Culture

Scientists reveal why tummy bugs are so good at swimming through your gut

video: The cell bodies and flagella of C. jejuni are made to fluorescent, showing how they swim by wrapping their flagella around their bodies

Image: 
Eli Cohen / Imperial College London

Researchers have solved the mystery of why a species of bacteria that causes food poisoning can swim faster in stickier liquids, such as within guts.

The findings could potentially help scientists halt the bacteria in its tracks, because they show how the shape of the bacteria's body and the components that help it swim are all dependent on each other to work. This means any disruption to one part could stop the bacteria getting through to the gut.

Campylobacter jejuni is responsible for millions of food poisoning cases every year, and a key step in its invasion of the body is swimming through the viscous (sticky) mucous layer of the guts. Researchers have observed that C. jejuni swims faster in viscous liquids than in less-viscous liquids, like water, but until now they didn't know why.

Now, researchers from Imperial College London, Gakushuin University in Tokyo and the University of Texas Southwestern Medical Center have filmed C. jejuni in action to uncover the mystery. Their results are published today in PLOS Pathogens.

C. jejuni uses its two opposing tails, called flagella, to help it move. It has a flagellum at each end of its body that spin around to propel itself through liquid. However, the opposing flagella have confused scientists.

Co-first author Dr Eli Cohen, from the Department of Life Sciences at Imperial, said: "It seemed very strange that the bacteria had a tail at both ends - it's like having two opposing motors at either end of a ship. It was only when we watched the bacteria in action that we could see how the two tails work cleverly together to help the bacteria move through the body."

The team created C. jejuni strains that have fluorescent flagella and used high-speed microscopy to see what happened as they swam around. They discovered that to move forward, the bacteria wrap their leading flagella around their helically shaped bodies, meaning both flagella were then pointing in the same direction and providing unified thrust.

To change direction, they changed which flagella were wrapped around their body, enabling quick 180 degree turns and potential escape from confined spaces.

They also found that the process of wrapping the flagella was easier when swimming through viscous liquids; the stickiness helping push the leading flagella back around the body. In less-viscous liquids neither flagella were able to wrap around the body.

Lead researcher Dr Morgan Beeby, from the Department of Life Sciences at Imperial, said: "Our study kills two birds with one stone: in setting out to understand how C. jejuni moves, we resolved the apparent paradoxes of how it swims in one direction with opposing flagella and how it swims faster in more viscous liquid.

"As well as solving some long-standing mysteries, the research could also help researchers find new way to prevent infection by C. jejuni, by targeting any of its interconnected structures that help it move around."

The research also revealed that the helical shape of the bacteria body is crucial for allowing the flagella to wrap around it, showing how the two components are reliant on each other. This adds to the team's previous work showing how parts of the 'motor' that drives the flagella are co-dependent, and that none would work without the others.

Credit: 
Imperial College London

Rising water temperatures could endanger the mating of many fish species

Because fish that are ready to mate and their young are especially sensitive to changes in temperature, in the future up to 60 percent of all species may be forced to leave their traditional spawning areas

In a new meta-study, experts from the Alfred Wegener Institute, Helmholtz Centre for Polar and Marine Research (AWI) have published ground-breaking findings on the effects of climate change for fish stock around the globe. As they report, the risks for fish are much higher than previously assumed, especially given the fact that in certain developmental stages they are especially sensitive to rising water temperatures. One critical bottleneck in the lifecycle of fish is their low tolerance for heat during mating. In other words, the water temperature in their spawning areas determines to a great extent how successfully they reproduce, making fish particularly vulnerable to the impacts of climate change - not only in the ocean, but also in lakes, ponds and rivers. According to the researchers' analyses, if left unchecked, climate change and rising water temperatures will negatively affect the reproduction of up to 60 percent of all fish species. Their study was released today in the latest issue of the journal Science.

Organisms have to breathe in order for their bodies to produce energy; this is equally true for human beings and for fish. In addition, we know that the energy needs of humans and animals alike depend on the temperature: when it's warmer, the need for energy rises exponentially, and with it, the need for oxygen. On this basis, it follows that organisms can only adapt to rising temperatures in their immediate vicinity by providing their bodies with more oxygen. But there are certain species-specific limits on this ability; if those limits are exceeded, it can lead to cardiovascular collapse.

Armed with this knowledge, in a new meta-study, experts from the Alfred Wegener Institute, Helmholtz Centre for Polar and Marine Research (AWI) have investigated in which life phases saltwater and freshwater fish around the world are most sensitive to heat. To do so, the biologists compiled scientific data on the temperature tolerance of 694 fish species and analysed the temperature ranges within which fish can survive as adults ready to mate, as embryos in eggs, as larvae, and as adults outside the mating season.

Most sensitive during the mating season

"Our findings show that, both as embryos in eggs and as adults ready to mate, fish are far more sensitive to heat than in their larval stage or sexually mature adults outside the mating season," says first author and AWI marine biologist Dr Flemming Dahlke. "On the global average, for example, adults outside the mating season can survive in water that's up to 10 degrees Celsius warmer than adults ready to mate or fish eggs can."

The reason for this variable temperature tolerance lies in the anatomy of fish: fish embryos have no gills that would allow them to take in more oxygen. In contrast, fish that are ready to mate produce egg and sperm cells; this additional body mass also needs to be supplied with oxygen, which is why, even at lower temperatures, their cardiovascular systems are under enormous strain.

Every degree of warming increases the pressure on fish stocks

These findings apply to all fish species, and make it clear why fish are sensitive to heat, especially during the mating season and in their embryonic stage. Accordingly, in a second step the team of researchers analysed to what extent water temperatures in the spawning areas of the species investigated would likely rise due to climate change. For this purpose, they employed new climate scenarios (Shared Socioeconomic Pathways - SSPs), which will also be used in the IPCC's next Assessment Report.

Their conclusions confirm that every degree Celsius of warming spells more trouble for the world's fish stocks. "If we human beings can successfully limit climate warming to 1.5 degrees Celsius by the year 2100, only ten percent of the fish species we investigated will be forced to leave their traditional spawning areas due to rising temperatures," explains AWI biologist and co-author Prof Hans-Otto Pörtner. In contrast, if greenhouse-gas emissions remain at a high or very high level (SSP 5 - 8.5), it's likely to produce average warming of 5 degrees Celsius or more, which would endanger up to 60 percent of all fish species.

Limited options for adapting

Those species affected would then be forced to either adapt through biological evolution - a process that would most likely take far too long - or to mate at another time of year or in some other place. "Some species might successfully manage this change," says Flemming Dahlke. "But if you consider the fact that fish have adapted their mating patterns to specific habitats over extremely long timeframes, and have tailored their mating cycles to specific ocean currents and available food sources, it has to be assumed that being forced to abandon their normal spawning areas will mean major problems for them." In addition, fish living in rivers and lakes have the problem that their habitat is limited by the size and geographic location of the waters they live in: migrating to deeper waters or to cooler regions is nearly impossible.

New level of detail for improved projections

"Our detailed analyses, which cover all of the fishes' developmental stages, will help us to understand how these species are being affected by climate change, and to what extent the loss of suitable habitats is being driven by the climate-related transformation of ecosystems," says Hans-Otto Pörtner.

Wherever fish migrate or their reproduction rates decline, there will be new interactions between species, and in some cases the ecosystems will experience a drop in productivity. The IPCC published corresponding projections on the future of worldwide fish stocks in its Special Report on the Ocean and Cryosphere in a Changing Climate. According to Pörtner: "Our new detailed assessments will help to improve those projections."

Journal

Science

Credit: 
Alfred Wegener Institute, Helmholtz Centre for Polar and Marine Research

How the body fights off urinary tract infections

image: A larger scale shows how the uromodulin filaments (blue) envelop an E. coli cell, thus preventing the pathogen's pili from docking on the cell walls in the urinary tract and causing an infection. The image is a 3D visualisation from electron tomography measurements.

Image: 
Dawid Zyla / ETH Zurich

Anyone who has ever had cystitis knows that urinary tract infections of this kind are annoying and painful. They can be well treated by antibiotics, but may be fatal if left untreated. These infections are usually caused by what are known as uropathogenic E. coli bacteria when they bind to the cells of the bladder, ureter or urethra with their pili, the thread-like appendages that grow out of them like hairs. But protection is at hand in the form of a certain protein, produced naturally in the body, called uromodulin. Around 70 percent of all people carry a uromodulin gene variant in their genome, which means that they produce this protective protein in particularly large quantities. Accordingly, they have a smaller risk of contracting urinary tract infections.

But the exact process by which uromodulin prevents inflammation had never been understood. Now an interdisciplinary team, drawn from three research groups at ETH Zurich together with researchers from the University of Zurich and the Children's Hospital Zurich, has filled this knowledge gap by investigating uromodulin's appearance and how the protein goes about neutralising uropathogenic E. coli. Their findings, which have been published in the journal Science, should help to develop new strategies for the treatment of urinary tract infections in the future.

A detailed look at how it works

First, the researchers analysed how the protein binds to the bacterial pili at the molecular level. "We already knew that a bond is formed and that this presumably plays a part in uromodulin's protective function, but nobody had studied this in greater detail," says Gregor Weiss, a doctoral student in molecular biology at ETH and one of the study's lead authors. Their biochemical investigations have now shown that the bacterial pili recognise certain sugar chains on the surface of the uromodulin and bind to them extremely readily and strongly.

Next, the team examined uromodulin using cryo-electron tomography, an imaging technique that produces three-dimensional views of the structure of proteins and cells with no need for chemical modification or dehydration. This showed them that uromodulin forms long filaments consisting on average of around 400 individual protein molecules strung together. And that each link of this protein chain contains the characteristic pattern of sugar chains to which bacterial pili like to bind.

Fruitful collaboration

Cryo-electron tomography was also the team's chosen technique for investigating at a larger scale what effect these properties have - this time in the presence of the culprits, the uropathogenic E. coli bacteria. They discovered that the uromodulin filaments literally envelop the pathogen, and that a single uromodulin filament can dock with several pili of a bacterium. "This neutralises the pathogens," Weiss explains: "Once the bacteria are shielded in this way, they can no longer bind to the cells in the urinary tract, which means they can't cause infection." Under an optical microscope, the team also noted the formation of large clumps of hundreds of uromodulin filaments and E. coli cells, which are then presumably simply excreted with the urine.

Finally, the researchers checked to see whether all these processes they had observed in the laboratory also occur in patients. They analysed urine samples from infected patients provided by the Children's Hospital in Zurich and found exactly the same interactions between uromodulin and the pathogens. "Without interdisciplinary collaboration between different research groups and institutes, it would have been impossible to obtain this set of findings," stresses ETH Professor Martin Pilhofer, who led the electron tomography investigations.

Pointers for treatment and drug development

The research team's work offers pointers for how to treat and prevent urinary tract infections without using antibiotics. Until now, patients have often been given preparations that contain the sugar mannose. To a certain extent, these prevent the E. coli bacteria from attaching themselves to the cells of the urinary tract. "Thanks to our analyses, we now know that the bacterial pili recognise not only mannose but also other sugars present on uromodulin," says Jessica Stanisich, doctoral student and another lead author of the study. "This might indicate that treatment with combined sugar supplements would be more effective."

The new findings also help in the development of new active substances, adds ETH Professor Rudi Glockshuber. This is because during an infection the uropathogenic E. coli attach themselves to the same sugar chains on the cell surfaces of the urinary tract as on uromodulin. Pharmaceutical companies are looking to identify new active substances that will prevent precisely these interactions - but this risks also disrupting the protective binding of uromodulin to the bacteria. "It would obviously be a highly undesirable side effect for a drug if that treatment simultaneously interfered with a natural protective function," Glockshuber says. However, the research team's analyses have now shown that the bonds between bacteria and uromodulin are extremely stable and cannot be broken down by active substances - an important finding in the search for remedies for unpleasant urinary tract infections.

Credit: 
ETH Zurich

Call for immunology to return to the wild

video: Rewilding immunology across species and environments can initiate a dynamic feedback cycle to improve human, animal, and ecosystem health.

Image: 
@WACImmuno

In an article published today in Science, a multidisciplinary research team from more
than 10 universities and research institutes outlines how integrating a more diverse
set of species and environments could enhance the biomedical research cycle.
The viruses that cause COVID-19, AIDS, Ebola, and rabies - among others - all
made the lethal jump from wildlife into humans. Understanding how the immune
system works in animals that live with coronaviruses in a natural environment, such
as bats, can give us direction for developing treatments and vaccines to protect
humans from viruses.

Lead author, Dr Andrew Flies from the Menzies Institute for Medical Research at the
University of Tasmania, says this is not a new concept.

"The very first vaccine arose from observing people interacting with animals in a realworld
environment. Specifically, milkmaids who acquired a mild cowpox infection
from cows were protected from the deadly smallpox. That observation led to the idea
of inoculating people with non-lethal viruses to protect them from deadly viruses.
This type of discovery can only be made by studying new species in variable
environments."

Modern research relies heavily on mouse experiments in laboratory settings, which
limits the scope for this type of ground-breaking discovery. For example, a new class
of antibodies, often referred to as nanobodies, was discovered in camels. Easier and
faster to make than traditional antibodies used in biomedicine, camel-derived
nanobodies are playing an import role in biomedical research, including the global
COVID-19 response. This shows how stepping out of the lab and studying new
species can yield large long-term payoffs.

"We are really excited to see how our initial group discussions held at the first
Australian Wild and Comparative Immunology (WACI) workshop
(https://www.wacimmuno.com/ ) led to publishing a Perspective article in a world
leading journal", said co-author Dr Jerome Le Nours, from the Biomedicine
Discovery Institute at Monash University, who was co-organiser of the WACI
meeting.

"There are many excellent wildlife and disease ecologists, veterinarian scientists and
immunologists in Australia, and beyond. We hope that our contribution will inspire
them to seek mutually beneficial, inter-disciplinary collaboration" said Associate
Professor Anne Peters, Monash University, co-author and consortium collaborator.

WACI Consortium collaborator and co-author, Associate Professor Julie Old from
Western Sydney University, said it's important for immunology research to include
more diverse species. "If we want to evolve our understanding of the immune
system, and potentially get ahead of any future pandemics, the research community
needs to expand. We need to broaden our scope, and bring new species and new
environments into the research paradigm."

''Realising wild immunology needs initiatives like the WACI Consortium that harness
the wide expertise of scientists and diverse technologies within individual areas' says
Associate Professor Michelle Power from Macquarie University. "The risks of
emerging infectious diseases are not going away. We need new ideas, new tools
and dynamic collaboration to address them".

Director of the Menzies Institute for Medical Research, Distinguished Professor
Alison Venn, said new technology has broken down research barriers to integrating
new species and environments into the research cycle.
"Proactive investment in wild immunology can stimulate discoveries with real-world
applications for human and veterinary medicine and conservation. It could help us
prepare for the next pandemic."

Credit: 
Menzies Institute for Medical Research

Study explains potential causes for 'happy hypoxia' condition in COVID-19 patients

MAYWOOD, IL--A new research study provides possible explanations for COVID-19 patients who present with extremely low, otherwise life-threatening levels of oxygen, but no signs of dyspnea (difficulty breathing). This new understanding of the condition, known as silent hypoxemia or "happy hypoxia," could prevent unnecessary intubation and ventilation in patients during the current and expected second wave of coronavirus.

The condition "is especially bewildering to physicians as it defies basic biology," said Martin J. Tobin, MD, Loyola Medicine and Edward J. Hines Jr. VA Hospital pulmonologist and critical care specialist, and professor, Loyola University Chicago Stritch School of Medicine. Dr. Tobin is lead author of the study, "Why COVID-19 Silent Hypoxemia is Baffling to Physicians," appearing recently in the online American Journal of Respiratory and Critical Care Medicine.

"In some instances, the patient is comfortable and using a phone at a point when the physician is about to insert a breathing (endotracheal) tube and connect the patient to a mechanical ventilator," said Dr. Tobin, "which while potentially lifesaving carries its own set of risks."

The study included 16 COVID-19 patients with very low levels of oxygen (as low as 50%; normal blood oxygen saturation is between 95 and 100%), without shortness of breath or dyspnea, and found that "several pathophysiological mechanisms account for most, if not all, cases of silent hypoxemia. This includes the initial assessment of a patient's oxygen level with a pulse oximeter.

"While a pulse oximeter is remarkably accurate when oxygen readings are high, it markedly exaggerates the severity of low levels of oxygen when readings are low," said Dr. Tobin. "Another factor is how the brain responds to low levels of oxygen. As oxygen levels drop in patients with COVID-19, the brain does not respond until oxygen falls to very low levels--at which point a patient typically becomes short of breath," he said.

In addition, more than half of the patients had low levels of carbon dioxide, which may diminish the impact of an extremely low oxygen level.

"It is also possible that the coronavirus is exerting a peculiar action on how the body senses low levels of oxygen," said Dr. Tobin, which could be linked to the lack of smell, experienced by two-thirds of COVID-19 patients.

While acknowledging that further research is needed, the study concludes that "features about COVID-19 that physicians find baffling become less strange when viewed in the light of long-established principles of respiratory physiology."

"This new information may help to avoid unnecessary endotracheal intubation and mechanical ventilation, which presents risks, when the ongoing and much anticipated second wave of COVID-19 emerges," said Dr. Tobin.

Credit: 
Loyola Medicine

Global threats: How lessons from COVID-19 can prevent environmental meltdown

image: Covid-19, climate emergencies, and mass extinction all share striking similarities, especially with regard to their "lagged impacts." In each, early intervention can prevent further damage.

Image: 
Open Source

Epidemiologists highlighted the dangers of Covid-19 in its early stages, but their warnings went largely ignored until rising infection rates forced policymakers to take action.

Likewise, climate and environmental scientists have warned, for decades, that human activity is triggering global heating and another mass extinction could occur if countries do not enact regulations to reduce their environmental impact.

Covid-19, climate emergencies, and mass extinction all share striking similarities, according to an essay co-authored by David S. Wilcove, professor of ecology and evolutionary biology and public affairs and the Princeton Environmental Institute at the Princeton School of Public and International Affairs.

Wilcove and his co-authors draw analogies between Covid-19 and environmental threats, especially with regard to their "lagged impacts."

That is, a lag exists between the first few cases of Covid-19 to the worldwide pandemic it has become. The same is true of ongoing environmental crises. Human-induced shifts in climate and habitat can seem minor now but will have catastrophic effects down the road, the authors wrote.

Early intervention is necessary in order to contain them and prevent future damage.

Multiple analyses have confirmed that delaying "stay at home" orders increased the mortality rates due to Covid-19 in many countries. If lockdown had been enacted just one week earlier, there would have been approximately 17,000 fewer deaths in the United Kingdom and 45,000 fewer deaths in the United States, according to the co-authors.

On a global level, the world is on track to experience a net temperature increase of +2.0° C. With early action, this could have been reduced to a net increase of +1.5° C. Although this difference appears insignificant, it has grave ramifications.

Since early intervention was not taken to reduce this global heating, an estimated 62 to 457 million more people will be exposed to a broad range of climate risks. Early intervention is also crucial for species conservation; when action is delayed, species losses increase, and conservation efforts become less likely to succeed.

While intervention is often delayed under the premise that it will interfere with peoples' livelihoods, the researchers posit that the opposite is true.

The International Monetary Fund (IMF) predicts that economic growth will be lower in countries with higher current rates of Covid-attributed deaths. This means countries that delayed lockdown to sustain their economic stability could ultimately lose out in the end, just as climate change will curtail economic growth as countries delay reducing their environmental impacts.

"The notion that paying short-term costs may be vital to securing longer-term prosperity is echoed in several assessments of the overall economic consequences of responding to the climate and extinction crises," the team wrote. "On both environmental fronts intervening now rather than delaying further is critical to securing our future wellbeing and that of our children and grandchildren."

The magnitude of these issues require policymakers and citizens to look beyond self-interests and make choices that will safeguard society's most vulnerable populations as well as future generations.

"In the Covid-19 crisis, this means young and working people making sacrifices for the older and more vulnerable. For the climate and extinction crises, effective action requires wealthier people forgoing extravagance both for the present-day poor and for all future generations," the team wrote.

In moving forward to address these challenges, it is essential that governments listen to and act in accordance with independent scientists. Their voices have gone ignored by policymakers who can create the changes necessary to avoid global catastrophe, the team believes. This requires coordination and cooperation on the international level, not just local or federal.

Credit: 
Princeton School of Public and International Affairs

How prison and police discrimination affect black sexual minority men's health

Incarceration and police discrimination may contribute to HIV, depression and anxiety among Black gay, bisexual and other sexual minority men, according to a Rutgers led study.

The study, funded by the National Institute of Health (NIH) and published in the journal Social Science & Medicine, examined associations between incarceration, police and law enforcement discrimination and recent arrest with Black sexual minority mens' psychological distress, risk for HIV and willingness to take pre-exposure prophylaxis (PrEP) for HIV prevention.

"Evidence suggests Black sexual minority men in the United States may face some of the highest rates of policing and incarceration in the world," said lead author, Devin English, assistant professor at the Rutgers School of Public Health. "Despite this, research examining the health impacts of the U.S. carceral system rarely focuses on their experiences. This study helps to address this gap."

"We examined how incarceration and police discrimination, which have roots in enforcing White supremacy and societal heterosexism, are associated with some of the most pressing health crises among Black sexual minority men like depression, anxiety, and HIV," English added.

The researchers surveyed 1,172 Black, gay, bisexual, and other sexual minority men over the age of 16 from across the U.S. who reported behaviors that increased their risk for HIV over the previous six months. Participants reported on their incarceration history, experiences of police and law enforcement discrimination, anxiety and depression, sexual behavior, and willingness to take PrEP.

They found that 43 percent of study participants reported police discrimination within the previous year, which was most frequent among those with a history of incarceration. Respondents who faced high levels of police discrimination within the previous year also tended to show high levels of psychological distress and HIV risk, and a low willingness to take PrEP compared with their peers. The study also found that respondents who were previously incarcerated or recently arrested had a heightened HIV risk and lower willingness to take PrEP.

"These findings transcend individual-level only explanations to offer structural-level insights about how we think about Black sexual minority men's HIV risk," says co-author Lisa Bowleg, professor of psychology at The George Washington University. "The study rightly directs attention to the structural intersectional discrimination that negatively affects Black sexual minority men's health."

The article states that the findings support the need for anti-racist and anti-heterosexist advocacy and interventions focused on reducing discrimination in U.S. society, and the carceral system specifically.

"Despite experiencing a disproportionate burden of violence and discrimination at the hands of the police, and extremely high carceral rates, Black queer men are largely invisible in discourse on anti-Black policing and incarceration," says co-author Joseph Carter, doctoral student of health psychology at the City University of New York's Graduate Center. "Our study provides empirical support for the intersectional health impacts of police and carceral discrimination that have been systemically perpetrated onto Black queer men."

Credit: 
Rutgers University

Sniffing out smell

The premiere of the movie Scent of Mystery in 1960 marked a singular event in the annals of cinema: the first, and last, motion picture debut "in glorious Smell-O-Vision." Hoping to wow moviegoers with a dynamic olfactory experience alongside the familiar spectacles of sight and sound, select theaters were outfitted with a Rube Goldberg-esque device that piped different scents directly to seats.

Audiences and critics quickly concluded that the experience stunk. Fraught with technical issues, Smell-O-Vision was panned and became a running gag that holds a unique place in entertainment history. The flop of Smell-O-Vision, however, failed to deter entrepreneurs from continuing to chase the dream of delivering smells to consumers, particularly in recent years, through digital scent technologies.

Such efforts have generated news headlines but scant success, due in part to a limited understanding of how the brain translates odor chemistry into perceptions of smell--a phenomenon that in many ways remains opaque to scientists.

A study by neurobiologists at Harvard Medical School now provides new insights into the mystery of scent. Reporting in Nature on July 1, the researchers describe for the first time how relationships between different odors are encoded in the olfactory cortex, the region of brain responsible for processing smell.

By delivering odors with carefully selected molecular structures and analyzing neural activity in awake mice, the team showed that neuronal representations of smell in the cortex reflect chemical similarities between odors, thus enabling scents to be placed into categories by the brain. Moreover, these representations can be rewired by sensory experiences.

The findings suggest a neurobiological mechanism that may explain why individuals have common but highly personalized experiences with smell.

"All of us share a common frame of reference with smells. You and I both think lemon and lime smell similar and agree that they smell different from pizza, but until now, we didn't know how the brain organizes that kind of information," said senior study author Sandeep Robert Datta, associate professor of neurobiology in the Blavatnik Institute at HMS.

The results open new avenues of study to better understand how the brain transforms information about odor chemistry into the perception of smell.

"This is the first demonstration of how the olfactory cortex encodes information about the very thing that it's responsible for, which is odor chemistry, the fundamental sensory cues of olfaction," Datta said.

Computing odor

The sense of smell allows animals to identify the chemical nature of the world around them. Sensory neurons in the nose detect odor molecules and relay signals to the olfactory bulb, a structure in the forebrain where initial odor processing occurs. The olfactory bulb primarily transmits information to the piriform cortex, the main structure of the olfactory cortex, for more comprehensive processing.

Unlike light or sound, stimuli easily controlled by tweaking characteristics such as frequency and wavelength, it is difficult to probe how the brain builds neural representations of the small molecules that transmit odor. Often, subtle chemical changes--a few carbon atoms here or oxygen atoms there--can lead to significant differences in smell perception.

Datta, along with study first author Stan Pashkovski, research fellow in neurobiology at HMS, and colleagues approached this challenge by focusing on the question of how the brain identifies related but distinct odors.

"The fact that we all think a lemon and lime smell similar means that their chemical makeup must somehow evoke similar or related neural representations in our brains," Datta said.

To investigate, the researchers developed an approach to quantitatively compare odor chemicals analogous to how differences in wavelength, for example, can be used to quantitatively compare colors of light.

They used machine learning to look at thousands of chemical structures known to have odors and analyzed thousands of different features for each structure, such as the number of atoms, molecular weight, electrochemical properties and more. Together, these data allowed the researchers to systematically compute how similar or different any odor was relative to another.

From this library, the team designed three sets of odors: a set with high diversity; one with intermediate diversity, with odors divided into related clusters; and one of low diversity, where structures varied only by incremental increases in carbon-chain length.

They then exposed mice to various combinations of odors from the different sets and used multiphoton microscopy to image patterns of neural activity in the piriform cortex and olfactory bulb.

Smell prediction

The experiments revealed that similarities in odor chemistry were mirrored by similarities in neural activity. Related odors produced correlated neuronal patterns in both the piriform cortex and olfactory bulb, as measured by overlaps in neuron activity. Weakly related odors, by contrast, produced weakly related activity patterns.

In the cortex, related odors led to more strongly clustered patterns of neural activity compared with patterns in the olfactory bulb. This observation held true across individual mice. Cortical representations of odor relationships were so well-correlated that they could be used to predict the identity of a held-out odor in one mouse based on measurements made in a different mouse.

Additional analyses identified a diverse array of chemical features, such as molecular weight and certain electrochemical properties, that were linked to patterns of neural activity. Information gleaned from these features was robust enough to predict cortical responses to an odor in one animal based on experiments with a separate set of odors in a different animal.

The researchers also found that these neural representations were flexible. Mice were repeatedly given a mixture of two odors, and over time, the corresponding neural patterns of these odors in the cortex became more strongly correlated. This occurred even when the two odors had dissimilar chemical structures.

The ability of the cortex to adapt was generated in part by networks of neurons that selectively reshape odor relationships. When the normal activity of these networks was blocked, the cortex encoded smells more like the olfactory bulb.

"We presented two odors as if they're from the same source and observed that the brain can rearrange itself to reflect passive olfactory experiences," Datta said.

Part of the reason why things like lemon and lime smell alike, he added, is likely because animals of the same species have similar genomes and therefore similarities in smell perception. But each individual has personalized perceptions as well.

"The plasticity of the cortex may help explain why smell is on one hand invariant between individuals, and yet customizable depending on our unique experiences," Datta said.

Together, the results of the study demonstrate for the first time how the brain encodes relationships between odors. In comparison to the relatively well-understood visual and auditory cortices, it is still unclear how the olfactory cortex converts information about odor chemistry into the perception of smell.

Identifying how the olfactory cortex maps similar odors now provides new insights that inform efforts to understand and potentially control the sense of smell, according to the authors.

"We don't fully understand how chemistries translate to perception yet," Datta said. "There's no computer algorithm or machine that will take a chemical structure and tell us what that chemical will smell like."

"To actually build that machine and to be able to someday create a controllable, virtual olfactory world for a person, we need to understand how the brain encodes information about smells," Datta said. "We hope our findings are a step down that path."

Credit: 
Harvard Medical School

Study: Crowdsourced data could help map urban food deserts

New research from The University of Texas at Dallas suggests food deserts might be more prevalent in the U.S. than the numbers reported in government estimates.

In a feasibility study published in the journal Frontiers in Public Health, scholars found that the methods used by the U.S. Department of Agriculture (USDA) to identify areas with low access to healthy food are often outdated and narrow in scope.

Their findings indicate that crowdsourced information gathered from mobile apps such as Yelp could help provide more accurate real-time representation of food deserts in impoverished communities.

"Using data from the city of Dallas, we compared our results with the 2015 USDA database and discovered the agency needs an up-to-date source of information on grocery stores," said Dr. Dohyeong Kim, associate professor of public policy and political economy and of geospatial information sciences in the School of Economic, Political and Policy Sciences at UT Dallas. "The number of food deserts may be a lot larger than what the USDA says it is."

The USDA considers three metrics when identifying "food deserts," areas where residents lack access to fresh and healthy food: income, car ownership and distance to the nearest supermarket. In an effort to improve accuracy of food desert locations, the UT Dallas researchers looked at two additional variables not included by the USDA: access to public transit and shopper-provided food pricing gathered from Yelp, an online source of business reviews by the public.

"If a community has few public transportation options nearby, that may contribute to the existence of a food desert," Kim said. "Plus, low-income households still face limited access to healthy food if prices are too high."

The researchers analyzed data from Dallas' 296 census tracts, which are neighborhood-sized geographical areas used by government agencies to collect population data. Nine census tracts were identified as food deserts based on the USDA's 2015 data only. Using 2018 Yelp data alone, the researchers identified 50 census tracts -- mostly in south Dallas -- as food deserts. Thirty-three census tracts were overlapped by both data sources.

Due to the time difference between the two data sources, Kim cautioned that their findings could not confirm which dataset -- USDA vs. Yelp -- matches the situation on the ground more accurately, and he stressed that Yelp should not be considered as a replacement for government data. The results do show, however, that crowdsourced, georeferenced data could be a good supplement to improve accuracy of official government data and help guide health policies.

"Yelp data is still incomplete in coverage and limited for wide application, although it has the potential to be improved in the future," Kim said. "This study sheds light on the need for on-the-ground, place-specific observation in the study of food deserts, and future studies should include multiple cities to gauge the quality of Yelp data across the country."

Kim added that use of such crowdsourced information also could give guidance to other public-health mapping, such as for noise or pollution.

Credit: 
University of Texas at Dallas

COVID-19 news from Annals of Internal Medicine

Below please find a summary and link(s) of new coronavirus-related content published today in Annals of Internal Medicine. The summary below is not intended to substitute for the full article as a source of information. A collection of coronavirus-related content is free to the public at http://go.annals.org/coronavirus.

1. How to Safely Reopen Colleges and Universities During COVID-19: Experiences From Taiwan

The safe reopening of colleges and universities this fall is an ongoing concern in many countries. Authors from several institutions, including the National Taiwan University, share the combination of strategies undertaken by universities in Taiwan to keep campuses open while maintaining the health and safety of students and faculty. They describe the plan in the backdrop of effective public health strategies undertaken in Taiwan to keep case counts of COVID-19 low. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-2927.

Editorial: Reopening Colleges and Universities During the COVID-19 Pandemic

There are important differences between Taiwan and other countries, but residential colleges and universities present similar challenges to pandemic control for all. Considering how well Taiwan has managed COVID-19 overall, the editorialists from Washington University, St. Louis believe that the plan for safely reopening colleges and universities in Taiwan offers important principles that may help to advise the United States and other countries. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-4752.

Media contacts: PDFs for these articles is not yet available. Please click the link to read full text. The lead author, Shan-Chwen Chang, MD, PhD, can be reached at changsc@ntu.edu.tw. The editorialist, Mark S. Wrighton, PhD, can be reached directly at wrighton@wustl.edu.

2. Urgent Issues Facing Immigrant Physicians in the U.S. in the COVID-19 Era

Physicians who received their medical training outside the United States constitute a substantial proportion of the physician workforce in states with a high burden of COVID-19 cases and deaths. Authors from HSHS St. John's Hospital in Springfield, Illinois, and Cleveland Clinic Foundation describe how immigrant physicians and their families also may be especially vulnerable because of several circumstances that relate to their visa status. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-4103.

Media contacts: PDFs for these articles is not yet available. Please click the link to read full text. The lead author, Vivekanand Tiwari, MD, can be reached at drtiwari2008@gmail.com.

Credit: 
American College of Physicians

Mobile clinics can help address health care needs of Latino farmworkers

image: A mobile health clinic the researchers used.

Image: 
Center for Healthy Communities, UC Riverside

RIVERSIDE, Calif. -- A University of California, Riverside, study that sought to determine barriers to health care among Spanish-speaking Latino farmworkers in rural communities has devised an innovative health care service delivery model that addresses many challenges these communities face.

The researchers, led by Ann Cheney, a medical anthropologist and assistant professor in the Department of Social Medicine, Population, and Public Health in the School of Medicine, advocate the use of mobile health clinics, or MHCs, that bring health care services to patients in their community spaces. Cheney was assisted in the research by Dr. Monica Tulimiero, who graduated from the UCR School of Medicine earlier this year and is now a resident in family medicine at Ventura County Medical Center.

MHCs, the researchers argue, offer health care services at times outside of business hours, which suits farmworkers. The researchers also urge providers to immerse themselves and practice in patient communities to better understand their health care needs.

The study, published in the Journal of Rural Health, was conducted in inland Southern California's eastern Coachella Valley, an agricultural region home to many undocumented and underinsured Latino immigrants. It also included focus group discussions and one-on-one interviews with patients.

In partnership with Health to Hope, a federally qualified health center, Cheney and her team implemented three MHCs in 2019 in locations close to patients’ homes and community spaces, making sure the clinics accommodated patients’ time constraints. The MHC included two exam rooms. Patients were treated at no or very low cost.

According to the researchers, traditional models of care -- the kind that expect patients to access health care services at brick-and-mortar structures within defined clinic hours -- work for patients with resources such as paid sick leave and job stability but are not practical for Latino farmworkers in rural communities.

"MHCs present an innovative health care service delivery model for chronic disease screening and prevention in underserved communities like the eastern Coachella Valley and can reduce access barriers and emergency department use and improve health outcomes for such vulnerable populations," Cheney said. "Farmworkers in eastern Coachella Valley face several barriers such as limited health services and public transportation, language barriers, unfamiliar medical systems, no health insurance, and financial challenges made worse by a lack of workers' rights."

Cheney has worked with farmworkers in eastern Coachella Valley since 2016. Originally from upstate New York, she grew up in the poorest county in the state. Her family owned a farm that cultivated fruits and vegetables; eventually, it turned into a horticultural farm. For most of her professional career, Cheney conducted research within rural farmworking communities, including rural southern Italy and rural Southern California. In Arkansas, she worked with rural African Americans connected to the history of agriculture and slavery.

More than 80% of all farmworkers in the United States are Latino, 95% of whom are immigrants. This population experiences some of the greatest disparities in health care access and health status due to lack of physicians and hospitals in rural locations; insufficient public transportation; poverty; cultural values such as self-reliance and community belonging; and inconvenient clinic hours.

"MHCs are especially relevant for immigrant communities as they minimize structural barriers to care, offer culturally and linguistically appropriate care, and familiarize and connect foreign-born patients with the U.S. health care system," said Tumiliero, the first author of the research paper. "Future research could study whether implementation of MHCs reduces emergency room visits."

HABLAMoS

At UCR, Tulimiero participated in Hispanic and Bilingual Longitudinal Medical Studies, or HABLAMoS, and is one of the first students to graduate from the medical school with a designated emphasis in medical Spanish.

"Monica utilized opportunities via HABLAMoS to further her language skills, as well as learn more about the health and well-being of underserved Latino immigrants in rural Southern California," Cheney said. "She did this through her research as well as a four-week immersion experience in eastern Coachella Valley in which she lived with a Spanish-speaking family and practiced in a clinic serving Spanish-speaking patients. HABLAMoS prepares students like Monica to serve the medically underserved in the Inland Empire."

Launched in 2018, HABLAMoS provides UCR medical students opportunities to develop language skills in medical contexts. It also increases students' understanding of the role of culture in clinical interactions with Spanish-speaking patients as well as structural factors that shape inequalities in health among Latino patients. UCR medical students can opt into HABLAMoS during their first two years of medical school. The heart of the program is a four-week clinical rotation and homestay with a Spanish-speaking family in the fourth year.

"HABLAMoS helped me improve my Spanish and allowed me to get to know the community in the eastern Coachella Valley, which I really enjoyed," Tulimiero said. "Through HABLAMoS I was also able to get involved in research and serve as first author of our research paper. I never imagined myself doing research in medical school, but I ended up enjoying it because it helped me get to know the community and advocate for both the people there and other similar communities. Dr. Cheney served as an amazing mentor throughout the process."

Tulimiero lived with a family of six people -- a mother, father, and their four sons aged 11 to 18 -- in February 2020.

"They welcomed me in and called me their 'daughter for the month,'" she said. "The way my host parents and their friends shared their stories and culture with me was probably the most memorable and meaningful experience. From going out dancing, to making pupusas salvadoreñas, to riding horses, to sharing their childhood memories with me, I felt generously welcomed and genuinely befriended."

Tulimiero did her rotations at clinics in Coachella and Mecca and worked closely with a doctor who treated roughly 30 patients a day. Tulimiero either assisted or observed the doctor in nearly all the patient visits.

Credit: 
University of California - Riverside

Twenty-year study tracks a sparrow song that went "viral" across Canada

video: This video shows the two different white-throated sparrow songs.

Image: 
Scott M. Ramsay

Most bird species are slow to change their tune, preferring to stick with tried-and-true songs to defend territories and attract females. Now, with the help of citizen scientists, researchers have tracked how one rare sparrow song went "viral" across Canada, traveling over 3,000 kilometers between 2000 and 2019 and wiping out a historic song ending in the process. The study, publishing July 2 in the journal Current Biology, reports that white-throated sparrows from British Columbia to central Ontario have ditched their traditional three-note-ending song in favor of a unique two-note-ending variant--although researchers still don't know what made the new song so compelling.

"As far as we know, it's unprecedented," says senior author Ken Otter, a biology professor at the University of Northern British Columbia. "We don't know of any other study that has ever seen this sort of spread through cultural evolution of a song type." Although it's well known that some bird species change their songs over time, these cultural evolutions tend to stay in local populations, becoming regional dialects rather than the norm for the species. This is how the two-note ending got its start.

In the 1960s, white-throated sparrows across the country whistled a song that ended in a repeated three-note triplet, but by the time Otter moved to western Canada in the late 1990s and began listening to the local bird songs, the new two-note ending had already invaded local sparrow populations. "When I first moved to Prince George in British Columbia, they were singing something atypical from what was the classic white-throated sparrow song across all of eastern Canada," he says. Over the course of 40 years, songs ending in two notes, or doublet-ending songs, had become universal west of the Rocky Mountains.

Otter and his team used the large network of citizen scientist birders across North America who had uploaded recordings of white-throated sparrow songs to online databases to track the new doublet-ending song. They found that the song was not only more popular west of the Rocky Mountains, but was also spreading rapidly across Canada beyond these western populations. "Originally, we measured the dialect boundaries in 2004 and it stopped about halfway through Alberta," he says. "By 2014, every bird we recorded in Alberta was singing this western dialect, and we started to see it appearing in populations as far away as Ontario, which is 3,000 kilometers from us."

The scientists predicted that the sparrows' overwintering grounds were playing a role in the rapid spread of the two-note ending. "We know that birds sing on the wintering grounds, so juvenile males may be able to pick up new song types if they overwinter with birds from other dialect areas. This would allow males to learn new song types in the winter and take them to new locations when they return to breeding grounds, helping explain how the song type could spread," Otter says.

So the researchers harnessed sparrows with geolocators--what Otter calls "tiny backpacks"--to see if western sparrows who knew the new song might share overwintering grounds with eastern populations that would later adopt it. They found that they did. And not only did it appear that this rare song was spreading across the continent from these overwintering grounds, but it was also completely replacing the historic triple-note ending that had persisted for so many decades--something almost unheard of in male songbirds.

Otter and his team found that the new song didn't give male birds a territorial advantage over male counterparts, but still want to study whether female birds have a preference between the two songs. "In many previous studies, the females tend to prefer whatever the local song type is," says Otter. "But in white-throated sparrows, we might find a situation in which the females actually like songs that aren't typical in their environment. If that's the case, there's a big advantage to any male who can sing a new song type."

Now, another new song has appeared in a western sparrow population whose early spread may mirror that of the doublet-note ending. Otter and his team are excited to continue their work and see how this song shifts in real time with more help from citizen scientists. "By having all these people contribute their private recordings that they just make when they go bird watching, it's giving us a much more complete picture of what's going on throughout the continent," he says. "It's allowing us to do research that was never possible before."

Credit: 
Cell Press

Global e-waste surging: Up 21% in 5 years

image: E-waste -- discarded products with a battery or plug -- will reach 74 Mt by 2030, almost a doubling of e-waste in just 16 years. This makes e-waste the world's fastest-growing domestic waste stream, fueled mainly by higher consumption rates of electric and electronic equipment, short life cycles, and few options for repair.

Image: 
Yassyn Sidki

A record 53.6 million metric tonnes (Mt) of electronic waste was generated worldwide in 2019, up 21 per cent in just five years, according to the UN's Global E-waste Monitor 2020.

The new report also predicts global e-waste -- discarded products with a battery or plug -- will reach 74 Mt by 2030, almost a doubling of e-waste in just 16 years. This makes e-waste the world's fastest-growing domestic waste stream, fueled mainly by higher consumption rates of electric and electronic equipment, short life cycles, and few options for repair.

Only 17.4 per cent of 2019's e-waste was collected and recycled. This means that gold, silver, copper, platinum and other high-value, recoverable materials conservatively valued at US $57 billion -- a sum greater than the Gross Domestic Product of most countries - were mostly dumped or burned rather than being collected for treatment and reuse.

According to the report, Asia generated the greatest volume of e-waste in 2019, some 24.9 Mt, followed by the Americas (13.1 Mt) and Europe (12 Mt), while Africa and Oceania generated 2.9 Mt and 0.7 Mt respectively.

For perspective, last year's e-waste weighed substantially more than all the adults in Europe, or as much as 350 cruise ships the size of the Queen Mary 2, enough to form a line 125 km long.

E-waste is a health and environmental hazard, containing toxic additives or hazardous substances such as mercury, which damages the human brain and / or coordination system.

Other key findings from the Global E-waste Monitor 2020:

Proper e-waste management can help mitigate global warming. In 2019, an estimated 98 Mt of CO2-equivalents were released into the atmosphere from discarded fridges and air-conditioners, contributing roughly 0.3 per cent of global greenhouse gas emissions

In per capita terms, last year's discarded e-waste averaged 7.3 kg for every man, woman and child on Earth

Europe ranked first worldwide in terms of e-waste generation per capita with 16.2 kg per capita. Oceania came second (16.1 kg) followed by the Americas (13.3 kg). Asia and Africa were much lower: 5.6 and 2.5 kg respectively

E-waste is a health and environmental hazard, containing toxic additives or hazardous substances such as mercury, which damages the human brain and / or coordination system. An estimated 50 tonnes of mercury - used in monitors, PCBs and fluorescent and energy-saving light sources - are contained in undocumented flows of e-waste annually

E-waste in 2019 was mainly comprised of small equipment (17.4 Mt), large equipment (13.1 Mt), and temperature exchange equipment (10.8 Mt). Screens and monitors, small IT and telecommunication equipment, and lamps represented 6.7 Mt, 4.7 Mt, and 0.9 Mt respectively

Since 2014 the e-waste categories increasing fastest in total weight terms: temperature exchange equipment (+7 per cent), large equipment (+5 per cent), lamps and small equipment (+4 per cent). According to the report, this trend is driven by the growing consumption of those products in lower income countries, where those products improve the living standards. Small IT and telecommunication equipment have been growing more slowly, and screens and monitors have shown a slight decrease (-1 per cent), explained largely by lighter flat panel displays replacing heavy CRT monitors and screens

Since 2014, the number of countries that have adopted a national e-waste policy, legislation or regulation in place has increased from 61 to 78. While a positive trend, this is far from the target set by the International Telecommunication Union which is to raise the percentage of countries with an e-waste legislation to 50 per cent

The Global E-waste Monitor 2020 is a collaborative product of the Global E-waste Statistics Partnership (GESP), formed by UN University (UNU), the International Telecommunication Union (ITU), and the International Solid Waste Association (ISWA), in close collaboration with the UN Environment Programme (UNEP). The World Health Organization (WHO) and the German Ministry of Economic Cooperation and Development (BMZ) also substantially contributed to this year's Global E-waste Monitor 2020.

Comments

"The findings of this year's UNU-affiliated Global E-waste Monitor suggest that humanity is not sufficiently implementing the SDGs. Substantially greater efforts are urgently required to ensure smarter and more sustainable global production, consumption, and disposal of electrical and electronic equipment. This report contributes mightily to the sense of urgency in turning around this dangerous global pattern."

- David M. Malone, Rector United Nations University (UNU) & UN Under Secretary General

"Far more electronic waste is generated than is being safely recycled in most parts of the world. More cooperative efforts are required to make aware of this increasing issue and take appropriate countermeasures supplement by appropriate research and training. I am pleased that UNITAR now joins this important Global E-waste Statistics Partnership of UNU, ITU and ISWA, illustrating how valuable these activities are."

- Nikhil Seth, Executive Director, United Nations Institute for Training and Research (UNITAR) & UN Assistant Secretary-General

''The Global E-waste Monitor highlights the pressing issue of e-waste management in today's digitally connected world in that the way we produce, consume, and dispose of electronic devices has become unsustainable. Monitoring e-waste streams will contribute to the achievement of the Sustainable Development Goals and tracking the implementation of the ITU Connect 2030 Agenda. The Monitor serves as a valuable resource for governments to improve their global e-waste recycling rate by developing the necessary/needed/required e-waste policies and legislation. ITU will continue to support the efforts made in this report towards the global response required in identifying solutions for e-waste."

- Doreen Bogdan-Martin, Director, Telecommunication Development Bureau, International Telecommunication Union (ITU)

"E-waste quantities are rising 3 times faster than the world's population and 13 per cent faster than the world's GDP during the last five years. This sharp rise creates substantial environmental and health pressures and demonstrates the urgency to combine the fourth industrial revolution with circular economy. The fourth industrial revolution either will advance a new circular economy approach for our economies or it will stimulate further resource depletion and new pollution waves. The progress achieved in e-waste monitoring by the Global E-waste Statistics Partnership is a sign of hope that the world can manage not only to monitor closely the e-waste rise but also to control their impacts and set up proper management schemes"

- Antonis Mavropoulos, President, International Solid Waste Association (ISWA)

"Informal and improper e-waste recycling is a major emerging hazard silently affecting our health and that of future generations. One in four children are dying from avoidable environmental exposures. One in four children could be saved, if we take action to protect their health and ensure a safe environment. WHO is pleased to join forces in this new Global E-waste Monitor to allow evidence, information about health impacts and joint solutions and policies to be made available to protect our future generations' health."

- Maria Neira, Director, Environment, Climate Change and Health Department, World Health Organization (WHO

Credit: 
Terry Collins Assoc

Evolution of loss of smell or taste in COVID-19

What The Study Did: This survey-based study examines the clinical course of the loss of sense of smell and taste in a case series of mildly symptomatic patients with SARS-CoV-2 infection.

Authors: Daniele Borsetto, M.D., of Guy's and St Thomas' Hospitals in London, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamaoto.2020.1379)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflicts of interest and financial disclosures, and funding and support.

#  #  #

Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/jamaoto.2020.1379?guestAccessKey=2e0cf7c3-ca46-47d9-902b-1f97e228e6be&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=070220

Credit: 
JAMA Network

Decontamination methods for reuse of filtering facepiece respirators

What The Article Says: Studies describing various methods of decontamination to allow safe reuse of N95 respirators are summarized in this article.

Authors: Brooke M. Su-Velez, M.D., M.P.H., of the University of California, Los Angeles, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamaoto.2020.1423)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflicts of interest and financial disclosures, and funding and support.

#  #  #

Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/jamaoto.2020.1423?guestAccessKey=3479b786-fe51-48b6-af75-5a1b58486b24&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=070220

Credit: 
JAMA Network