Culture

When a star unleashes as much energy in a matter of days as our Sun does in several billion years, you know it's not going to remain visible for long.

Like intergalactic paparazzi, NASA's Hubble Space Telescope captured the quick, fading celebrity status of a supernova, the self-detonation of a star. The Hubble snapshots have been assembled into a telling movie of the titanic stellar blast disappearing into oblivion in the spiral galaxy NGC 2525, located 70 million light-years away.

Hubble began observing SN 2018gv in February 2018, after the supernova was first detected by amateur astronomer Koichi Itagaki a few weeks earlier in mid-January. Hubble astronomers were using the supernova as part of a program to precisely measure the expansion rate of the universe -- a key value in understanding the physical underpinnings of the cosmos. The supernova serves as a milepost marker to measure galaxy distances, a fundamental value needed for measuring the expansion of space.

In the time-lapse sequence, spanning nearly a year, the supernova first appears as a blazing star located on the galaxy's outer edge. It initially outshines the brightest stars in the galaxy before fading out of sight.

"No Earthly fireworks display can compete with this supernova, captured in its fading glory by the Hubble Space Telescope," said Nobel laureate Adam Riess, of the Space Telescope Science Institute (STScI) and Johns Hopkins University in Baltimore, leader of the High-z Supernova Search Team and the Supernovae H0 for the Equation of State (SH0ES) Team to measure the universe's expansion rate.

The type of supernova seen in this sequence originated from a burned-out star -- a white dwarf located in a close binary system -- that is accreting material from its companion star. When the white dwarf reaches a critical mass, its core becomes hot enough to ignite nuclear fusion, turning it into a giant atomic bomb. This thermonuclear runaway process tears the dwarf apart. The opulence is short-lived as the fireball fades away.

Because supernovae of this type all peak at the same brightness, they are known as "standard candles," which act as cosmic tape measures. Knowing the actual brightness of the supernova and observing its brightness in the sky, astronomers can calculate the distances of their host galaxies. This allows astronomers to measure the expansion rate of the universe. Over the past 30 years Hubble has helped dramatically improve the precision of the universe's expansion rate.

You could say Seattle came alive with more than an even flow of tourism dollars from a pair of highly-anticipated Pearl Jam concerts, according to rockin’ new research by West Virginia University economists.

Dubbed the “Home Shows,” two Pearl Jam concerts in August 2018 helped net the seaport city $58 million in additional hotel revenue and $9 million in hotel tax revenue. Compare that to Seattle Mariners baseball games, which generate $140,000 in additional hotel revenue on game days, and the researchers make a clear case for large, one-off events as economic boosters.

The study, “Why Go Home? Pearl Jam’s ‘Home Shows’ & Hotel Demand,” was authored by Joshua Hall, chair and professor of economics, and Justin Parker, a 2020 Ph.D. economics graduate. It was published in the Annals of Tourism Research Empirical Insights.

“While many events that attract visitors do not create large economic impacts (sports, for example) because a portion of the attendees are local and thus just represent spending that would happen anyway, events can generate large impacts under the right conditions,” Hall said. “The Pearl Jam ‘Home Shows’ seem to be the perfect conditions.

“Baseball games are primarily visited by local fans. While there will be some out-of-area visitors who stay overnight, our data show they are small and do not shift demand enough to lead to a large increase in room prices and thus hotel revenue and taxes. The key difference is not between a concert and Mariners games, rather it is between events that draw people in from far away – thus requiring hotel nights – and events that mostly draw locals.”

Hall believed the timing of the concert – at summer’s end in early August – combined with a planned off-day between the two shows made it ideal for loyal fans wanting to combine a live music experience with a vacation. The shows marked Pearl Jam’s first in Seattle – their hometown – in five years and attracted fans from across the globe.

Every Pearl Jam show is also different than the one prior, so fans attending both were guaranteed a unique opportunity from each performance.

Hall and Parker found that the concerts, held Aug. 8 and 10, increased average daily room rates by as much as $144 a night and hotel occupancy to more than 90 percent.

One contributor to the Seattle economy was Hall himself, who attended the concerts with his wife, Sabrina, as part of their 20th wedding anniversary. The couple flew from Clarksburg to Seattle via Chicago, and the plane from Clarksburg was full with everyone wearing Pearl Jam apparel, Hall said.

“Then when I checked into the hotel, I chatted with the manager,” he said. “He told me that room rates got up to over $400 a night and that he thought everyone in the hotel was a Pearl Jam fan based on their clothing when they checked in. That made me think – based on what I knew about their ticketing system – that this would be the ideal conditions for large economic impacts.

“In the stands I saw and met people from all over the country and world - many international fans bring their country’s flags to hold up - which further led me to realize that I wanted to estimate the impact of these shows on hotel demand and hotel tax revenue.”

Hall added that research like this can inform policymakers’ decisions regarding permitting and other forms of public support for concerts and cultural events.

By contrast, some sporting events do not result in economic boosts for host cities. The City of Charlotte spent $330,000 on public safety surrounding the 2017 PGA Championship, although the event had no significant impact on hotel revenue and taxes, according to one study. Meanwhile, the City of Seattle estimates each World Cup 2026 game hosted will cost $1.32 million for security. Hall projects the city will only be able to recoup those costs through the hotel tax if most attendees are from outside Seattle.

“Given the uniqueness of Pearl Jam the band and the ‘Home Shows,’ we argue that this case presents an upper bound of what an event designed to attract tourists can have on hotel demand,” Hall said. “Tourism, and consequently hotel demand, are a key component of the economic development strategy of many cities.”

Citation: “Why go home? Pearl Jam's ‘Home Shows’ & hotel demand”

Journal

Annals of Tourism Research Empirical Insights

More than 100 million infections of Zika virus within Central and South America and the Caribbean went undetected between 2015 and 2018, according to a new study.

The University of Notre Dame researchers who conducted the study, published in PLOS Neglected Tropical Diseases, said the results show a need for improvements to current infectious disease surveillance systems. The study also provides insight into the potential severity of future outbreaks and the current state of herd immunity of Zika in the West.

"Fewer than 1 percent of cases were actually reported and it shows our surveillance systems catch only a small percentage of actual infections," said Sean Moore, research assistant professor in the Department of Biological Sciences at Notre Dame and lead author of the study. "We need to think about how to improve surveillance systems to get a better sense of transmission, especially in cases of diseases that yield a high number of asymptomatic infections."

The first confirmed case of Zika in the Americas was reported in Brazil in 2015, with infection spreading rapidly, reaching as far north as Florida and Puerto Rico. In 2016 the World Health Organization (WHO) declared the epidemic a Public Health Emergency of International Concern.

The Pan American Health Organization, which serves as an international agency for the Americas and a regional office of the WHO, totaled symptomatic infections of Zika at more than 800,000 between 2015 and 2018 -- a number far below the results of the Notre Dame study. Moore's team estimated 132.3 million infections across Latin America and the Caribbean, having collected data from 15 countries and territories in South America, Central America and the Caribbean with a combined total population of 507.1 million.

"There are some similarities to the current situation with COVID-19," Moore said. "Between 20 and 50 percent of Zika infections are asymptomatic. Even when symptoms are present, they tend to be mild, so if the infection is not severe enough for an individual to seek medical attention, those cases can go undiagnosed."

Understanding the scope of underreporting is particularly important to gain an accurate sense of herd immunity in the region. Once infected, individuals who recover from Zika virus are believed to have lifelong immunity, Moore said. While cases have dropped substantially since 2018, a remaining concern is the potential for future outbreaks.

"Our research suggests a need for a better understanding of how much transmission is happening within a community," said Moore. "The risk of congenital birth defects in pregnant women infected with Zika virus required a separate surveillance system -- testing both the mother and the baby -- to capture a more accurate indicator of underlying transmission. Without widescale testing and a comprehensive system like that, we can miss how large an outbreak is in the general population."

A recent study co-authored by Moore and colleagues at Notre Dame found that gaps in surveillance and limited testing resulted in more than 100,000 coronavirus infections in the United States that went undetected in the early months of the pandemic.

Many marketing studies have examined the impact of direct-to-consumer advertising of pharmaceuticals on sales and market shares. But in a new study, a researcher from The University of Texas at Dallas wanted to know whether drug advertising might have some unintended, population-level health consequences.

"A colleague and I were brainstorming, and I wondered, 'Can Viagra ads result in more babies?'" said Dr. Tongil "TI" Kim, assistant professor of marketing in the Naveen Jindal School of Management and one of the study's co-authors. "With a more or less fixed gestation period, my colleague and I knew that we could compare advertising amount and birth rates after 10 months."

In the study, published online April 28 and in the August print issue of the Journal of Marketing Research, Kim and Dr. Diwas KC of Emory University explored the impact of direct-to-consumer advertising of erectile dysfunction (ED) drugs on birth rate at the population level.

The researchers examined local television commercials for three drug brands: Viagra (sildenafil), Levitra (vardenafil) and Cialis (tadalafil). They compared advertising data with hospital data from Massachusetts between 2001 and 2010, and with 15 million birth certificate records from the U.S. between 2000 and 2004.

They used a type of quasi field experiment -- a way to show causality in economics and marketing -- to address many potential confounding factors. They examined two sets of adjacent rural ZIP codes with similar characteristics, where one side received more ED drug ads than the other side due to discontinuity in TV ad market delineation. In other words, they compared two sets of ZIP codes that are very similar in terms of demographics and socioeconomic factors except for the level of ED drug ads.

Additionally, the researchers considered other variables that might have affected increased birth rates during these time periods, such as inclement or cold weather. They also considered other advertising, over-the-air signal quality and the possibility of couples moving across the television markets' geographic borders, and determined those factors were not major concerns in the study's setting.

In further robustness checks, the researchers replaced ED drug advertising with advertising for an unrelated drug category and found no impact on birth rates. Also, they did not find significant effects in earlier months as gestation would take at least nine months.

The researchers found that in ZIP codes where more ED drug ads ran than in neighboring ZIP codes, the birth rates were higher 10 months after the advertising aired. Their results showed that a 1% increase in ED drug advertising contributed to an increase of 0.04% to 0.08% of total births. They also found the ads particularly increased births among families with children.

The researchers believe that some viewers watched the ads and purchased ED drugs to improve their chances of achieving pregnancy (consumption effect), while others may have been affected by the suggestive nature of the ads without purchasing ED drugs (media effect).

"As for the content of the ads, many of the ED drug commercials during the data period featured suggestive ad copy and content," Kim said, "which resulted in some people deeming ED drug ads inappropriate for family viewing, as demonstrated by a legislative bill that was introduced in 2009 calling to ban ED drug ads on TV between 6 a.m. and 10 p.m."

Further analysis using Google Trends data indicated that more frequent ED drug advertising was associated with higher pregnancy-intent keyword searches.

One popular hypothesis for the increased birth rates focused on older male ad viewers taking the pill and fathering more babies, Kim said. The data, however, did not show an increase in the average age of the fathers. It is possible this effect plays a role equally across different age groups, he said.

An unexpected finding was a stronger effect from the ads on birth rates in regions with lower incomes.

"It was surprising. During our data period, the majority of ED drug consumers paid the full price out of their own pockets because ED drugs were generally not covered by insurance in the U.S.," Kim said.

Based on the increased Google searches with intent to get pregnant and higher birth rates in lower-income areas that cannot be solely explained by the consumption effect, the researchers believe the media effect is possible.

"Can mere TV content affect fertility decisions? Many studies have found this. For example, the launch of TV shows in Brazil about female working professionals was linked to a substantial decrease in the nation's birth rates," Kim said.

The researchers said their study could provide companies a framework to monitor unintended health consequences in relation to the launch and marketing of pharmaceutical goods. Companies should be aware that, beyond simply increasing sales and market shares, marketing activities may have unforeseen spillover effects on societal outcomes, especially if the products are related to health or wellness.

"This is not only a responsible thing to do, but it can also create creative marketing opportunities," Kim said. "For example, companies selling infant-related medicines and goods like children's cold medicine, baby car seats or diapers might use ED drug ads as an additional market variable to better anticipate and predict local pregnancy rates 10 months later -- essentially their market potential -- and improve upon jointly deploying marketing and distribution resources across various regions."

The study also has implications for policymakers. Kim said they should be mindful of the multifaceted and even unexpected outcomes when considering whether to allow direct-to-consumer advertising of pharmaceuticals -- something that only is permitted in the U.S. and New Zealand. The Food and Drug Administration relaxed restrictions on direct-to-consumer advertising in 1997. Since then, TV advertising for pharmaceuticals increased substantially, with more than 80 drug ads estimated to be aired every hour on U.S. television.

Religious hospital policies that restrict reproductive health care are poorly understood by patients, according to a new study published Sept. 17 in AJOB Empirical Bioethics.

Researchers from the University of Chicago and the University of California, San Francisco found that women value clear information shared early from their health care providers to help them anticipate religious restrictions before their care becomes urgent.

Jocelyn Wascher, MD, an obstetrician-gynecologist resident at the University of Chicago Medicine, Debra Stulberg, MD, Chair of UChicago's Department of Family Medicine, and UCSF medical sociologist Lori Freedman, PhD, interviewed 33 reproductive-age women from a national survey sample who had sought care from a Catholic hospital. Most women identified as Christian or Catholic, and were diverse geographically, in age, and in racial and ethnic identity. The women expressed respect for the religious beliefs of the doctors and hospital administrators, but struggled to balance this with valuing personal autonomy and decision-making.

One woman interviewed by researchers needed a Cesarean-section delivery and wanted to have her tubes tied at the same time. However, she was told on the day of her C-section that the hospital did not perform tubal ligations due to its religious beliefs. She told researchers, "When you go to a hospital, you want them to do what you want them to do. You should be in charge of your own medical care and not their beliefs."

Other women in the study shared that sentiment, adding that patients should research hospital policies and affiliations before choosing where to receive care. However, they also wanted the hospital to make more effort to inform them.

The woman who was denied tubal ligations during her C-section said she was upset that the hospital didn't tell her about their rules beforehand. "I also feel that they could've told me sooner than the day of my C-section," the woman said.

Another interviewee told researchers that religious restrictions on care "need to be plastered in 50-foot neon letters at the front door of the building," rather than something a woman learns in real time if she happens to have a helpful physician.

The study's authors highlighted that the American Medical Association advises physicians who hold moral objections to specific services should disclose any objections prior to establishing a patient-physician relationship. They also recommend informing patients of all available treatment options, and referring them to other providers if necessary. The authors recommend that health care institutions be held to the same ethical standards.

"I've cared for numerous patients who were denied desired reproductive health care because of the religion of the hospital they happened to show up at," said Stulberg, who completed her residency at a hospital that transitioned from secular to Catholic during her time there.

Stulberg saw patients quickly lose access to contraception and pregnancy-related care. It spurred her interest in the topic and led her to pursue ethics training through UChicago's MacLean Center for Clinical Medical Ethics before joining the University's faculty. Today it's her primary research focus.

Wascher, the paper's first author, chose to be an OB-GYN in order to provide comprehensive care around pregnancy and reproductive health. "It's hard to imagine sitting with a patient who wants and would medically benefit from my care, and then having to tell her, 'I'm sorry, we can't do that here.' It would break my heart," she said.

Research from the University of Kent's School of Economics sheds new light on a long-standing obstacle to improving agricultural productivity in developing countries: the reluctance of small-scale farmers to adopt modern technologies because of the risks associated with them.

The paper, published in Science Direct, examined the relationship between attitudes towards risk among small-scale aquafarmers in Ghana and the time they take to adopt new technologies that reduce traditional risks, including; poor weather conditions, aquatic predators and poor hygiene.

The researchers conducted a series of psychological experiments with aquafarmers in 30 villages in four regions in southern Ghana to measure their aversion to risk and willingness to take gambles. They also recorded the aquafarmers' adoption of three innovative technologies recently introduced to Ghana: predator-proof floating cages for fish; a nutrient-rich fish feed; and a fast-growing, disease-resistant breed of tilapia fish.

Results showed that aversion to traditional production risks accelerated the adoption of all three technologies. However, adoption of floating cages was slower due to the significant upfront financial investment required, making small-scale experimentation with the technology impractical. The study also found that once aquafarmers in a community have started using the cages, the aversion by others to take the risk was further reduced.

Based on their findings, the study's authors advocate providing practical information about new agricultural technologies and information about positive returns from their adoption with the help and encouragement of regional extension agents to encourage the adoption of new agricultural technologies by small-scale farmers in developing countries.

Dr Adelina Gschwandtner, Senior Lecturer in Economics and Principle Investigator, said: 'These findings may have significant consequences beyond Africa and onto the global agricultural sector. Addressing traditional perceptions with this new understanding of the potential to reduce risk by adopting new ideas, methods, and technologies, may broaden how business ventures are viewed and conducted in the future. This in turn may help agricultural ventures in developing nations become secure and allow them to flourish.'

Researchers at Yale and elsewhere previously identified a host of genetic risk factors that help explain why some veterans are especially susceptible to the debilitating symptoms of post-traumatic stress disorder (PTSD).

A new Yale-led study published Oct. 1 in the journal Biological Psychiatry has now identified a social factor that can mitigate these genetic risks: the ability to form loving and trusting relationships with others.

The study is one of the first to explore the role of nurture as well as nature in its investigation of the biological basis of PTSD.

"We exist in a context. We are more than our genes," said Yale's Robert H. Pietrzak, associate professor of psychiatry and public health, and senior author of the study.

Pietrzak is also director of the Translational Psychiatric Epidemiology Laboratory of the Clinical Neurosciences Division of the U.S. Department of Veterans Affairs National Center for PTSD.

Like many genetic studies on mental disorders such as depression, anxiety, and schizophrenia, PTSD studies have revealed numerous genetic risk factors that contribute to the severity of the disorder. For instance, a previous study of more than 165,000 U.S. military veterans led by Yale's Joel Gelernter, the Foundations Fund Professor of Psychiatry and professor of genetics and of neuroscience, found variants in eight separate regions of the genome that help predict who is most likely to experience the repeated disturbing memories and flashbacks that are hallmark symptoms of PTSD.

In the new study, Pietrzak, Gelernter, and colleagues looked at psychological as well as genetic data collected from the National Health and Resilience in Veterans Study, which surveyed a national sample of U.S. military veterans, and is supported by the National Center for PTSD. The researchers specifically focused on a measure of attachment style -- the ability or inability to form meaningful relations with others -- as a potential moderator of genetic risk for PTSD symptoms.

Individuals with a secure attachment style perceive relationships as stable, feel that they are worthy of love and trust, and are able to solicit help from others. Those with an insecure attachment style report an aversion to or anxiety about intimacy with others, and have difficulty asking for help from others.

They found that the ability to form secure attachments essentially neutralized the collective effects of genetic risk for PTSD symptoms. The impact was particularly pronounced in a variant of the IGSF11 gene, which has been linked to synaptic plasticity or the ability of the brain to form new connections between brain cells.

Pietrzak noted that deficits in synaptic plasticity have also been linked to PTSD, depression, and anxiety, among other mental disorders. The findings illustrate the importance of integrating environmental and social as well as genetic factors in the study of PTSD and related disorders, the authors said.

"Social environmental factors are critical to informing risk for PTSD and should be considered as potential moderators of genetic effects," he said. "The ability to form secure attachments is one of the strongest protective factors for PTSD."

The findings, which will help predict who is at greater risk of experiencing severe symptoms of PTSD, also suggest that psychological treatments targeting interpersonal relationships may help mitigate PTSD symptoms in veterans with elevated genetic risk for this disorder, he said.

Chicago--October 1, 2020--A mindfulness-based stress reduction (MBSR) course was found to benefit patients with chronic pain and depression, leading to significant improvement in participant perceptions of pain, mood and functional capacity, according to a study in the Journal of the American Osteopathic Association. Most of the study respondents (89%) reported the program helped them find ways to better cope with their pain while 11% remained neutral.

Chronic pain is a common and serious medical condition affecting an estimated 100 million people in the United States, which correlates with annual costs of approximately $635 billion. The small-scale study was conducted in a semi-rural population in Oregon where issues of affordability, addiction and access to care are common. Participants received intensive instruction in mindfulness meditation and mindful hatha yoga during an eight-week period.

"Many people have lost hope because, in most cases, chronic pain will never fully resolve," says Cynthia Marske, DO, an osteopathic physician and director of graduate medical education at the Community Health Clinics of Benton and Linn County. "However, mindful yoga and meditation can help improve the structure and function of the body, which supports the process of healing."

Healing and curing are inherently different, explains Dr. Marske.

"Curing means eliminating disease, while healing refers to becoming more whole," Dr. Marske says. "With chronic pain, healing involves learning to live with a level of pain this is manageable. For this, yoga and meditation can be very beneficial."

The study found mindful meditation and yoga led to significant improvements in patients' perceptions of pain, depression and disability. Following the course, Patient Health Questionnaire (PHQ-9) scores, a standard measure of depression, dropped by 3.7 points on a 27-point scale. According to Dr. Marske, some patients experience a similar drop from the use of an antidepressant.

"Chronic pain often goes hand-in-hand with depression," says Dr. Marske. "Mindfulness-based meditation and yoga can help restore both a patient's mental and physical health and can be effective alone or in combination with other treatments such as therapy and medication."

Study participants received instruction in MBSR, a systematic educational program based on training people to have an awareness of the self in the present moment and a nonjudgmental manner. The findings bolster other evidence that MBSR can be a useful adjunctive treatment for chronic pain while improving perceived depression.

"The bottom line is that patients are seeking new ways to cope with chronic pain and effective non-pharmaceutical treatments are available," says Dr. Marske. "Our findings show meditation and yoga can be a viable option for people seeking relief from chronic pain."

A new study of approximately 80,000 patients shows that people with Parkinson's disease (PD) have a 30% higher risk of dying from COVID-19 than people without the neurodegenerative condition.

The new analysis conducted by researchers with University of Iowa Health Care based on patient data in the TriNetX COVID-19 research network suggests that Parkinson's disease is an independent risk factor for dying from COVID-19.

The UI research team led by neurologists Qiang Zhang, MD, and Nandakumar Narayanan, MD, PhD, identified the COVID-19 patient cohort as of July 15 and analyzed the mortality data eight weeks later. They found that 5.5% (4,290 out of 78,355) of COVID-19 patients without PD died compared to 21.3% (148 of 694) COVID-19 patients who also had PD.

However, the patients with PD were generally older, more likely to be male, and less likely to be African American than the patients without PD. All of these factors also increase the risk of death from COVID-19.

So, the UI team used two approaches to account for these differences: logistic regression with age, sex, and race as covariates, and matching each PD patient with five non-PD patients with the exact age, sex, and race, and performing a conditional logistic regression. In both cases, the researchers found that the risk of dying from COVID-19 was 30% higher for patients with PD. The findings are published in the journal Movement Disorders.

"We recognize the limitations of this study; it is retrospective data from a single database, but we are confident that these data show that Parkinson's disease is independent risk factor for death in COVID-19," says Narayanan, UI associate professor of neurology and a member of the Iowa Neuroscience Institute. "We believe this observation will be of interest to clinicians treating patients with Parkinson's disease, and public health officials."

The researchers say the findings should also inform patients with PD, and their physicians, of the increased importance of preventing COVID-19 infection in these patients.

"For our own patients, we can give advice that it's important that you wear a mask. It's important that you socially distance," says Zhang, an associate in the UI Department of Neurology.

Zhang adds that physicians should also weigh the increased risk of death from COVID-19 when considering how to care for PD patients in person during the pandemic.

A potential reason why PD patients have an increased risk of death from COVID-19 may be related to the fact that COVID can cause pneumonia and pneumonia is a leading cause of death in patients with PD. This is partly because Parkinson's patients can have trouble swallowing or choking that can cause aspiration.

"We are all focused on COVID right now, but this is a clear example of a respiratory illness that leads to increased mortality [in PD patients]. These findings may also have implications for understanding risks for PD patients from other diseases, including influenza," Narayanan says. "I would recommend a flu vaccine and pneumonia vaccine to try to prevent these problems in patients with PD."

In a recently published study in the Journal of Clinical Oncology - Oncology Practice, investigators from MUSC Hollings Cancer Center classify numerous barriers to a recommended therapy for head and neck cancer that may mean the difference between life and death for these patients.

Cancer of the head and neck is one of the deadliest cancers. Only half of those with head and neck cancer are alive five years following initial diagnosis. African Americans, in particular, experience worse survival outcomes. These patients are 50% more likely to die from the disease than white people, a concerning trend that has prompted deeper research into factors that might drive these significant disparities in head and neck cancer mortality.

The Hollings study team is led by Evan Graboyes, M.D., a surgeon scientist who is examining how to improve the timeliness and equity of care delivery to decrease head and neck cancer recurrence and improve survival. "The key measure of timely head and neck cancer care is the time between when patients get surgery and when they start their radiation. When people get their care within six weeks, it is less likely to recur. Unfortunately, we also know that nationally about half of head and neck cancer patients don't get their radiation started on time, and that radiation treatment delays disproportionately burden African Americans."

To understand more fully factors contributing to head and neck cancer treatment delays, Graboyes and his team conducted structured interviews with patients, providers, nurses, nurse practitioners, surgeons and radiation and medical oncologists across South Carolina. "It's a qualitative study," Graboyes explained, "where the key unit of analysis isn't numbers but rather words and stories. Qualitative studies are really helpful for providing an in-depth understanding of experiences that patients, providers and other interviewees can offer us."

Multiple levels of barriers

What makes this issue complex is that there are multiple obstacles that interact to prevent a patient from getting radiation treatment in a timely manner. The researchers found those obstacles include:

A lack of patient and provider education on national standards of care.

Unexpected post-surgical complications that interrupted tight treatment timelines.

Poor communication between medical teams.

Burdensome travel requirements to see different specialists.

"One of the interesting things we found is that patients might experience several of these barriers, just at different points in time during their treatments," Graboyes said. "Their difficulties were constantly evolving as they progressed through the cancer care continuum."

The study presents a novel theory-driven conceptual framework that classifies common treatment hurdles. The categories include problematic individual behaviors of patients and providers (intrapersonal barriers); insufficient communication between patients, providers, and caregivers (interpersonal barriers); insufficient communication between disparate care teams (health care barriers); inefficiencies related to fragmentation of care across organizations (organizational barriers); and challenges in health care access (community-level barriers).

"Within the cancer care delivery research spectrum, we as cancer researchers have spent a lot of time trying to understand how and why people do or don't participate in screening activities and then developing interventions to implement into health care systems to help address those determinants," he said. "There is a much less concerted effort and less scientific progress in trying to understand how the actual cancer care delivery itself happens. That's why I think this research really is exciting."

Beyond the study

Graboyes hopes that their model will facilitate future head and neck cancer interventions that target treatment barriers at one or more levels. "We know a lot about who is at risk for experiencing treatment delays, but before this study, we didn't really understand why," said Graboyes. "What this study does is give us a framework, a vocabulary and an understanding of how to relate these themes together in future quantitative studies."

Graboyes credits the resources of the Hollings Cancer Control Research Program; the expertise of his team, including center members Chanita Hughes-Halbert, Ph.D., Katherine Sterba, Ph.D., Hong Li, Ph.D., and Graham Warren, M.D., Ph.D.; and the outstanding multidisciplinary head and neck oncology group as being critical to the success of the study.

"Hollings Cancer Center has been a major enabler of this research where we are trying to understand cancer care delivery across the state, with a specific focus on the racial minority patient population and the challenges they face."

Next, Graboyes intends to test whether an intervention strategy funded by the National Cancer Institute, referred to as NDURE (Navigation for Disparities and Untimely Radiation thErapy), can improve patient outcomes. A major feature of this intervention will be the role of an assigned navigator who will work with head and neck cancer patients to create a tailored and dynamically evolving plan based on which barriers they are experiencing. A patient and referral tracking system also will be employed to check on the patient's progress across health care systems, remind them of upcoming appointments and help to identify needed travel resources to keep care timelines on track.

Graboyes anticipates that his conceptual framework will facilitate novel intervention strategies for other cancers besides head and neck cancer. "There are many other cancer types besides head and neck cancer that are treated with multimodal, sequential cancer treatment paradigms. The work we are doing, trying to understand the determinants of head and neck cancer, certainly can benefit other cancers with similar care delivery challenges."

For many developing countries, it is difficult to break the cycle of corruption on their own. Historically, multinational firms have assumed that they have two options available when dealing with corruption in developing countries: "play the game," meaning pay bribes or engage in corrupt activities, or "leave the table" by avoiding investing in countries where corruption is widespread. New research from Charles E. Stevens, associate professor of management in Lehigh's College of Business, shows firms taking a third approach-managing corruption by promoting positive engagement with the host country.

The study, "Avoid, acquiesce ... or engage? New insights from sub-Saharan Africa on MNE strategies for managing corruption," funded by a Social Sciences and Humanities Research Council of Canada grant, is published in the latest issue of Strategic Management Journal.

Using an inductive, qualitative research design, Stevens, in collaboration with Aloysius Newenham-Kahindi, associate professor at the University of Victoria, was able to better understand how and why issues relating to corruption arose and how firms dealt with them. According to Stevens, firms may typically "tread lightly," but his research shows firms having success by making deeper, long-term commitments.

"Within the last decade, a number of developing country firms, many of them from China, were taking a different approach that we termed an engagement strategy that, in many ways, was unexpected and counter-intuitive because it tended to involve greater commitment and greater investment to countries where there was more corruption," said Stevens.

Stevens and Newenham-Kahindi were curious to see if these firms were less concerned with corruption, but research found that was not the case.

"Many of these firms were following rather interesting and complex strategies, many that involved multiple actors that were designed at minimizing the ability of host-country actors to request bribes by maximizing their bargaining power or by minimizing the motivation of host-country actors to request bribes by increasing their legitimacy," explained Stevens.

Facing challenges related to studying corruption due to the illegal activity often being hidden, Stevens and Newenham-Kahindi surveyed those who experience dealing with corruption directly. Among those interviewed for the study were 445 individuals representing industries such as construction, mining, manufacturing, energy, and telecommunications in both developed and developing country firms; 126 host country government officials and employees; 34 local private sector employees; 44 local institutional researchers; and 142 members of the general public.

According to Stevens, this paper fills an important gap in corruption literature by increasing the understanding of the options and strategies that firms have at their disposal when they invest in countries where corruption is a greater problem.

With this study, the researchers are hoping to change policies and practices by both firms and governments.

"We hope that this research allows firms, governments, and the general public to achieve economic prosperity, reduce corruption, and create mutually-beneficial solutions through investment and growth," said Stevens. "Firms shouldn't automatically be afraid to invest in countries where risks like corruption are present. Such countries present many challenges, but for firms that go in with a comprehensive plan, are prepared to make a long-term commitment, and find ways to leverage partnerships with governments and other firms, the rewards can be worth the risks."

A group led by researchers at Butantan Institute in Brazil and supported by FAPESP has described for the first time the presence of venom glands in the mouth of an amphibian. The legless animal is a caecilian and lives underground. It has tooth-related glands that, when compressed during biting, release a secretion into its prey - earthworms, insect larvae, small amphibians and snakes, and even rodent pups. A paper reporting the study is published
in iScience.

"We were analyzing the mucus glands in the skin of the animal's head, which it uses to burrow down into the soil, when we discovered these structures. They're located at the base of the teeth and develop out of the dental lamina, the tissue that typically gives rise to teeth, as is the case with snakes' venom glands," said Pedro Luiz Mailho-Fontana, first author of the paper and a postdoctoral intern at Butantan Institute with a scholarship from São Paulo Research Foundation - FAPESP.

An article by the same group published in 2018 in Scientific Reports showed that in addition to mucus glands in the skin all over the body caecilians have many poison glands in the skin of the tail as a passive defense against predators. This system, which is also found in frogs, toads and salamanders, poisons predators when they bite caecilians.

In the new report the researchers show that caecilians can be venomous, and indeed are the first amphibians to have an active defense system. Biologists apply the term venomous to organisms that bite or sting to inject their toxins, such as snakes, spiders, and scorpions, whereas poisonous refers to organisms that deliver toxins when touched or eaten.

In these caecilians, the secretion released by the glands also serves to lubricate a prey so that it is easier to swallow.

"Snakes have pouches to accumulate venom, which they inject through fangs when the pouches are squeezed by muscles. In rattlesnakes and pit vipers, for example, the teeth are hollow like hypodermic needles. In caecilians, gland compression during biting releases the venom, which penetrates the puncture wound. The same goes for lizards like the Komodo dragon and Gila monster," said Carlos Jared, a researcher at Butantan Institute and principal investigator for the study.

The study was part of the FAPESP-funded project "Unraveling parental care in caecilians: nutritional and toxinological implications in Siphonops annulatus". In a paper published in Nature in 2006, the researchers were the first to show that offspring of the caecilian species Boulengerula taitanus feed solely on the mother's skin in the first two months of their lives. In 2008 the group described the same behavior for Siphonops annulatus in a paper published in Biology Letters .

Except for a group that lives in aquatic environments, caecilians spend their entire lives in burrows or underground tunnels. As a result, they have very small eyes, which sense light but do not form images. They are also the only vertebrates that have tentacles. In caecilians, these are near the eyes and act as feelers equipped with chemical sensors that test the environment for sensory data.

Characterization of venom

The researchers' biochemical analysis showed that the secretion released from the animal's mouth while it is biting contains phospholipase A2, an enzyme commonly found in the venom of bees, wasps, and snakes. They found the enzyme to be more active in caecilians than in rattlesnakes. However, this trait is not sufficient to prove they are more venomous than snakes.

The group will now conduct tests using molecular biology techniques to characterize caecilians' dental gland secretion more precisely and confirm that it is venomous. In the future they may test any proteins they find in order to explore possible biotechnological applications such as drug development.

Four species were analyzed in the study. In Typhlonectes compressicauda, the only one that lives in aquatic environments, the glands were found only in the lower jaw. The researchers believe it may have lost the upper-jaw glands during the evolutionary process (as did some water snakes) since the water in the environment naturally lubricates prey. The mandibular glands were retained, probably for venom.

Most of the 214 known species of caecilians live underground in the humid forests of South America, India, and Africa. Owing to their subterranean habits, biologists rarely have a chance to find out more about these animals.

More than new data about caecilians, the study offers important information regarding the evolution of amphibians and reptiles. "For snakes and caecilians, the head is the only tool for exploring the environment, fighting, eating and killing. This may have fueled evolutionary pressure for these limbless animals to develop venom," said Marta Maria Antoniazzi , also a researcher at Butantan Institute and a co-author of the study.

October 1, 2020 -- Menthol could be exacerbating deep social inequities according to a paper just published in Nicotine & Tobacco Research. Researchers at Columbia University Mailman School of Public Health and colleagues at CUNY and Rutgers School of Public Health suggest that a ban on menthol cigarettes could have monumental implications for both the short- and long-term physical and mental health of communities of color.

"Assessing menthol smoking status should be a priority in all substance use research and smoking cessation interventions," observed Renee Goodwin, PhD, an epidemiologist at Columbia Mailman School, and senior author. "A decade after Congress exempted menthol from the flavored cigarette ban, preference for menthol remains more popular among young smokers and extremely high among Black smokers."

Overall estimates indicate that over 630,000 deaths would be averted and that one of three of these would be a Black life if menthol was included in the flavored cigarette ban.

Using data from the most recent National Survey on Drug Use and Health (NSDUH), the analysis showed that 10 years after the exemption of menthol from the ban, its preference among cigarette smokers remains inversely correlated with age and race. Among black smokers, 85 percent had a preference for menthol cigarettes while only 29 percent of Non-Hispanic Whites expressed the same penchant.

According to Goodwin, in the context of inaction on menthol, young people and Black smokers are not the only vulnerable populations that warrant attention with respect to menthol smoking. Preference for menthol among cigarette smokers was also disproportionately high among lesbian and gay smokers (51 percent), bisexual smokers (46 percent), and smokers with mental health problems (45 percent). The analyses also highlighted disproportionately high percentages among socioeconomically disadvantaged populations and pregnant women.

"The menthol loophole and subsequent inaction on menthol comes down to policy makers, political influence, and power," noted Cristine Delnevo of Rutgers and the first author. "For decades, tobacco companies have been targeting marginalized populations with advertising for menthol cigarettes. It's clear that a ban on menthol is not only necessary for the protection of public health, but also to achieve health equity in the U.S."

Studies have long reported that Black cancer patients have poorer outcomes than their white counterparts. But two University of Colorado Cancer Center researchers decided to investigate the data further and figure out why. What they found was that the outcome disparity was caused not by biology, but simply by differences in access to health care.

The researchers, Jessica McDermott, MD, an assistant professor in the Department of Medical Oncology, and Sana Karam, MD, PhD, an associate professor in the Department of Radiation Oncology, examined Medicare data for individuals suffering squamous cell cancer of the head and neck. All 13,117 patients in this study were diagnosed with their first and only malignant tumor at age 66 or older sometime between 2006 and 2015.

The data confirmed what has been widely reported for years ¬- that the Black head and neck cancer patients had worse outcomes than the white cancer patients.

"But then when we controlled for access to care, those differences suddenly disappeared," says McDermott. "When you closely examine the data, it becomes clear what is going on."

Their findings were published this week in the Journal of the National Comprehensive Cancer Network. The physicians hope their research will catch the attention of those who can help narrow those disparate outcomes.

McDermott and Karam identified two major differences for Black patients: first, they presented at later stages of cancer, and second, they were less likely to receive treatment.

"This is an interesting finding," says McDermott. "A lot of the reasons driving the disparate outcomes came down to socially related things - they were less likely to be married, lived in poor areas, had comorbidities [presence of two or more chronic diseases], were less likely to see a primary care provider in the year leading up to the diagnosis, and were more likely to present in the emergency room."

For most cancers, where and when a patient first presents can make a large difference both in the care received and in the outcome.

"Just a reminder that we are talking about a curable disease, a disease that, if treated properly, can be eradicated with a high degree of certainty," says Karam. "I hope that more targeted interventions can be developed as a result of our findings. The problem lies not so much in biological differences, but access. If Black patients get the treatment, they do just as well."

A teaching and research hospital like the University of Colorado can lead the way in improving the care of underserved communities.

"Like many other tertiary care centers, we have a great number of clinical trials, but not everyone who could benefit from them enjoys access," says Karam. "We need to enhance our ability to deliver more broadly the best and newest trials that can extend life and decrease symptom burden."

Black lives matter

The disparities that Black community members face are gaining national attention after the deaths of George Floyd and other Black men and women. But one area of inequity that has not received as much attention is access to medical care. Last month, dozens of providers gathered at the Anschutz Medical Campus to support a national movement by kneeling with fellow White Coats for Black Lives members.

"Speaking up is an important first step towards change," says Karam. "But it must be accompanied by policy change aimed at expanding access to care. We invest billions in new therapies that might or might not work but devote far less attention to helping our socially challenged patients get through the door, which our study shows does work."

The doctors say that more work is needed to overcome hurdles to health care access.

"We also need to educate the next generation of doctors on showing compassion and sensitivity to issues of race, income, social challenges, addiction, and other access barriers," says Karam.

What the CU Cancer Center is doing to help

Prior to this study's publication, Dr. McDermott was awarded a grant from the CU Cancer Center Office of Community Outreach and Engagement to increase the representation of the Hispanic populations in head and neck cancer clinical trials. Colorado has a large population of Hispanics, which makes that population an easier place to begin making changes.

"Our goal is to use that project to branch out to Hispanics, Blacks, and anyone else with socioeconomic issues that currently compromise their access to care," says McDermott.

The CU Cancer Center will continue studying the health disparities for different types of cancer and investigating strategies for eliminating the barriers faced by those needing care.

PHILADELPHIA (October 1, 2020) - Insulin pumps are widely used in the management of type 1 diabetes (T1D) and reviews have shown insulin pump therapy to be associated with improved glycemic control, fewer severe hypoglycemia events, and improved quality of life. Yet, non-Hispanic white children (NHW) are more than twice as likely as non-Hispanic Black children (NHB) to use this technology.

In an article in the Journal of Pediatric Nursing, researchers outline their study findings which have determined that this gap has persisted for 15 years. They consider that this inequity among children with T1D may not be simply attributable to socioeconomic status. They also believe it plays a role in the racial disparities in clinical outcomes seen in type 1 diabetes as NHB children have worse glycemic control and higher rates of complications of the disease.

"This study demonstrates a remarkable lack of progress in addressing racial and ethnic disparities in the area of T1D over the past decade. The extent of these disparities must be fully investigated through research with parents of children with diabetes, and with providers, to determine the contributing factors -- including the impact of implicit bias and structural racism," writes Terri H. Lipman, PhD, CRNP, FAAN, the Miriam Stirl Endowed Term Professor of Nutrition, Professor of Nursing of Children and Assistant Dean for Community Engagement at the University of Pennsylvania School of Nursing (Penn Nursing)

The researchers suggest that increasing diversity in the health care workforce or adding community health workers to the team may play an important role in overcoming these barriers to equitable care. "Interventions must be developed to address these disparities so that optimal diabetes care can be provided to children of all racial, ethnic, and socioeconomic backgrounds," writes Lipman.