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AGA has published new expert recommendations in Gastroenterology: AGA Institute Rapid Review of the GI and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19.

Key guidance for gastroenterologists:

GI symptoms are not as common in COVID-19 as previously estimated: The overall prevalence was 7.7% (95% CI 7.4 to 8.6%) for diarrhea, 7.8% (95% CI: 7.1 to 8.5%) for nausea/vomiting, and 3.6% (95% CI 3.0 to 4.3%) for abdominal pain. Notably, in outpatients, the pooled prevalence of diarrhea is lower (4.0%).

However, COVID-19 can present atypically, with GI symptoms: COVID-19 can present with diarrhea as an initial symptom, with a pooled prevalence of 7.9% across 35 studies, encompassing 9,717 patients. Most often, diarrhea is accompanied by other upper respiratory infection symptoms. However, in some cases, diarrhea can precede other symptoms by a few days, and COVID-19 may present as isolated GI symptoms prior to the development of upper respiratory infection symptoms.

Monitor patients with new diarrhea, nausea or vomiting for other COVID-19 symptoms: Patients should inform gastroenterologists if they begin to experience new fever, cough, shortness of breath or other upper respiratory infection symptoms after the onset of GI symptoms. If this occurs, testing for COVID-19 should be considered.

Abnormalities in liver function tests should prompt thorough evaluation: Liver test abnormalities can be seen in COVID-19 (in approximately 15% of patients); however, available data support that these abnormalities are more commonly attributable to secondary effects from severe disease, rather than primary virus-mediated liver injury. Therefore, it is important to consider alternative etiologies, such as viral hepatitis, when new elevations in aminotransferases are observed.

For all seven evidence-based recommendations and a detailed discussion, review the full publication in Gastroenterology.

May 4, 2020n -- Researchers at Columbia University Mailman School of Public Health found that 92 percent of employers who responded to a survey on climate change and public health reported need for public health professionals with training in climate change will very likely increase in the next 5 to 10 years. While graduates of public health programs who focus on climate change are in demand in the current job market as well, these positions appear to be just a small proportion of the total number of jobs available in the field of public health. The findings are published online in the International Journal of Environmental Research and Public Health.

"It is clear from our analysis that current employers value a host of skills and competencies such as knowledge of climate mitigation, health equity and climate justice, pollution-health consequences and causes, risk assessment, and policy analysis, among others," said Heather Krasna, MS, assistant dean and director, Career Services at Columbia Mailman School. "At the same time, we recognize that predicting future workforce needs with historical data or surveys does not give a complete picture of the disruptive reality created by climate change. We cannot model the emerging future from prior trends only, but also must adopt new paradigms of education."

The researchers analyzed 16 years' worth of public health job postings for their projections of the skills needed for this future workforce using keyword searches, and survey responses from prospective employers of public health graduates focusing on climate change. In addition to searching keywords or a combination of terms on Indeed.com and LinkedIn, the authors were provided access to 32,093 job postings on the free job board managed by the Association of Schools and Programs of Public Health (ASPPH). The researchers found a statistically significant increase in the number of jobs in the ASPPH job board which mentioned climate change or global warming over the last 16 years.

A search of keywords "climate change" OR "global warming" on Indeed.com in mid-December 2019, found 2423 results, of which 159 also mentioned "public health." Thus, approximately 6.6 percent of the search results on the job board related to climate change had an overlap with public health (159 of 2423). An Indeed.com search for ("public health" OR "environmental health" OR epidemiology OR "health policy") in late December, found 37,490 public health-related jobs, of which approximately 0.4 percent also mentioned climate change or global warming. Using the National Cancer Institute's SOCcer (Standardized Occupation Coding for Computer-assisted Epidemiological Research) system the researchers analyzed organizations, job titles and descriptions.

To assess the views of current employers who are likely to need candidates with training in both public health and climate change, the researchers consulted with experts in both climate change and public health education, and included survey questions regarding specific competencies based on the current curriculum of Columbia University's Climate and Health Certificate program.

"For those institutions creating new training programs focusing on both climate change and public health, it will be important to assess whether their graduates will be in demand in the labor market, and if so, which sectors are most interested in hiring candidates with these skills," noted Krasna.

While the Mailman School research team describes the current state of the job market for public health graduates with climate change training as "emerging," there are relatively few roles currently available specifically for a graduate with a master's level public health degree and a focus in climate change. Notwithstanding, it is likely that graduates would benefit from training in climate change-related competencies, they noted, especially as we face the enormity of unpredictable global issues such as climate change.

"The scope and framing of our study focused primarily on the role of educational institutions in preparing graduates to solve the problems of today, and to meet the demands of today's employers," said Krasna. "However, we believe that universities provide much more than education, research, and service to their communities; they also take on an essential role moving our world toward sustainability."

New York, May 4, 2020 -- New Yorkers now think that the worst of the COVID-19 epidemic has passed but remain cautious about resuming normal activities. Many say they will not participate fully in everyday life until a vaccine is available. These are the major findings of the eighth weekly city and statewide tracking survey from the CUNY Graduate School of Public Health & Health Policy (CUNY SPH) conducted May 1-3.
 

"New Yorkers are realists first and foremost," said Dr. Ayman El-Mohandes, Dean of CUNY SPH. "They know we can't just flip a switch and go back to the way things were. Many people believe a safe, effective coronavirus vaccine is essential to restoring public confidence, which suggests that they know they are facing a fairly long period of uncertainty, even with the expedited vaccine development program now under way."
 

Less than half (46%) of New Yorkers now think they are at high risk of getting sick with the virus, the lowest percentage since the second week of polling, when it was at 43% before peaking at 58% the following week. However, 53% of this week's respondents said they know someone who has tested positive for the coronavirus, which is the highest reported since the start of the survey two months ago. The percentage of both African American and Caucasian respondents who reported knowing someone who tested positive increased significantly to 61%. Findings were unchanged among Latinx/Hispanics this week (46%), while the percentage of Asians who reported knowing someone who tested positive rose to 35% from 21% in week 7.
 

Reports of social isolation dropped last week for the first time in a month, with 35% reporting not feeling socially connected at all, down from 43% in weeks 4 and 6. New Yorkers also appeared to be coping better with mental stress. A third (33%) of this past week's respondents report feeling anxious and less than a quarter (24%) felt depressed more than half the time over the past two weeks. This is down considerably from earlier reports, when 40% reported anxiety and 32% said they felt depressed more than half the time.
 

A Vaccine as the Key to 'Normalcy' 

We asked New Yorkers how comfortable they would feel about participating in a number of activities if business reopened June 1st with some spacing precautions. Responses listed below indicate the desire of New Yorkers to prioritize certain activities they consider essential after June 1st.

65% of respondents said they would make a routine doctor's visit June 1st but 7% will wait until a vaccine is available

48% said they would take part in recreational activities like going to the beach or a park June 1st but 18% say they will wait until a vaccine is available

46% said they would go to a hairdresser June 1st but 12% say they will wait until a vaccine is available

31% said they would go to the gym June 1st but 20% say they will wait until a vaccine is available

31% said they would go to a restaurant June 1st but 14% say they will wait until a vaccine is available

23% said yes to going to the theatre on June 1st but 29% say they will wait until a vaccine is available

16% said yes to attending an outdoor activity with over 500 people in attendance June 1st but 31% say they will wait until a vaccine is available

These percentages varied by age and income level. Younger groups were consistently more willing to venture back into 'normal' life, while those in lower income categories were less willing. 

The number of New Yorkers who said they would take a coronavirus vaccine when it becomes available is now quite high, under the right circumstances. More than 3 in ten (31%) said they would take the vaccine immediately. An additional (48%) said they would if their doctor recommended it, and another 8% would if it were required by their school or employer. The remaining 12% of New York City residents said they would not take a coronavirus vaccine and almost all of those (82%) said they would not take the vaccine because they are worried about vaccine side effects.
 

"When seven in eight New Yorkers say they would take a proven safe and effective coronavirus vaccine, that is cause for optimism. However, to reach that level of community protection we will have to mount a major vaccine education initiative. Our already overburdened physicians and health system will need support for the front-line communication responsibilities that our respondents expect their doctor to do. Meeting this health communication challenge will require almost as much effort as the vaccine development process itself," stated Dr. Scott Ratzan, Distinguished Lecturer at CUNY SPH.  
 

Food Security: Paying for Food and Paying Grocery Workers
 

Since March 1, 44% of households said they are worried they would run out of food before they had money to buy more. Those reporting the greatest concern are lower income households (56%) and Latinx/Hispanic households (65%). In response to a related question 30% of New Yorkers reported not having money to buy food, a serious problem that disproportionately impacts younger, lower income, and Latinx/Hispanic households.

"These findings show food insecurity levels in New York City three times higher than before the epidemic. This and our previous surveys provides further evidence that the COVID-19 epidemic is having a disproportionate impact on New York City's Latinx/Hispanic population, who report higher rates of food insecurity, loss of health insurance and loss of employment than other population groups," said Nicholas Freudenberg, Distinguished Professor of Public Health at the CUNY SPH. "As the city launches relief programs, it will need to make sure they are reaching Latinx/Hispanic communities."
 

This week the New York City Council will hold a hearing on 'bonus pay' for essential workers like grocery store employees for bonuses of $30 to $75 per shift throughout the COVID-19 pandemic. Eighty percent (80%) of New Yorkers surveyed supported bonus pay. When asked how this program should be funded, 60% thought the bonus should be paid by the city while 40% thought it should be paid by the groceries or retailers. A fifth (20%) of respondents did not think the City Council had the authority to mandate bonus pay from retailers.
 

The complete survey results and related commentary can be found at https://sph.cuny.edu/research/covid-19-tracking-survey/week-8 and JHC Impact, an initiative of the Journal of Health Communication: International Perspectives.

Survey methodology:

The CUNY Graduate School of Public Health and Health Policy (CUNY SPH) survey was conducted by Emerson College Polling from May 1-3, 2020 (week 8). This tracking effort started March 13-15 (week 1) and continued with questions fielded March 20-22 (week 2) and March 27-29 (week 3), April 3-5, 2020 (week 4), April 10-12, 2020 (week 5), April 17-29 (week 6), April 24-26, 2020 (week 7).
 

The sample for the NY Statewide and New York City results were both, n=1,000, with a Credibility Interval (CI) similar to a poll's margin of error (MOE) of +/- 3 percentage points. The data sets were weighted by gender, age, ethnicity, education and region based on the 2018 1-year American Community Survey model. It is important to remember that subsets based on gender, age, ethnicity and region carry with them higher margins of error, as the sample size is reduced. In the New York City results, data was collected using an Interactive Voice Response (IVR) system of landlines (n=497), SMS-to-online (n=272) and an online panel provided by MTurk and Survey Monkey (n=232). In the Statewide results, data was collected using an Interactive Voice Response (IVR) system of landlines (n=472), SMS-to-online (n=292) and an online panel provided by MTurk and Survey Monkey (n=237).
 

In the statewide survey regions were broken out into the following:

Region 1: Long Island 14.7% (USC1-4), Shirley, Seaford, Glen Cove, Garden City

Region 2: NYC 45.3% (USC 5-16) Queens, Brooklyn, Manhattan, Staten Island, Bronx

Region 3: Upstate 40% (USC 17-27): Albany, Harrison, Carmel, Rhinebeck, Amsterdam, Schuylerville, Utica, Corning, Irondequoit, Buffalo, Rochester

Recommender systems are used in e-commerce to guide consumers with messages like "People who purchased this item also purchased ..." Past research has shown that these systems affect consumers' choices and generally boost sales, but few studies have examined how product-specific attributes or review ratings influence the effectiveness of such systems. A new study sought to determine how the impact of recommender systems (also called recommenders) is affected by factors such as product type, attributes, and other sources of information about products on retailers' websites. The study found that recommenders increased the number of consumer views of product pages as well as the number of products consumers consider, but that the increase was moderated by product attributes and review ratings.

The study, by researchers at Carnegie Mellon University and The Wharton School, appears in Management Science.

"Our findings can guide the effective use of recommender systems in e-commerce and provide insight into consumers' purchasing behavior," says Dokyun Lee, Assistant Professor of Business Analytics at Carnegie Mellon University's Tepper School of Business, who coauthored the study. "Understanding whether and how the effectiveness of recommender systems varies across product categories and by the number of reviews can help managers better understand how best to use these systems."

Researchers conducted an experiment on an e-commerce site of a top North American retailer with 184,375 users. In the experiment, about half the users were randomly selected to receive recommendations from a purchase-based filtering algorithm ("People who bought this also bought..."), while the other half, randomly selected to be in a control group, received no recommendations. The study used Amazon Mechanical Turk, a crowd-sourcing marketplace, to code the attributes of 37,125 unique products. The researchers then analyzed the resulting dataset to determine how factors that influence the costs, uncertainty, and risk related to searching for products interact with the positive impact of recommenders on customers' views of products and their purchasing decisions.

The study found that using recommenders increased both the volume of consumers' views of products and consumers' likelihood of buying a product. A recommender's positive impact on product views was greater for utilitarian products (e.g., a hammer) than it was for hedonic products (e.g., perfume), and greater for products with characteristics that can only be discerned by use (e.g., wine, movies) than for products for which consumers can easily judge the quality by reading descriptions (e.g., computers, phones).

In contrast, a recommender's positive impact on the likelihood of buying a product was greater for hedonic products than for utilitarian products. Contrary to past research, the attribute related to use or prior experience did not influence recommenders' effect on consumers' likelihood of purchasing a product.

The authors of the study note several limitations, including the use of just one type of recommender system. Also, they did not know which products were actually recommended by the recommender and therefore could not analyze whether a specific purchase resulted from a recommendation; instead, they compared the purchase behavior of consumers in the two groups and, because of randomization, attributed the difference to the recommender. Finally, they could not determine how long the impact of a recommender system would last.

"Our results suggest that the way recommenders help boost product sales differs by type of product," explains Kartik Hosanagar, Professor of Operations, Information and Decisions at The Wharton School, who coauthored the study. "We found that recommenders' positive impact on views is greater for products with high average review ratings, suggesting that a recommender complements review ratings, while the opposite is true for conversion rates conditional on views, that is, recommender and review ratings are substitutes."

PISCATAWAY, NJ - When alcohol bottles come with conspicuous labels providing information on the risks of alcohol consumption or drinking guidelines, people are better informed about alcohol's harms and may cut down their drinking, according to a series of studies in the Journal of Studies on Alcohol and Drugs.

"The results provide the first real-world evidence that relatively large, bright yellow alcohol labels with rotating health messages get noticed by consumers and can increase awareness of national drinking guidelines, improve knowledge of alcohol-related health risks, such as cancer, and reduce alcohol sales compared to control sites without the labels," says Erin Hobin, Ph.D., affiliated scientist at the University of Toronto's Dalla Lana School of Public Health. She is principal investigator on the studies in this series.

The Canadian research, called the Northern Territories Alcohol Label Study, involved placing bright-colored labels on bottles of beer, wine and distilled spirits with one of three brief messages: One label displayed scientific evidence regarding the established link between alcohol and cancer, the second contained the Canadian government's low-risk drinking guidelines and the third provided information about the number of standard drinks in the container.

One of the studies, led by Jinhui Zhao, Ph.D., and Tim Stockwell, Ph.D., both of the Canadian Institute for Substance Use Research at the University of Victoria, found that adding such labels to alcohol bottles (300,000 labels in all) decreased total sales of alcohol by 6.9% compared with sales in regions without the new labels.

In another article, researchers led by Nour Schoueri-Mychasiw, Ph.D., of Public Health Ontario, found that, among 2,049 participants, awareness of Canada's low-risk drinking guidelines increased nearly three times in the site in which the labels were placed compared with a control location. (Canada recommends no more than two drinks a day for women, no more than three for men and at least two alcohol-free days per week.)

A third study generated controversy. Here, Hobin and her colleagues queried the same 2,049 participants about their knowledge of the link between alcohol consumption and cancer. (The cancer label read, "Chief Medical Officer of Health advises alcohol can cause cancer, including breast and colon cancer.")

Before the label intervention, only about 25% of participants knew alcohol consumption can cause cancer. After the labeling, awareness in Yukon rose to 42%, a 10% greater increase in awareness of the alcohol-cancer link relative to the control site in neighboring Northwest Territories.

However, the cancer label part of these studies was cut short because the alcohol industry protested about the placement of labels on their products. The industry complained that the Yukon Government, who helped coordinate the study and is responsible for alcohol distribution and sales in the territory, did not have legal authority to place such labels, that the labels violated industry's freedom of expression and that the government was defaming alcohol manufacturers.

Under pressure, the Yukon Government shut down the cancer label research in December 2017, only one month after the study's launch.

"I'd describe this study as a David versus Goliath scenario," says Hobin. "Our Yukon partners and research team members worked tirelessly to execute this study and persevered, despite tremendous adversity."

After consultation with legal experts, Stockwell and colleagues concluded, "none of the industry's claims had any merit." In fact, they note that provincial and territorial governments in Canada could be held liable if they do not warn consumers about the link between alcohol and cancer. (The World Health Organization declared alcohol as a human carcinogen more than 30 years ago.)

"Warning labels help drinkers to be better informed about alcohol’s health risks and prompted many to cut down their drinking,” says Stockwell, co-lead on the studies. "This is an especially vital public health intervention now, as we see people at risk of increasing their alcohol intake as they isolate at home during the COVID-19 outbreak."

Sophia Antipolis - 4 May 2020: The top three heart attack symptoms in both women and men are chest pain, sweating, and shortness of breath, reports a study presented today on EAPC Essentials 4 You, a scientific platform of the European Society of Cardiology (ESC), and published in the Journal of the American Heart Association.1

“Heart attack symptoms are often labelled as ‘typical’ in men and ‘atypical’ in women,” said study author Dr. Annemarijn de Boer of the University Medical Centre Utrecht, the Netherlands. “But our study shows that while symptoms can differ between the sexes, there are also many similarities.”

Whatever your gender, if you experience heart attack symptoms, don't delay. Call the emergency services immediately.

Symptom recognition is crucial to enable fast, live saving treatment for people having a heart attack. Some previous studies report sex differences in symptoms while others report shared symptoms.

This study compiled the highest quality studies - 27 in total - from the past two decades detailing symptoms in patients with confirmed acute coronary syndrome (heart attack or unstable angina).

In addition to sharing the three most common symptoms, the majority of men and women experiencing an acute coronary syndrome had chest pain: 79% of men and 74% of women.

Significant differences in symptom presentation between women and men were also reported. Compared to men, women were more than twice as likely to have pain between the shoulder blades, 64% more likely to have nausea or vomiting, and 34% more likely to experience shortness of breath. Although chest pain and sweating were the most frequent symptoms in both women and men, they occurred less often in women, who had a 30% lower odds of chest pain and 26% lower odds of sweating compared to men.

The study did not investigate the reasons why there are some variations in symptom presentation between women and men, but Dr. de Boer said: “Previous research has shown sex differences in how heart attacks occur in the body, but it is uncertain how or whether this relates to symptom presentation. The cause of symptom differences between the sexes deserves further study.”

Over the past 30 years, colleges and universities have increasingly screened athletes for health conditions that may pose undue risk to sports participation. Sudden cardiac death is the leading cause of death among college athletes, so a primary function of these screenings is to reveal unknown heart conditions.

The National Collegiate Athletic Association requires a baseline pre-participation physical exam and patient history; some schools also administer an electrocardiogram (ECG), which measures the electrical output of a person's heartbeat. Disagreement exists, however, about ECGs' value. While experts generally agree that an ECG can flag cardiac issues of concern, detractors say they result in too many false-positive findings, leading to unnecessary additional tests and costs.

Research published today indicates that screenings that incorporate an ECG are more effective at detecting cardiac conditions that put athletes at risk, and more efficient in terms of cost-per-diagnosis of at-risk players, than screenings involving only a physical exam and patient history.

The journal Heart Rhythm published the multi-institutional research. It was led by Dr. Kimberly Harmon, section head of sports medicine at the University of Washington School of Medicine and lead physician for the UW football team.

Harmon and colleagues found that, across 8,602 records of Pacific-12 Conference athletes, cardiovascular screenings with an ECG in addition to a patient history and physical exam were six times more likely to detect a risky heart condition than screenings that involved only a patient history and physical. In parallel, ECG use improved the cost efficiency per diagnosis by five-fold.

"This is a real-world assessment of the discoveries resulting from different screening strategies, and how much they cost," Harmon said. "This study shows that screening with ECG is not only significantly more effective, it is only incrementally more expensive overall and costs much less per diagnosis. It can be implemented for much less than the cost of a pair of athletic shoes."

The researchers sought to compare positive findings, disease prevalence, and the costs of two screening strategies. They collected nine years of athletes' de-identified data from Pac-12 Conference institutions, which employ varied strategies for pre-participation physical screenings. Also analyzed were secondary tests, cardiac diagnoses, return-to-play outcomes, and complications from testing.

From 8,602 screenings, 11 athletes were identified with cardiovascular conditions:

History and physical exam: Two athletes (of 4,955) were identified as at risk, equating with a prevalence of 0.05% (1 in 2,454). Per-athlete screening cost averaged $130; cost per diagnosis was $312,407.

History, physical and ECG: nine athletes (of 3,647) were identified as at risk, equating with a prevalence of 0.024% (1 in 410). Per-athlete screening test cost was $152; cost per diagnosis was $61,712.

The costs of screenings and secondary testing were based on the Centers for Medicare and Medicaid Services Physician Fee Schedule.

"This is the first study to compare screenings by using real-life outcomes rather than theoretical models and variable assumptions," said Harmon, a UW professor of family medicine and of orthopedics and sports medicine.

Not every school can incorporate ECG tests into athlete screenings, Harmon said. It's less a question about covering a $22 test cost and more about whether physicians are readily available to interpret the ECGs.

The study included screenings of athletes across all varsity sports, though men's basketball and football account for more than 50% of sudden cardiac deaths among college athletes, she said. Several Pac-12 schools have prioritized those sports for screening.

A uniquely resilient organism all but unheard of in the Arabian Sea 20 years ago has been proliferating and spreading at an alarming pace, forming thick, malodorous green swirls and filaments that are visible even from space. This unusual organism is Noctiluca scintillans--a millimeter-size planktonic organism with an extraordinary capacity to survive, thrive and force out diatoms, the photosynthesizing plankton that have traditionally supported the Arabian Sea food web. Noctiluca is not a preferred food for larger organisms, so these large blooms, recurring annually and lasting for several months, are disrupting the base of the region's marine food chain, threatening fisheries that sustain 150 million people, and possibly exacerbating the rise of criminal piracy in the region.

New research published this week in Nature's Scientific Reports describes how the continued loss of snow over the Himalayan-Tibetan Plateau region is fueling the expansion of this destructive algal bloom. Led by Joaquim I. Goes from Columbia University's Lamont-Doherty Earth Observatory, the study uses field data, laboratory experiments, and decades of NASA satellite imagery to link the rise of Noctiluca in the Arabian Sea with melting glaciers and a weakened winter monsoon.

Normally, cold winter monsoon winds blowing from the Himalayas cool the surface of the oceans. These colder waters sink and are replaced with nutrient-rich waters from below. This convective mixing is no different than putting an ice cube into a mug of hot coffee. During this time, phytoplankton, the primary producers of the food chain, thrive in the sunlit, nutrient-rich upper layers, and surrounding countries see a bounty of fish that feed directly or indirectly on the phytoplankton. But with the shrinking of glaciers and snow cover in the Himalayas, the monsoon winds blowing offshore from land are warmer and moister, resulting in diminished convective mixing and decreased fertilization of the upper layers.

In this scenario, phytoplankton such as diatoms are at a disadvantage, but not Noctiluca. Unlike diatoms, Noctiluca (also known as sea sparkle) doesn't rely only on sunlight and nutrients; it can also survive by eating other microorganisms. Noctiluca hosts thousands of photosynthesizing endosymbionts within its bulbous, transparent, greenhouse-like cell. The green endosymbionts provide it with energy from photosynthesis, while its tail-like flagella allows it to grab any microscopic plankton from the surrounding water as an additional source of food.

This dual mode of energy acquisition gives it a tremendous advantage to flourish and disrupt the classic food chain of the Arabian Sea. Noctiluca's second advantage is that its endosymbionts accumulate a lot of ammonia in the cell, making the organism unpalatable to larger grazers. As a third advantage, the accumulated ammonia is also a repository of nitrogenous nutrients for the endosymbionts, making them less vulnerable to diminishing inputs of nutrients from a weakened convective mixing.

Noctiluca blooms first appeared in the late 1990s. The sheer size of their blooms, which occur annually, threaten the Arabian Sea's already vulnerable food chain because its symbionts not only compete with phytoplankton for the annually replenished nutrients, but feed on the phytoplankton themselves. However, only jellyfish and salps seem to find Noctiluca palatable. In Oman, desalination plants, oil refineries and natural gas plants are forced to scale down operations because they are choked by Noctiluca blooms and the jellyfish that swarm to feed on them. The resulting pressure on the marine food supply, and economic security may also have fueled the rise in piracy in countries like Yemen and Somalia.

"This is probably one of the most dramatic changes that we have seen that's related to climate change," said Goes who, along with Lamont researcher Helga do Rosario Gomes, has been studying the rapid rise of this organism for more than 18 years. "We are seeing Noctiluca in Southeast Asia, off the coasts of Thailand and Vietnam, and as far south as the Seychelles, and everywhere it blooms it is becoming a problem. It also harms water quality and causes a lot of fish mortality."

The study provides compelling new evidence of the cascading impacts of global warming on the Indian monsoons, with socio-economic implications for large populations of the Indian sub-continent and the Middle East.

"Most studies related to climate change and ocean biology are focused on the polar and temperate waters, and changes in the tropics are going largely unnoticed," said Goes.

The study highlights how tropical oceans are being disproportionately impacted, losing their biodiversity, and changing faster than conventional model predictions. This may portend dire consequences over the long term for countries in the region already gripped by socioeconomic problems from war, poverty and loss of livelihoods, said Goes.

Doctors have relentlessly impressed upon us the many benefits of exercise. Energy, mood, sleep and motor skills all improve with a regular fitness regimen that includes activities such as running. This has become of particular interest in the time of the COVID-19 pandemic.

But what happens in the brain during these improved states of health? The underlying neurological changes that open the door to these benefits have been unclear.

Now, Assistant Project Scientist Hui-quan Li and Distinguished Professor Nick Spitzer of the University of California San Diego have identified key neurological modifications following sustained exercise. Comparing the brains of mice that exercised with those that did not, Li and Spitzer found that specific neurons switched their chemical signals, called neurotransmitters, following exercise, leading to improved learning for motor-skill acquisition.

"This study provides new insight into how we get good at things that require motor skills and provides information about how these skills are actually learned," said Spitzer, the Atkinson Family Chair in the Biological Sciences Section of Neurobiology and a director of the Kavli Institute for Brain and Mind.

The study's results are published May 4 in Nature Communications.

Spitzer's laboratory discovered neurotransmitter switching in the adult mammalian brain and has led groundbreaking research on the ability of neurons to change their transmitter identity in response to sustained stimuli, typically leading to changes in behavior. After carrying out research that described neurotransmitter switching in depression, Spitzer and his colleagues began to turn their attention to how such switching might be involved in healthy conditions.

Li says the results underscore the importance of exercise, even at home during the current pandemic quarantine situation.

"This study shows that it's good for the brain to add more plasticity," said Li. "For people who would like to enhance their motor skill learning, it may be useful to do some exercise to promote this form of plasticity to benefit the brain. For example, if you hope to learn and enjoy challenging sports such as surfing or rock climbing when we're no longer sheltering at home, it can be good to routinely run on a treadmill or maintain a yoga practice at home now."

During the new study, Li and Spitzer compared mice that completed a week's worth of exercise on running wheels with mice that had no access to running wheels. They found that the exercised group acquired several demanding motor skills such as staying on a rotating rod or crossing a balance beam more rapidly than the non-exercised group.

When the brains of the running mice were examined, a group of neurons in the brain region known as the caudal pedunculopontine nucleus (cPPN) that regulates motor coordination was discovered to have switched neurotransmitters from acetylcholine to GABA.

To confirm their findings, the researchers used molecular tools to block the newly identified transmitter switch resulting from exercise. They found that the enhancement of motor skill learning in these mice was prevented. Based on their findings, the researchers propose a new model in which conversion of cPPN excitatory cholinergic neurons to inhibitory GABAergic neurons provides feedback control regulating motor coordination and skill learning.

The researchers say the discovery could lead to further findings where neurotransmitter switching leads to key motor skill changes. The researchers say they'd like to test ideas such as whether neurotransmitters could be deliberately switched to benefit motor skills, even without exercise. They also plan to conduct research on whether exercise similarly triggers benefits of motor skill learning in those with neurological disorders.

"We suggest that neurotransmitter switching provides the basis by which sustained running benefits motor skill learning, presenting a target for clinical treatment of movement disorders," the authors conclude in the paper.

Says Spitzer: "With an understanding of this mechanism comes the opportunity to manipulate and to harness it for further beneficial purposes. In the injured or diseased individual, it could be a way of turning things around... to give the nervous system a further boost."

Researchers at Utrecht University, Erasmus Medical Center and Harbour BioMed (HBM) today reported that they have identified a fully human monoclonal antibody that prevents the SARS-CoV-2 (COVID-19) virus from infecting cultured cells. The discovery, published online today in Nature Communications, is an initial step towards developing a fully human antibody to treat or prevent the respiratory disease COVID-19 caused by the novel coronavirus SARS-CoV-2.

The COVID-19 pandemic has spread rapidly across the globe infecting more than 3.3M people worldwide and killing more than 235,000 people so far.

"This research builds on the work our groups have done in the past on antibodies targeting the SARS-CoV that emerged in 2002/2003," said Berend-Jan Bosch, Associate Professor, Research leader at Utrecht University, and co-lead author of the Nature Communications study. "Using this collection of SARS-CoV antibodies, we identified an antibody that also neutralizes infection of SARS-CoV-2 in cultured cells. Such a neutralizing antibody has potential to alter the course of infection in the infected host, support virus clearance or protect an uninfected individual that is exposed to the virus."

Dr. Bosch noted that the antibody binds to a domain that is conserved in both SARS-CoV and SARS-CoV-2, explaining its ability to neutralize both viruses. "This cross-neutralizing feature of the antibody is very interesting and suggests it may have potential in mitigation of diseases caused by future-emerging related coronaviruses."

"This discovery provides a strong foundation for additional research to characterize this antibody and begin development as a potential COVID-19 treatment," said Frank Grosveld, PhD. co-lead author on the study, Academy Professor of Cell Biology, Erasmus Medical Center, Rotterdam and Founding Chief Scientific Officer at Harbour BioMed. "The antibody used in this work is 'fully human,' allowing development to proceed more rapidly and reducing the potential for immune-related side effects." Conventional therapeutic antibodies are first developed in other species and then must undergo additional work to 'humanize' them. The antibody was generated using Harbour BioMed's H2L2 transgenic mouse technology.

"This is groundbreaking research," said Dr. Jingsong Wang, Founder, Chairman & Chief Executive Officer of HBM. "Much more work is needed to assess whether this antibody can protect or reduce the severity of disease in humans. We expect to advance development of the antibody with partners. We believe our technology can contribute to addressing this most urgent public health need and we are pursuing several other research avenues."

For the first time, labs around the world can 3D print their own precision microscopes to analyse samples and detect diseases , thanks to an open-source design created at the University of Bath.

The OpenFlexure Microscope, described in Biomedical Optics Express, is a fully automated, laboratory-grade instrument with motorised sample positioning and focus control. It is unique among 3D-printed microscope in its ability to yield high-quality images. It has been designed to be easy to use, with an intuitive software interface and simplified alignment procedures. It is also highly customisable, meaning it can be adapted for laboratory, school and home use.

Best of all, the Bath design is a lot more affordable than a commercial microscope, both in terms of the upfront cost and the maintenance costs of the equipment. A commercial microscope intended for lab use can sell for tens of thousands of pounds. An OpenFlexure microscope can be constructed for as little as £15 or US$18 (this would cover the cost of the printed plastic, a camera and some fastening hardware). A top-end version would cost a couple of hundred pounds to produce, and would include a microscope objective and an embedded Raspberry Pi computer.

Dr Joel Collins, co-creator of the microscope and physics researcher at the University of Bath, said, "We want these microscopes to be used around the world - in schools, in research laboratories, in clinics and in people's homes if they want a microscope just to play with. You need to be able to pick it up and use it straight away. You also need it to be affordable."

To date, over 100 OpenFlexure microscopes have been printed in Tanzania and Kenya, demonstrating the viability of a complex piece of hardware being conceptualised in one part of the world and manufactured elsewhere.

Co-creator Dr Richard Bowman said, "Our Tanzanian partners, STICLab, have modified the design to better suit their local market, demonstrating another key strength of open source hardware - the ability to customise, improve, and take ownership of a product."

COVID-19 AND 3D PRINTED MEDICAL DEVICES

There has been a surge of interest in 3D printers since the onset of the pandemic, with many projects springing up around the world to develop low-cost, open-source 3D ventilators - or ventilator parts - to address the global shortage.

However, a piece of medical hardware requires years of detailed safety checks before it can be trusted for medical or laboratory use - the OpenFlexure Microscope project, for instance, has taken five years to complete. The Bath team believes it is highly unlikely that a new ventilator will be designed and approved during the course of this pandemic. They say it is much more likely that modifications of existing designs will be chosen by health authorities, where this is an option.

Dr Bowman, who has been working on the OpenFlexure project since its inception, first from the University of Cambridge and then from the Department of Physics at Bath, said, "Building a safety-critical medical device like a ventilator takes years for an organisation with hundreds of experienced engineers and an established quality management system. Making a ventilator that works in a few weeks is an impressive achievement, but ensuring it complies with even the relaxed, emergency version of the rules takes a lot longer than creating the initial design. Demonstrating to a regulator that the design and the manufacturing process meet all the requirements will be even harder."

He added, "The flip side is that the medical device industry is very conservatively regulated, and it would be a good thing if all of this new attention (in 3D printed hardware) means there's some rethinking done about how we can uphold high safety standards but make it easier to build something if you're not a mega corporation."

The SARS coronavirus 2 (SARS-CoV-2) infects lung cells and is responsible for the COVID-19 pandemic. The viral spike protein mediates entry of the virus into host cells and harbors an unusual activation sequence. The Infection Biology Unit of the German Primate Center (DPZ) - Leibniz Institute for Primate Research has now shown that this sequence is cleaved by the cellular enzyme furin and that the cleavage is important for the infection of lung cells. These results define new starting points for therapy and vaccine research. In addition, they provide information on how coronaviruses from animals need to change in order to be able to spread in the human population (Molecular Cell).

The new coronavirus SARS-CoV-2 has been transmitted from animals to humans and is spreading worldwide. It causes the new lung disease COVID-19, which has already killed over 200,000 people. The spike protein on the virus surface serves as a key for the virus to enter host cells. It facilitates viral attachment to cells and fuses the viral with a cellular membrane, thereby allowing the virus to deliver its genome into the cell, which is essential for viral replication. For this, activation sequences of the spike protein need to be cleaved by cellular enzymes, called proteases. The spike protein of SARS-CoV-2 carries an activation sequence at the so-called S1/S2 cleavage site, which is similar to those observed in highly pathogenic avian influenza viruses, but which has so far not been found in viruses closely related to SARS-CoV-2. The importance of this sequence for the virus was so far unknown.

In their current study, the infection biologists of the German Primate Center led by Markus Hoffmann and Stefan Pöhlmann were able to show that the S1/S2 activation sequence of the SARS-CoV-2 spike protein is cleaved by the cellular protease furin and that this cleavage event is essential for the infection of lung cells. It is also important for the fusion of infected cells with non-infected cells, which might allow the virus to spread in the body without leaving the host cell.

"Our results suggest that inhibition of furin should block the spread of SARS-CoV-2 in the lung," says Stefan Pöhlmann, head of the Infection Biology Unit at DPZ. "Furthermore, our present study and previous work demonstrate that the virus uses a two-step activation mechanism: In infected cells, the spike protein has to be cleaved by the protease furin so that newly formed viruses can then use the protease TMPRSS2 for further cleavage of the spike protein, which is important for the entry into lung cells."

Development of live attenuated vaccines

For a live attenuated vaccine to trigger a strong immune response, it has to be able to replicate in the body to a limited extent, for example locally at the site of injection. "SARS-CoV-2 variants, in which the activation sequence for furin has been removed, could be used as a basis for the development of such live attenuated vaccines, since the lack of cleavage of the spike protein should greatly limit the spread of the virus in the body. A sufficiently attenuated virus would no longer be able to cause disease, but would still enable the immune system to react to the pathogen and, for example, produce neutralizing antibodies," says Markus Hoffmann, first author of the study.

Risk assessment

In wildlife, especially bats, a large number of coronaviruses that are closely related to SARS-CoV and SARS-CoV-2 has been discovered over the past 20 years. However, so far an S1/S2 activation sequence that can be cleaved by furin has only been detected in SARS-CoV-2. "Wildlife sampling and the targeted search for coronaviruses with a focus on the S1/S2 activation sequence is necessary to identify those viruses that have the potential to infect and efficiently spread in humans. In addition, in the case of potential future coronavirus outbreaks, we should specifically analyze the S1/S2 cleavage site as it might serve as a marker for human-to-human transmissibility," says Markus Hoffmann.

Researchers from DTU Biosustain and DTU Bioengineering have elucidated the activity of the enzyme N-acetylgalactosaminidase (GH109) whose mechanism of activity has until now been a mystery. This enzyme can convert a group of low cost, abundant so-called beta-sugars into high-value, hard-to-produce alpha-sugars with interesting therapeutic properties.

This novel work on the chemistry and catalytic activity of this enzyme opens opportunities to a wide range of applications and has now been published in the well-renowned journal ACS Catalysis.

"We are very excited to have discovered how this human symbiont uses so far unknown chemistry to feed on human sugars. Now that we understand the chemistry behind this mode of action, we can change the enzyme to make valuable sugars," says David Teze, interim Group Leader of Enzyme Engineering at The Novo Nordisk Foundation Center for Biosustainability (DTU Biosustain) and first-author of this publication.

Bacterium with anti-cancer qualities

GH109 is found in the human gut bacterium Akkermansia muciniphila, where it degrades sugars in mucus found in the gut. When GH109 degrades the sugars of the mucus, it makes them into so-called alpha-GalNAc sugars, which it feeds on.

Biotechnologically, GH109 could allow for adding alpha-GalNAc to other compounds. This is particularly relevant, as alpha-GalNAc is the "hard to make" part of one of the most common cancer antigens, namely the Thomsen-Friedenreich antigen (Galβ1-3GalNAcα1). Thus, alpha-GalNAc sugars could potentially be formulated for cancer vaccines.

"Alpha-GalNAc containing sugars could be protective against cancer, but it is hard to synthesize enough of them for vaccines. But now, we may be able to optimize an enzyme to produce them biotechnologically," David Teze says.

These sugars also have health-promoting features by working as potent prebiotics (food for probiotic bacteria), and other studies also suggest that they have anti-inflammatory properties. But alpha-GalNAc sugars are hard to make chemically. This is why biological production is very interesting and, hence, the function of GH109 becomes very interesting.

Using bioinformatics, mutational analysis, structural analysis, computational modeling as well as crystallography studies - the latter being conducted in one of the world's most powerful X-ray facilities, MaxIV, in Lund, Sweden - the researchers revealed an interesting feature of GH109. The active site, which is where the enzyme activity takes place, could actually handle two types of input molecules (alpha and beta glycans). The enzyme does this by having a flexible 'arm' that place the right input in the active site.

Due to this revelation, the researchers have a clearer idea about how to optimise this enzyme, opening an opportunity to big scale, green production of α-GalNAc's in the future.

Nowadays many work duties can be dealt with by means of mobile devices at home, a situation which blurs the boundary between work and other daily life. This blurring of boundaries between work and non-work domains may both be challenging and beneficial to employees and their organizations.

A study at the University of Jyväskylä reveals that the mixing of work and other daily life may have more benefits than previously assumed, and points to the importance of boundary-spanning communication.

A smartphone enables phone calls, email and file transfers from the comfort of home. The question is, therefore, how to balance work and other life when technology blurs the boundary between these.

People easily think that by restricting employees' working hours and their use of work phones we can mitigate the negative consequences of technology use. A recent study at the University of Jyväskylä shows that there may be more effective ways to maximize the benefits of smartphone use, without diminishing employees' flexibility and use of these technologies.

"People often forget to talk about positive effects, such as autonomy and freedom the employees gain when they have the flexibility to schedule their work" says Postdoctoral Researcher Ward van Zoonen from JYU, who with his colleagues examined the use of smartphones for work matters outside working hours.

Supportive interaction makes people commit themselves to work

The study paid special attention to the benefits that flexible work and talking about domestic matters with the immediate supervisor outside working hours give to an employee.

"This reduces the conflict between work and other life," van Zoonen says. "If people in an organisation strive for more dialogue between employees' different life domains, it is possible to create a functional environment where people can talk about different matters."

The research findings show that when employees communicate across boundaries and talk at work about their life in other respects, they can receive new kinds of support and understanding from their immediate supervisor.

"This kind of communication creates a low threshold for contacting one's supervisor, which helps employees build a balance between the different domains of their lives and strengthens their organisational identification," says Professor Anu Sivunen describing the findings.

This means that tight working time restrictions to protect employees might not be beneficial after all, if they hinder reaching the positive results indicated in this research.

Supervisor plays a pivotal role for the success of flexible work

The data for this research were collected by two surveys, both answered by the same 367 employees from a Nordic company. They were asked, for example, how much they talk about their work with their family, and how much they talk about their family with their immediate supervisor.

"Both supervisors and their employees answered the surveys, and the study actually focused on their mutual communication," Sivunen says.

"Usually people at workplaces are interested in how communication within the work community is succeeding. It is often forgotten how an immediate supervisor can take an employer's other life into account and thereby help the employee gain work-related benefits."

According to van Zoonen, there is a need for this kind of research in today's working life.

"The use of a work phone in one's free time can be decreased, but such measures are challenging to put into practice in our current global environment," he says. "For example, in international organisations different time zones may render it impractical to work solely from 8 a.m. to 4 p.m."

In addition, due to the current exceptional situation with remote working because of the coronavirus, many work communities are faced with a setting where there are no daily face-to-face meetings at the workplace.

"Communication with one's immediate supervisor during flexible working hours, also on matters other than work, could ease the daily lives of many employees if they could share the possible challenges of their family life or free time with their supervisor in these settings," Sivunen says. "This would also make the supervisor better aware of the employee's situation working from home and the related impacts on work performance."

When an emergency dispatcher calls for a helicopter or plane to fly a critically ill patient to a hospital, they don't have time to check whether they take the patient's insurance.

Every minute matters for someone badly injured in a car crash, suffering a heart attack or stroke, or needing critical care for serious birth defects, organ transplants or COVID-19.

But after those patients land, 72% of them could face a potential "surprise bill" because their ambulance provider isn't "in network" with their insurance, a new study of people with private insurance finds. When ambulances aren't in-network, they can charge whatever they see fit, and insurance is not always obligated to pay those charges in full.

So patients could be on the hook for "balance bills" up to $20,000 per ride, the study by a University of Michigan team in the May issue of the journal Health Affairs shows.

Even if the dispatcher chooses a ground ambulance to drive a patient with a medical emergency to a hospital, the study finds that 79% of patients could get a surprise bill, with an average total around $550.

And even for patients who take ambulances for non-emergency reasons, arranged in advance with time enough to check insurance coverage, over half of patients could face a surprise bill for the out-of-network portion of the cost. On average, the study shows that bill could top $400.

The authors note that, while air ambulance charges are high, ground ambulance rides are far more common. As a result, out-of-network ground ambulance bills amount to a larger problem overall: $129 million per year, versus $91 million for out-of-network air ambulances. But annual out-of-network air ambulance bills are catching up quickly.

Shedding light on potential surprises

People with emergency medical needs should never let worries about surprise bills keep them from riding in any ambulance called by a 911 operator, physician or first responder, say the researchers behind the new study.

"Anecdotally, we hear of more people taking Uber or a Lyft, or having someone drive them, to the emergency room to avoid an ambulance bill," says Karan Chhabra, M.D., M.Sc., a National Clinician Scholar at the U-M Institute for Healthcare Policy and Innovation and surgery resident at Brigham and Women's Hospital in Boston. "But if you truly need an ambulance, concerns about cost should not get in the way. Arriving by ambulance, with a trained crew that can assess your needs, begin treatment and radio ahead to the hospital, means you're more likely to be triaged and treated appropriately when you arrive."

The new study can't tell how many patients actually got a surprise bill - just how many could have. It's based on five years' worth of insurance claims from nearly 1.5 million ambulance transports, including nearly 26,000 by air in the 41 states with more than 50 flights. The study is based on data from patients with commercial insurance offered by one large national company.

Policy implications

Chhabra and his colleagues hope that their work will shine new light on the size and frequency of potential surprise bills from a type of care that federal and state policy fixes often overlook.

Lawmakers have been looking closely at "surprise" out-of-network bills in hospital care, but those occur in only 10 to 20 percent of cases. The new study shows that the risk of out-of-network bills in ambulance-based care is many times higher.

The study also challenges claims by the growing for-profit air ambulance industry that increased competition among service providers would hold down cost growth. From 2013 to 2017, the size of a potential surprise bill for air ambulance rides rose 15 percent, after adjustment for inflation, driven by an increase in the amounts air ambulance companies charged insurance companies for transport of patients.

Air ambulance companies have fought surprise billing legislation in court, using the federal Airline Deregulation Act passed in 1978, which was actually designed to increase competition in commercial airline travel.

Air ambulance companies operating on a for-profit basis have proliferated across the country since the deregulation of the air ambulance industry in 2008. The air ambulance service for U-M's academic medical center, Michigan Medicine's Survival Flight, is a nonprofit service that was established in 1984 and does not balance-bill patients.

Future directions

Because of previous research and media reports about surprise bills, policymakers are already assessing potential approaches for reducing the risk to patients. Medicare and Medicaid already bars healthcare providers from sending "balance bills", to their members.

But patients with commercial insurance -- who far outnumber those in Medicare and Medicaid -- can still legally be balance billed for out-of-network care in many states. In fact, most patients with commercial insurance cannot be protected by state legislation because their plans can only be regulated federally.

Lawmakers in both chambers of Congress have proposed legislation to end surprise billing, and have even tried to include these fixes in COVID-19 relief packages. Chhabra and the study team believe that protections for patients who require air and ground ambulance care should be incorporated into these federal efforts.