Culture

Black and Hispanic people and people with low incomes are more likely to live in areas at high risk of flooding from natural disasters than white and Asian people, according to a new study led by the University of Arizona.

The study also found that certain reforms to the federal government's widely used flood insurance program could be disproportionately burdensome to the same groups of people.

The findings come amid a record-breaking 2020 Atlantic hurricane season that has pummeled the southeastern United States. Hurricane Sally, which made landfall on Sept. 16, devastated parts of Alabama and Florida. Two days later, forecasters at the National Hurricane Center ran out of the 21 storm names, following the Latin alphabet, that it had decided on for this year. Scientists turned to the Greek alphabet, for only the second time ever, to name the following storms.

The study will be published in the November issue of the Journal of Environmental Economics and Management. Laura Bakkensen, an associate professor in the School of Government and Public Policy in the College of Social and Behavioral Sciences, was the paper's lead author. Bakkensen, an environmental economist, researches policy responses to natural disasters.

"We see a lot of news reports where sometimes poorer or minority-rich communities may feel greater losses," Bakkensen said. "Understanding whether that's happening and what might be driving that is really what got me interested in this."

A Database of Homebuyers' Choices

Bakkensen and her colleague Lala Ma at the University of Kentucky looked at four years of property sales data for nearly 50,000 homes in south Florida. The area has many properties prone to flooding, which made it a strong case study, Bakkensen said.

Bakkensen's study relied on individual property sales data linked with data on homebuyer ethnicity and income, providing a much more granular picture than many previous studies. This ultimately allowed researchers to get a clear idea of what factors played into homeowners' different choices about where to buy a house - or where not to buy a house.

"Flood risk house-by-house may be very different. My neighbor across the street from me might be at low risk but maybe I'm at a lower elevation and maybe I'm at high risk," Bakkensen said. "We wanted to be really careful to disentangle what is really flood risk versus a lot of other things that might correlate with flood risk in the data," such as proximity to the coastline, which is typically considered an amenity.

The key question from the data, Bakkensen said, became: How much would somebody be willing or able to pay to avoid living in a high flood-risk zone?

The answer was different depending on homebuyers' ethnicities, researchers found. The study reports that white and Asian people with low incomes would be willing or able to pay about $710 per year on average to avoid living in an area at high risk of flooding. Because Asian people accounted for only 2.5% of all the property sales data, they could not be separated as their own category. They were combined with white people because the two groups' average incomes were similar in the study's sample.

Among Black people, that number was around $500. Hispanic people, on average, were willing or able to pay an additional $618.

Predictably, the study found that the amounts homebuyers were willing or able to pay increased with their income levels.

The study notes that other factors beyond income - such as access to information about homes' flood risk - could explain why certain groups are able or willing to pay more than others to avoid flood risk. But determining that would require further research and additional data, Bakkensen said.

Reforming Flood Insurance Through Simulations

The study also sought to find ways to improve the National Flood Insurance Program, which has long been a target of reform by both political parties in Congress, Bakkensen said.

Under federal law, most lenders require flood insurance for homebuyers who are buying properties in areas at high risk for flooding. Due to a small market of private flood insurers, the federal program is the largest and most widely used, Bakkensen said.

But the seemingly competing missions at the core of the program - provide flood insurance and make it affordable for homebuyers - have made it difficult to fund, Bakkensen said. The program regularly borrows money from the Treasury Department to cover the cost of payouts.

Using the housing data and model results, Bakkensen and Ma ran simulations that predicted how certain proposals to reform the program could affect homebuyers. In one case, the researchers simulated removing two subsidy programs that make the insurance more affordable for homeowners.

They found the change would have disparately negative effects on homeowners of certain ethnicities. Removing the subsidies would cost white and Asian homeowners with low incomes only about 0.45% of their average annual incomes, compared to 0.55% of the average annual incomes for Black homeowners and 0.7% for Hispanic homeowners.

As homeowners' incomes increase, the cost of losing the subsidies took up less of their annual income, but the disparities for people of different ethnicities remain.

Another simulation took aim at the National Flood Insurance Program's flood risk maps, which are used by homeowners and officials to determine the flood risk of neighborhoods and homes in large sections of the U.S. But many of the maps are outdated, meaning the flood risk information in those maps is unreliable.

On average, Bakkensen and Ma found that updated maps provided significant value to homeowners, especially to lower income homeowners as a fraction of their income, and the researchers were able to translate those advantages into dollar figures. But the value fluctuated based on ethnicity: For white and Asian homeowners, revised maps provided an annual value of $144; that value was $70 for Hispanic homeowners and $60 for Black homeowners.

That finding alone has already raised eyebrows at the National Flood Insurance Program, Bakkensen said, where program staff have been trying to get an idea of the value of updating the maps.

The disproportionate costs of reforming the program to Black and Hispanic people and people with low incomes, Bakkensen said, were among the findings that surprised her the most. She had no pre-conceived notions, she added, about whether she would find disparities in reform outcomes.

"It was quite a striking finding, and I think it was an important one," Bakkensen said. "It shows that even with good-intentioned policy reform, we still have to be careful and do our due diligence to make sure there aren't unintended consequences that could cause harm to communities that may already experience a lot of harm from flooding and other natural disasters."

Bakkensen plans to expand her research to other areas of the country, as well as to renters, who were not included in this study. The new findings help illustrate just how differently certain groups of people experience natural disasters, she said.

"There's a lot of complexity to who's living in harm's way, and that's why we oftentimes see very different losses, or it can be an important contributing factor," Bakkensen added. "That's quite relevant for a lot of the hurricanes we're seeing this season."

Requirements for electronic health records are greater now than ever, and that burden is exacerbating the problem of physician burnout. However, there might be a solution: the medical scribe.

New research led by Neda Laiteerapong MD, Associate Professor of Medicine at the University Chicago Medicine, indicates the real value of adding this healthcare professional to a medical practice. It gives physicians more time to treat patients, add new ones, and schedule more return visits. This research also indicates that the initial cost of employing a medical scribe can be offset in a year or less, after which the possibility of increased profit follows.

"We did an economic evaluation, a pretty common technique for healthcare administrators," Laiteerapong said. "And we did it for a total of 30 specialties, plus physician assistants and nurse practitioners." The study was published October 6, 2020, in Annals of Internal Medicine.

The research assumed that every patient visit would be reimbursed by Medicare. Based on that, Laiteerapong and her team determined the number of additional visits needed to have 90% certainty of breaking even one year after hiring a scribe. However, most practices are made up of a combination of Medicare, Medicaid and privately insured patients, making it possible to reach that break-even point even sooner.

Studies show that physicians with scribes can increase their availability by as much as 20%, which is about the same amount of time that it takes to see the two or three additional patients.

"The idea that you have to see more patients can be really scary," Laiteerapong said. "But the idea is that you're actually spending that time more focused on the patient. A scribe allows doctors to focus on thinking and talking and listening, and not on the typing and clicking and ordering. I don't know anyone who became a doctor to do those things.

"We found that an average of 1.3 new patient visits per day was required to recover the cost of a scribe at the one-year point," Laiteerapong added. "And for returning patient visits, it's two or three patients per day."

The number of new patients or return visits needed to recoup costs varies depending on the type of specialty. It is lower for those who order a lot of lab testing and radiology (assuming the revenue from these tests are recovered by those physicians), and higher for others. A scribe makes that time more efficient and increases satisfaction for doctor and patient alike.

A 2018 University of Chicago study measured physician satisfaction with the scribe program in a primary care clinic. Participants reported greater satisfaction with clinic workflow when a scribe was present and that they no longer felt rushed.

The new study was completed before the new realities imposed on medical practices by COVID-19.

"Obviously, having an extra person in the room is not something that many physicians can do these days," Laiteerapong said. "But with modern technology, there can be a device in the room listening to the conversation and transmitting it electronically. So, a scribe working in another space can still have the notes 90% done when the physician leaves the room."

What it all comes down to, she said, is improved care, financial sustainability and outcomes.

"Scribes can help a practice add up to 20% more visits, which increases patient satisfaction," she said. "That is valuable to patients, who have increased access, and to providers who are able to do what they were trained to do, which is take care of patients, not paperwork."

"The Productivity Requirements of Implementing a Medical Scribe Program" was published October 6, 2020, in Annals of Internal Medicine. Additional authors are Tyler J. Miksanek, Sandra A. Ham, Wei Wei Lee and Valerie G. Press of the University of Chicago; Marie T. Brown of Rush University Medical Center; and M. Reza Skandari of Imperial College London. The study received funding from the University of Chicago Medicine Center for Healthcare Delivery Science and Innovation and the University of Chicago Bucksbaum Institute for Clinical Excellence.

Semiconductive photocatalysts that efficiently absorb solar energy could help reduce the energy required to drive a bioelectrochemical process that converts CO2 emissions into valuable chemicals, KAUST researchers have shown.

Recycling CO2 could simultaneously reduce carbon emissions into the atmosphere while generating useful chemicals and fuels, explains Bin Bian, a Ph.D. student in Pascal Saikaly's lab, who led the research. "Microbial electrosynthesis (MES), coupled with a renewable energy supply, could be one such technology," Bian says.

MES exploits the capacity of some microbes to take up CO2 and convert it into chemicals, such as acetate. In nature, chemolithoautotroph microbes metabolize minerals as a source of energy in a process that involves the shuttling of electrons. This capability can be exploited to turn CO2 into value-added products if the microbes are supplied with a stream of electrons and protons from anodic water splitting in an electrochemical cell (see image).

In their latest work, rather than focus on the CO2-to-acetate step, the team worked on reducing the energy input for molecular oxygen (O2) production at the anode, a reaction that keeps the overall cell in balance. "In MES systems, the process that consumes the most energy is believed to be the oxygen evolution reaction (OER)," Bian explains. Researchers have used light-capturing anode materials, such as titanium dioxide, that harness energy from sunlight to help drive the OER. In their current work, the team investigated a promising alternative for the photoanode, the light-harvesting material, bismuth vanadate.

Bismuth vanadate absorbed energy from a much broader range of the solar spectrum than titanium dioxide, making the whole MES cell more efficient, the team showed. "We obtained solar-to-acetate conversion efficiency of 1.65 percent, which is the highest reported so far," Saikaly says. "This efficiency is around eight times higher than the 0.2 percent efficiency of global natural photosynthesis, which is nature's solar-powered process for converting CO2 into energy-rich molecules," Bian notes.

So far the team has kept the microbe biocatalysts supplied with a steady stream of electrons and CO2 to sustain their growth. "The next step for us is to test our system under real sunlight and monitor the resilience of the biocatalysts under an intermittent renewable energy source," Saikaly says.

BOSTON - Across the U.S., the relaxation of statewide physical distancing measures that are designed to control the COVID-19 pandemic frequently resulted in an immediate reversal of public health gains against SARS-CoV-2, the virus that causes the disease, researchers from Massachusetts General Hospital (MGH) and colleagues reported.

Looking at data from all 50 states and the District of Columbia, the researchers found a gradual but steady decline in viral transmission rates during the eight weeks immediately preceding relaxation of physical distancing rules. But almost immediately after those rules were relaxed, most states reversed course. Eight weeks after restrictions were lifted or loosened, only nine of 51 still had low rates of transmission.

"Premature relaxation of social distancing measures undermined the country's ability to control the disease burden associated with COVID-19," writes Alexander C. Tsai, MD, investigator in the Department of Psychiatry at MGH and associate professor of Psychiatry at Harvard Medical School, and colleagues in the journal Clinical Infectious Diseases.

Tsai continues: "COVID-19 is disproportionately killing so-called essential workers, poorer people, and racialized minorities. In the absence of public health leadership at the federal level, these lockdowns are the best tool we have to slow transmission. But there are real costs to these lockdowns, costs that are again inequitably borne by so-called essential workers, poorer people, and racialized minorities, as well as children in public school programs who disproportionately miss out on school. So local governments need to continue to weigh the risks and benefits of these policies, and not be convinced that once you relax, there is no turning back."

The investigators previously reported that statewide physical distancing measures were associated with a reduction in the growth rate of COVID-19 cases in the U.S. and a short-term reduction in COVID-19 related deaths. Results of that study were published August 11, 2020 in the open-access journal PLOS Medicine.

"Essentially the moment those restrictions were released, those trends reversed," says Mark J. Siedner, MD, MPH, an investigator in the Division of Infectious Diseases at MGH, an associate professor of Medicine at Harvard Medical School (HMS), and senior author of the study.

The team found that this reversal occurred regardless of the type of restriction: school closings, restaurant/bar closings, workplace rules, limiting public events, closing of outdoor recreational facilities, and limits on in-state travel.

Tsai and colleagues used data from state governments and third-party sources and regression modeling to estimate the extent to which relaxation of physical distancing measures affected control of COVID-19, expressed as a value represented by the number Rt.

"Rt is the average number of people each person with COVID-19 will infect," Siedner says. "The goal of every public health intervention should be to get the Rt down to less than one, because if each person on average infects less than one other person, ultimately the epidemic will be extinguished."

The data showed that the Rt, averaged across jurisdictions, declined by 0.012 units per day in the eight weeks leading up to relaxation of restrictions, with 46 of the 51 jurisdictions studied achieving an Rt below one while the measures were in place.

After physical distancing regulations were relaxed, the transmission rate increased by an average of 0.007 units per day. Eight weeks into the relaxation period, the average Rt was 1.16, and only nine of the 51 jurisdictions had Rt rates that remained below one.

Siedner adds: "The hope was that these measures would lead to sustained changes in behavior: mask wearing and physical distancing. These data do not give us hope. Until a vaccine is available, these measures are proving to be the most effective solutions to contain epidemic hotspots."

DALLAS, Oct. 5, 2020 -- Having a spouse in a hospital's intensive care unit (ICU) may make a person more likely to have a heart attack or cardiac-related hospitalization themselves within a few weeks of the ICU admission, according to new research published today in the American Heart Association's flagship journal Circulation.

"Spouses of ICU patients should pay attention to their own physical health, especially in terms of cardiovascular disease," said the study's senior author Hiroyuki Ohbe, M.D., M.P.H., a Ph.D. student in the department of clinical epidemiology and health economics in the School of Public Health at The University of Tokyo in Japan. "The ICU can be a stressful environment with significant caregiving burdens, and spouses may face tough decisions about continuing or ending life-sustaining treatment."

"A patient's admission to ICU puts acute psychological stress on family members, and that stress may increase the risk for cardiovascular disease particularly for the other spouse," Ohbe said.

This study is the first to suggest ICU admission of a spouse may be a risk factor for cardiovascular disease events and hospitalization in the other spouse. According to previous research, about a quarter to one-half of family members of a critically ill patient experience symptoms of post-traumatic stress, anxiety and depression, known as "post-intensive care syndrome-family." Studies about bereavement have shown an increased risk of cardiovascular diseases particularly in the early weeks and months after a loved one has died, known as broken-heart syndrome (also called stress-induced cardiomyopathy or takutsobo cardiomyopathy).

Researchers matched spouses of patients admitted to the ICU for more than two days with people randomly selected from the Japan Medical Data Center database of 6 million inpatient and outpatient health insurance claims between January 2005 and August 2018.

Among 2.1 million people (just over one million married couples), more than 7,800 spouses of patients admitted to ICUs were matched with more than 31,000 people randomly selected from the database. The average age of the spouses was 54, and 35% were men. The two groups were matched for sex, age and medical insurance status.

Researchers evaluated data for any visit for cardiovascular disease, hospitalization for cardiovascular diseases and severe cardiovascular events. Compared to people without a spouse in the ICU, those with a husband or wife in the ICU:

had increased odds of having a cardiovascular event, such as chest pain, heart attack, stroke, irregular heart rhythm, heart failure or pulmonary embolism (a blood clot in the lungs) within a month; and

were more likely to be hospitalized for cardiovascular diseases and hospitalized for severe cardiovascular events.

Because the database includes only patients with employment health insurance, it may limit the ability to generalize the findings to other populations such as older adults or those without insurance. The findings should also be applicable to U.S. adults who have health insurance.

Previous studies and the current American College of Critical Care Medicine guidelines on care for family members of ICU patients have focused mostly on mental health, researchers noted. No studies have examined the physical health risks for family members. More studies are needed to confirm the findings of this research and to explore if behavior adjustments during this stressful time, such as changes in social ties, living arrangements, eating habits, alcohol consumption and economic support, are factors.

Numerous animals may be vulnerable to SARS-CoV-2, the virus that causes Covid-19, according to a large study modelling how the virus might infect different animals' cells, led by UCL researchers.

The study, published in Scientific Reports, reports evidence that 26 animals regularly in contact with people may be susceptible to infection.

The researchers investigated how the spike protein from SARS-CoV-2 could interact with the ACE2 protein it attaches to when it infects people.

The focus of the investigation was whether mutations in the ACE2 protein in 215 different animals, that make it different from the human version, would reduce the stability of the binding complex between the virus protein and host protein. Binding to the protein enables the virus to gain entry into host cells; while it is possible the virus might be able to infect animals via another pathway, it is unlikely based on current evidence that the virus could infect an animal if it cannot form a stable binding complex with ACE2.

The researchers found that for some animals, such as sheep and great apes (chimpanzee, gorilla, orangutan, and bonobo, many of which are endangered in the wild), the proteins would be able to bind together just as strongly as they do when the virus infects people. Some of the animals, such as sheep, have not yet been studied with infection tests, so this does not confirm that the animal can indeed be infected.

Lead author Professor Christine Orengo (UCL Structural & Molecular Biology) said: "We wanted to look beyond just the animals that had been studied experimentally, to see which animals might be at risk of infection, and would warrant further investigation and possible monitoring.

"The animals we identified may be at risk of outbreaks that could threaten endangered species or harm the livelihoods of farmers. The animals might also act as reservoirs of the virus, with the potential to re-infect humans later on, as has been documented on mink farms."

The research team also performed more detailed structural analyses for certain animals, to gain a better understanding of how infection risks may differ across animal species. By comparing their findings to other experimental data, they set thresholds to predict which animals are at risk of infection, and which ones most likely cannot be infected.

They found that most birds, fish, and reptiles do not appear to be at risk of infection, but the majority of the mammals they reviewed could potentially be infected.

Professor Orengo added: "The details of host infection and severity of response are more complex than just the interactions of the spike protein with ACE2, so our research is continuing to explore interactions involving other host virus proteins."

The team's findings mostly agree with experiments conducted in living animals and with reported cases of infections. They predict possible infection in domestic cats, dogs, mink, lions, and tigers, all of which have had reported cases, as well as ferrets and macaques, which have been infected in laboratory studies.

First author, Su Datt Lam (UCL Structural & Molecular Biology and the National University of Malaysia) said: "Unlike laboratory-based experiments, the computational analyses we devised can be run automatically and rapidly. Therefore, these methods could be applied easily to future virus outbreaks that, unfortunately, are becoming more common due to human encroachment into natural habitats."

Co-author Professor Joanne Santini (UCL Structural & Molecular Biology) said: "To protect animals, as well as to protect ourselves from the risk of one day catching Covid-19 from an infected animal, we need large-scale surveillance of animals, particularly pets and farm animals, to catch cases or clusters early on while they're still manageable.

"It may also be important to employ hygiene measures when dealing with animals, similar to the behaviours we've all been learning this year to reduce transmission, and for infected people to isolate from animals as well as from other people."

PULLMAN, Wash. - Earth is not necessarily the best planet in the universe. Researchers have identified two dozen planets outside our solar system that may have conditions more suitable for life than our own. Some of these orbit stars that may be better than even our sun.

A study led by Washington State University scientist Dirk Schulze-Makuch recently published in the journal Astrobiology details characteristics of potential "superhabitable" planets, that include those that are older, a little larger, slightly warmer and possibly wetter than Earth. Life could also more easily thrive on planets that circle more slowly changing stars with longer lifespans than our sun.

The 24 top contenders for superhabitable planets are all more than 100 light years away, but Schulze-Makuch said the study could help focus future observation efforts, such as from NASA's James Web Space Telescope, the LUVIOR space observatory and the European Space Agency's PLATO space telescope.

"With the next space telescopes coming up, we will get more information, so it is important to select some targets," said Schulze-Makuch, a professor with WSU and the Technical University in Berlin. "We have to focus on certain planets that have the most promising conditions for complex life. However, we have to be careful to not get stuck looking for a second Earth because there could be planets that might be more suitable for life than ours."

For the study, Schulze-Makuch, a geobiologist with expertise in planetary habitability teamed up with astronomers Rene Heller of the Max Planck Institute for Solar System Research and Edward Guinan of Villanova University to identify superhabitability criteria and search among the 4,500 known exoplanets beyond our solar system for good candidates. Habitability does not mean these planets definitely have life, merely the conditions that would be conducive to life.

The researchers selected planet-star systems with probable terrestrial planets orbiting within the host star's liquid water habitable zone from the Kepler Object of Interest Exoplanet Archive of transiting exoplanets.

While the sun is the center of our solar system, it has a relatively short lifespan of less than 10 billion years. Since it took nearly 4 billion years before any form of complex life appeared on Earth, many similar stars to our sun, called G stars, might run out of fuel before complex life can develop.

In addition to looking at systems with cooler G stars, the researchers also looked at systems with K dwarf stars, which are somewhat cooler, less massive and less luminous than our sun. K stars have the advantage of long lifespans of 20 billion to 70 billion years. This would allow orbiting planets to be older as well as giving life more time to advance to the complexity currently found on Earth. However, to be habitable, planets should not be so old that they have exhausted their geothermal heat and lack protective geomagnetic fields. Earth is around 4.5 billion years old, but the researchers argue that the sweet spot for life is a planet that is between 5 billion to 8 billion years old.

Size and mass also matter. A planet that is 10% larger than the Earth should have more habitable land. One that is about 1.5 times Earth's mass would be expected to retain its interior heating through radioactive decay longer and would also have a stronger gravity to retain an atmosphere over a longer time period.

Water is key to life and the authors argue that a little more of it would help, especially in the form of moisture, clouds and humidity. A slightly overall warmer temperature, a mean surface temperature of about 5 degrees Celsius (or about 8 degrees Fahrenheit) greater than Earth, together with the additional moisture, would be also better for life. This warmth and moisture preference is seen on Earth with the greater biodiversity in tropical rain forests than in colder, drier areas.

Among the 24 top planet candidates none of them meet all the criteria for superhabitable planets, but one has four of the critical characteristics, making it possibly much more comfortable for life than our home planet.

"It's sometimes difficult to convey this principle of superhabitable planets because we think we have the
best planet," said Schulze-Makuch. "We have a great number of complex and diverse lifeforms, and many that can survive in extreme environments. It is good to have adaptable life, but that doesn't mean that we have the best of everything."

More than 27 percent of children living on Guam between the ages of 2 and 8 were found to be obese or overweight, according to a study from the University of Guam's Children's Healthy Living Program. The findings were published on Aug. 20 in the journal Nutrients.

Guam's statistic sits just above the national average, based on reports from the U.S. Centers for Disease Control and Prevention.

"The big -- and concerning -- take home message is the unhealthy habits and behavioral patterns we found likely contributing to this high rate: too much screen time, the processed and sugary foods and beverages, and, most surprisingly, poor sleeping habits," said co-author and program lead Rachael T. Leon Guerrero, a registered dietitian who holds a doctorate in human nutrition. "It's a dangerous territory to be in since childhood weight issues can lead to obesity in adulthood, which only increases their risk for health problems like cardiovascular disease and cancer among others."

The study helps fill a longstanding gap in health data collection in the United States and its territories, which has historically omitted Pacific Islanders from many national surveys and studies. Pacific Islanders remain one of the largest growing ethnic minorities in the United States, yet their needs are often unmet due to a dearth in data often used to inform prevention strategies and programs.

The study surveyed 860 children and their caregivers and found that 99 percent of children did not consume the recommended daily fruit and vegetable intake (1 to 1.5 cups per day), while 40 percent did not meet the recommended daily hours of sleep (between eight and 11 hours). Obese or overweight children are statistically more likely to suffer from sleep disturbances.

Nearly 85 percent of children exceeded the two-hour recommended screen time. The average was five hours per day, which is comparable to figures in the states. Among the group, 83 percent consumed sugary and sweet beverages. The recommended consumption is zero.

Those who considered themselves part of the Westernized lifestyle (80 percent) -- which contains processed, high fat, and sugary foods -- were twice as likely to be overweight or obese. More than half of the children (58 percent) also came from families living below the poverty line, and more than 80 percent were receiving some form of food assistance.

In Guam, the program -- officially known as the Children's Healthy Living Program for Remote Underserved Minority Populations in the Pacific Region -- is a partnership among the University of Guam, the government, and schools that tracks children's weight rates on Guam and throughout the region and implements interventions to help improve them.

Most recently, researchers collected data in March 2020 to analyze the effectiveness of those interventions. Those results are expected in 2021.

"We need to better understand these types of disparities so we can help our communities and their children maximize their health and well-being," Leon Guerrero said.

The study was supported with grants from U.S. Department of Agriculture's National Institute of Food and Agriculture. Researchers included Rachael T. Leon Guerrero, L. Robert Barber, Tanisha F. Aflague, Yvette C. Paulino, Margaret P. Hattori-Uchima, and Mark Acosta from the University of Guam, Lynne R. Wilkens from the University of Hawaii Cancer Center, and Rachel Novotny from the University of Hawaii at Manoa.

The complete research article can be read at https://www.mdpi.com/2072-6643/12/9/2527.

A new study published this week in the journal Philosophical Transactions of the Royal Society B demonstrates a first attempt at using the methods of ancient bacterial detection, pioneered in studies of past epidemics, to characterise the microbial diversity of ancient gut contents from two medieval latrines. The findings provide insights into the microbiomes of pre-industrial agricultural populations, which may provide much-needed context for interpreting the health of modern microbiomes.

Over the years, scientists have noted that those living in industrialised societies have a notably different microbiome compared to hunter-gatherer communities around the world. From this, a growing body of evidence has linked changes in our microbiome to many of the diseases of the modern industrialised world, such as inflammatory bowel disease, allergies, and obesity. The current study helps to characterize the change in gut microbiomes and highlights the value of ancient latrines as sources of bio-molecular information.

Piers Mitchell of Cambridge University specialises in the gut contents of past people through analysis of unusual substrates. By looking at the contents of archaeological latrines and desiccated faeces under the microscope, he and his team have learned volumes about the intestinal parasites that plagued our ancestors.

"Microscopic analysis can show the eggs of parasitic worms that lived in the intestines, but many microbes in the gut are simply too small to see," comments Mitchell. "If we are to determine what constitutes a healthy microbiome for modern people, we should start looking at the microbiomes of our ancestors who lived before antibiotic use, fast food, and the other trappings of industrialisation."

Kirsten Bos, a specialist in ancient bacterial DNA from the Max Planck Institute for the Science of Human History and co-leader the study, was first sceptical about the feasibility of investigating the contents of latrines that had long been out of order.

"At the outset we weren't sure if molecular signatures of gut contents would survive in the latrines over hundreds of years. Many of our successes in ancient bacterial retrieval thus far have come from calcified tissues like bones and dental calculus, which offer very different preservation conditions. Nevertheless," says Bos, "I was really hoping the data here would change my perspective."

The team analysed sediment from medieval latrines in Jerusalem and Riga, Latvia dating from the 14th-15th century CE. The first challenge was distinguishing bacteria that once formed the ancient gut from those that are normally found in the soil, an unavoidable consequence of working with archaeological material.

The researchers identified a wide range of bacteria, archaea, protozoa, parasitic worms, fungi and other organisms, including many taxa known to inhabit the intestines of modern humans. "It seems latrines are indeed valuable sources for both microscopic and molecular information," concludes Bos.

Susanna Sabin, a doctoral alumna of the MPI-SHH who co-led the study, compared the latrine DNA to those from other sources, including microbiomes from industrial and foraging populations, as well as waste water and soil.

"We found that the microbiome at Jerusalem and Riga had some common characteristics - they did show similarity to modern hunter gatherer microbiomes and modern industrial microbiomes, but were different enough that they formed their own unique group. We don't know of a modern source that harbours the microbial content we see here."

The use of latrines, where the faeces of many people are mixed together, allowed the researchers unprecedented insight into the microbiomes of entire communities.

"These latrines gave us much more representative information about the wider pre-industrial population of these regions than an individual faecal sample would have," explains Mitchell. "Combining evidence from light microscopy and ancient DNA analysis allows us to identify the amazing variety of organisms present in the intestines of our ancestors who lived centuries ago."

Despite the promise of this new approach for investigating the microbiome, challenges remain.

"We'll need many more studies at other archaeological sites and time periods to fully understand how the microbiome changed in human groups over time," says Bos. "However, we have taken a key step in showing that DNA recovery of ancient intestinal contents from past latrines can work."

A new study published this week demonstrates a first attempt at using the methods of ancient bacterial detection, pioneered in studies of past epidemics, to characterize the microbial diversity of ancient gut contents from two medieval latrines. The findings provide insights into the microbiomes of pre-industrial agricultural populations, which may provide much-needed context for interpreting the health of modern microbiomes.

Over the years, scientists have noted that those living in industrialized societies have a notably different microbiome compared to hunter-gatherer communities around the world. From this, a growing body of evidence has linked changes in our microbiome to many of the diseases of the modern industrialized world, such as inflammatory bowel disease, allergies, and obesity. The current study helps to characterize the change in gut microbiomes and highlights the value of ancient latrines as sources of bio-molecular information.

Ancient Gut Microbiomes: Exploring the Bowels of History

Piers Mitchell of Cambridge University specializes in the gut contents of past people through analysis of unusual substrates. By looking at the contents of archaeological latrines and desiccated faeces under the microscope, he and his team have learned volumes about the intestinal parasites that plagued our ancestors.

"Microscopic analysis can show the eggs of parasitic worms that lived in the intestines, but many microbes in the gut are simply too small to see," comments Mitchell. "If we are to determine what constitutes a healthy microbiome for modern people, we should start looking at the microbiomes of our ancestors who lived before antibiotic use, fast food, and the other trappings of industrialization."

Kirsten Bos, a specialist in ancient bacterial DNA from the Max Planck Institute for the Science of Human History and co-leader the study, was first skeptical about the feasibility of investigating the contents of latrines that had long been out of order.

"At the outset we weren't sure if molecular signatures of gut contents would survive in the latrines over hundreds of years. Many of our successes in ancient bacterial retrieval thus far have come from calcified tissues like bones and dental calculus, which offer very different preservation conditions. Nevertheless," says Bos, "I was really hoping the data here would change my perspective."

The team analyzed sediment from medieval latrines in Jerusalem and Riga, Latvia dating from the 14th-15th century CE. The first challenge was distinguishing bacteria that once formed the ancient gut from those that were introduced by the environment, an unavoidable consequence of working with archaeological material.

The researchers identified a wide range of bacteria, archaea, protozoa, parasitic worms, fungi and other organisms, including many taxa known to inhabit the intestines of modern humans.

"It seems latrines are indeed valuable sources for both microscopic and molecular information," concludes Bos.

No Modern Matches for Ancient Microbiomes

Susanna Sabin, a doctoral alumna of the MPI-SHH who co-led the study, compared the latrine DNA to those from other sources, including microbiomes from industrial and foraging populations, as well as waste water and soil.

"We found that the microbiome at Jerusalem and Riga had some common characteristics - they did show similarity to modern hunter gatherer microbiomes and modern industrial microbiomes, but were different enough that they formed their own unique group. We don't know of a modern source that harbors the microbial content we see here."

The use of latrines, where the faeces of many people are mixed together, allowed the researchers unprecedented insight into the microbiomes of entire communities.

"These latrines gave us much more representative information about the wider pre-industrial population of these regions than an individual faecal sample would have," explains Mitchell. "Combining evidence from light microscopy and ancient DNA analysis allows us to identify the amazing variety of organisms present in the intestines of our ancestors who lived centuries ago."

Despite the promise of this new approach for investigating the microbiome, challenges remain.

"We'll need many more studies at other archaeological sites and time periods to fully understand how the microbiome changed in human groups over time," says Bos. "However, we have taken a key step in showing that DNA recovery of ancient intestinal contents from past latrines can work."

Our brain responds differently if we talk to a person of a different socioeconomic background from our own compared to when we speak to someone whose background is similar, according to a new imaging study by UCL and Yale researchers.

In the study, published in the journal Social Cognitive and Affective Neuroscience, 39 pairs of participants had a conversation with each other while wearing headsets that tracked brain activity.

Researchers found that, among pairs of people who had very different socioeconomic backgrounds - calculated according to education level and family income - there was a higher level of activity in an area of the frontal lobe called the left dorsolateral prefrontal cortex. The area is associated with speech production and rule-based language as well as cognitive and attentional control.

The findings support previous research suggesting that frontal lobe systems play a role in detecting bias and helping us to regulate our behaviour to avoid bias expression. The increased activity in the left frontal lobe was observed in both participants and was more alike than the brain responses of participants talking to someone of a similar background.

In a questionnaire following their task, participants paired with people of different backgrounds reported a slightly higher level of anxiety and effort during their conversation than those in similar-background pairs.

Professor Joy Hirsch (UCL Medical Physics & Biomedical Engineering and Yale) said: "For the first time, we have identified the neural mechanisms involved in social interactions between people of different backgrounds.

"I believe our findings offer a hopeful message. We know that humans can have positive social encounters with others who are different. Now we have the neurobiological basis - our brains have apparently developed a frontal lobe system that helps us deal with diversity."

Participants' brain activity was tracked using a new technique called functional near-infrared spectroscopy (fNIRS), which monitors blood flow and blood oxygenation by measuring changes in near-infrared light and involves wearing only a light headset. Previous studies have involved using MRI scans, which require patients to lie down and keep still, making conversation difficult.

The conversation task lasted for 12 minutes and involved participants being randomly assigned four subjects on themes such as "What did you do last summer?" and "How do you bake a cake?"

After their conversation task, participants were asked about the level of education they had completed and their parents' annual income and given a score based on these details. Pairs of participants were classified as either "high-disparity" or "low-disparity" depending on how different their scores were.

The two groups - different-background pairs and similar-background pairs - were matched in terms of age, race and gender, minimising the impact of these variables on the results. The participants were recruited from Yale's home city of New Haven in Connecticut, both from within the campus and beyond. They ranged in age from 19 to 44 and had a wide variety of socioeconomic backgrounds.

Lead author Olivia Descorbeth, a Yale University graduate who came up with the research proposal while still at school, said: "We wanted to know if the brain responded differently when we talked to others of a different socioeconomic background. Now we know that it does and that humans have a neurobiology that helps us navigate social differences."

For many, getting older can unfortunately mean an increased risk of illness from cardiovascular disease to cancer. University of Michigan scientists are actively researching the biological underpinnings of aging with the aim of developing interventions that could potentially help people live longer, healthier lives.

A new paper in the journal Science Advances describes the discovery of several promising small molecules that appear to reduce cellular stress in mouse skin cells and could lengthen life.

"Cellular stress resistance appears to be a common feature of long-lived organisms, such as invertebrates and mice," says the paper's lead author David Lombard, M.D., Ph.D., associate professor of pathology. Lombard is part of a multidisciplinary group at U-M's Paul F. Glenn Center for Aging. Recent research from colleague and fellow study author Richard Miller, M.D., Ph.D., found several promising drugs, including rapamycin, a cancer drug, and acarbose, a diabetes drug, that extended life in mice.

The new study, which uses high throughput screening, a technique that allows for the examination of hundreds of compounds at once, gets around some of the limitations posed by mouse studies.

"Mice live on average three years, which makes using them for longevity studies time-consuming and expensive," Lombard explains. By using cells to examine how a cell responds to stress, they hope to develop a proxy system with which to look at aging.

For the study, mouse skin cells were exposed to three types of environmental stress: a toxic herbicide called paraquat, the heavy metal cadmium and methyl methansulfonate, which damages DNA. After treatment with more than 4500 compounds, the team identified hundreds of small molecules that conferred some degree of protection against one or more of the stressors. The team then focused on eight compounds for a closer examination of how they worked at the molecular level.

Lombard explains that two candidates, AEG 3482 and cardamonin (found in spices such as cardamom), appeared to activate the Nrf2/SKN-1 pathway. Previous research has shown that this pathway helps cells resist stress and is implicated in the life-lengthening effects of several other interventions in C. elegans, a worm frequently used for aging studies, and can even extend the lifespan of male mice.

Comparing their findings to a different study of longevity in C. elegans, they found some of the same compounds that protected worms from stress were of the same class as those that their team identified as effective in mouse cells.

The team notes that their method has limitations. For example, they found that rapamycin and acarbose, previously shown to extend life in mice, did not protect against the stressors they used. And, says Lombard, a lot more work needs to occur before the findings can be extrapolated to humans. "I think the bottom line is we're fairly different than worms and flies, and some of these drugs have similar effects in different organisms, but it's not a one to one relationship."

Lombard says the promise of the method is its ability to find interesting drugs for follow up, especially to study their mechanism of action. "I don't think any are ready for lifespan studies, but what we've identified is an interesting group of compounds that have some intriguing effects in cells and in invertebrates."

Paper cited: "High-throughput small-molecule screening reveals Nrf2-dependent and -independent pathways of cellular stress resistance," Science Advances, DOI: 10.1126/sciadv.aaz7628

CHICAGO - Researchers have identified genetic mutations that appear to protect women from severe bleeding after childbirth, a leading cause of maternal death. A preliminary study of the findings is being presented at the ANESTHESIOLOGY® 2020 annual meeting.

DNA, which carries genetic information in cells, contain biological instructions. A genetic mutation, which is a permanent change in the DNA, can be beneficial, decreasing a person's risk for a disease or condition, or harmful, increasing that risk.

Previous research has suggested genetics may play a role in the risk of bleeding after childbirth, called postpartum hemorrhage, but specific genes associated with the risk have not been identified. In this study, researchers identified several genetic mutations that appear to be associated with a reduced risk for postpartum hemorrhage.

"This research suggests there may be biological mechanisms that are protective," said Vesela Kovacheva, M.D., Ph.D., lead author of the study and an assistant professor of anesthesiology at Harvard Medical School, Boston. "After further research, we may be able to design drugs that target these pathways to prevent or help treat postpartum hemorrhage."

Drawing from the UK Biobank, an independent nonprofit initiative of more than 500,000 people, the researchers compared DNA in 1,424 women who had postpartum hemorrhage to 4,272 women who had an uncomplicated childbirth. They identified five genetic mutations that were associated with the risk for postpartum hemorrhage. The common theme in all of these mutations is that they are found near genes associated with the immune system.

The research adds to the growing evidence that the immune system plays a role in a normal pregnancy and delivery. Once the genes that have been identified in the study are verified, women could eventually be screened to determine their risk for postpartum hemorrhage, Dr. Kovacheva said.

"These newly identified mutations - or differences in the structure of the DNA - may decrease the risk for hemorrhage, but we do not know why," said Dr. Kovacheva. "We don't know if the exact genes identified are involved or if those mutations affect other genes. Our next step is to study them further to learn more about how they work."

CHICAGO - Almost 20 years into the opioid epidemic, there finally is evidence of significant and continual decreases in the abuse of these risky pain medications, according to an analysis of national data being presented at the ANESTHESIOLOGY® 2020 annual meeting.

The rate of prescription opioids fell 26% between 2007 and 2018, according to the researchers' analysis of the National Survey on Drug Use and Health, an annual survey of about 70,000 Americans age 12 and older asking about their use of tobacco, alcohol and drugs.

For the analysis, prescription opioid abuse was defined as use without the consent of a physician. While opioids can be beneficial for short-term relief, in most cases they should not be used long-term because of their significant side effects and risk for addiction.

"Prior research has shown slight reductions in abuse rates, but our analysis shows we're tracking statistically significant year-to-year declines in abuse, indicating that the decrease is not an anomaly and truly represents a trend in falling prescription drug abuse levels," said Mario Moric, M.S., lead author of the study and a biostatistician at Rush University Medical Center, Chicago. "We believe the message of the dangers of opioid use without supervision of a medical professional is finally getting through and changing people's mindset and behavior."

In 2007, 4.9% of the respondents said they had abused prescription pain medications the previous year. In 2018 (the most recent year for which data are available), 3.7% said they had done so. The difference represents a 26% decrease in abuse. The analysis showed significant declines from 2012 to 2018, with the exception of 2015, when higher numbers were reported due to a survey redesign introduced that year.

"Pain medications such as opioids are an important resource in the treatment and care of patients, but they are not a cure-all," said Asokumar Buvanendran, M.D., co-author of the study, chair of the American Society of Anesthesiologists Committee on Pain Medicine and executive vice chair of anesthesiology at Rush University Medical Center. "Since opioids have risks and can be highly addictive, they should be used only under the supervision of a physician who can consider their safety and how the medication will affect a patient over time. Prescribers and patients are now better armed with the information they need to make educated choices in pain management."

CHICAGO: Military surgical teams face unique demands on and off the battlefield. Combat trauma represents 0.5 percent of the 1 million annual military health system hospital admissions, presenting a challenge for military surgical teams to remain combat ready. Previous research has established the many benefits of military-civilian partnerships for training military surgeons prior to deployment and retaining critical skills during deployment.* However, there exists a lack of data about the readiness and case volumes of other members of Army Forward Resuscitative Surgical Teams (FRSTs). Researchers who studied clinical practice patterns in non-physician members of Army FRSTs, particularly comparing the experience of active duty and Army reservist team members, presented their findings during the virtual American College of Surgeons (ACS) Clinical Congress 2020.

"When we split up the groups into Army reservists and active duty members of FRSTs, we saw that the Army reservists were spending a lot more time in their civilian duties treating patients and gaining health care experience," said lead study author Matthew S. Sussman, MD, a resident in vascular surgery at the University of Miami/Jackson Memorial Hospital. "But if we can integrate the active duty members into civilian centers, it can provide more experience for these team members so that when they are deployed, they can provide the best and safest care to the wounded."

The driving idea behind military-civilian partnerships is that by integrating military surgical teams in civilian trauma centers, military surgeons will be able to keep their skills sharp while they're not deployed, and will also be able to share lessons learned from the battlefield to enhance civilian trauma care back home. This study, which looked at non-physician members of FRSTs at Ryder Trauma Center at Jackson Memorial Hospital in Miami - a facility with a longstanding military-civilian partnership - established that the benefits of military-civilian partnerships also extend to other members of the surgical team.

The research team surveyed 499 FRST members. Of the 483 responses received, 208 were Army reservists (AR) and 275 were active duty (AD). For the FRST members surveyed, combat experience was similar for AD vs. AR non-physician team members: 50 percent vs. 52 percent had at least one combat deployment, 52 percent vs. 60 percent of peri-deployment patient load was trauma-related, and 31 percent vs. 32 percent had at least 40 patient contacts during their most recent deployment. However, the medical experience differed between the two groups: 18 percent of AD vs. 29 percent of AR had more than 15 years of experience in practice, and 4 percent AD vs. 17 percent AR spent more than 50 percent of their time treating critically injured patients. The researchers noted that these differences persisted across all specialties, including CRNAs, critical care nurses, ER nurses, perioperative nurses, OR techs, LPNs, and combat medics.

"The deployed experience is very similar, regardless of whether you're active duty or a reservist. But it's the clinical practice at home that really makes a difference between these groups. The acuity of patient contacts, the focus on trauma, and the years of experience were significantly different in the reservists compared with active duty team members," said Lieutenant Colonel Mark D. Buzzelli, MD, FACS, Army Trauma Training Detachment, Ryder Trauma Center, Miami, Fla.

The researchers noted that to address these gaps and to enhance care provided while deployed, active duty FRST members should have plenty of clinical training opportunities prior to deployment. "To maintain readiness and provide optimal care for our injured warriors, trauma teams - not just individuals - must embed within civilian centers," the researchers concluded.

"The Army has been proactive in terms of establishing additional military-civilian partnerships, identifying the need to ensure our military providers who provide trauma care have those optimal opportunities for training," said Colonel Kirby R. Gross, MD, FACS, Army Trauma Training Detachment, Ryder Trauma Center, Miami, Fla. "These findings reinforce and validate the proactive decisions our leadership has been making."