Culture

UNIVERSITY PARK, Pa. -- Experts have documented that political polarization is intensifying in the United States. However, a Penn State sociologist now suggests that this separation isn't just more intense, but it is also growing broader, coagulating into an ideological slick of opinions.

In the study of data from a national opinion survey, Daniel DellaPosta, assistant professor of sociology and social data analytics, said that opinions on many seemingly unconnected political issues -- and even non-political issues -- have become increasingly correlated ideologically.

As an example of this division, DellaPosta said that, in the past, people could have disagreed on abortion rights, but they may have still agreed on gun control or tax rates. Now agreement on those unconnected issues have become more tightly bound with the person's ideology.

"This study represents a different structural element of polarization, which is how different opinions and beliefs are related to one another in the population at large," said DellaPosta." This builds on a long line of work, often called opinion alignment."

More troubling, added DellaPosta, who is also an affiliate of the Institute for Computational and Data Sciences (ICDS), there is a drop in opinions that people from opposing groups could agree on -- often referred to as cross-cutting alignments -- which may mean there is less room for compromise and agreement.

"People who have studied polarization in the past have often concluded that polarization has increased in some ways, but it is not occurring in the opinions in the population as a whole -- and that's been a somewhat comforting thought," said DellaPosta. "In a sense, this study provides a less hopeful conclusion because it suggests that it's not just that, for example, political parties have become more extreme, but that polarization has happened in the population itself."

According to DellaPosta, the results may show that there is a widening gap in political divisions.

"Political divisions have become broader and it seems that these divisions have come to incorporate much more and include opinions that were once not involved," said DellaPosta.

DellaPosta, who reports his findings in the current issue of American Sociological Review, which is available online now, compared the difference between the increase in the average political opinion alignment and the broadening of social, cultural and political alignments as the difference between a fence and an oil spill.

"I think of that average opinion alignment as a fence -- the divisions are there, but they're not moving," he said. "In an oil spill division, it's not just that the previously existing division is getting stronger, it's that other opinions that weren't even part of those division to begin with are getting drawn in."

The opinion oil spill can also be seen in how non-political issues and behaviors, such as sports interests, or even food and beverage preferences, can become part of the nation's political division, he added.

"You may have heard politicians referring to 'latte-drinking liberals,' for example, which captures the idea of the oil spill," said DellaPosta. "Why should something like drinking a latte become associated with your political ideology? Or, if someone goes to a football game and sees a bunch of trucks in the parking lot with [U.S. President Donald] Trump bumper stickers and that becomes internalized to suggest that liking football means fans support Trump. That's another way that things that previously weren't political suddenly get sucked into this matrix of political identity."

DellaPosta created a network model using data from the General Social Survey (GSS), a robust data set that the University of Chicago has gathered about the nation's opinion between 1972 and 2016. The network model is similar to the way sociologists track social networks by asking people who they know and what their relationship is with that person.

However, rather than just seeing the average intensity of the disagreement over issues between people, DellaPosta analyzed the network of opinions itself.

DellaPosta analyzed about 14,910 pairs of opinions in the GSS poll, which was conducted almost annually, except 1979, 1981 and 1992 and has been conducted in even numbered years since 1994. The questionnaires cover important topics, including national spending priorities, crime and punishment, intergroup relations and confidence in institutions.

ABERDEEN PROVING GROUND, Md. -- The U.S. Army has implemented a one-of-a-kind outdoor system to test swarming drones--with a capacity of more than 1,500 times the volume of a typical testing facility.

Future Soldiers will operate with many of these unmanned aircraft systems across the battlespace, using an interconnected swarm to provide capabilities for situational awareness, defense and logistics.

To enable the testing capability, Army researchers worked with PhaseSpace, Inc., to develop a new motion-capture capability that works for outdoor use -- where sunlight interferes with motion-capture devices typically used for purposes such as video game development.

"This new capability enables us to expand the scale of our testing -- from indoor testing in small rooms or spaces typically smaller than half of a basketball court, to now the size of five football fields," said Dan Everson, a researcher at the U.S. Army Combat Capabilities Development Command's Army Research Laboratory. "This will allow us to replicate more realistic UAS operation conditions and conduct experiments that were previously not possible, such as using cameras to navigate terrains, testing RF [radio frequency] communication within a swarm and flying larger drones."

The system enables the lab to focus on advancements in multi-agent collaborative navigation technologies, heterogeneous swarming concepts, ground/aerial agent interactions, counter-UAS systems and human-agent teaming, Everson said. The researchers described their findings in their technical report, Implementation and Evaluation of the World's Largest Outdoor Optical Motion-Capture System.

PhaseSpace developed the system to track motion, creating brightly illuminated LED marker strobes that attach to the UAS test devices and move throughout the entirety of the testing area.

To track the LED markers, 96 cameras housed within 16 tracking pods are positioned around the perimeter of the testing area. Evaluation of the Army-developed system demonstrated accurate marker tracking within a space of 460 x 110 x 70 meters--more than 1,500 times as large as a typical 15 x 15 x 10-meter system. The system has a measurement rate of 100Hz, meaning it measures the position of the markers 100 times every second.

Located at APG, the testing system is transportable, and can be scaled up or down and even change shape. Everson said he hopes collaborators in academia, industry or within the government can use this capability to test their own research and development in robotics.

"Our future Army will need to interact with a large number of autonomous agents to compete in future conflicts," Everson said. "The flexibility and scalability of this system will help the Army develop capabilities that will achieve overmatch against our adversaries."

For a nematode worm, a big lawn of the bacteria that it eats is a great place for it to disperse its eggs so that each hatchling can emerge into a nutritive environment. That's why when a worm speedily roams about a food patch it methodically lays its eggs as it goes. A new study by neuroscientists at MIT's Picower Institute for Learning and Memory investigates this example of action coordination - where egg-laying is coupled to the animal's roaming - to demonstrate how a nervous system coordinates distinct behavioral outputs. That's a challenge many organisms face, albeit in different ways, during daily life.

"All animals display a remarkable ability to coordinate their diverse motor programs, but the mechanisms within the brain that allow for this coordination are poorly understood," note the scientists, including Steven Flavell, Lister Brothers Career Development Assistant Professor in MIT's Department of Brain and Cognitive Sciences.

Flavell lab members Nathan Cermak, Stephanie Yu, and Rebekah Clark were co-lead authors of the study published June 8 in eLife.

A new imaging platform

To study how animals coordinate their motor programs, Flavell's team invented a new microscopy platform capable of taking sharp, high-frame-rate videos of nematodes for hours or days on end. Guided by custom software, the scope automatically tracks the worms, allowing the researchers to compile information about each animal's behavior. The team also wrote machine vision software to automatically extract information about each of the C. elegans motor programs - locomotion, feeding, egg-laying, and more -- from these videos, yielding a near-comprehensive picture of each animal's behavioral outputs. Flavell said the scope parts cost about $3,000 and can be assembled in a day or two using the team's online tutorial. They have posted that and the system's software online for free. The affordability and flexibility of these microscopes should allow them to be useful for many different applications in the biological sciences.

By using this system and then analyzing the data, Flavell's team was able to identify for the first time a number of patterns of nematode behavior that involve the coordination of multiple motor actions. Flavell said one insight yielded by the system and the subsequent analysis is that the intensely studied nematodes, known scientifically as C. elegans, have more distinct behavioral states than generally assumed. For example, the study finds that the behavioral state known as "dwelling," previously defined based on the animal staying put, actually consists of multiple different sub-states that could be readily identified using this new imaging approach.

Behaviors coordinated by dopamine

But one of the most pronounced new behavioral patterns that emerged from the analyses was the observation that worms lay many more eggs while roaming on a food lawn than they do while dwelling. This likely allows animals to thoroughly disperse their eggs across a nutritive environment. The two motor circuits that control locomotion and egg-laying in this animal had been carefully defined by previous work. So, based on their new observation, Flavell's team decided to investigate how the worm's nervous system couples locomotion and egg-laying together. It turned out to hinge on the neurotransmitter dopamine, which is abundant in all animals including humans.

They started out by knocking out genes for various neurotransmitters and other brain-modulating molecules. Many of those candidates, such as serotonin, affected the animal's behavior in important ways, but did not disrupt this coupling of roaming and egg laying. It was only when the team knocked out a gene called cat-2, which is needed for dopamine production, that the worms no longer increased their egg laying while roaming. Notably, it didn't affect the pace of egg laying while dwelling, suggesting that the worms without dopamine were still capable of laying eggs normally while engaged in other behavioral states.

The team further confirmed the role of dopamine by taking direct control of dopamine-producing cells using optogenetics, a technology that allows neuron activity to be turned on or off with flashes of light. In these experiments, they learned that acutely shutting down the dopaminergic neurons reduced egg-laying only while animals were in the roaming state, but activating these neurons could drive the animals to start laying eggs, even under circumstances when the pace of egg-laying is normally low.

Next, the team wanted to know where the dopamine that triggers this coordinated response emerges and when. They engineered worms so that their neurons would glow when they became electrically active, an indication provided by a surge of calcium ions. From those flashes they saw that a particular dopamine-producing neuron called PDE stood out as being especially active as worms roamed across a food lawn, and their activity fluctuated in association with the worms' motion. It peaked, they saw, just before the worm assumed the posture that precipitates egg laying, but only when the worms were crawling along a bacterial food source. Notably, the neuron has the means - a little hair-like structure called a cilium - to sense food outside the worm's body. These studies suggested that the PDE neuron integrates the presence of food in the environment with the worm's own motion, generating an activity pattern that essentially reports how quickly worms are progressing through their nutritive environment. The release of dopamine by this neuron, and potentially others as well, could relay this information to the egg-laying circuit, allowing for coordination between the behaviors.

Flavell's team also mapped out the neural circuitry downstream of dopamine and found that its effects are mediated by two receptors in the D2 family of dopamine receptors (dop-2 and dop-3). In addition, a set of neurons that utilize the neurotransmitter GABA appear to play a critical role downstream of dopamine release. They hypothesize that the role of dopamine may be a send the signal amid plentiful food and roaming behavior to override GABA's inhibition of egg laying, allowing this behavior to proceed.

Ultimately, egg laying while roaming was just one example of motor program coupling that the lab chose to dissect. Flavell and co-authors note there are many others, too.

"One thing that excites us about this study is that it's now easy with this new microscopy platform to simultaneously measure each of the main motor programs generated by this animal. Hopefully, we can start thinking about the full repertoire of behaviors that it generates as a complete, coordinated set," they said.

The research team notes that recently-developed technologies for whole-brain calcium imaging have opened the possibility of measuring neuronal activity throughout the brains of various animals, including the worm.

"To understand these comprehensive neural imaging datasets, it will be important to consider how they relate to the output of the whole brain: the full repertoire of behavioral outputs that an animal generates" Flavell said.

The covid-19 pandemic remains an important topic throughout the world. A number of contributions on the IASS website address the pandemic and its consequences from the perspective of sustainability. We would be happy to put you in contact with the respective authors.

How ecological Value Chains Can Help Societies Tackle the Coronavirus Crisis

(Armin Haas)

The coronavirus pandemic has cast a spotlight on the vulnerability of global value chains. Sustainable value chains at the regional level could bring more stability to the post-pandemic world. A team of researchers at the Institute for Advanced Sustainability Studies (IASS) has developed a typology of climate win-win strategies that can be used to identify sustainable regional value chains.

Article and publication: https://www.iass-potsdam.de/en/news/how-ecological-value-chains-can-help-societies-tackle-coronavirus-crisis

Brazil: Can Covid-19 Open the Door for New Pandemics?

(Artur Sgambatti Monteiro)

Brazil is one of the hotspots of the corona pandemic, and the Brazilian Amazon is particularly hard hit. In a new Discussion Paper, IASS Fellow Artur Sgambatti Monteiro and Lucas Lima dos Santos describe the impacts of the pandemic on the region. The virus has overwhelmed the poor healthcare system in Amazonian cities and towns. Indigenous groups are especially vulnerable because the pandemic has opened the floodgates for the illegal deforestation and invasion of their territories. The authors warn that the encroachment on previously untouched parts of the forest could give rise to new transmissible zoonoses.

Article: https://www.iass-potsdam.de/en/news/brazil-can-covid-19-open-door-new-pandemics

Discussion paper: https://www.iass-potsdam.de/sites/default/files/2020-05/Discussion%20Paper%20Covid%2019%20Artur_0.pdf

Better Prepared for Future Crises: Recommendations from Risk Researchers

(Ortwin Renn)

Although there were early warnings of an exponentially growing pandemic, most policymakers around the world were unprepared and reluctant to act when Covid-19 first spread from China around the world. Since then the crisis has led to unprecedented restrictions and triggered the worst recession since the Second World War. In an article published in the Journal of Risk Research, Aengus Collins, Marie-Valentine Florin (both EPFL International Risk Governance Center) and IASS Scientific Director Ortwin Renn analyze the key factors and offer recommendations on how we can better prepare for future crises.

Article and publication: https://www.iass-potsdam.de/en/news/better-prepared-future-crises-recommendations-risk-researchers

Covid-19 Crisis: Renewables Can Help to Unburden Health Care Systems and Restart Economies

(Laura Nagel)

Economies around the world have been severely affected by the Covid-19 pandemic. Substantial political efforts will be needed to stabilize employment markets and relieve pressure on health systems. Renewable energy generation can provide important stimuli for efforts to achieve these goals. A team of researchers with the COBENEFITS project at the IASS has analysed the potential benefits of decarbonizing the energy sector.

Article: https://www.iass-potsdam.de/en/news/covid-19-crisis-renewables-can-help-unburden-health-care-systems-and-restart-economies

Fact Sheet: https://www.iass-potsdam.de/sites/default/files/2020-05/COBENEFITS-COVID-19_Recovery_factsheet_200511_web.pdf

Build Resilience with Cleaner Air: Learning from Covid-19

(Kathleen A. Mar, Erika von Schneidemesser)

New research links air pollution to severe Covid-19 progression. This should prompt a re-evaluation of German commitments to safeguarding and improving air quality. Clean air deserves a more prominent place in Germany's Strategy for Sustainable Development 2020.

Blogpost: https://www.iass-potsdam.de/en/blog/2020/06/build-resilience-cleaner-air-learning-covid-19

The transport sector - Climate policy's problem child and the coronavirus crisis

(Tobias Haas, Ina Richter)

Transport is the problem child of climate). While emissions reductions have been achieved across every other sector since 1990, transport-related emissions have climbed by 3.7 percent between 1990 and 2018. And the number of passengers on public transport has collapsed in the pandemic.

Blogpost: https://www.iass-potsdam.de/en/blog/2020/06/transport-sector-climate-policys-problem-child-and-coronavirus-crisis

Impacts of the Pandemic on the Argentinean Energy Sector

(German Bersalli)

Argentina is among the countries hardest hit by the social and economic consequences of the current pandemic. The Economic Commission for Latin America and the Caribbean (ECLAC) is predicting the worst economic crisis in the history of Latin America, with a fall in GDP of over 5 percent and millions more people pushed into poverty.

Blogpost: https://www.iass-potsdam.de/en/blog/2020/05/tale-golden-goose-and-ugly-duckling-impacts-pandemic-argentinean-energy-sector

Lack of Clean Cooking Energy Aggravates Coronavirus Impact in Africa (Grace Kageni Mbungu)

d the world the coronavirus pandemic has disrupted life as we know it. However, it is important not to lose sight of the fact that the coronavirus exists on top of many underlying health, social, and economic inequalities, and vulnerabilities. The best hope for African countries is to be spared by the coronavirus, but in truth, people are already suffering from the burdens of stringent lockdown measures imposed to contain the spread of the virus.

Blogpost: https://www.iass-potsdam.de/en/blog/2020/05/lack-clean-cooking-energy-aggravates-coronavirus-impact-africa

CHAMPAIGN, Ill. -- Many Christian and political conservatives in the U.S. support legislation to deny sexual and gender minorities the rights most Americans enjoy: unfettered access to jobs, housing, services and public facilities; the opportunity to marry as they choose; and the right to adopt a child.

A new study published in the American Journal of Community Psychology offers insight into the factors that correlate with support for such laws. The study asked 1,015 heterosexual college undergraduates who self-identified as either Christian (68%) or nonreligious a series of questions to determine their thoughts and attitudes about Christian privilege and power in American society. The researchers also asked whether participants supported or opposed efforts to curtail the rights of sexual and gender minorities.

"Although same-sex marriage is now the law of the land in the U.S., there continue to be problems with employment discrimination, housing discrimination and other types of discrimination against sexual and gender minorities," said Nathan Todd, a psychology professor at the University of Illinois at Urbana-Champaign who led the study. "One of the key barriers to those rights has been opposition from some Christian and political conservatives. We wanted to know whether people's ideas about political power explain some of this opposition."

Todd and his colleagues evaluated participants' take on Christian power and influence in society. The students were asked to rank how strongly they agreed or disagreed with statements such as: "To be Christian is to have religious advantage in this country." Or, "Christianity is valued more in this society than other religions."

The researchers also asked participants whether Christians "should have religious advantage in this country," or if Christianity "should be valued more in this society than other religions." These questions differentiated participants' awareness of advantages conferred to Christians in the U.S. from the belief that such advantages are right and should exist, Todd said.

Because Christian practices and traditions are so embedded in American life and politics, identifying as Christian confers a lot of privileges, he said.

"People who are Christian are not singled out or asked to speak for their religion on a regular basis, as members of other religions often are," Todd said. "Christians in the U.S. do not face systemic bias or violence based on their religion and they do not live in fear of this type of experience."

Other advantages stem from the fact that government and school calendars revolve around the Christian sabbath and Christian holidays. A large majority of elected officials also identify as Christian.

"All of these factors work together to the advantage of Christians," Todd said.

Participants also rated their support or opposition to specific sexual- and gender-minority rights, such as the right to marry, to adopt children or to have equal access to jobs and housing, and to use public bathroom facilities that align with one's gender identity. They also rated how strongly they identified as political conservatives, and Christian students rated how strongly their religious beliefs aligned with conservative Christian views.

"Our analyses revealed that opposition to sexual- and gender-minority rights was correlated with Christian and political conservatism, and with the belief that Christians should be the dominant group in society," Todd said.

Further analyses suggested that greater support for Christians being the dominant group in power in the U.S. partially explains why Christian conservatives and political conservatives oppose sexual- and gender-minority rights, he said. These findings were consistent across Christian and nonreligious students.

"Our goal with this study is not to antagonize or demonize political or Christian conservatives, but to learn more about what drives them to support or oppose sexual- and gender-minority rights," Todd said. "I also think it's a mistake to characterize all Christians as thinking or acting the same way, especially as some Christians do support rights for sexual and gender minorities."

Todd said he hopes the research will increase constructive dialogue by promoting a broader understanding of the relationship between Christianity, politics, and sexual- and gender-minority rights.

Pump threads rings onto polymer chains to build polyrotaxanes

Polyrotaxanes show promise in soft materials, such as scratch-resistant coatings and actuators

Pump allows researchers to control precisely how many rings thread onto the chain, which was previously impossible

Nobel laureate: 'This is one of the best papers I've been associated with during the past 50 years'

EVANSTON, Ill. -- Northwestern University researchers have developed the most precise way to build polyrotaxanes, a mechanically locked polymer for slide-ring gels, battery electrode materials and drug-delivery platforms.

A necklace-like molecule made with rings threaded onto a polymer string, polyrotaxanes are notoriously difficult to construct. A new method from the laboratory of Nobel Prize-winning chemist Sir Fraser Stoddart uses two artificial molecular pumps to install rings onto each end of a polymer string. The tiny pumps allow researchers to control precisely how many rings pass onto the polymer.

"These polyrotaxanes have never before been made with such precision," Stoddart said. "Without the ability to define accurately the polymer's structure, you cannot fine-tune the material's overall properties."

The paper will be published on Friday, June 12 in the journal Science.

Stoddart is the Board of Trustees Professor in Northwestern's Weinberg College of Arts and Sciences. Yunyan Qiu, a postdoctoral fellow in Stoddart's lab, is the paper's first author.

Researchers have studied polyrotaxanes for years, fascinated by their stretchy mechanical properties and potential of materials containing them to self-heal. But, until now, it was impossible to build these promising polymers with a precise number of rings.

"Traditionally, researchers mix the rings and polymers together, and they form inclusion complexes by noncovalent interactions," Qiu said. "But you couldn't know how many rings were threaded until you analyzed it later using nuclear magnetic resonance microscopy. People could roughly control the percentage of rings to some extent, but it was still an estimate."

To overcome this challenge, the Northwestern researchers used an artificial molecular pump, which was developed in Stoddart's laboratory in 2015. The first of its kind, the pump draws power from redox reactions, driving molecules from a low-energy state to a high-energy state.

To build polyrotaxanes, the pump employs repetitive redox reactions either chemically or electrochemically, in which a molecule gains or loses electrons. Initially, the pump -- situated at both ends of the polymer string -- and the rings are both positively charged and, thus, repel each other.

Upon injecting electrons, units in both pumps and rings change from dicationic to radical cationic states. Suddenly, the rings are attracted to the pump heads and thread onto both ends of the polymer string. Subsequent oxidation removes the electrons, restoring the positive charges. The rings try to escape but cannot due to the positively charged units at both end of the polymer string. Mild heating allows the ring to pass over a speed bump onto the polymer chain. The pump repeats this process to recruit rings in pairs onto the polymer string.

"We can recruit up to 10 rings onto the thread," Qiu said. "But we believe we're only limited by the length of the chosen polymer chain. If we double the length of the polymer, we can double the number of rings."

The team also believes that, with this method, they could use many different types of polymers to create untraditional polyrotaxanes with unusual properties.

"I'm very excited about this research," Stoddart said. "I put it up there with some of the best papers I've been associated with during the past 50 years."

Toronto - We think that we will choose our personal and professional advisors based on reasoned criteria about their expertise, competence and experience.

In practice, we go more with our gut than our head, choosing the person who shows enthusiasm for us and our goals. A team of researchers has used the popular singing competition show The Voice to prove it.

Now in its 18th season, The Voice is a "really extreme version of life," said researcher Rachel Ruttan, an assistant professor of organizational behaviour and human resources at the University of Toronto's Rotman School of Management. Yet the high stakes environment is ideal for studying decision-making.

"For the purposes of the research, it was perfect," said Prof. Ruttan, who worked with Julia Hur of New York University and Catherine Shea of Carnegie Mellon University. "We think that our findings apply to a wide range of contexts and all sorts of advising relationships."

Show contestants first go through "blind auditions," each performing before a panel of four potential coaches whose chairs are turned away from the singer. A coach signals they're interested in working with a singer by turning their chair towards them, displaying a message that says, "I want you." Singers and coaches next have a brief on-stage chat. Singers with more than one interested coach must then choose who will coach them for the rest of the multi-stage competition.

The researchers analysed and coded four early seasons of the show, finding a significant correlation between the enthusiasm coaches showed for a contestant and the likelihood the contestant would choose them. A coach's track record in coaching other successful contestants played less of a factor.

That result flew in the face of a separate experiment in which the researchers interviewed aspiring contestants while they lined up to apply for a spot on the show. Not yet in the spotlight, those people ranked enthusiasm significantly below experience and expertise in the qualities they would want in a coach. Other lab-based experiments confirmed the "prediction error" between what people say they want in an advisor and the way they ultimately choose them. In another experiment, the researchers also tested how people select advisors for their professional careers.

The findings are useful, said Prof. Ruttan, because quality mentorship has become increasingly important in the pursuit of personal and professional goals. Setting up a checklist of priorities in advance may help people choose job coaches, educational supervisors, financial advisors and others more wisely.

Besides that, their choice "may actually be consequential for performance," said Prof. Ruttan. In a final experiment, lab volunteers twice sang the popular karaoke song Don't Stop Believin' by Journey, receiving feedback in between from randomly assigned advisors who were also professional musicians. An advisor's enthusiasm made no difference the second time, but singers who got feedback from those with specific expertise in vocal music showed better subsequent performance.

While the research was extremely time-consuming, it ranks among Prof. Ruttan's favourites. "It's not often that you get to include reality TV and karaoke in a single paper," she said.

Philadelphia, June 11, 2020 - Diabetic retinopathy is a common complication of diabetes and a leading cause of blindness among the working-age population. A new study in the American Journal of Pathology reports that visual function in diabetic mice was significantly improved after treatment with a single dose of visual chromophore 9-cis-retinal, a vitamin A analog that can form a visual pigment in the retina cells, thereby producing a light sensitive element of the retina.

"In an earlier study we found that diabetes causes vitamin A deficiency in the retina, which results in deterioration of vision, even before any vascular changes can be seen. That finding led to the assumption that early changes in vision in diabetes are probably caused by vitamin A deficiency in the retina," explained lead investigator Gennadiy Moiseyev, PhD, Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

In the current study investigators hypothesized that treating diabetic mice with 11-cis-retinal could rescue visual function. They investigated its effect in Akita mice, a genetic model of type 1 diabetes, by measuring electroretinogram (ERG) responses, retinal oxidative stress, and neuronal apoptosis (cell death). ERG was performed on two groups of three-month-old Akita mice and one group of non-diabetic control mice matched for age and genetic background. One group of Akita mice was treated with 9-cis-retinal and the other with a vehicle solution. Average blood glucose concentrations and body weights of the mice were measured monthly during the study. Akita mice showed high glucose concentrations throughout the study. ERG recordings and rhodopsin assay were performed two hours after 9-cis-retinal injection, whereas assessment of cell death by ELISA and TUNEL assay were both performed 24 hours after the injection.

Results showed that the visual function in diabetic mice improved significantly after treatment with the single dose of 9-cis-retinal. In addition, researchers reported that the treatment reduced oxidative stress in the retina, decreased retina cell death and retina degeneration, and improved visual function.

"This work supports our novel hypothesis that diabetes-induced disturbance of the vitamin A metabolism in the eye is responsible for reduced visual function in early stages of diabetic retinopathy," commented Dr. Moiseyev. "Currently, there is no available therapy to prevent the development of the retinal complication in patients suffering from diabetes. This study suggests that the delivery of visual chromophore to the diabetic eye may represent a potential therapeutic strategy for the early stages of diabetic retinopathy to prevent vision loss in patients with diabetes."

Traditionally, diabetic retinopathy was considered a disease caused by the pathology of blood vessels in the retina, whereby light-sensitive tissue at the back of the eye (fundus) becomes damaged. Patients with diabetes often experience functional deficits in dark adaptation, contrast sensitivity, and color perception before any microvascular pathologies are detected on the eye fundus. However, recent data underscore the importance of vitamin A for normal visual function. It serves as a precursor for light-sensitive 11-cis-retinal, the chromophore of visual pigments that can produce a light-sensitive protein in the retina.

ITHACA, N.Y. - Electronic food vouchers provided young Rohingya children in Bangladeshi refugee camps with better health and nutrition than direct food assistance, according to new research led by Cornell University, in conjunction with the International Food Policy Research Institute.

The electronic vouchers are provided by United Nations' World Food Programme to Rohingya families forcibly displaced into refugee camps. As of last summer, more than 911,000 Rohingya - a Muslim minority ethnic group of Mynamnar nationals who have faced decades of persecution - were living in Bangladesh, where they relied on international aid for food, shelter and medical care.

"We were trying to assess the impact of the nutritional status of children," said lead author John Hoddinott, the H.E. Babcock Professor of Food and Nutrition Economics, who holds appointments in the Division of Nutritional Sciences, the Charles H. Dyson School of Applied Economics and Management, and the Department of Global Development.

"The refugees are hungry and food-insecure. Giving them food helps but results in a monotonous diet," he said. "Often people have a better idea of what foods they need. If families are given an electronic voucher - much like the Supplemental Nutrition Assistance Program in the U.S. - families can buy a range of food products in the small markets in the camps.

"In our observations, we found that Myanmar's refugee children were better off if their household received an electronic voucher," he said.

Hoddinott and his colleagues report that electronic food vouchers allow families to buy a greater range of nutritionally diverse foods. Electronic food vouchers are more efficient than transporting food. The Rohingya get about $9 a month in their electronic food vouchers, which look like debit cards.

In the humanitarian refugee camps, the economists measured the heights and weights of 523 children, ages 6 months to 23 months. They found that receipt of the electronic voucher was associated with improved height.

"These children are at a point in their development where they grow rapidly," Hoddinott said. "That kind of growth requires a variety of foods that are calorically and nutrient dense."

There are circumstances where delivering food is a better option, but "when we want to make these monetary transfers for vulnerable populations, we want to be as efficient as possible," he said. "The money we spend on program administration or transporting food from one continent to another costs money that can't be used to help people directly."

At a glance:

Neuroscientists have discovered neurons that control hibernation-like behavior, or torpor, in mice.

Stimulating these neurons induces torpor, while blocking their activity disrupts natural torpor.

Findings inform efforts to better understand and control torpor in mice, other animal models and enable applications in humans.

The dream of suspended animation has long captivated the human imagination, reflected in countless works of mythology and fiction, from King Arthur and Sleeping Beauty to Captain America and Han Solo. By effectively pausing time itself for an individual, a state of stasis promises to enable the repair of lethal injuries, prolong life and allow for travel to distant stars.

While suspended animation may seem a fantasy, a strikingly diverse array of life has already achieved a version of it. Through behaviors like hibernation, animals such as bears, frogs and hummingbirds can survive harsh winters, droughts, food shortages and other extreme conditions by essentially entering into biological stasis, where metabolism, heart rate and breathing slow to a crawl and body temperature drops.

Now, Harvard Medical School neuroscientists have discovered a population of neurons in the hypothalamus that controls hibernation-like behavior, or torpor, in mice, revealing for the first time the neural circuits that regulate this state.

Reporting in Nature on June 11, the team demonstrated that when these neurons are stimulated, mice enter torpor and can be kept in that state for days. When the activity of these neurons is blocked, natural torpor is disrupted.

Another study published simultaneously in Nature by researchers from the University of Tsukuba in Japan also identified a similar population of neurons in the hypothalamus.

By better understanding these processes in mice and other animal models, the authors envision the possibility of one day working toward inducing torpor in humans--an achievement that could have a vast array of applications, such as preventing brain injury during stroke, enabling new treatments for metabolic diseases or even helping NASA send humans to Mars.

"The imagination runs wild when we think about the potential of hibernation-like states in humans. Could we really extend lifespan? Is this the way to send people to Mars?" said study co-lead author Sinisa Hrvatin, instructor in neurobiology in the Blavatnik Institute at HMS.

"To answer these questions, we must first study the fundamental biology of torpor and hibernation in animals," Hrvatin said. "We and others are doing this--it is not science fiction."

To reduce energy expenditure in times of scarcity, many animals enter a state of torpor. Hibernation is an extended seasonal form of this. Unlike sleep, torpor is associated with systemic physiological changes, particularly significant drops in body temperature and suppression of metabolic activity. While common in nature, the biological mechanisms that underlie torpor and hibernation are still poorly understood.

The role of the brain, in particular, has remained largely unknown, a question that drove the research efforts of Hrvatin and colleagues, including co-lead author Senmiao Sun, a graduate student in the Harvard Program in Neuroscience, and study senior author Michael Greenberg, the Nathan Marsh Pusey Professor and chair of the Department of Neurobiology in the Blavatnik Institute at HMS.

Neural TRAP

The researchers studied mice, which do not hibernate but experience bouts of torpor when food is scarce and temperatures are low. When housed at 22 C (72 F), fasting mice exhibited a sharp drop in core body temperature and significant reduction in metabolic rate and movement. In comparison, well-fed mice retained normal body temperatures.

As mice began to enter torpor, the team focused on a gene called Fos--previously shown by the Greenberg lab to be expressed in active neurons. Labeling the protein product of the Fos gene allowed them to identify which neurons are activated during the transition to torpor throughout the entire brain.

This approach revealed widespread neuronal activity, including in brain regions that regulate hunger, feeding, body temperature and many other functions. To see if brain activity was sufficient to trigger torpor, the team combined two techniques--FosTRAP and chemogenetics--to genetically tag neurons that are active during torpor. These neurons could then be re-stimulated later by adding a chemical compound.

The experiments confirmed that torpor could indeed be induced--even in well-fed mice--by re-stimulating neurons in this manner after the mice recovered from their initial bout of inactivity.

However, because the approach labeled neurons throughout the entire brain, the researchers worked to narrow in on the specific area that controls torpor. To do so, they designed a virus-based tool that they used to selectively activate neurons only at the site of injection.

Focusing on the hypothalamus, the region of the brain responsible for regulating body temperature, hunger, thirst, hormone secretion and other functions, the researchers carried out a series of painstaking experiments. They systematically injected 54 animals with minute amounts of the virus covering 226 different regions of the hypothalamus, then activated neurons only in the injected regions and looked for signs of torpor.

Neurons in one specific region of the hypothalamus, known as the avMLPA, triggered torpor when activated. Stimulating neurons in other areas of the hypothalamus had no effect.

"When the initial experiment worked, we knew we had something," Greenberg said. "We gained control over torpor in these mice using FosTRAP, which allowed us to then identify the subset of cells that are involved in the process. It's an elegant demonstration of how Fos can be used to study neuronal activity and behavioral states in the brain."

Worthwhile goal

The team further analyzed the neurons that occupy the region, using single-cell RNA sequencing to look at almost 50,000 individual cells representing 36 different cell types, ultimately pinpointing a subset of torpor-driving neurons, marked by the neurotransmitter transporter gene Vglut2 and the peptide Adcyap1.

Stimulating only these neurons was sufficient to induce rapid drops in body temperature and motor activity, key features of torpor. To confirm that these neurons are critical for torpor, the researchers used a separate virus-based tool to silence the activity of avMLPA-Vglut2 neurons. This prevented fasting mice from entering natural torpor, and in particular disrupted the associated decrease in core body temperature. In contrast, silencing these neurons in well-fed mice had no effect.

"In warm-blooded animals, body temperature is tightly regulated," Sun said. "A drop of a couple of degrees in humans, for example, leads to hypothermia and can be fatal. However, torpor circumvents this regulation and allows body temperatures to fall dramatically. Studying torpor in mice helps us understand how this fascinating feature of warm-blooded animals might be manipulated through neural processes."

The researchers caution that their experiments do not conclusively prove that one specific neuron type controls torpor, a complex behavior that likely involves many different cell types. By identifying the specific brain region and subset of neurons involved in the process, however, scientists now have a point of entry for efforts to better understand and control the state in mice and other animal models, the authors said.

They are now studying the long-term effects of torpor on mice, the roles of other populations of neurons and the underlying mechanisms and pathways that allow avMLPA neurons to regulate torpor.

"Our findings open the door to a new understanding of what torpor and hibernation are, and how they affect cells, the brain and the body," Hrvatin said. "We can now rigorously study how animals enter and exit these states, identify the underlying biology, and think about applications in humans. This study represents one of the key steps of this journey."

The implications of one day being able to induce torpor or hibernation in humans, if ever realized, are profound.

"It's far too soon to say whether we could induce this type of state in a human, but it is a goal that could be worthwhile," Greenberg said. "It could potentially lead to an understanding of suspended animation, metabolic control and possibly extended lifespan. Suspended animation in particular is a common theme in science fiction, and perhaps our ability to traverse the stars will someday depend on it."

Athens, Ga. - A team of researchers at the University of Georgia has successfully demonstrated that a set of drug-like small molecules can block the activity of a key SARS-CoV-2 protein--providing a promising path for new COVID-19 therapeutics.

Led by Scott Pegan, director of UGA's Center for Drug Discovery, the team was the first to evaluate the SARS-CoV-2 protein PLpro, known to be essential in other coronaviruses for both its replication and its ability to suppress host immune function.

"The PLpro from SARS-CoV-2 behaved differently than its predecessor that caused the SARS outbreak in 2003. Specifically, our data suggests that the SARS-CoV-2 PLpro is less effective at its immune suppression roles," said Pegan, professor of pharmaceutical and biomedical sciences in the College of Pharmacy. "This may be one of the underlying reasons why the current virus is not as fatal as the virus from the 2003 outbreak."

The COVID-19 pandemic has affected more lives globally than the SARS outbreak of 2002-03, but its mortality rate is lower based on available numbers in early June. After the SARS outbreak, the World Health Organization reported 8,098 cases and 774 deaths--a mortality rate of nearly 10%. According to Johns Hopkins University's COVID-19 dashboard on June 3, there were 6,435,453 confirmed cases globally and 382,093 deaths--a mortality rate of nearly 6%.

From an evolutionary standpoint, it's not good for a virus to be fatal for the host, and SARS in 2003 was particularly lethal, according to Pegan.

"The COVID-19 virus infects, but people don't run a fever before they are contagious, so there's a lot of focus on how virulence factors like PLpro have been modified by nature to give the virus a better chance, from its perspective, to coexist with us," he said. "Obviously we would not like for it to coexist, but COVID-19 seems to have solved the Goldilocks paradox of being in the right place at the right time and with the right infection level."

Pegan collaborated with UGA scientists David Crich, Ralph Tripp and Brian Cummings to explore inhibitors designed to knock out PLpro and stop replication of the virus. They began with a series of compounds that were discovered 12 years ago and shown to be effective against SARS, but development was cut short since SARS had not reappeared.

"Obviously now we see the current coronavirus is probably going to be with us for a while--if not this one, then probably other types of coronaviruses," Pegan said. "These compounds are a good starting point for therapeutic development. They have all the properties you would typically want to find in a drug, and they have a history of not being considered toxic."

These compounds, naphthalene-based PLpro inhibitors, are shown to be effective at halting SARS-CoV-2 PLpro activity as well as replication. They offer a potential rapid development path to generating PLpro-targeted therapeutics for use against SARS-CoV-2.

"The kind of small molecules that we're developing are some of the first that are specifically designed for this coronavirus protease," Pegan said. "Up till now, most therapeutic work against SARS has targeted another virulence factor, C3Lpro. This is a great start with a different target. Our hope is that we can turn this into a starting point for creating a drug that we can get in front of the Food and Drug Administration."

Four UGA labs, including students, brought their expertise to the project. Pegan's lab used modeling techniques to locate the differences between PLpro in the 2003 outbreak and the current outbreak, revealing the comparative weakness of the SARS-CoV-2 PLpro and suggesting potential inhibitors for testing.

Medicinal chemist David Crich, professor and Georgia Research Alliance and David Chu Eminent Scholar in Drug Design, provided guidance on understanding the attributes of the inhibitors and is working to synthesize new compounds with improved properties.

Testing of compounds against the virus was led by Ralph Tripp, an expert in respiratory viruses and related diseases who is Georgia Research Alliance Eminent Scholar of Vaccine and Therapeutic Studies and professor of infectious diseases in the College of Veterinary Medicine.

Brian Cummings, professor and head of pharmaceutical and biomedical sciences, covered toxicology, ensuring that the compounds tested killed their intended targets without causing toxic effects for the host.

WASHINGTON, DC (June 10, 2020)--The Journal of Alzheimer's Disease has just published a paper with a comprehensive review of the COVID-19's effect on the nervous system which classifies brain damage caused by COVID-19 into three stages. One of the authors, nationally-recognized neurologist Dr. Majid Fotuhi, MD, PhD, who is the medical director of NeuroGrow Brain Fitness Center in Northern Virginia and an affiliate staff at Johns Hopkins Medicine, encourages the adoption of this three-stage classification, calls for more research on COVID's long-term effects on the brain, and stresses the need for patients to receive a brain MRI before leaving the hospital.

"We are learning that a significant number of hospitalized COVID-19 patients have various degrees of brain impairment. As a medical community, we need to monitor these patients over time as some of them may develop cognitive decline, attention deficit, brain fog, or Alzheimer's disease in the future. There is a lot we can do to promote brain healing in COVID-19 patients, but first we must understand the nature and severity of their neurological deficits. At the patient level, getting a baseline MRI before leaving the hospital is imperative so that we have a starting point to evaluate and treat them," explained Fotuhi.

In the just published paper, Dr. Fotuhi and his colleagues warn about neurological issues in patients who suffer from COVID-19, including stroke, seizures, confusion, dizziness, paralysis, and/or coma. Already, two dozen case reports are revealing the impact of COVID-19 on the brains of patients. In fact, one study from Wuhan, China, showed that 45% of patients with severe COVID-19 illness experience marked neurological deficits. Another study from France showed 84% of ICU patients with COVID-19 have positive abnormalities on their neurological examination, and that 15% of patients who leave the ICU have residual "dysexecutive function," which involves poor attention and difficulty with decision-making and controlling behavior.

The paper proposes the adoption of a three stage "NeuroCovid" classification scheme to provide a basis from which to build on future hypotheses and investigations regarding SARS-Cov2 and the nervous system. These stages include:

NeuroCovid Stage I: The virus damage is limited to epithelial cells of nose and mouth and the main symptoms include transient loss of smell and taste.

NeuroCovid Stage II: The virus triggers a flood of inflammation, called cytokine storm, which begins in the lungs and travels in the blood vessels throughout all body organs. This cytokine storm leads to the formation of blood clots which cause small or large strokes in the brain.

NeuroCovid Stage III: An explosive level of cytokine storm damages the blood brain barrier, the protective insulation layer in blood vessels of the brain. As a result, blood content, inflammatory markers, and virus particles invade the brain and patients develop seizures, confusion, coma, or encephalopathy.

Fotuhi points out that many patients with COVID-19 may have no noticeable neurological symptoms at first; but in some cases, patients may present with neurological symptoms even before they have fever, cough, or shortness of breath. In addition to having an MRI while at the hospital, he stresses that patients will need to be monitored in a few months after their hospitalization.

"Our experience with previous forms of coronaviruses suggest that in the long-term patients may develop depression, insomnia, Parkinson's disease, memory loss, or accelerated aging in the brain," elaborated Fotuhi. "For those recovering from COVID-19, I recommend regular exercise, eating a heart healthy diet, reducing stress, and improving sleep; these are critical ways patients can rejuvenate their brain and minimize having poor outcomes in the future."

These interventions, along with targeted brain training and neurofeedback therapy, are the main features of Dr. Fotuhi's 12-week Brain Fitness Program. As published in the Journal of Prevention of Alzheimer's Disease (2016), 84% of elderly with cognitive impairment who complete this brain rehabilitation program gain improvements in their brain function and many of them experience growth in the parts of their brain for learning and memory. These findings were similar for patients who gained recovery from their persistent post-concussion syndrome. The program will now be tailored for patients suffering from post-COVID neurological issues.

A Harvard- and Johns Hopkins-trained neurologist and neuroscientist, Dr. Fotuhi is widely regarded as an authority in the field of memory, Alzheimer's Disease, concussion treatment, ADHD, and increasing brain vitality at any age.

Hackers in possession of quantum computers represent a serious threat to today's cryptosystems. Researchers are therefore working on new encryption methods based on the principles of quantum mechanics. However, current encryption protocols assume that the communicating devices are known, trustworthy entities. But what if this is not the case and the devices leave a back door open for eavesdropping attacks?

A team of physicists led by Professor Nicolas Sangouard of the University of Basel and Professor Renato Renner of ETH Zurich have developed the theoretical foundations for a communication protocol that offers ultimate privacy protection and can be implemented experimentally. This protocol guarantees security not only against hackers with quantum computers, but also in cases where the devices used for communication are "black boxes" whose trustworthiness is a completely unknown quality. They published their results in the journal Physical Review Letters and have applied for a patent.

Diluting information with noise

While there are already some theoretical proposals for communication protocols with black boxes, there was one obstacle to their experimental implementation: the devices used had to be highly efficient in detecting information about the crypto key. If too many of the information units (in the form of entangled pairs of light particles) remained undetected, it was impossible to know whether they had been intercepted by a third party.

The new protocol overcomes this hurdle with a trick - the researchers add artificial noise to the actual information about the crypto key. Even if many of the information units are undetected, an "eavesdropper" receives so little real information about the crypto key that the security of the protocol remains guaranteed. In this way, the researchers lowered the requirement on the detection efficiency of the devices.

"Since the first small-scale quantum computers are now available, we urgently need new solutions for protecting privacy," says Professor Sangouard. "Our work represents a significant step toward the next milestone in secure communications."

NEW YORK, NY (June 11, 2020)--A study led by researchers at Columbia University Irving Medical Center confirms that minimally invasive surgery for early-stage cervical cancer is linked to higher rates of recurrence and death compared with open surgery.

The study was published online today in JAMA Oncology.

Until the early 1990s, most women with early-stage cervical cancer underwent open radical hysterectomy (removal of the uterus, as well as some surrounding tissue). When a laparoscopic, or minimally invasive, approach to radical hysterectomy was introduced in 1992, it found favor among many oncological surgeons and eventually became a standard surgical treatment. Though minimally invasive surgery leads to fewer complications and a shorter recovery than open surgery, data comparing long-term outcomes of the two approaches have been limited.

A 2018 epidemiological study also led by Columbia, and published in the New England Journal of Medicine, found the four-year mortality rate among women with cervical cancer who had minimally invasive surgery was around 9% compared with around 5% for those who had open surgery. The researchers also found that survival among women undergoing cervical cancer surgery had declined since the adoption of minimally invasive techniques.

The new JAMA Oncology study was a meta-analysis of 15 observational studies including 9,499 women with cervical cancer. Of those who had minimally invasive radical hysterectomy, 530 had a recurrence and 451 died. The combined risk of recurrence or death was 71% higher for those who had minimally invasive surgery versus open surgery, and mortality risk was 56% higher. The results were similar for those who had robot-assisted minimally invasive surgery.

"It is important to keep in mind that there may be more differences between minimally invasive and open procedures besides the size of the incisions," says the study's lead author, Alexander Melamed, MD, MPH, assistant professor of obstetrics and gynecology at Columbia University Vagelos College of Physicians and Surgeons and a member of Columbia's Herbert Irving Comprehensive Cancer Center. "In the case of radical hysterectomy, these are two different operations, albeit with the same goal. Subtle technical differences may affect the oncologic efficacy of these procedures. We just don't know yet."

According to Melamed, some of the early studies were likely biased toward minimally invasive radical hysterectomy because of confounding factors that were not accounted for by the study authors. Those treated with minimally invasive surgery, for example, were more likely to be white women, to be from a higher socioeconomic class, to have private health insurance, and to have smaller, lower-grade tumors--all of which can contribute to a better prognosis. The JAMA Oncology meta-analysis only included studies that had attempted to account for some of these confounding factors.

"Since the publication of the 2018 studies," says Melamed, "there has been a lot of hand-wringing and debate. I hope that this new meta-analysis will help clinicians and patients understand that the available evidence strongly suggests that the harm of minimally invasive surgery for cervical cancer outweighs the benefits. A number of medical centers, in fact, no longer even offer the option of minimally invasive radical hysterectomy for early-stage cervical cancer."

"If there is a larger lesson to be learned," he adds, "it is that we should never take the status quo for granted. Conventional wisdom and tradition need to be constantly revisited."

- Research released during Diabetes Awareness Week (8-14 June 2020) shows people living with both type 1 and type 2 diabetes are at greater risk of bone fractures

- One in 15 people in the UK have diabetes, but until now bone fracture was not a well-known complication of the condition

- People with type 1 diabetes are at increased risk of hip fractures compared to people with type 2 diabetes

- Severity and length of time someone has lived with the condition increases risk of fractures for those with type 2 diabetes

People living with diabetes are at greater risk of bone fractures, new research led by the University of Sheffield has found.

The research, conducted in collaboration with scientists from Sutter Health, concluded that people with type 1 and type 2 diabetes have an increased risk of suffering hip and non-vertebral fractures (those not occurring in the spine or skull).

The findings, revealed during Diabetes Awareness Week (8-14 June 2020), show people with type 1 diabetes are at greater risk than people with type 2 diabetes, however insulin use and length of time someone has lived with the condition further increased the risk for people with type 2 diabetes.

Diabetes has a number of widely-known complications, however this study highlights the impact of the condition on bone health - specifically fractures.

Lead researcher Dr Tatiane Vilaca, from the University of Sheffield's Mellanby Centre for Bone Research, said: "Diabetes can cause a number of well-known complications including kidney problems, loss of eyesight, problems with your feet and nerve damage. However, until now many people with diabetes and their doctors are unaware that they are also at greater risk of bone fractures.

"We need to raise awareness about the greater risk people with diabetes face to help them to prevent fractures. For example, preventing falls can reduce their risk of fracture.

"Fractures can be very serious, especially in older people. Hip fractures are the most severe as they cause such high disability. Around 76,000 people in the UK suffer a hip fracture every year and it is thought as many as 20 per cent of people will die within a year of the fracture. Many others don't fully regain mobility, and for many people it can cause a loss of independence."

One in 15 people in the UK have diabetes - a serious condition where your blood glucose level is too high. There are two main types, type 1 - when your body can't make insulin at all, and type 2 - when the insulin your body makes either can't work effectively, or you can't produce enough of it.

Professor Richard Eastell, Professor of Bone Metabolism and Director of the University of Sheffield's Mellanby Centre for Bone Research, said: "This important research highlights the urgent need for doctors to evaluate the risk of fracture for patients with diabetes and also to look at potential treatments which may help to reduce that risk.

"We hope that by raising awareness about the greater risk people with diabetes face, bone density and bone strength will become something that doctors assess routinely in patients with the condition in the same way they do currently for other well-known complications."

The research published online in Bone was conducted in collaboration with researchers from the University of Sheffield's School of Health and Related Research (ScHARR) and the University of California.

Steven Cummings, M.D., from Sutter Health, California, said: "Patients with diabetes and the doctors who care for them should be aware of the increased risk of fractures. Patients are encouraged to ask their doctors what to do about that risk, and doctors should assess the risk and consider treatment to reduce that risk."