Culture

As Italy urges tourists not to cancel their plans in the face of the coronavirus outbreak and a National Basketball Association memo reportedly encourages teammates to avoid high-fives, a new study conducted at the Smithsonian Tropical Research Institute (STRI) in Panama takes a look at how social bonds change in response to illness in another highly social animal: the vampire bat. In these bats, just as in humans, strong family bonds were less affected by the appearance of disease than were weaker social relationships.

Vampire bats are an extremely social species. Their interactions range from grooming family members and unrelated individuals to saving another bat from starvation by sharing a regurgitated blood meal.

“By asking how different social connections change in response to sickness, we can better understand how social networks change as a pathogen spreads,” said Gerry Carter, research associate at STRI and assistant professor of biology at The Ohio State University.

The lead author of the paper, Sebastian Stockmaier, did this project at STRI as part of his doctoral research at the University of Texas at Austin, advised by Daniel Bolnick at the University of Connecticut. Stockmaier injected vampire bats in a captive colony with a bacterial extract that challenged their immune systems, making them feel sick without harming their health or any risk of transmission. He then observed how the appearance of being sick would affect the ill bats’ social relationships with other colony members.

Just as a sick person might choose to stop shaking hands with strangers, but would still need to go to buy groceries, their results, published in the Journal of Animal Ecology, showed that sick vampire bats may reduce the amount of time they spend grooming—not a very important social interaction—but not food sharing—a more important social interaction.

Family relationships are very important: “A female vampire bat is less likely to groom an unrelated bat that is sick, but she won’t reduce the amount of time grooming her own sick offspring,” Stockmaier said.

“What we demonstrated in this study is that the type of social connection matters,” Carter said. “Just as in the recent COVID-19 outbreak, we would expect that a virus transmitted by contact would spread mainly within family groups, because these social connections will not be reduced by sickness behavior. In vampire bats, as well as in humans, the most important social behaviors and relationships don’t change as much when individuals are sick.”

“This study underlies the importance of basic research,” said Rachel Page, research biologist at STRI and a co-author of the paper. “Understanding how social interactions change in the face of illness is a key component in predicting the channels and speed at which a pathogen can spread across a population. Close observation of vampire bat behavior sheds light on how social animals interact, and how these interactions change—and importantly, when they do not change but persist—as individuals become sick.”

The Smithsonian Tropical Research Institute, headquartered in Panama City, Panama, is a unit of the Smithsonian Institution. The institute furthers the understanding of tropical biodiversity and its importance to human welfare, trains students to conduct research in the tropics and promotes conservation by increasing public awareness of the beauty and importance of tropical ecosystems. Promo video.

Stockmaier, S., Bolnick, D.I., Page, R.A. and Carter, G.G. 2020. Sickness effects on social interactions depend on the type of behavior and relationship. Journal of Animal Ecology. https://doi.org/10.1111/1365-2656.13193

Journal

Journal of Animal Ecology

DOI

10.1111/1365-2656.13193

TALLAHASSEE, Fla. -- Florida State University physicists believe they have an answer to unusual incidents of rare decay of a subatomic particle called a Kaon that were reported last year by scientists in the KOTO experiment at the Japan Proton Accelerator Research Complex.

FSU Associate Professor of Physics Takemichi Okui and Assistant Professor of Physics Kohsaku Tobioka published a new paper in the journal Physical Review Letters that proposes that this decay is actually a new, short-lived particle that has avoided detection in similar experiments.

"This is such a rare disintegration," Okui said. "It's so rare, that they should not have seen any. But if this is correct, how do we explain it? We think this is one possibility."

Kaons are particles made of one quark and one antiquark. Researchers study how they function -- which includes their decay -- as a way to better understand how the world works. But last year, researchers in the KOTO experiment reported four instances of a particular rare decay that should have been too rare to be detected yet.

This observation violates the standard model of physics that explains the basic fundamental forces of the universe and classifies all known elementary particles.

According to their calculations, there could be two possibilities for new particles. In one scenario, they suggest that the Kaon might decay into a pion -- a subatomic particle with a mass about 270 times that of an electron -- and some sort of invisible particle. Or, the researchers in the KOTO experiment could have witnessed the production and decay of something completely unknown to physicists.

Researchers in Japan are conducting a special data run to confirm whether the previous observations were true detections of new particles or simply noise.

"If it's confirmed, it's very exciting because it's completely unexpected," Tobioka said. "It might be noise, but it might not be. In this case, expectation of noise is very low, so even one event or observation is very striking. And in this case there were four."

Each week, millions of runners around the world lace up their running shoes, spurred on by the psychological, health and social benefits that running delivers.

The birth of Parkrun in 2004 - now an international activity with more than 20 countries involved - is credited with a sharp rise in the popularity of running in the past decade, but with benefits come downsides.

A new research paper by University of South Australia Adjunct Professor Jan de Jonge and his team reveals the price that runners (and society) pay when the sport becomes an obsession.

Prof de Jonge, based in the Netherlands at Eindhoven University of Technology and Utrecht University, surveyed 246 recreational runners aged 19 to 77 years to investigate how a person's mental outlook (mental recovery and passion for running) affects their risk of running-related injuries.

Not surprisingly, the more "obsessively passionate" runners - where the sport fully controlled their life to the detriment of partners, friends and relatives - reported far more running-related injuries than those who were more "harmoniously passionate" and laid back in their approach to running.

The latter group, who are in full control of their running and integrate the sport into their life and other activities, reported faster mental recovery after a run and sustained fewer running-related injuries. They were more likely to heed the early warning signs of injuries and take both physical and mental breaks from running whenever necessary.

Obsessively passionate runners disregarded the need to recover after training and failed to mentally detach from the sport, even when running became harmful. Their approach to running delivered short-term gains such as faster times but resulted in more running-related injuries.

Age and gender played a part. The older runners were able to mentally detach and recover a lot faster after a run than those in the 20-34 age group - especially females - who were more prone to running-related injuries.

"Most running-related injuries are sustained as a result of overtraining and overuse or failing to adequately recover, merely due to an obsessive passion for running," Prof de Jonge says.

"The majority of research focuses on the physical aspects of overtraining and lack of recovery time, but the mental aspects of running-related injuries have been ignored to date.

"When running becomes obsessive, it leads to problems. It controls the person's life at the expense of other people and activities and leads to more running-related injuries. This behaviour has also been reported in other sports, including professional dancing and cycling."

In the Netherlands, where the study was undertaken, running-related injuries costs the economy approximately €10 million a year (A$16 million) in medical costs, work absences and reduced productivity. Next to soccer, running is the Dutch sport with the highest number of injuries.

While there are no comparative figures available for Australia, a study by Medibank Private lists running as the 4th most injury-prone sport in Australia after Aussie Rules, basketball and netball, with sporting injuries overall costing the economy more than $2 billion a year.

The paper, "Mental Recovery and Running-Related Injuries in Recreational Runners: the Moderating Role of Passion for Running", is published open access in the International Journal of Environmental Research and Public Health.

Notes to editors

The pilot study was undertaken by Prof Jan de Jonge, Professor Toon W. Taris from Utrecht University and Dr Yannick A. Balk from the University of Amsterdam.

Prof Jan de Jonge is based at Eindhoven University of Technology and Utrecht University, and is an Adjunct Professor in the Asia Pacific Centre for Work Health and Safety at the University of South Australia.

The study examined 246 recreational runners (54 per cent male and 46 per cent female) with a mean age of 47 years. The average running experience was 14 years. On average, participants engaged in running activities three times a week, and the average running distance was about 27 kilometres per week. Two-thirds of the runners ran in groups, and approximately half of the runners used an individualised training schedule for their training activities.

Of all participants, 51.2 per cent reported running-related injuries over the past 12 months, such as knee, Achilles tendon and foot injuries.

Corals are constantly exposed to multiple environmental stressors at any given time. On a global scale, climate change is increasing seawater temperatures which can cause coral to bleach. Locally, land-use practices can cause poor water quality run-off of land-based fertilizers and sediment washing over our coral reefs. A new study conducted by researchers at the University of Hawai'i at Mānoa School of Ocean and Earth Science and Technology (SOEST) found the survival and development of coral larvae in their first few days of life was negatively affected by elevated nutrients and a modest increase in water temperature.

Before reef corals build their hard, rocky skeletons they actually start their life as tiny, gelatinous larvae adrift in waters adjacent to coral reefs. The research team used larvae of three common Hawaiian coral species, starting at less than one-day old, and exposing them to various combinations of low or high nutrients and water temperatures. At the end of five days, the team determined how the individual and interacting stressors impacted coral during the first days of the life cycle for each species.

In particular, when nitrogen was high, coral larva showed the lowest survivorship. However, when phosphate was also added, the negative effects of nitrate were lessened. Surprisingly warming didn't reduce survivorship, but the interaction of high temperature with nutrients affected larval growth, generally reducing larval size. This showed that nutrients can have serious impacts on coral larvae, but importantly the imbalance of nutrients and their interactions with temperature can harm corals at very early stages.

"The study also revealed that the way corals reproduce and other biological differences among larvae influence how they respond to environmental change," said Chris Wall, study co-author and postdoctoral researcher at SOEST's Pacific Biosciences Research Center. "The impacts of warming and elevated nutrients were greatest on small larvae that develop outside the parents, called broadcast spawners, and dependent on whether the larvae had already formed a relationship with their symbiotic algae. And interestingly, those larger larvae that develop inside their parents, called brooders, were quite resistant to warming and nutrient spikes."

In adult corals, nutrient pollution can increase the negative effects of ocean warming, such as increasing the severity of coral bleaching. As marine heat waves and bleaching events have already become more common because of climate change, it is critical that conservationists and managers consider how reducing different forms of local impacts like pollution - such as nitrogen and phosphate from residential and agricultural runoff- can significantly affect adult corals and also the viability of coral larvae.
 
"Understanding the impacts of stressors on adult corals has been a primary focus of coral research, but this is just one piece of the puzzle," said study co-author Madeline Piscetta. "In order to gain a comprehensive understanding of how temperature and nutrients will shape coral reefs, we need to examine these interactions across all life history stages."

WASHINGTON - Scientists at the Environmental Working Group and Indiana University have for the first time conducted a review of 26 fluorinated chemicals, or PFAS, and found that all display at least one characteristic of known human carcinogens.

The study, published today in the International Journal of Environmental Research and Public Health, found that the most well-studied PFAS compounds - PFOA, formerly used by DuPont to make Teflon, and PFOS, formerly an ingredient in 3M's Scotchgard - exhibit up to five key carcinogenic characteristics.

"Our research has shown that PFAS impact biological functions linked to an increased risk of cancer," says Alexis Temkin, Ph.D., EWG toxicologist and the primary author of the new study. "This is worrisome, given that all Americans are exposed to PFAS mixtures on a daily basis, from contamination in water, food and everyday products."

Americans are exposed to hundreds of cancer-causing chemicals, many of which can build up in the body over time. Changes in the body, such as hormonal dysregulation and weakened immune system, increase cancer risk, and PFAS chemicals cause many such changes. The International Agency for Research on Cancer classifies PFOA as a possible human carcinogen. The U.S. Environmental Protection Agency says both PFOS and the PFOA replacement chemical GenX show evidence of carcinogenicity.

"Data from animal and epidemiological studies point to human health risks for PFAS, especially an elevated risk of cancer," said Lisa Kamendulis, an associate professor at Indiana University and one of the authors of the study.

PFAS chemicals never break down in the environment and can stay in the human body for many years. According to the new study, some so-called short-chain and replacement PFAS, touted by the chemical industry as safer alternatives to long-chain PFAS, exhibited the same key characteristics as the toxic chemicals they were designed to replace.

"We should focus on preventing cancer by preventing human exposure to potential carcinogens," said Olga Naidenko, Ph.D., vice president for science investigations at EWG. "Cancer causes staggering costs to society, and compelling evidence tells us that exposures to toxic chemicals in the environment are a significant risk factor."

In the C8 Health Project, which studied more than 70,000 people who lived or worked in the mid-Ohio Valley, where drinking water was contaminated with PFOA, elevated PFOA levels in the body were associated with greater risk of non-Hodgkin lymphoma and kidney, testicular, prostate and ovarian cancers.

In January, laboratory tests commissioned by EWG found the toxic PFAS chemicals in the drinking water of dozens of U.S. cities. Some of the highest PFAS levels detected were in samples from major metropolitan areas, including Miami, Philadelphia, New Orleans and the northern New Jersey suburbs of New York City.

Drawing on results from those tests and new academic research that found PFAS widespread in rainwater, EWG scientists believe PFAS is likely detectable in all major water supplies in the U.S., almost certainly in all that use surface water. EWG's tests also found chemicals from the PFAS family that are not commonly tested for in drinking water.

EWG's tap water samples, collected from May to December 2019, were analyzed for the presence of 30 different PFAS compounds by an accredited independent laboratory. That's five times as many chemicals as were tested for, from 2014 to 2015, in an EPA-mandated program that grossly underreported the true extent of contamination. On average, six or seven different PFAS chemicals were detected in samples.

In addition to elevated risk of cancer, exposure to PFAS chemicals is also linked to other serious health concerns, including reproductive and developmental harms, and reduced effectiveness of vaccines. Independent scientific studies have recommended a safe level for PFAS in drinking water of 1 part per trillion, a standard that is endorsed by EWG.

A new study in the Journal of the National Cancer Institute, published by Oxford University Press, finds improvements in five-year survival rates for all cancers in young adults. For some cancers, however, there has been little improvement since the 1970s.

Over the past several decades, treatment of cancer in adolescents and young adults (people between age 15 and 39) has evolved significantly, leading to steady improvements in estimated survival rates.

Researchers here found that, among 282,969 five-year young adult cancer survivors, five-year mortality (from five through ten years after diagnosis) from all causes decreased from 8.3% among those diagnosed in 1975-1984 to 5.4% among those diagnosed in 2005-2011. However, for specific cancer types, including colorectal, bone, sarcomas, cervical/uterine, and bladder, there was little improvement in mortality over time. Researchers here found some reduction in late mortality in Hodgkin lymphoma, non-Hodgkin lymphoma, leukemia, central nervous system tumors, melanoma, breast cancer, and kidney cancer.

Some of the most obvious improvements in mortality over time were observed among young adult survivors of hematologic malignancies and central nervous system tumors, cancer types that are also predominant among children and have therefore been the focus of considerable cancer research in recent decades. Notably, the mortality rate among five-year young adult leukemia survivors dropped from over 25% to less than 5% between patients treated in the late 1970s and early 1980s and those treated more recently. Reductions in mortality over were also pronounced for survivors of lymphomas and central nervous system tumors, cancer types with some of the highest mortality rates. These findings show the impact of new treatments for patients with these cancers.

Although improvements in mortality rates have been more dramatic for children and older adults with cancer, findings from these reports indicate that early survival among young adults has improved steadily over the past several decades. Reported five-year survival gains likely reflect, in large part, the impact of advances in therapy for several of the most common cancers in young adults.

Researcher quote "It is important that we monitor trends in survival not only among recently diagnosed patients, but also among survivors who are several years beyond their initial cancer diagnosis," said the paper's lead author, Chelsea Anderson. "There have been substantial improvements over the past several decades for five-year survivors, though some cancer types have not shared in these improvements. Survivors of these cancer types may therefore be priority groups for efforts to improve long-term surveillance to reduce late mortality from cancer among adolescents and young adults."

BINGHAMTON, N.Y. - Research led by faculty at Binghamton University, State University of New York has revealed the most effective hospital-based methods for reducing readmission rates.

The Patient Protection and Affordable Care Act requires the Centers for Medicare and Medicaid Services to penalize hospitals by reimbursing them at lower rates for what they consider excess readmissions when compared to expected levels of readmissions.

According to the American Hospital Association, since the start of the program in October 2012, hospitals have experienced nearly $1.9 billion in penalties.

As a result, hospital organizations nationwide have implemented various hospital readmission reduction programs (HRRPs) over the past several years to improve health outcomes for patients and control costs. Some examples of HRRPs include collaborating with certified home healthcare agencies; using telehealth programs, post-discharge phone calls or house-call programs; implementing interdisciplinary case-management or discharge-planning programs; and creating partnerships with primary care practices.

Binghamton University researcher Michele Summers decided to investigate which of these programs is the most effective. She confined the research to hospitals within upstate New York, investigating 94 facilities across 53 counties ranging from rural to metropolitan status. She also restricted the study to HRRPs aimed at patients admitted with heart failure or pneumonia.

"I chose heart failure and pneumonia because those are two of the most common diagnoses requiring hospital admission," she said.

First, Summers gathered data regarding which, if any, HRRPs the hospital organizations used. For facilities with an interdisciplinary case-management team, she further identified whether there was a registered nurse or advanced-practice registered nurse (a nurse with post-graduate nursing education) on or leading the team. Then, she analyzed the relationship between the type and number of HRRPs used by the hospital organization and the facility's readmission and reimbursement outcomes.

Results from the study showed that collaborating with home healthcare agencies, using telehealth or implementing house calls for follow-up with post-discharge patients lowered the incidence of readmission for patients who had previously been hospitalized for heart failure or pneumonia. In addition, Summers found that facilities that employed more than one HRRP also had lower rates for readmission. Finally, the research also indicated that including an advanced practice nurse on interdisciplinary case-management teams resulted in better patient outcomes and lower readmission rates.

Summers was particularly happy to see house-call programs get good results. These initiatives bring nurse practitioners or physicians into the patient's home for care following discharge.

"Of all the different programs I looked at, house calls had the most significant impact on decreasing reimbursement penalties in hospitals located in primary care provider shortage areas," Summer said.

As a nurse practitioner with a home-care background, Summers hopes to design a house-call intervention program and test it in the area.

"I think it would be wise for hospitals to develop programs that provide house calls," she said. "The organizations that do this are saving money because they're getting fewer penalties due to readmissions. It's an investment up front, but there can be a huge return on that investment."

WEST LAFAYETTE, Ind. - Make them tougher by making them weaker.

That's the proposed solution from a Purdue University research team - well-known for its adhesive technology.

"We have been using inspiration from sea creatures to develop several new adhesives," said Jonathan Wilker, a Purdue professor of chemistry and materials engineering, who helps lead the research team. "Recently we have been seeking strategies for making adhesives tougher. One way to get there can be viewed as making the materials tougher by, first, making them weaker."

The Purdue team added bonds that are broken easily throughout the material. When pressure or stress is applied to the glue, these sacrificial bonds are designed to absorb energy and break apart. Meanwhile, the rest of the larger adhesive system remains intact.

The Purdue team's work is published in the Journal of the American Chemical Society.

"The idea is somewhat similar to how a brick wall is made of bricks that are offset from each other," Wilker said. "You stagger the bricks and cement so that a crack does not shoot right down through the cement lines. A crack hits the middle of a brick and the forces get spread out toward both sides, eventually decreasing to the point that the wall stays intact.

"We added weak bonds within the adhesive so that mechanical forces and growing cracks lose energy by breaking these bonds instead of having the whole, larger material fracture. The idea is to manage how energy moves through the material. The overall adhesive system can become tougher and less likely to break apart when placed under mechanical stress."

Wilker's team tested this idea with several types of bonds. The ones that worked best were neither too weak nor too strong. He said that this technique for managing energy in adhesives might be a general phenomenon that could be applied to adhesives in industries ranging from consumer electronics to construction to manufacturing airplanes and automobiles.

The team has hundreds of mussels and oysters growing in its laboratory for studying proteins used by the sea creatures attaching to rocks. After working to understand the nature of these natural adhesives, the researchers then generate several synthetic versions with different properties.

They have worked to patent several of their toxin-free adhesive systems with the Purdue Research Foundation Office of Technology Commercialization, which recently moved into the Convergence Center for Innovation and Collaboration in Discovery Park District.

The researchers are looking for partners to continue developing their technology. For more information on licensing and other opportunities, contact Joseph Kasper of OTC at jrkasper@prf.org.

A caesarean birth had little impact on whether a child would go onto develop allergies, a new study led by the Murdoch Children's Research Institute (MCRI) has shown.

The research, published in the Archives of Disease in Childhood journal, found only a small link between caesarean delivery and asthma and no association between the delivery method and eczema or lung function.

The research team, headed by MCRI's Professor Melissa Wake and Dr Rachel Peters, used parent-reported asthma and eczema data drawn from the HealthNuts study (3135 participants) and the Longitudinal Study of Australian Children (3654 participants) at age 6-7 years and lung function data from Child Health CheckPoint study (1502 participants) at age 11-12 years.

Professor Wake said previous data from the 1990s suggesting a link between caesarean delivery and childhood allergic diseases such as eczema, asthma and poor lung function had warranted further examination.

"Scientists are racing to find out what's behind the epidemic of allergy affecting our kids," she said.

"One possibility is caesarean delivery, because rates of allergy and caesarean have rocketed up together since the 1990s. It's plausible, because a healthy start to a good immune system includes a baby's exposure to the mother's microbiome - bacteria, fungi, protozoa and viruses that live on and inside the body - during a normal delivery."

Dr Peters said both caesarean delivery and childhood allergic disease have rapidly risen over the past 30 years.

"The global caesarean rate is higher than 20 per cent, and North America, East Asia and the Pacific regions, including Australia, all now have caesarean rates around 30 per cent. At the same time, rates of asthma and eczema in children aged 6-7 years globally are 12 per cent and 8 per cent respectively, with higher prevalence reported in Australia (20 per cent and 17 per cent)," Dr Peters said.

"Our study gives parents confidence that if they want or need to have a caesarean birth, their child is unlikely to be at higher risk of having eczema and poor lung function than children delivered vaginally," Dr Peters said. "And only a possible small risk of developing asthma."

Climate change is heating the oceans, which affects billions of marine microbes in ways scientists don't fully understand. In response, USC researchers have developed a model to forecast how these important organisms will adapt to warming seas.

Oceans substantially shape life and climate on Earth. Marine microorganisms are responsible for producing half of the oxygen that we breathe. The oceans sequester vast amounts of carbon dioxide from the atmosphere -- taking up about 30% of human-derived CO2. Fisheries, which are supported by marine microorganisms, contribute to food and income for about 820 million people worldwide, according to the Food and Agriculture Organization of the United Nations.

Those vital tasks and more are accomplished by plants and animals so tiny that thousands could swim in a teaspoon. In many ways, what Earth will look like in 50 to 100 years depends on how these tiny creatures respond to a changing climate.

"Microorganisms are critical to life on earth," said Naomi Levine, assistant professor of biological and Earth sciences at the USC Dornsife College of Letters, Arts and Sciences and senior author of a new study about marine microbes. "The oceans are changing, but we don't know what future ocean ecosystems will look like because we don't know how these organisms will respond to changes."

Researchers at USC -- in collaboration with scientists at the University of Edinburgh and the National Oceanic and Atmospheric Administration (NOAA) -- developed a predictive model to estimate how those microbes will adapt. Previously, the future of ocean systems has proven very complex to predict at the level of microscopic organisms living in the sea. However, this model provides a simple framework that can be used to understand the adaptation of different types of microorganisms to numerous variables, including human-derived changes in marine environments. It is also freely available to other scientists around the world.

Tweaking simulations of future ocean conditions, Levine and colleagues discovered marine microbes responded in two ways. Some microbes changed easily; suited for success in the short run, they thrived with little preparation for the future. Meanwhile, competitors -- pushed to the margins for a spell -- evolved to position for rapid proliferation over the long run once temperatures stabilized at a higher level.

"It's like a tortoise and hare comparison, two different strategies to finishing the race," Levine said.

Their findings appear today in Proceedings of the Natural Academy of Sciences.

This genetic turn of the tables shows how climate change works as a selective pressure on the evolution of marine microbes. While the study looks at two specific scenarios, the tool USC scientists developed has wider utility.

In addition, the study results show the importance of the interplay between physical and biological time intervals in determining evolutionary outcomes, which is valuable information to include in other models of global carbon cycles now being used to forecast climate change.

The UK's National Health Service (NHS) needs to do more to address the ingrained stigma and discrimination faced by people with obesity, says a leading health psychologist.

Although it is a problem rooted in wider society, Dr Stuart Flint, Associate Professor in the Psychology of Obesity at the University of Leeds, says negative attitudes around weight gain are pervasive in the NHS and they can affect the way patients are treated.

Writing a Comment article in The Lancet Diabetes and Endocrinology to mark World Obesity Day (March 4th), Dr Flint argues: "A core value of the NHS is to provide a comprehensive service that is available to all.

"Despite this core value, many processes prevent it from being achieved.

"For instance, weight stigma and discrimination are common within healthcare settings and affects the quality of care that patients receive."

The All Party Parliamentary Group on Obesity has reported that only one in four people with obesity said they were being treated with dignity and respect by health professionals when they sought advice or treatment for their weight.

Ignorance about the scientific causes of weight gain is part of the problem. Dr Flint says many people hold stereotypes where they believe individuals are responsible for their own weight gain because they are either lazy or greedy.

"Attributions of personal responsibility can lead to bias... with a person's health status perceived to be within an individual's control, which leads to fault and blame," he writes.

However research shows that obesity is "...a complex, multifaceted health condition that can be caused by, for instance, by genetics, epigenetics, biological, environmental, and societal factors."

Dr Flint also compared the narrative around obesity with that for cancer in the NHS long term plan, highlighting that the language and framing of obesity may also contribute to weight stigma.

"The most striking difference is that the language used about cancer is positive, reflecting optimism and hope," he says. "When compared with obesity, the language is negative, reflecting pessimism, fear and unpleasantness."

For example, people with cancer are discussed as survivors whereas obesity is seen as a burden.

Earlier this week, Dr Flint launched a list of dos and don'ts to help MPs avoid loaded language when they discuss obesity.

The list suggests:

Use object descriptions such as "weight" or "excess weight"

Put people first - do not use 'obese people' but 'people with obesity'

Be accurate in the description of the complex causes of weight gain

Do not to imply there is a group of people who do not wish to manage their weight.

The guidelines were drawn up in partnership with the charity Obesity UK and MPs on the All-Party Parliamentary Group on Obesity.

Mary Glindon, Labour MP for North Tyneside and chair of the All-Party Parliamentary Group, said: "Current efforts to reduce obesity simply aren't working.

"Weight stigma acts as a barrier to people with obesity seeking help and getting treatment.

"These guidelines will help MPs to lead the way in changing the way we speak about obesity, help to promote a wider understanding of the complexities of obesity, and help us move away from damaging stereotypes.

"Reducing obesity is not necessarily all about eating less and moving more."

March 3, 2020 --The fierce national debate over health care reform includes deep divisions over the appropriate roles of the federal and state governments. For example, while Sen Bernie Sanders (I-VT) calls for expanding the federal Medicare program to cover all Americans, the Trump administration pushes for the states to have far greater authority. However, according to Michael Sparer, JD, PhD, chair of health policy and management at the Columbia Mailman School of Public Health, the Affordable Care Act (ACA) points towards a more effective inter-governmental partnership, one in which the states have significant policy and administrative discretion, bounded by strong national standards designed to limit unacceptable inequities.

In a policy paper titled "Federalism And The ACA: Lessons For The 2020 Health Policy Debate" in a special issue of the journal Health Affairs, Professor Sparer writes: "States are too prominent and too engaged in every aspect of the nation's health care system not to insist on playing an important ongoing role." Proposals to eliminate a significant state role are both unlikely to be enacted and at odds with 250 years of American history. But he adds that future reforms also need strong national standards to guarantee the desired policy outcome (such as universal coverage) and to limit unacceptable inter-state inequities

The ACA offers several models for combining centralized and state-based approaches for policy makers to develop the next generation of health reform, notes Sparer, and each of them could achieve universal coverage without eliminating the private insurance system. Indeed, rather than abandoning the ACA, reformers ought to recognize that the law suggests "the sort of intergovernmental partnership that just might lead to a US version of affordable universal coverage.

On March 10th Professor Sparer will take part in a briefing in Washington hosted by the journal. Here is more information. Registration is free.

In recent years, criticism has been levelled at economics for being insular and unconcerned about real-world problems. But a new study led by MIT scholars finds that the field increasingly overlaps with the work of other disciplines, and, in a related development, has become more empirical and data-driven, while producing less work of pure theory.

The study examines 140,000 economics papers published over a 45-year span, from 1970 to 2015, tallying the "extramural" citations that economics papers received in 16 other academic fields -- ranging from other social sciences such as sociology to medicine and public health. In seven of those fields, economics is the social science most likely to be cited, and it is virtually tied for first in citations in another two disciplines.

In psychology journals, for instance, citations of economics papers have more than doubled since 2000. Public health papers now cite economics work twice as often as they did 10 years ago, and citations of economics research in fields from operations research to computer science have risen sharply as well.

While citations of economics papers in the field of finance have risen slightly in the last two decades, that rate of growth is no higher than it is in many other fields, and the overall interaction between economics and finance has not changed much. That suggests economics has not been unusually oriented toward finance issues -- as some critics have claimed since the banking-sector crash of 2007-2008. And the study's authors contend that as economics becomes more empirical, it is less dogmatic.

"If you ask me, economics has never been better," says Josh Angrist, an MIT economist who led the study. "It's never been more useful. It's never been more scientific and more evidence-based."

Indeed, the proportion of economics papers based on empirical work -- as opposed to theory or methodology -- cited in top journals within the field has risen by roughly 20 percentage points since 1990.

The paper, "Inside Job or Deep Impact? Extramural Citations and the Influence of Economic Scholarship," appears in this month's issue of the Journal of Economic Literature.

The co-authors are Angrist, who is the Ford Professor of Economics in MIT Department of Economics; Pierre Azoulay, the International Programs Professor of Management at the MIT Sloan School of Management; Glenn Ellison, the Gregory K. Palm Professor Economics and associate head of the Department of Economics; Ryan Hill, a doctoral candidate in MIT's Department of Economics; and Susan Feng Lu, an associate professor of management in Purdue University's Krannert School of Management.

Taking critics seriously

As Angrist acknowledges, one impetus for the study was the wave of criticism the economics profession has faced over the last decade, after the banking crisis and the "Great Recession" of 2008-2009, which included the finance-sector crash of 2008. The paper's title alludes to the film "Inside Job" -- whose thesis holds that, as Angrist puts it, "economics scholarship as an academic enterprise was captured somehow by finance, and that academic economists should therefore be blamed for the Great Recession."

To conduct the study, the researchers used the Web of Science, a comprehensive bibliographic database, to examine citations between 1970 and 2015. The scholars developed machine-learning techniques to classify economics papers into subfields (such as macroeconomics or industrial organization) and by research "style" -- meaning whether papers are primarily concerned with economic theory, empirical analysis, or econometric methods.

"We did a lot of fine-tuning of that," says Hill, noting that for a study of this size, a machine-learning approach is a necessity.

The study also details the relationship between economics and four additional social science disciplines: anthropology, political science, psychology, and sociology. Among these, political science has overtaken sociology as the discipline most engaged with economics. Psychology papers now cite economics research about as often as they cite works of sociology.

The new intellectual connectivity between economics and psychology appears to be a product of the growth of behavioral economics, which examines the irrational, short-sighted financial decision-making of individuals -- a different paradigm than the assumptions about rational decision-making found in neoclassical economics. During the study's entire time period, one of the economics papers cited most often by other disciplines is the classic article "Prospect Theory: An Analysis of Decision under Risk," by behavioral economists Daniel Kahneman and Amos Tversky.

Beyond the social sciences, other academic disciplines for which the researchers studied the influence of economics include four classic business fields -- accounting, finance, management, and marketing -- as well as computer science, mathematics, medicine, operations research, physics, public health, and statistics.

The researchers believe these "extramural" citations of economics are a good indicator of economics' scientific value and relevance.

"Economics is getting more citations from computer science and sociology, political science, and psychology, but we also see fields like public health and medicine starting to cite economics papers," Angrist says. "The empirical share of the economics publication output is growing. That's a fairly marked change. But even more dramatic is the proportion of citations that flow to empirical work."

Ellison emphasizes that because other disciplines are citing empirical economics more often, it shows that the growth of empirical research in economics is not just a self-reinforcing change, in which scholars chase trendy ideas. Instead, he notes, economists are producing broadly useful empirical research.

"Political scientists would feel totally free to ignore what economists were writing if what economists were writing today wasn't of interest to them," Ellison says. "But we've had this big shift in what we do, and other disciplines are showing their interest."

It may also be that the empirical methods used in economics now more closely match those in other disciplines as well.

"What's new is that economics is producing more accessible empirical work," Hill says. "Our methods are becoming more similar ... through randomized controlled trials, lab experiments, and other experimental approaches."

But as the scholars note, there are exceptions to the general pattern in which greater empiricism in economics corresponds to greater interest from other fields. Computer science and operations research papers, which increasingly cite economists' research, are mostly interested in the theory side of economics. And the growing overlap between psychology and economics involves a mix of theory and data-driven work.

In a big country

Angrist says he hopes the paper will help journalists and the general public appreciate how varied economics research is.

"To talk about economics is sort of like talking about [the United States of] America," Angrist says. "America is a big, diverse country, and economics scholarship is a big, diverse enterprise, with many fields."

He adds: "I think economics is incredibly eclectic."

Ellison emphasizes this point as well, observing that the sheer breadth of the discipline gives economics the ability to have an impact in so many other fields.

"It really seems to be the diversity of economics that makes it do well in influencing other fields," Ellison says. "Operations research, computer science, and psychology are paying a lot of attention to economic theory. Sociologists are paying a lot of attention to labor economics, marketing and management are paying attention to industrial organization, statisticians are paying attention to econometrics, and the public health people are paying attention to health economics. Just about everything in economics is influential somewhere."

For his part, Angrist notes that he is a biased observer: He is a dedicated empiricist and a leading practitioner of research that uses quasiexperimental methods. His studies leverage circumstances in which, say, policy changes random assignments in civic life allow researchers to study two otherwise similar groups of people separated by one thing, such as access to health care.

Angrist was also a graduate-school advisor of Esther Duflo PhD '99, who won the Nobel Prize in Economics last fall, along with MIT's Abhijit Banerjee -- and Duflo thanked Angrist at their Nobel press conference, citing his methodological influence on her work. Duflo and Banerjee, as co-founders of MIT's Abdul Latif Jameel Poverty Action Lab (J-PAL), are advocates of using field experiments in economics, which is still another way of producing empirical results with policy implications.

"More and more of our empirical work is worth paying attention to, and people do increasingly pay attention to it," Angrist says. "At the same time, economists are much less inward-looking than they used to be."

Timely treatment is critical for stroke victims, yet only 19.8% of the U.S. population can access a stroke center capable of endovascular thrombectomy to remove a large clot in 15 minutes or less by ambulance, according to researchers from The University of Texas Health Science Center at Houston (UTHealth). Only 30% of Americans can access a thrombectomy-equipped center in 30 minutes.

The study, published in Stroke, assessed the current state of access to endovascular thrombectomy treatment in the U.S. and evaluated two different strategies to optimize it.

Stroke is the leading cause of long-term disability and fourth-leading cause of death in the world. An ischemic stroke, caused by a blockage of an artery, is the most common form. Endovascular thrombectomy can be performed to remove a clot lodged in a blood vessel with a mechanical device threaded through an artery. Research shows it is an effective treatment for improving clinical outcomes in stroke up to 24 hours from onset, but currently not everyone can have it done.

"This is a significant unmet need in stroke care, as the majority of stroke patients may not have a timely access to thrombectomy, a highly effective treatment," said Amrou Sarraj, MD, lead author and associate professor of neurology at McGovern Medical School at UTHealth. Sarraj is also a member of the UTHealth Institute for Stroke and Cerebrovascular Disease.

One strategy, the flipping model, would convert a percentage of hospitals within geographic areas to be endovascular thrombectomy-capable. The second method, the bypassing model, would transport patients directly to hospitals capable of thrombectomy, bypassing facilities that aren't when the reroute would take less than 15 minutes.

The 15-minute bypassing model improved access by 16.7%, meaning about 51.7 million more people would be able to have an endovascular thrombectomy procedure in a timely manner. This model is also easier and more cost-effective to implement, according to the authors.

"The bypassing model would alter current stroke treatment paradigms, which still emphasize taking patients to the closest hospital with the ability to administer clot-busting tissue plasminogen activator (tPA) intravenously, regardless of their thrombectomy capability. It would be an optimal solution for resource-strapped areas, because it leverages the existing infrastructure by triaging patients with large strokes in the field to take them directly to a hospital capable of thrombectomy," Sarraj said.

The flipping model, which equips 10% of the most impactful hospitals to do thrombectomies, improved 15-minute access by 7.5%, and would work best in areas with more plentiful stroke care resources.

"The flipping approach emphasizes infrastructure development. When ample resources are available, this may result in providing access in areas that are currently devoid of thrombectomy services. While each approach has pros and cons, both strategies represent a tremendous opportunity to improve the current access to thrombectomy, which would result in significant stroke care improvement," Sarraj said.

The research is the first comprehensive assessment of the status of patient access to thrombectomy in the contemporary era, and it is necessary to know how to effectively improve access in the future, Sarraj said.

"While randomized trials are ongoing for better triage of stroke patients, a few states have already implemented legislation for bypassing hospitals without thrombectomy capability. Having more neuro-interventionalists trained and hospitals with the capability to perform thrombectomy would also help increase access. We hope to see more happening on both fronts in the near future to improve stroke care," Sarraj said.

RESEARCH TRIANGLE PARK, N.C. -- A new computational model could be used to expedite military operations aimed at evacuating civilians during disaster response or humanitarian relief.

Researchers at North Carolina State University, with funding from the U.S. Army, designed a new model to help planners and logisticians determine what needs to be where and at what time in order to complete an evacuation as quickly as possible. This includes where vehicles need to be when, and routing alternatives as well as supply requirements by location over time for food, water and shelter.

"What sets this tool apart from other models is that it is designed for use in both planning and during operations," said Brandon McConnell, corresponding author of a paper on the new model and a research assistant professor in NC State's Edward P. Fitts Department of Industrial and Systems Engineering. "In terms of specificity, we're talking about where a given truck will be at any point in time during an operation."

The research, published in the Journal of Defense Analytics and Logistics, focuses on noncombatant evacuation operations in the Republic of Korea; however, it could be used in a wide variety of scenarios.

"The tool will need fine-tuning before it can be implemented -- it would benefit from a user-friendly interface, for one thing -- but it highlights the potential that operational models have for helping the military achieve its objectives both in or out of wartime," said Dr. Joseph Myers, mathematical sciences division chief at the Army Research Office, an element of U.S. Army Combat Capabilities Development Command's Army Research Laboratory.

The Army Research Office funded this research through a short-term innovation research grant that explores proof-of-concept ideas in a nine-month period.

The authors said this research will provide military logistics planners with capabilities that are currently lacking in prevalent logistics planning tools. The project lays the mathematical and operations research foundation for the development of a network-based model that captures routing alternatives and characterizes the solutions to conduct capacity planning and resiliency analysis in near-real time.

"There is a tremendous amount of complexity associated with the Army's South Korea noncombatant evacuation mission, and that presents a great opportunity for investigation and improvement," said U.S. Army Capt. John Kearby, first author of the paper and a former NC State graduate student. "The goal of this research was, and is, to encourage the development of better and more robust evacuation plans."

Kearby is currently a U.S. Military Academy instructor, but previously served in Korea as an engineer company commander.

"The existing simulation models are both sophisticated and detailed -- they have been valuable tools for helping us study operations like these," McConnell said. "However, they're not designed to respond to rapidly changing scenarios. The new model can operate in near-real time, making it operationally relevant. After all, even the best plans need at least minor modifications during execution."