Culture

LOS ANGELES (May 31, 2021) -- Today The Lundquist Institute announced that its investigators contributed data from several studies, including data on Hispanics, African-Americans and East Asians, to the international MAGIC collaboration, composed of more than 400 global academics, who conducted a genome-wide association meta-analysis led by the University of Exeter. Now published in Nature Genetics, their findings demonstrate that expanding research into different ancestries yields more and better results, as well as ultimately benefitting global patient care. Up to now nearly 87 percent of genomic research of this type has been conducted in Europeans.

"We are very excited about contributing to this global study," said Dr. Jerome I. Rotter, Investigator and Director of the Institute for Translational Genomics and Population Sciences at The Lundquist Institute and Professor of Pediatrics and Human Genetics at the Geffen School of Medicine at UCLA. "It is highly significant that this global study is multi-ethnic and trans-ethnic. Such multi-ethnic studies are a major strength and focus of the cardiometabolic genomic epidemiology at The Lundquist. Our studies examine type 2 diabetes, coronary artery disease, hypertension, cardiac arrhythmias, and fatty liver, as well as studying their risk factors and related traits such as insulin resistance, dyslipidemia, and obesity."

The global study team analyzed data across a wide range of cohorts, encompassing more than 280,000 people without diabetes. Researchers looked at glycemic traits, which are used to diagnose diabetes and monitor sugar and insulin levels in the blood.

The researchers incorporated 30 percent of the overall cohort with individuals of East Asian, Hispanic, African-American, South Asian and sub-Saharan African origin. By doing so, they discovered 24 more loci - or regions of the genome - linked to glycaemic traits than if they had conducted the research in Europeans alone.

Professor Inês Barroso, of the University of Exeter, who led the research, said: "Type 2 diabetes is an increasingly huge global health challenge - with most of the biggest increases occurring outside of Europe. While there are a lot of shared genetic factors between different countries and cultures, our research tells us that they do differ, in ways that we need to understand. It's critical to ensuring we can deliver a precision diabetes medicine approach that optimizes treatment and care for everyone."

First author Dr. Ji Chen, of the University of Exeter, said: "We discovered 24 additional regions of the genome by including cohorts which were more ethnically diverse than we would have done if we'd restricted our work to Europeans. Beyond the moral arguments for ensuring research is reflective of global populations, our work demonstrates that this approach generates better results."

The team found that though some loci were not detected in all ancestries, they were still useful to capture information about the glycaemic trait in that ancestry.

Co-author Cassandra Spracklen, Assistant Professor at the University of Massachusetts-Amherst, said: "Our findings matter because we're moving towards using genetic scores to weigh up a person's risk of diabetes. We know that scores developed exclusively in individuals of one ancestry don't work well in people of a different ancestry. This is important as increasingly healthcare is moving towards a more precise approach. Failing to account for genetic variation according to ancestry will impact our ability to accurately diagnose diabetes."

Gender roles absorbed at an early age seem to have shaped today's youth regarding their involvement in politics, in line with traditional stereotypes, concludes a new study, conducted amongst adolescents and young adults aged between 15 and 30 in Italy, within the Horizon 2020 project: "CATCH-EyoU. Processes in Youth's Construction of Active EU Citizenship".

In their research article, published in the peer-reviewed, open-access scientific journal Social Psychological Bulletin, the research team from the University of Bologna report that it is young males that would more often engage directly with politics, like enrolling in a political party, acting to influence government policy, contacting a politician or taking part in a protest. On the other hand, young females would rather opt for civic activities, such as volunteering, charities, religious-based initiatives, boycotting etc.

Interestingly, previous research has attributed the higher level of political participation amongst males to women generally having lower incomes and access to education, as well as the fact they are generally busier with housework and caring for the family. However, by controlling for educational and socioeconomic background, the new study concludes the reason behind the gender gaps is rather the roles the society has been instilling in the survey's participants from an early age.

The researchers explain that, culturally, traits like autonomy, leadership, self-affirmation and dominance are seen as manlike, and as such, they are taught to boys through all possible channels, including family, school, peers and the media. As a result, later on, these boys are likely to feel more confident in expressing their political views and taking actions to defend them.

"The findings suggest that reducing the gender gap in political participation requires to give girls from an early age the opportunity to exercise leadership, experience a sense of agency and gain a critical awareness of the constraints and barriers they face as women to overcome them. Educational programs on gender equality, Youth Participatory Action Research, and girls' empowerment projects may serve to this scope," comment the authors of the study.

Nevertheless, gender gaps in voter turnout are effectively non-existing, according to the study. This has been true for the last European parliamentary elections, national parliamentary elections, and local elections. In fact, in Italy, gender gaps in voter turnout have been negligible ever since women were allowed to vote.

However, the reasons why women and men vote might be quite different, speculate the researchers. While men might have the desire to cast their votes simply because it's a logical part of their political behaviour, in women, it might rather be a case of exercising the stereotypical role of a woman, associated with stronger feelings for civic duty, conscientiousness and proneness to abiding by the rules.

"Studying youth engagement is highly informative because participation at a young age is conducive to future engagement in one's life course," says the team in conclusion. "Future research should further examine the evolution of gender differences over time, their causes and effects among younger generations, as well as their impact on political equality."

"While the current era of the #metoo movement suggests that gender dynamics may be undergoing new and promising social changes toward greater female involvement, the existing data on the persistence of gender gaps in participation among youth--also confirmed by our results--poses important questions on the factors that determine differential preferences for specific typologies of actions by men and women."

Pollution from manufacturing is now widespread, affecting all regions in the world, with serious ecological, economic, and political consequences. Heightened public concern and scrutiny have led to numerous governments considering policies that aim to lower pollution and improve environmental qualities. Inter-governmental agreements such as the Paris Agreement and the United Nations' Sustainable Development Goals all focus on lowering emissions of pollution. Specifically, they aim to achieve a "zero-emission society," which means that pollution is cleaned up as it is produced, while also reducing pollution (This idea of dealing with pollution is referred to as the "kindergarten rule.")

Of course, any efforts to achieve this goal require monetary investment and changes to manufacturing strategies, which, many worry, could hurt the economy. Now, a modeling study conducted by researchers from Tokyo University of Science and The Shoko Chukin Bank, Japan, published in the Journal of Cleaner Production, shows that it is possible to achieve economic growth simultaneously with environmental preservation. "There are existing models that look at how economies fluctuate under various conditions, such as differing environmental quality or tax rates, but these models haven't examined the effects of implementing the kindergarten rule," Prof. Hideo Noda, the study's lead author, explained. "So we thought it was important to extend the model and include a condition where the hypothetical society spends a part of its GDP to achieve zero emissions. Looking at emissions is also more tangible and easier to grasp than a vaguer concept of 'environmental quality.'"

The researchers used an economic model that allows for movement back and forth between two stages: a no-innovation phase and an innovation phase. The key to this model is the importance of innovation; previous models that focus on the environment and the economy did not account for innovation (e.g., research and development) as a major driver of economic growth in most developed nations. Acknowledging this connection is essential for improving our knowledge regarding how environmental problems and economic growth are linked.

When researchers included rules for the zero-emission society, the model indicated that it was compatible with economic growth (i.e., a sustained GDP growth), despite a portion of the GDP being dedicated to reducing pollution. For this to work, however, the model says that the GDP needs to be above a certain level. Additionally, the amount of GDP allocated to lowering pollution must be flexible. Researchers also observed that under the no-innovation phase, GDP growth is higher and the amount spent on pollution reduction decreases faster. In contrast, under the innovation phase, GDP growth is lower and the decrease in amount spent combating pollution is also slower.

According to Prof. Noda, this work provides important theoretical groundwork for policy, because currently, the relationship between zero emissions and economic growth isn't well understood. "Yet, this topic is extremely relevant to any policy push for sustainability--for example, one section of the UN's Sustainable Development Goals explicitly focuses on economic growth," he explains. "Our model should help persuade the leaders of some countries that it is feasible to reduce emissions without tanking the economy."

That, Prof. Noda hopes, may in turn make leaders more eager to implement the changes that are urgently needed to address global environmental crises like climate change.

It is time for the management and conservation of the Antarctic to begin focusing on responsibility, rather than rights, through an Indigenous Māori framework, a University of Otago academic argues.

In an article published in Nature Ecology & Evolution, Associate Professor Priscilla Wehi, of the Centre for Sustainability, says now is the time to be thinking of these potential changes.

"New Zealand is currently re-setting its priorities for future Antarctic research, and there may be review of the current international environmental conventions as we approach the 50-year anniversary of the protocols in 2048.

"We argue that Indigenous Māori frameworks offer powerful ways of thinking about how we protect the Antarctic, by focusing on responsibilities rather than rights, including the responsibilities we have to future generations," she says.

Antarctica is unlike any other place on earth - it is remote, there are no permanent human settlements, and no one nation has sovereignty.

"Consensus decision making by Antarctic Treaty nations will determine what happens next, but within that group there are many different interests and perspectives on what should happen, from mining rights through to ecosystem protection.

"Global conceptions of Antarctica are dominated by colonial narratives. On the other hand, an Indigenous Māori framework, focussing on relational thinking and connectedness, humans and non-human kin, and drawing on concepts of both reciprocity and responsibility, offers transformational insight into true collective management and conservation of Antarctica.

"Because mātauranga has a foundation where relationships between different parts of the universe, between humans and other living beings, and so on, are acknowledged and embedded, this is a very different way of examining the world and offers a different perspective on what we could - or even should - do next."

The article brings together mostly Indigenous researchers from Otago, Massey University, and Te R?nanga o Ngāi Tahu and is the first paper to bring Indigenous frameworks to the issue of what an Antarctic future might look like, Associate Professor Wehi says.

Human navigation into Antarctic waters dates back to about the 7th century with Hui Te Rangiora. Accounts of a frozen ocean and enormous ice cliffs were passed down through generations.

Observing and recording changes in the physical environment, naming and classifying areas of risk, and predicting environmental disturbance are critical for voyages like those of Hui Te Rangiora.

"Incorporating Indigenous environmental knowledge enhances our ability to understand, monitor, plan for, and adapt to weather and climate variability, but can also offer alternate frameworks from which to enhance practice," she says.

"Recognizing the intrinsic link between the well-being of tangata and whenua, Māori have an intergenerational obligation to ensure that the relationship with Antarctica is reciprocal and sustainable."

Co-author Associate Professor Krushil Watene, of Massey University, says Antarctica is one of the most important and one of the most fascinating places on Earth - both for science and philosophy.

"Antarctica challenges our perspectives, unsettles them and in doing so provides us with opportunities to reimagine our lives together, to reimagine our relationships with the natural environment, and to rethink our responsibilities globally.

"We need to urgently prompt thinking and discussion around the deep reflection and transformative change that Antarctica challenges us, as a global community to undertake. We need to be bold and brave in charting a future in which our planet can thrive. Philosophy generally, and indigenous philosophy in particular, brings important and valuable perspectives through which such futures can be charted," she says.

Debates over women's health have long been contentious, but have also resulted in significant improvements in areas like equitable access to health care and survivorship. But the overall picture remains far from perfect. For example, the United States still has the highest rate of maternal death among high-income countries, particularly among African American women.

As the United States Supreme Court prepares to hear a Mississippi abortion case challenging the landmark 1973 Roe v. Wade decision, some experts are questioning whether women's health may be reversing course.

Cynthia A. Stuenkel, MD, clinical professor of medicine at University of California San Diego School of Medicine, and JoAnn E. Manson, MD, DrPH, professor of epidemiology at Harvard T.H. Chan School Of Public Health, review 50 years of progress in women's health in a perspective article published in the May 29, 2021 online issue of the New England Journal of Medicine.

"Reproductive justice is broader than the pro-choice movement and encompasses equity and accessibility of reproductive health care, as well as enhanced pathways to parenthood," wrote the authors.

In addition to Roe v. Wade, advances in reproductive health include:

1972 US Supreme Court ruling on Eisenstadt vs Baird ensuring unmarried persons equal access to contraception
2010 Affordable Care Act made contraceptives an insured preventive health benefit
Advances in reproductive technologies, including in vitro fertilization, genetic testing and fertility preservation by cancer specialists

Advances in women's health go beyond reproduction, said the authors. As interest and focus has expanded to all stages of a woman's life, science has begun to catch up to the specialized needs of women and sex-specific risk factors for chronic diseases that disproportionately affect women's health, such as autoimmune diseases, mental health, osteoporosis and coronary heart disease.

Progress in breast cancer care and prevention yielded a five-year overall survival rate of 90 percent
The human papillomavirus (HPV) vaccine reduced cervical cancer mortality decreased by 50 percent

"Moving forward, it will be essential to recognize and study intersectional health disparities, including disparities based on sex, race, ethnicity, gender identity, sexual orientation, income and disability status. Overcoming these challenges and addressing these inequities will contribute to improved health for everyone," wrote the authors.

Tokyo, Japan - Researchers from Tokyo Metropolitan University have enhanced "super-resolution" machine learning techniques to study phase transitions. They identified key features of how large arrays of interacting "particles" behave at different temperatures by simulating tiny arrays before using a convolutional neural network to generate a good estimate of what a larger array would look like using "correlation" configurations. The massive saving in computational cost may realize unique ways of understanding how materials behave.

We are surrounded by different states or "phases" of matter i.e. gases, liquids, and solids. The study of phase transitions, how one phase transforms into another, lies at the heart of our understanding of matter in the universe, and remains a hot topic for physicists. In particular, the idea of universality, where wildly different materials behave in similar ways thanks to a few shared features, is a powerful one. That's why physicists study model systems, often simple grids of "particles" on an array that interact via simple rules. These models distill the essence of the common physics shared by materials and, amazingly, still exhibit many of the properties of real materials, like phase transitions. Due to their elegant simplicity, these rules can be encoded into simulations that tell us what materials look like under different conditions.

However, like all simulations, the trouble starts when we want to look at lots of particles at the same time. The computation time required becomes particularly prohibitive near phase transitions, where dynamics slows down, and the "correlation length," a measure of how the state of one atom relates to the state of another some distance away, grows larger and larger. This is a real dilemma if we want to apply these findings to the real world: real materials generally always contain many more orders of magnitude of atoms and molecules than simulated matter.

That's why a team led by Professors Yutaka Okabe and Hiroyuki Mori of Tokyo Metropolitan University, in collaboration with researchers in Shibaura Institute of Technology and Bioinformatics Institute of Singapore, have been studying how to reliably extrapolate smaller simulations to larger ones using a concept known as an inverse renormalization group (RG). The renormalization group is a fundamental concept in the understanding of phase transitions and led Wilson to be awarded the 1982 Nobel Prize in Physics. Recently, the field met a powerful ally in convolutional neural networks (CNN), the same machine learning tool helping computer vision identify objects and decipher handwriting. The idea would be to give an algorithm the state of a small array of particles and get it to "estimate" what a larger array would look like. There is a strong analogy to the idea of super-resolution images, where blocky, pixelated images are used to generate smoother images at a higher resolution.

The team has been looking at how this is applied to "spin" models of matter, where particles interact with other nearby particles via the direction of their "spins." Previous attempts have particularly struggled to apply this to systems at temperatures above a phase transition, where configurations tend to look more random. Now, instead of using spin configurations i.e. simple snapshots of which direction the particle spins are pointing, they considered correlation configurations, where each particle is characterized by how similar its own spin is to that of other particles, specifically those which are very far away. It turns out correlation configurations contain more subtle queues about how particles are arranged, particularly at higher temperatures.

Like all machine learning techniques, the key is to be able to generate a reliable "training set". The team developed a new algorithm called the block-cluster transformation for correlation configurations to reduce these down to smaller patterns. Applying an improved estimator technique to both the original and reduced patterns, they had pairs of configurations of different size based on the same information. All that's left is to train the CNN to convert the small patterns to larger ones.

The group considered two systems, the 2D Ising model and the three-state Potts model, both key benchmarks for studies of condensed matter. For both, they found that their CNN could use a simulation of a very small array of points to reproduce how a measure of the correlation g(T) changed across a phase transition point in much larger systems. Comparing with direct simulations of larger systems, the same trends were reproduced for both systems, combined with a simple temperature rescaling based on data at an arbitrary system size.

A successful implementation of inverse RG transformations promises to give scientists a glimpse of previously inaccessible system sizes, and help physicists understand the larger scale features of materials. The team now hopes to apply their method to other models which can map more complex features such as a continuous range of spins, as well as the study of quantum systems.

Five researchers shed new light on a key argument to reduce greenhouse gases (GHG): they provided the first economic analysis of conversion factors of other GHG like methane into their CO2 equivalent in overshoot scenarios. Although the United Nations Framework Convention on Climate Change (UNFCCC) considers settling for one value of reference (known as "Common Metric") to make this conversion among the Paris Agreement, the models presented here show the economic advantage of flexibility between various factors of conversion. "A key notion in the UNFCCC is to reduce GHG emissions in the least costly way so as to ensure global benefits" highlights Katsumasa Tanaka, primary author of the Science Advances study.

The research provides series of dynamic variations of conversion factors depending on possible trajectories of global warming to lessen the economic cost while maintaining some stability to anticipate the implementation of policies. They took into consideration different scenarios, one in which we reach the Paris Agreement's objectives of stabilization at 2°C and 1.5°C and others in which we would overshoot these objectives and need to strengthen efforts later on. These overshoot scenarios are a violation of the Paris Agreement, but the authors argued that such possibilities cannot be ruled out, in view of the near-term climate policies currently. They further noted that the feasibility of these scenarios still depends on very deep mitigation needed later in this century. They applied conversion factors in the numerical model and simulated the additional mitigation costs in all these scenarios to target the most favourable values.

The choice of a common conversion factor

A conversion system into CO2 equivalent is used to determine the participation of different GHG on a given time to prioritize actions. A well-known example is the global warming potential (GWP). To enable comparison among the parties of the Paris Agreement, the 100-year global warming potential (GWP100) was chosen as a reference. Greenhouse gases having very different lifespan and radiative impact, this conversion system is dependent on the choice of a time horizon.

"With GWP100 we look at the cumulative greenhouse effect on a 100-year period, which for methane gives a conversion factor of 28. This means 1 kilogram of methane is 28 times more potent than a kilogram of CO2" explains Johannes Morfeldt, a collaborator of this study joined from Sweden. Yet, since methane has a shorter lifespan and a higher radiative impact than CO2, the cumulative effect on 20 years (GWP20) is much more significant: 84 times more than 1 kilogram of CO2.

Changing the time horizon changes the conversion factor, and therefore influences which gas gets high on the agenda. If a kilogram of methane is 84 times more important than one of CO2, it will be more efficient to lower the global emissions by reducing methane. A debate is in motion since the nineties regarding which conversion factor should be used, and this team of researchers meant to bring additional information on their economic cost in light of possible pathways of global warming.

"We realized with our model that GWP100 is good for the coming decades, but is far from ideal in the long run" says Philippe Ciais, one of the co-authors of the study. "We don't see much variation in an optimal scenario of stabilization at 2°C. But in the event of an overshoot scenario we observe a high discrepancy among ideal conversion factors for today and when we reach 2°C of global warming. If we do not have a dynamic approach to change these values along the way, then society will bear an additional cost to mitigate climate change" adds Olivier Boucher, another co-author.

An optimal agenda

The researchers then modelled these additional costs to estimate which conversion factor would be ideal at a given time for different temperature trajectories. They showed that setting in stone GWP100 would bring about additional mitigation costs that could be avoided by switching to a dynamic factor. In a scenario of stabilization at 2°C these additional costs round up near 2%, but in high overshoot scenarios it goes up to 5%. "This shows that the ideal factors of conversion depend on a time horizon but are also primarily determined by the pathway, and strongly influenced by a temperature overshoot" underlines Daniel Johansson, a Swedish co-author.

This study shows that adapting to possible trajectories by switching from GWP100 to shorter time-horizons in the future could spare additional mitigation costs compared to the sole use of GWP100. The researchers also understand that these values cannot continuously change to enable policies to be anticipated and implemented. Thus, they put forward series of simple combinations of cost-effective conversion factors depending on the possible pathways. The authors suggest that "the UNFCCC and Parties to the Paris Agreement consider adapting the choice of conversion factors to the future pathway as it unfolds, to implement the cheapest options to reduce greenhouse gases emissions."

As we do not know yet the long-term pathway, the matter of the cost-effectiveness could be included in the technical assessment supporting the global stocktake within the UNFCCC. This key element of the Paris Agreement evaluates every five years the countries' collective progress toward long-term goals and aims at increasing the level of ambition of national policies. An inclusion of cost-effectiveness of factors of conversion on this recurring stocktaking process could allow the necessary assessment in time to inform following sessions as the long-term pathway unfolds.

A study coordinated by Luís Graça, principal investigator at the Instituto de Medicina Molecular João Lobo Antunes (iMM; Portugal) and Professor at the Faculty of Medicine of the University of Lisbon (FMUL) used lymph nodes, tonsils and blood, to show how the cells that control production of antibodies are formed and act. The results published now in the scientific journal Science Immunology* unveiled key aspects about the regulation of antibody production, with significant importance for diseases where antibody production is dysregulated such as autoimmune diseases or allergies.

In the last few months we witnessed the importance of vaccine-induced antibody protection against infections like COVID-19. However, it has been very difficult to study the human cells involved in the production of antibodies after vaccination, as this process takes place in the lymph nodes and not in the blood. To study this process, it was necessary to use emerging technologies for the sequencing and identification of genes in each individual cell. "To understand the power of this technology, we must note that all of our cells have the same genes. However, a cell like a lymphocyte uses a different combination of genes compared to a neuron. Thus, after vaccination, when a lymphocyte starts the process of controlling the production of antibodies, it will turn on some genes and turn off others. This is what we studied for hundreds of cells simultaneously", explains Luís Graça.

The difficulty of the process can be appreciated if we remember that about 20 years ago the sequencing of the human genome required a large group of laboratories in several countries benefiting from a series of further developments for over 10 years. Now, this sequenced genome is available for scientists to study the activity of genes in hundreds of independent cells. Something that would have been impossible a few years ago. Saumya Kumar, the first author of the work, says: "When the study started four years ago, we did not have the experimental tools needed and the advances in technology have been extraordinary. Using omics technology offered an incredible solution to this problem and we ended up using it".

The information thus obtained allowed the researchers to study, in great detail, the genes and molecules involved in regulating the production of antibodies. In this way, a wide range of opportunities open up to attempt the manipulation of some of these molecules for enhanced production of antibodies in vaccines, or to decrease the production of antibodies in diseases caused by them (such as autoimmunity or allergy).

In the words of Luís Graça: "When the biological systems of our organism are not properly regulated, disease arises. It is the knowledge of the organism's regulation that allows to correct these pathological situations restoring the healthy balance of a well regulated system".

This study also demonstrates that science has no boundaries: the group at iMM includes scientists from different nationalities, with different skills, from clinicians to bioinformaticians.

Highlight

Among individuals with healthy kidneys, those with more frequent depressive symptoms were more likely to show signs of rapid kidney function decline over a median follow-up of 4 years.

Washington, DC (May 28, 2021) -- In a study of adults with normal kidney function, those who had frequent depressive symptoms were more likely to later experience a rapid decline in kidney function. The study will appear in an upcoming issue of CJASN.

Depression is a common condition in middle-aged and older adults, and it can contribute to a variety of mental and physical problems. Previous research has found a link between depressive symptoms and rapid kidney function decline in patients with chronic kidney disease (CKD). To look for a potential link in adults with normal kidney function as well, a team led by Xianhui Qin, MD (Nanfang Hospital, Southern Medical University, in China) examined information on 4,763 individuals with healthy kidneys when they enrolled in the China Health and Retirement Longitudinal Study (CHARLS).

At the start of the study, 39% of participants had high depressive symptoms, and during a median follow-up of 4 years, 260 (6%) participants experienced rapid kidney function decline. There was a significant association between depressive symptoms at the start of the study and rapid decline in kidney function during follow-up. Participants with frequent depressive symptoms were 1.4-times more likely to experience rapid kidney function decline than participants with infrequent depressive symptoms, after adjustments.

"CKD is a leading risk factor for cardiovascular disease, kidney failure, and mortality worldwide. Therefore, the identification of more modifiable risk factors may possibly reduce the huge burden of CKD and its related complications by leading to early detection and prevention," said Dr. Qin. "While our study does not show causality, it demonstrated that high depressive symptoms were significantly associated with rapid decline in kidney function among Chinese adults with normal kidney function. If further confirmed, our data provide some evidence for depressive symptom screening and effective psychosocial interventions to improve the prevention of CKD."

An accompanying Pantiet Voice article provides the perspective of a two-time kidney transplant recipient with an American-Born Chinese background.

What The Study Did: Socioeconomic disparities in respiratory health over the past six decades in the United States are described in this study.

Authors: Adam W. Gaffney, M.D., of the Cambridge Health Alliance in Cambridge, Massachusetts, is the corresponding author.

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

(doi:10.1001/jamainternmed.2021.2441)

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

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What The Study Did: Study results suggest that reinfections are rare events and that patients who have recovered from COVID-19 have a lower risk of reinfection. However, the observation ended before SARS-CoV-2 variants began to spread, and it is unknown how well natural immunity to the wild-type virus will protect against variants. .

Authors: Nicola Mumoli, M.D., of the Ospedale Fornaroli in Magenta, Italy, is the corresponding author.

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(doi:10.1001/jamainternmed.2021.2959)

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What The Study Did: Researchers estimated the extent Medicare Part B medical services would have been subject to prior authorization under private insurance coverage policies and calculated the associated spending.

Authors: Aaron L. Schwartz, M.D., Ph.D., of the University of Pennsylvania in Philadelphia, is the corresponding author.

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(doi:10.1001/jamahealthforum.2021.0859)

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About JAMA Heath Forum: JAMA Health Forum has transitioned from an information channel to an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health and health care. The journal publishes original research, evidence-based reports and opinion about national and global health policy; innovative approaches to health care delivery; and health care economics, access, quality, safety, equity and reform. Its distribution will be solely digital and all content will be freely available for anyone to read.

As hospitals, insurance companies and policy makers seek to improve healthcare quality and reduce rising medical costs, one important metric used to assess clinicians hinges on how patients feel about their healthcare experience. Many healthcare providers and policy makers fear that increased pressure to please patients -- and ensure high satisfaction ratings as a result -- could lead to overuse of low-value care that doesn't provide any clinical benefit while unnecessarily ratcheting up medical bills.

But new research from the University of Chicago and Harvard Medical School may alleviate some of those concerns. The study, published May 28 in JAMA Internal Medicine, found no relationship between favorable patient ratings and exposure to more low-value care.

"Some believe that much low-value care is provided by doctors because they feel like they have to appease patients. This worry has become bigger as patient ratings are increasingly used in new payment models and public reporting of healthcare rankings," said lead author Prachi Sanghavi, PhD, Assistant Professor of Public Health Sciences at UChicago. "For example, if a patient asks for extra testing or screening when it's not medically indicated, should doctors worry they will be rated poorly if they don't comply? At the same time, physicians feel pressure to reduce unnecessary testing and procedures when possible, because they are wasteful and can lead to harm downstream."

At least one often-cited study supports the concern that a focus on patient ratings will lead to more low-value care, finding patients with higher satisfaction ratings had higher odds of inpatient admission, higher healthcare and prescription drug costs and higher mortality. This study implied that catering to patient satisfaction may lead to worse outcomes. But, Sanghavi says, these results are likely a reflection of the methods used in the study.

"The past research didn't adequately adjust for certain key factors, like how sick a patient might be, which could be a confounding factor," said Sanghavi. "For example, people who are chronically or terminally ill may use more care and may develop closer relationships with their doctors, which could in turn lead to higher patient satisfaction ratings."

In their new study, Sanghavi and her team examined data from the federal Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, which uses patient-provided observations to measure things like communication with a physician, timeliness of scheduling an appointment and time spent in the waiting room. They also analyzed Medicare claims to measure the amount of low-value care received by a physician's patient panel. Unlike past studies, the researchers' approach relied on sampling independence and little overlap between the patients in the CAHPS and claims datasets. With this innovative methodology, the researchers were able to eliminate patient-level, unconnected factors that could influence the results and gain a less-biased look at the relationship between patient satisfaction and low-value care exposure.

"While we found a wide range of low-value care across physician patient panels, there was no systematic association between low-value care exposure and favorable patient ratings," said Sanghavi. "So the physicians whose patients get more low-value care are not getting higher ratings."

These results, the investigators say, should help ease the concern that reducing the number of unnecessary care offerings will negatively impact patients' opinions of their physicians or healthcare organizations.

"In short, the concern is overblown," said study co-investigator Michael McWilliams, Professor of Health Care Policy at Harvard Medical School and a general internist at Brigham and Women's Hospital. "Whether it's because less wasteful physicians are adept at informing patients why a requested test or procedure is unnecessary, or because most low-value care is due to provider practice patterns and not patient demand, we should be reassured that we can tackle waste in the system without great patient backlash or flunking providers on their 'scorecards.'"

The researchers said they weren't surprised by the findings, since previous studies relied so heavily on anecdotal evidence.

"In fact, it is not settled whether patients even advocate for low-value services," Sanghavi said. "Either way, it is reasonable to imagine patients base their experience ratings on a range of quality dimensions and not just on how well their physicians give in to demands, should they be making them."

Understanding how patient experiences and ratings are impacted by the types of care they receive has important implications for future policies and funding models geared at reducing wasteful healthcare spending while improving the overall quality of care.

"These results should help alleviate the stress that physicians may feel around possibly leaving patients dissatisfied because they didn't do something the patient asked for," said Sanghavi. "It should also relieve pressure to provide unnecessary care in order to boost ratings."

MISSOULA - In bear country, it's normal to find bruins munching down on temptations left out by humans - from a backyard apple tree to leftovers in the trash bin - but these encounters can cause trouble for humans and bears alike. One method to reduce human-bear conflicts is to secure attractants like garbage and livestock feed.

While effective when implemented, this approach requires people to change their behavior, and that makes things a little more complicated.

University of Montana researchers recently published a new study in the Journal of Wildlife Management analyzing why landowners do or don't secure attractants in bear country. The results suggest that collective or socially motivated factors may be a missing and important piece of the puzzle for encouraging voluntary steps to secure attractants and improve wildlife-human coexistence. The researchers also offer suggestions for how wildlife managers might help increase these behaviors through improved messaging and outreach.

Social scientists in UM's Human Dimensions Lab, housed in UM's W. A. Franke College of Forestry and Conservation, classify human-wildlife interactions as a public-good, collective-action problem - a problem where solutions require contributions from many people and where people's actions affect others. For the study, they applied this theory in Montana's black bear and grizzly bear ranges to investigate how individual and collective factors work together to influence whether landowners secure bear attractants on their land.

"A collective-action problem requires the efforts of two or more individuals to solve," said Holly Nesbitt, a doctoral candidate in the College of Forestry and Conservation and the study's lead author. "We're arguing that securing bear attractants - that coexistence with wildlife - is a collective-action problem because you need multiple people - land owners specifically - to pull it off. Their actions protect themselves and their neighbors."

Nesbitt and her coauthors analyzed data from a 2018 survey of Montana landowners meant to understand their attitudes and behaviors related to bears. Among other questions, the survey asked people about their willingness to secure different attractants, like using bear-resistant garbage bins and removing bird feeders.

Researchers found that the most important factor in determining if a landowner would secure attractants was whether that landowner had talked to a wildlife professional.

"We think that landowners who have talked to a wildlife professional have received information more easily than those who haven't," Nesbitt said. "In theory, they have reduced the time costs of securing attractants, so we think that's why they are more likely to use bear-proof garbage cans, for example."

Other collective factors, like whether their neighbors secure attractants, and the existence of discussion networks (for example, how much social influence an individual has) were equally as important as individual factors like beliefs, age or gender.

"The fact that this is a collective-action problem - that we're in it together, that it needs all of us to solve it, that our behavior has impact on our neighbors, too - leads us to the conclusion that what people are doing around us matters and influences our own behavior," says UM Assistant Professor Alex Metcalf, a coauthor on the study.

The researchers hope the results help wildlife managers reimagine how they communicate with landowners.

For example, wildlife managers and outreach coordinators could potentially increase attractant securing behavior by emphasizing collective factors in addition to individual factors.

"With any sort of outreach or messaging to landowners, there's maybe another opportunity to lean on these other collective factors and include more normative messaging. It might be more effective," Nesbitt said. "Instead of saying, 'Bears are dangerous. Secure your attractants,' say, 'It's really important to your neighbors that you secure your attractants. Your neighbor is doing it, too.' Our data suggests that kind of messaging is likely to be more effective at promoting voluntary behaviors."

The researchers also say, based on the findings, that wildlife agencies would be justified in increasing their efforts to connect with landowners in person, as well as with members of the public who play an important role in discussion networks.

"Our wildlife professionals are critical in connecting with the public, playing an integral role in educating, listening and empowering landowners," said co-author Libby Metcalf, UM's Joel Meier Distinguished Professor of Wildland Management.

While large carnivore populations are decreasing across most of the globe, grizzly and black bear populations are increasing in Montana, offering a unique locale to study how humans and wildlife interact. Nesbitt and her co-authors say understanding how to manage conflict with large carnivores has never been more pressing.

"We need a more comprehensive understanding of how people behave in these situations, and it's often not as simple as we think," Alex Metcalf said.

ITHACA, N.Y. - A Cornell University-developed technology provides beekeepers, consumers and farmers with an antidote for deadly pesticides, which kill wild bees and cause beekeepers to lose around a third of their hives every year on average.

An early version of the technology ¬- which detoxified a widely-used group of insecticides called organophosphates - is described in a new study, "Pollen-Inspired Enzymatic Microparticles to Reduce Organophosphate Toxicity in Managed Pollinators," published in Nature Food. The antidote delivery method has now been adapted to effectively protect bees from all insecticides, and has inspired a new company, Beemmunity, based in New York state.

Studies show that wax and pollen in 98% of hives in the U.S. are contaminated with an average of six pesticides, which also lower a bee's immunity to devastating varroa mites and pathogens. At the same time, pollinators provide vital services by helping to fertilize crops that lead to production of a third of the food we consume, according to the paper.

"We have a solution whereby beekeepers can feed their bees our microparticle products in pollen patties or in a sugar syrup, and it allows them to detoxify the hive of any pesticides that they might find," said James Webb, a co-author of the paper and CEO of Beemmunity.

First author Jing Chen is a postdoctoral researcher in the lab of senior author Minglin Ma, associate professor in the Department of Biological and Environmental Engineering in the College of Agriculture and Life Sciences (CALS). Scott McArt, assistant professor of entomology in CALS, is also a co-author.

The paper focuses on organophosphate-based insecticides, which account for about a third of the insecticides on the market. A recent worldwide meta-analysis of in-hive pesticide residue studies found that, under current use patterns, five insecticides posed substantial risks to bees, two of which were organophosphates, McArt said.

The researchers developed a uniform pollen-sized microparticle filled with enzymes that detoxify organophosphate insecticides before they are absorbed and harm the bee. The particle's protective casing allows the enzymes to move past the bee's crop (stomach), which is acidic and breaks down enzymes.

Microparticles can be mixed with pollen patties or sugar water, and once ingested, the safe-guarded enzymes pass through the acidic crop to the midgut, where digestion occurs and where toxins and nutrients are absorbed. There, the enzymes can act to break down and detoxify the organophosphates.

After a series of in vitro experiments, the researchers tested the system on live bees in the lab. They fed a pod of bees malathion, an organophosphate pesticide, in contaminated pollen and also fed them the microparticles with enzyme. A control group was simultaneously fed the toxic pollen, without the enzyme-filled microparticles.

Bees that were fed the microparticles with a high dose of the enzyme had a 100% survival rate after exposure to malathion. Meanwhile, unprotected control bees died in a matter of days.

Beemmunity takes the concept a step further, where instead of filling the microparticles with enzymes that break down an insecticide, the particles have a shell made with insect proteins and are filled with a special absorptive oil, creating a kind of micro-sponge. Many insecticides, including widely-used neonicotinoids, are designed to target insect proteins, so the microparticle shell draws in the insecticide where it is sequestered inert within the casing. Eventually, the bees simply defecate the sequestered toxin.

The company is running colony-scale trials this summer on 240 hives in New Jersey and plans to publicly launch its products starting in February 2022. Products include microparticle sponges in a dry sugar medium that can be added to pollen patties or sugar water, and consumer bee feeders in development.

"This is a low-cost, scalable solution which we hope will be a first step to address the insecticide toxicity issue and contribute to the protection of managed pollinators," Ma said.