Another study showed that people who imagined getting a gift card intended to save them money were more likely to choose to buy a higher-status item with that card - presumably to boost their self-esteem that was damaged with the money-saving gift.

"In part because people feel they have lower status if they need money, they are more drawn to buy status-oriented products that can help them bolster this deficiency they perceive," Donnelly said.

But sending your friends gifts to save them money doesn't just make them feel bad about themselves. In one study, participants felt less appreciation for a money-saving gift than for a gift intending to save them time, or a gift with no communicated motive.

Donnelly said it is important for people to consider the message they send with their gifts.

"We can have this perspective gap where we don't really consider how our gifts are received. It can harm your relationship with the recipient if you're not careful," he said.

"It may be best to give a money-saving gift without acknowledging the reason, or to find a way to make it about saving time."

Military personnel who are at a greater risk of suicide are more likely to unsafely store firearms in unlocked cabinets where they can access them easily, according to a Rutgers researcher.

Firearms account for approximately half of all suicide deaths in the United States and approximately two-thirds of all suicide deaths in the military.

"Ready access to firearms is a robust risk factor for death by suicide, with data demonstrating that suicide is up to five times as likely in homes with a firearm present," said lead author Michael Anestis, executive director of the New Jersey Gun Violence Research Center, and an associate professor in the Department of Urban-Global Public Health at the Rutgers School of Public Health.

The study, published in the journal Psychiatry Research, stresses the importance of interventions to assure safe firearm storage as a suicide prevention strategy.

Researchers examined firearm ownership and storage and suicide risk factors such as depression and lifetime and current suicidal ideation in 953 service members, about 80 percent whom were in the National Guard.

They found that 18 percent of the service members who owned a personal firearm stored them unsafely -- loaded and in an accessible, non-secure location like a bedside table rather than a gun safe -- with 9 percent exhibiting current suicidal ideation. The study, however, found no association between lifetime suicidal ideation and a greater likelihood to own firearms.

"The fact that firearm-owning service members who are experiencing or have experienced severe distress appear to be more prone to unsafe storage practices is particularly dangerous since they are often hesitant to seek mental health care or to disclose or change their firearm storage practices," said lead author Michael Anestis.

Effective interventions include providing education on firearm suicide risk and safe storage strategies including storing the ammunition separately, removing firing pins and allowing someone else to keep a key or code to a gun locking devise and removing firearms from the home during times of suicidal crisis.

"We cannot simply wait to know a service member is at high risk for suicide before we encourage safe storage or temporary storage away from home," Anestis said. "We may not know they are at risk until it is too late, so we need to promote these practices to everyone. If it becomes more difficult for a suicidal person to access a firearm, it is far less likely they will die."

As the number of young adults infected with the coronavirus surges throughout the nation, a new study by researchers at UCSF Benioff Children's Hospitals indicates that youth may not shield people from serious disease.

The study looked at data drawn from a nationally representative sample of approximately 8,400 men and women ages 18 to 25 and concluded that overall "medical vulnerability" was 33 percent for males and 30 percent for females. The impact of smoking surpassed other less common risks, the UCSF researchers reported in their study, which publishes in the Journal of Adolescent Health on July 13, 2020.

Data from the U.S. Centers for Disease Control and Prevention (CDC), not included in the UCSF study, indicates that while patients over 65 are significantly more likely to be hospitalized than younger people, the gap is narrowing. For the week ending April 18, there were 8.7 hospitalizations per 100,000 of the population for the 18-to-29 age bracket, compared with 128.3 per 100,000 of the population for patients over 65. By the week ending June 27, the figures were 34.7 and 306.7 respectively, representing a 299 percent increase in hospitalizations for young adults, versus a 139 percent increase in hospitalizations for older adults.

The researchers, led by first author Sally Adams, PhD, of the UCSF Division of Adolescent and Young Adult Medicine, determined vulnerability by referencing indicators identified by the CDC. These included heart conditions, diabetes, current asthma, immune conditions (such as lupus, gout, rheumatoid arthritis), liver conditions, obesity and smoking within the previous 30 days. Additionally, the researchers added e-cigarettes to tobacco and cigar use, which the CDC had included, stating that all three were associated with adverse effects on respiratory and immune function.

Since there was no data on the relative impact of each of the CDC risk factors, the researchers used an overall medical vulnerability estimate of having at least one of the indicators as the outcome variable, rather than a cumulative score of indicators. Thus, medical vulnerability was assessed according to each indicator, so that among smokers for example, 100 percent were vulnerable for severe COVID-19.

Most notable among their results was that medical vulnerability stood at 16.1 percent for the 6,741 non-smokers, versus 31.5 percent for the full sample of 8,405 young adults, which included smokers.

Smoking Linked to Progression of COVID-19

"Recent evidence indicates that smoking is associated with a higher likelihood of COVID-19 progression, including increased illness severity, ICU admission or death," said Adams. "Smoking may have significant effects in young adults, who typically have low rates for most chronic diseases."

Recent research also shows that young adults are starting to smoke at higher rates than adolescents, a reversal of previous trends, she noted.

The study, which used data from the National Health Interview Survey, found that over the previous 30 days, 10.9 percent had smoked a cigarette, 4.5 percent had smoked a cigar product and 7.2 percent had smoked an e-cigarette. The number of smokers - 1,664 or 19.8 percent - was higher than the number of people with asthma (8.6 percent), obesity (3 percent) and immune disorders (2.4 percent). Additionally, 1.2 percent had diabetes, 0.6 percent had a liver condition and 0.5 percent had a heart condition.

"The risk of being medically vulnerable to severe disease is halved when smokers are removed from the sample," said senior author Charles Irwin Jr., MD, of the UCSF Division of Adolescent and Young Adult Medicine. "Efforts to reduce smoking and e-cigarette use among young adults would likely lower their vulnerability to severe disease."

Gender differences were noted in five vulnerability indicators. Women were more likely to have asthma, (10 percent versus 7.3 percent), to be obese (3.3 percent versus 2.6 percent) and to have immune conditions (3.2 percent versus 1.6 percent). But significantly fewer young women smoked, which resulted in overall medical vulnerability of 29.7 percent compared with 33.3 percent for young men.

Nuclear physicists affiliated with the U.S. Department of Energy's Lawrence Berkeley National Laboratory (Berkeley Lab) played a leading role in analyzing data for a demonstration experiment that has achieved record precision for a specialized detector material.

The CUPID-Mo experiment is among a field of experiments that are using a variety of approaches to detect a theorized particle process, called neutrinoless double-beta decay, that could revise our understanding of ghostly particles called neutrinos, and of their role in the formation of the universe.

The preliminary results from the CUPID-Mo experiment, based on the Berkeley Lab-led analysis of data collected from March 2019 to April 2020, set a new world-leading limit for the neutrinoless double-beta decay process in an isotope of molybdenum known as Mo-100. Isotopes are forms of an element that carry a different number of uncharged particles called neutrons in their atomic nuclei.

The new result sets the limit on the neutrinoless double-beta decay half-life in Mo-100 at 1.4 times a trillion-trillion years (that's 14 followed by 23 zeros), which is a 30% improvement in sensitivity over the Neutrino Ettore Majorana Observatory 3 (NEMO 3), a previous experiment that operated at the same site from 2003-2011 and also used Mo-100. A half-life is the time it takes for a radioactive isotope to shed half of its radioactivity.

The neutrinoless double-beta decay process is theorized to be very slow and rare, and not a single event was detected in CUPID-Mo after one year of data-taking.

While both experiments used Mo-100 in their detector arrays, NEMO 3 used a foil form of the isotope while CUPID-Mo used a crystal form that produces flashes of light in certain particle interactions.

Larger experiments that use different detector materials and that operate for longer periods of time have achieved greater sensitivity, though the reported early success of CUPID-Mo sets the stage for a planned successor experiment called CUPID with a detector array that will be 100 times larger.

Berkeley Lab's contributions to CUPID-Mo

No experiment has yet confirmed whether the neutrinoless process exists. Existence of this process would confirm that neutrinos serve as their own antiparticles, and such proof would also help explain why matter won out over antimatter in our universe.

All of the data from the CUPID-Mo experiment - the CUPID acronym stands for CUORE Upgrade with Particle IDentification, and "Mo" is for the molybdenum contained in the detector crystal - is transmitted from Modane Underground Laboratory (Laboratoire souterrain de Modane) in France to the Cori supercomputer at Berkeley Lab's National Energy Research Scientific Computing Center.

Benjamin Schmidt, a postdoctoral researcher in Berkeley Lab's Nuclear Science Division, led the overall data analysis effort for the CUPID-Mo result, and was supported by a team of Berkeley Lab-affiliated researchers and other members of the international collaboration.

Berkeley Lab also contributed 40 sensors that enabled readout of signals picked up by CUPID-Mo's 20-crystal detector array. The array was supercooled to about 0.02 kelvin, or minus 460 degrees Fahrenheit, to maintain its sensitivity. Its cylindrical crystals contain lithium, oxygen, and the isotope Mo-100, and produce tiny flashes of light in particle interactions.

The international effort to produce the CUPID-Mo result is remarkable, Schmidt said, given the context of the global pandemic that had cast uncertainty over the continuing operation of the experiment.

"For a while it looked like we would have to shut down the CUPID-Mo experiment prematurely due to the outbreak of COVID-19 in Europe at the beginning of March and the associated difficulties in supplying the experiment with required cryogenic liquids," he said.

He added, "Despite this uncertainty and the changes associated with the closure of office spaces and schools, as well as restricted access to the underground laboratory, our collaborators made every effort to keep the experiment running through the pandemic."

Schmidt credited the efforts of the data-analysis group that he led for finding a way to work from home and produce the results from the experiment in time to present them at Neutrino 2020, a virtual International Conference on Neutrino Physics and Astrophysics hosted by Fermi National Accelerator Laboratory. Members of the CUPID-Mo collaboration are planning to submit the results for publication in a peer-reviewed science journal.

Tuning up ultrasensitive detectors

A particular challenge in the data analysis, Schmidt said, was in ensuring that the detectors were properly calibrated to record the "extremely elusive set of events" that are predicted to be associated with a signal of neutrinoless double-beta decay.

The neutrinoless decay process is expected to generate a very-high-energy signal in the CUPID-Mo detector and a flash of light. The signal, because it is at such a high energy, is expected to be free from interference by natural sources of radioactivity.

To test CUPID-Mo's response to high-energy signals, researchers had placed other sources of high-energy signals, including Tl-208, a radioactive isotope of thallium, near the detector array. The signals generated by the decay of this isotope are at a high energy, but not as high as the energy predicted to be associated with the neutrinoless decay process in Mo-100, if it exists.

"Hence, a big challenge was to convince ourselves that we can calibrate our detectors with common sources, in particular Tl-208," Schmidt said, "and then extrapolate the detector response to our signal region and properly account for the uncertainties in this extrapolation."

To further improve the calibration with high-energy signals, nuclear physicists used Berkeley Lab's 88-Inch Cyclotron to produce a wire containing Co-56, an isotope of cobalt that that has a low level of radioactivity, as soon as the cyclotron reopened last month following a temporary shutdown in response to the COVID-19 pandemic. The wire has been shipped to France for testing with the CUPID-Mo detector array.

Preparing for next-gen experiment in Italy

While CUPID-Mo may now lag behind the sensitivity in measurements achieved by some other experiments - which use different detector techniques and materials - because it is smaller and hasn't yet gathered as much data, "With the full CUPID experiment, which will use about 100 times more Mo-100, and with 10 years of operation, we have excellent prospects for the search and potential discovery of neutrinoless double-beta decay," Schmidt said.

CUPID-Mo was installed at the site of the Edelweiss III dark matter search experiment in a tunnel more than a mile deep in France, near the Italian border, and uses some Edelweiss III components. CUPID, meanwhile, is proposed to replace the CUORE neutrinoless double-beta decay search experiment at Gran Sasso National Laboratory (Laboratori Nazionali del Gran Sasso) in Italy. While CUPID-Mo contains just 20 detector crystals, CUPID would contain more than 1,500.

"After CUORE finishes data-taking in two or three years, the CUPID detector could take four or five years to build," said Yury Kolomensky, U.S. spokesperson for the CUORE collaboration and senior faculty scientist at Berkeley Lab, which is leading CUORE's U.S. collaboration. "CUPID would be a relatively modest upgrade in terms of cost and technical challenges, but it will be a significant improvement in terms of sensitivity."

Physics data-taking for CUPID-Mo wrapped up June 22, and new data that weren't considered in the latest result represent about a 20% to 30% growth in overall data. CUPID-Mo is supported by a group of French laboratories, and by laboratories in the U.S., Ukraine, Russia, Italy, China, and Germany.

NERSC is a DOE Office of Science user facility.

The CUPID-Mo collaboration brings together researchers from 27 institutions, including the French laboratories Irfu/CEA and IJCLab in Orsay; IP2I in Lyon; and Institut Néel and SIMaP in Grenoble, as well as institutions in the U.S., Ukraine, Russia, Italy, China, and Germany.

The experiment is supported by the U.S. Department of Energy Office of Science's Office of Nuclear Physics, Berkeley Research Computing program, Agence Nationale de la Recherche, IDEATE International Associated Laboratory (LIA), Russian Science Foundation, National Academy of Sciences of Ukraine, National Science Foundation, the France-Berkeley Fund, the MISTI-France fund, and the Office for Science & Technology of the Embassy of France in the U.S.

Ever wonder how some leaders in business or politics who appear selfish, manipulative and domineering still manage to amass a following? A recent study in the Journal of Leadership & Organizational Studies by San Francisco State University Assistant Professor of Management Dayna Herbert Walker found a connection between a person's childhood family environment and the types of leaders they're drawn to as grown-ups.

Using data from the Fullerton Longitudinal Study, a long-term study that began tracking families in 1979, Herbert Walker and three other researchers noticed a correlation between adolescents who reported a high level of conflict at home and those who later identified socially undesirable traits as ideal leadership qualities.

"We see it all the time -- where the obnoxious leader rises to the top, but we don't know much about why," Herbert Walker said. "Tyrants, whether they be in the boardroom or in politics, wouldn't have the power they do if followers didn't support them. We often look to leaders to explain leadership, but we should also be looking to followers."

The survey, which tracked 130 individuals at various points of their life, gave researchers details about participants' home lives and the leadership traits they valued most. Researchers studied data gathered in 1996, when participants were 17 years old. Two decades later, as part of another round of data collection for the Fullerton Longitudinal Study, researchers asked the same individuals questions about ideal leadership qualities.

The 1996 survey asked participants about their family dynamics, such as whether people at home raised their voices, criticized one another or were physically violent. Twenty years later, those respondents were asked to measure on a scale whether 10 qualities researchers defined as tyrannical (domineering, pushy, dominant, manipulative, power-hungry, conceited, loud, selfish, obnoxious and demanding) were characteristics present in their image of an ideal leader.

"It's critical that we asked about ideal leadership and not just leadership in general," Herbert Walker said, "because we really wanted to get at a person's favored leadership image, the characteristics they ideally want to see in their leaders."

Herbert Walker and the study's other authors then compared the data from 2016 and 1996 and found a strong positive connection between those who reported living with a high level of conflict at home and those whose ideal image of a leader possessed these negative traits. A person who experiences high conflict in adolescence is 20% more likely than chance to prefer a tyrannical model of leadership, controlling for other known factors that shape leadership preferences like sex and personality. When adolescent family environments contain a high amount of dysfunctional conflict, it's likely that some tyrannical behavior is on display and that role modeling can shape the way a person views leadership, Herbert Walker explains.

The findings shed new light on what ideal leadership can look like for some followers, illuminating why some of us are drawn to tyrants despite their harsh approach.

Herbert Walker says another group could learn important lessons from the findings, as well: bad bosses. For instance, a manager who believes leaders should be overbearing or manipulative could end up acting out those traits.

"The first step is getting them to question their assumptions about why they do what they do," she said. "Maybe they'll realize that they believe this, because that's how their dad behaved and he was successful in business. And so they believe that's how they're supposed to act."

Marked racial disparities exist in confirmed COVID-19 cases and deaths, investigators say, and highlight urgent needs to ensure adequate testing and treatment are available to African Americans and safer working and living conditions are in place so they can better protect themselves.

Also, more complete surveillance data is needed that always includes race, ethnicity and gender to better identify those most at risk and enable better treatment and prevention strategies that target at-risk neighborhoods and engage trusted, faith-based community leaders to help, Medical College of Georgia investigators write in the American Journal of Public Health.

"A colorblind approach to public health surveillance and response cannot bring about equity when both the health care system and the structural conditions that inform it are so weak," corresponding author Dr. Steven S. Coughlin, interim chief of the Division of Epidemiology in the MCG Department of Population Health Sciences, and his colleagues write.

Poverty, lack of health insurance and decreased access to health care are factors that likely contribute, as are past transgressions that have left many African Americans distrustful of government and the health care system, they write.

"To mitigate racial disparities in COVID-19 infection and mortality, safer working conditions and living environments (also) are needed that include provisions for personal protective equipment, social distancing, and hand/surface hygiene," they add.

In reality, a higher percentage of African Americans work in jobs where it's difficult or impossible to work from home or maintain a safe social distance at work, Coughlin says. Additionally, many of these jobs don't offer paid leave or health insurance, which means individuals may delay being tested and even present at the hospital sicker, he says.

In New York City, for example, which became a COVID-19 epicenter in the United States, reports based on U.S. Census Bureau statistics indicate that about 75% of the frontline workers in the city -- those who work in grocery, convenience and drug stores; public transit; trucking, warehouse and postal services; health care; childcare, homeless, food and family services; and building cleaning services -- are African American. A large percentage of these workers have to travel long distances to their work and a significant percentage live at or below twice the poverty line.

When looking at statistics on who got COVID-19 and where, as recently as late April, the investigators found that a lot of states did not release confirmed cases and deaths broken down by race, and the data was often limited on the states that did, Coughlin says.

But the information that was available from select cities and states painted a clear picture that African Americans throughout the nation are disproportionately impacted by both infection rates and death, Coughlin says of statistics primarily available from predominantly bigger cities in the Midwest and Northeast like Chicago, Milwaukee, Philadelphia and New York.

In Wisconsin, for example, African Americans comprise 6% of the state's population but 25% of COVID-19 cases and 39% of deaths. In Georgia, as of April 23, African Americans accounted for 31% of COVID-19 cases and 52% of the deaths in a state that is nearly 31% black. In Washington D.C. about 46% of the population is African American but their rate of COVID-19 deaths is 62.5%. Nationally, the Centers for Disease Control and Prevention was reporting that 1 in 3 people who become sick enough to require hospitalization were African American while they make up about 13% of the population.

In fact, some studies indicate the infection rate in predominately black counties is three times higher than predominately white ones and death rates are six times higher.

The first cases of COVID-19 in the United States were reported in January 2020, and rates began to take off late March and early April, Coughlin says.

"Throughout this period, half the states had not released information about cases and deaths broken down by ethnicity," he says.

By mid-April, 21 states had not released racial or ethnic breakdowns of those infected and 26 states had not released breakdowns of fatalities, the investigators write. Subsequently some testing and treatment forms have been modified to include race and ethnicity but there are a lot of gaps in existing data as well, he says.

The official word was there was a bureaucratic lapse because things were moving so rapidly, says Dr. Joseph Hobbs, chair emeritus of the MCG Department of Family Medicine and a senior author on the paper, who was shocked both by race often not being noted and by the disproportionate number of African Americans that were noted among COVID-19 related deaths. "The lack of information is still there," Hobbs adds, and would help strategize how best to move forward.

"You can't test the whole world but you can test segments where you know there are potential problems ... if you are able to document those problems, then you can divert resources to those communities to try to work on processes that make the community more aware of the things they could do to support each other with regard to stopping transmission of the disease," Hobbs says.

"Black churches can serve as testing and triage centers, health action zones to bridge government resources with community resources, and serve as a platform to overcome trust issues related to health care," they write.

"Our editorial calls for improved public health surveillance data to monitor the COVID-19 epidemic in different, diverse communities," Coughlin says, noting that other people of color, like the Navajo population, are also disproportionately impacted by the novel coronavirus. Improved surveillance includes more testing as well as more contact tracing once positive individuals have been identified, he says, noting targeted testing initiatives in disadvantaged neighborhoods in New York state and culturally appropriate PSAs in Las Vegas and South Carolina.

Longer-term goals include addressing the structural problems at the heart of the issue, Coughlin says.

The investigators say structural problems, including poverty, unemployment, household and neighborhood crowding and otherwise substandard housing, account for the pronounced disparities they see in available data.

Coughlin notes that structural problems, that also include food deserts and lack of safe/affordable places to exercise, also likely play a major role in increased rates of chronic conditions like hypertension and diabetes that also are risk factors for novel coronavirus infection and death.

These structural conditions first expose a population disproportionately, says Hobbs, and the chronic conditions put African Americans at increased risk of dying from the infection.

"These are the individuals who end up in the hospital disproportionately," says Hobbs. "These are the ones who are going to have the most complex clinical courses in the hospital and they comprise a disproportionate percentage of the people who will die," the family medicine physician says.

"Some commentators have drawn an analogy between what happened after Katrina like in the lower Ninth Ward of New Orleans and what is happening now with disparities and COVID-19," Coughlin says of a predominately black area of the city that was pummeled by the 2005 Category 3 hurricane and was the last to have power and water restored.

"The poverty and substandard living conditions existed in New Orleans for hundreds of years, but the hurricane brought them to light," Coughlin says. "Here we have another national emergency and it is shedding light on long-existing structural problems like redlining and segregated neighborhoods," he says of the historical lending practice of limiting mortgages in communities of color.

As of mid-June, racial and ethnic information was available for only about 35% of the total deaths in the US, although it was clear that blacks and other disadvantaged groups are experiencing infection and death rates that are disproportionately high for their share of the total population, according to Dr. Lisa A. Cooper, Bloomberg Distinguished Professor at the Johns Hopkins Bloomberg School of Public Health and School of Medicine, and director of the Johns Hopkins Center for Health Equity. The university's COVID-19 Testing Insights Initiative provides a national perspective on COVID-19 testing, results and other insight.