Culture

University of Hawaii and iconic watercress farm collaborate on sustainability research

image: Sumida Farm employees hand plant, harvest, and prepare watercress for market in much the same way they have for more than 90 years. 

Image: 
Corey Rothwell

University of Hawai'i (UH) at Mānoa researchers and Sumida Farm farmers published a study this week detailing their collaboration to study the past, present and future of the multigenerational farm which produces 70 percent of Hawai'i's watercress. The study highlights that relationships with the broader community have enhanced Sumida Farm's ability to adapt and innovate their farm practices in response to challenges and changing conditions. 

Once a preferred swimming pool of Hawaiian ali'i, the Kalauao Spring on the island of O'ahu today continues to supply millions of gallons of clean, fresh water to the Pearl Harbor region. But changes to the environment, climate and continued development of the surrounding areas has put into question its sustainability.

Third-generation farmers, siblings Barbara and David Sumida had been running the farm for decades, and were starting to wonder if the clean fresh spring water that was the source of their livelihood was experiencing pollution from the surrounding urban development; if the springs were getting saltier from sea level rise; and why the crops were dying off during the hottest summer months.

In 2017, the Sumida family began to collaborate with members of UH Mānoa's 'Ike Wai research group. A team of UH earth scientists, economists, geographers and Hawaiian language experts, and the Sumida family used novel research methods to study this dynamic and fragile resource and investigate changes they were observing in the crops.

The team pursued an approach that included interviews about farm history and harvests; place name searches to research the mo'olelo of Kalauao (Kahuawai) Spring; a 25-year retrospective analysis of harvests, groundwater pumping, Oceanic Niño Index, and temperature to identify trends in productivity; a one-year intensive study of the freshwater springs at the farm to identify any seasonal, tidal and climate-induced changes to water quality, as well as pollution from agriculture or cesspools; and an analysis of local and national press to determine the community's valuation of the farm over its 90-year history.

"This deep dive into the history of the farm uncovered some very surprising insights," said Jennifer Engels, affiliate researcher with the UH Mānoa School of Ocean and Earth Science and Technology (SOEST) and lead author of the study. "The close partnership between the UH Mānoa team and the Sumidas resulted in a great synergy of ideas and information that would never have been possible without their generational accounts of lived experiences on the farm."

The team sought to gain insight into the resilience of the Sumidas' watercress farm despite the pressures of urbanization that have made other small farms obsolete around the islands.

It turns out that thousands of community members, from school children to senior citizens to celebrity chefs, have been welcomed to Sumida farm over the past several decades--creating deep and meaningful connections. Furthermore, as far back as the 1800's, hundreds of Hawaiian language newspaper reports indicate how valuable and useful the spring and the surrounding areas were for the community.

As urban areas expand around the world, there are growing efforts to restore and protect natural and agricultural systems for the services they provide to urban communities, such as crop production, flood prevention and nutrient retention.

"Hawai'i has ambitious goals around food sustainability by 2050, and yet small farms around the state have struggled or failed over the last several decades," said Engels. "Sumida Farm has survived and thrived despite multiple challenges throughout its history, from pests, to urbanization, to climate change. Their example can serve as a model for other small farms."

In an unfortunate and heartbreaking turn of events, Barbara Sumida passed away in February of this year. Although her presence is deeply missed, her spirit and legacy remain strong. Her brother David, and now the fourth generation of Sumida farmers, Emi and Kyle, are continuing their partnership with UH Mānoa's research team. Their goal is to adapt and evolve the farm in response to changing environmental and social needs so they can continue to nourish the islands and serve the community.

Credit: 
University of Hawaii at Manoa

COVID-19 news from Annals of Internal Medicine

Below please find a summary and link(s) of new coronavirus-related content published today in Annals of Internal Medicine. The summary below is not intended to substitute for the full article as a source of information. A collection of coronavirus-related content is free to the public at http://go.annals.org/coronavirus.

1. Opinion: During the COVID-19 pandemic, the public must be protected from research without consent

The COVID-19 pandemic demands a sweeping public health response, however, preventing unnecessary sacrifice of fundamental human rights under the pretext of public health is critical, according to a team of bioethicists from Johns Hopkins University. One area where this concern arises is differentiating public health activities classified as surveillance from those that constitute research. Defining activities as public health surveillance has profound implications, because there is then no further ethical oversight, no legal requirement in the United States for informed consent, and no specific protection for vulnerable participants or communities. The ethical basis for using surveillance data without consent, particularly in emergency situations, is that it serves a compelling common good. While public health activities should proceed without informed consent when it is not possible or would undermine effective public health response. However, researchers should not invoke the Common Rule's public health surveillance exclusion, under questionable pretenses, when there is clearly also a research intent, whether extant or downstream. Storage of data and biological specimens for future research should occur with informed consent. Activities that are truly research should be regulated as such, and public health surveillance should be done with consent if possible. According to the authors, we must execute good governance of the public health surveillance and emergency response infrastructure to maintain the public trust and avoid repeating research abuses of the past. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-4631.

Media contacts: A PDF for this article is not yet available. Please click the link to read full text. The lead author, Mary Catherine Beach, MD, MPH, can be reached at mcbeach@jhmi.edu.

2. Occupational Health: A Key to the Control of COVID-19 in Correctional Facilities

COVID-19 has swept through prisons in much the same way it has nursing homes: after being introduced by staff or newly arrived residents, it spreads efficiently, including to many with medical vulnerabilities. Yet, many correctional workers lack basic protections. The authors from Amend at UCSF: Changing Correctional Culture and University of California believe that ensuring community-standard occupational health for correctional staff during COVID-19 will protect prison residents, staff, and their communities. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-4543.

Media contacts: A PDF for this article is not yet available. Please click the link to read full text. The lead author, David Sears, MD, can be reached through Daryl Norcott at daryl.norcott@ucsf.edu.

Credit: 
American College of Physicians

Life in the pits: Scientists identify the key enzyme behind BO

Scientists have discovered a unique enzyme responsible for the pungent characteristic smell we call body odour or BO.

Researchers from the University of York have previously shown that only a few bacteria in your armpit are the real culprits behind BO. Now the same team, in collaboration with Unilever scientists, has gone a step further to discover a unique "BO enzyme" found only within these bacteria and responsible for the characteristic armpit odour.

This new research highlights how particular bacteria have evolved a specialised enzyme to produce some of the key molecules we recognise as BO.

Co-first author Dr Michelle Rudden from the group of Prof. Gavin Thomas in the University of York's Department of Biology, said: "Solving the structure of this 'BO enzyme' has allowed us to pinpoint the molecular step inside certain bacteria that makes the odour molecules. This is a key advancement in understanding how body odour works, and will enable the development of targeted inhibitors that stop BO production at source without disrupting the armpit microbiome."

Your armpit hosts a diverse community of bacteria that is part of your natural skin microbiome. This research highlights Staphylococcus hominis as one of the main microbes behind body odour.

Furthermore, the researchers say that this "BO enzyme" was present in S. hominis long before the emergence of Homo sapiens as a species, suggesting that body odour existed prior to the evolution of modern humans, and may have had an important role in societal communication among ancestral primates.

This research represents an important discovery for Unilever R&D, made possible by its long-standing academic-industry collaboration with the University of York. Unilever co-author Dr Gordon James said: "This research was a real eye-opener. It was fascinating to discover that a key odour-forming enzyme exists in only a select few armpit bacteria - and evolved there tens of millions of years ago."

Credit: 
University of York

Men are more likely than women to endorse COVID-19 conspiracy theories

video: University of Delaware Professor Joanne Miller talks about a new study that found men are more likely than women to endorse conspiracy theories related to COVID-19.

Image: 
University of Delaware

A new study has found that men are more likely than women to endorse coronavirus (COVID-19) related conspiracy theories.

The study, published in early July in Politics and Gender, builds upon research from earlier this year that revealed Republicans were more likely than Democrats to believe COVID-19 conspiracies.

The partisan split - shown in a previous study by University of Delaware professor Joanne Miller - makes sense, given that one of the reasons people believe conspiracy theories is to protect their political worldviews.

The current political context is one in which the Republican president is being widely criticized for his handling of the pandemic. So Republicans are more likely to believe that, for example, scientists or the media are exaggerating the seriousness of the virus. If the United States had a Democratic president who was being criticized for his/her handling of the pandemic, more Democrats would believe these COVID-19 conspiracy theories, said Miller, a professor in the University of Delaware's Department of Political Science and International Relations.

But the new research, co-authored by Miller, fellow University of Delaware professor Erin Cassese and Christina Farhart from Carleton College, shows that gender is more of a factor than party affiliation.

The COVID-19 pandemic is an easy target for conspiracy theories. Most of us are engulfed in worries over health, finances, jobs or our childrens' education and feel a lack of control, the authors say.

"During a global pandemic, it's kind of the perfect storm of uncertainty," Miller said. "And so when we feel a lack of control, uncertainty or powerlessness, we seek out explanations for why the event occurred that's causing us to feel that way. And what this can do is it can lead us to connect dots that shouldn't be connected because we're trying to seek out answers. And sometimes those answers are conspiracy theories."

Working with Farhart, Miller and Cassese used previous research as a jumping off point: Men and women are experiencing the pandemic differently. For example, men are more vulnerable to the virus, but women are more likely to be frontline workers and experience more of a burden as the primary caregivers at home.

Those findings raised questions as to whether gender also influenced conspiracy theory beliefs.

To find out, the team ran a survey of 3,000 people in April using 11 popular conspiracy theories, including claims that China or the U.S. accidentally released the virus; that 5G cell towers are causing the virus; that Bill Gates is plotting to somehow inject us with a vaccine; and that scientists are trying to make Donald Trump look bad by exaggerating the seriousness of the pandemic.

Among Democrats, there were statistically significant gender gaps for all 11 conspiracy theories; among Republicans, there were gender gaps for nine of the 11. The average gender gap among Democrats was 10.18% points (32.45% males to 22.27% females endorsed the theories), compared to 10.09% points among Republicans (48.9% males vs. 38.81% females). The gender differences were notable, researchers said, given that gender gaps in public opinion tend to be much smaller in magnitude, and the results were surprising, given that past work has not found a consistent association between gender and conspiracy theory beliefs.

So why men? Two dispositional factors are connected to the gender gap. Learned helplessness, which is a feeling like everything's out of your control and any actions that you try to take are basically pointless; and conspiratorial thinking, which is a tendency to think about major political events and problems in conspiratorial terms without having any connection to, in this case, COVID-19.

The key factor is learned helplessness, which is experienced by both men and women. Miller described the process: Some people, when faced with repeated failures at trying to affect positive change in their lives, come to believe that they are helpless to control the things that they want to control.

The resulting general sense of learned helplessness can lead to conspiracy theory beliefs, Miller said.

"What we're finding in this research is that men are more likely to score higher on learned helplessness," Miller said. "And that might be a boost that's happening just as a result of the pandemic itself, that they're feeling more of this because they can't control what's going on right now. That leads to these beliefs that, well, maybe there's a secret group of people controlling these things behind the scenes."

Cassese added, "It's something that both men and women can experience, but in our study we're finding that it's men who are really feeling this more at this moment, and it's influencing how they feel about COVID. Learned helplessness and a predisposition toward conspiratorial thinking explain about half of the gender difference that we find. But there's still more for us to do to try to understand this phenomenon."

Miller and Cassese said they hope to use their findings to affect positive change in public health. Recent research has found that women were more likely than men to engage in protective behaviors that have been recommended by scientists and health officials, such as wearing masks and social distancing.

"So there may be some connection here between engaging in those activities and belief in conspiracy theories that we plan on exploring in future research," Miller said.

Credit: 
University of Delaware

COVID-19 increased anxiety, depression for already stressed college students

image: Depression levels of students across the first academic term impacted by the COVID-19 pandemic (green) spike when compared to the historic average (red). Weeks nine through 12 were influenced by major campus policy changes and are represented with a shaded box (upper right).

Image: 
Figure courtesy of Jeremy Huckins.

HANOVER, N.H. - July 27, 2020 - College students were more anxious and depressed during the initial outbreak of COVID-19 than they were during similar time frames in previous academic years, according to a Dartmouth study.

The research also found that sedentary behavior increased dramatically during the onset of the public health crisis in early March.

The study, published in the Journal of Medical Internet Research, used a mix of smartphone sensing and digital questionnaires from more than 200 students participating in a research program that is tracking mental health throughout their undergraduate years.

"COVID-19 had an immediate negative impact on the emotional well-being of the college students we studied," said Jeremy Huckins, a lecturer on psychological and brain sciences at Dartmouth. "We observed a large-scale shift in mental health and behavior compared to the observed baseline established for this group over previous years."

Self-reported symptoms of depression and anxiety within the student research group spiked noticeably at the onset of COVID-19. At the time, major policy changes related to COVID-19 were also being put in place, including the request that students leave campus and the switch to remote learning.

These changes coincided with the end of classes and final exams, already one of the most stressful times for students in any academic term.

According to the study, anxiety and depression decreased slightly after the final exam period as students settled into shelter-in-place locations. This suggested some resilience in the face of COVID-19, but levels remained consistently higher than similar periods during previous academic terms.

Unlike previous terms studied, sedentary time increased dramatically during this year's spring break period.

"This was an atypical time for these college students. While spring break is usually a period of decreased stress and increased physical activity, spring break 2020 was stressful and confining for the students participating in this study. We suspect that this was the case for a large number of college students across the country," said Huckins.

The study used StudentLife, a sensing app developed at Dartmouth, to collect information from student volunteers. StudentLife passively collects behavioral information from user's smartphones such as duration of phone usage, number of phone unlocks, sleep duration, and sedentary time.

Data on depression and anxiety were collected using weekly, self-reported assessments also administered through the StudentLife app.

"This is the first time we have used sensor data from phones to give us unique behavioral insights into the reaction of students to the onset of the pandemic on a college campus," said Andrew Campbell, the Albert Bradley 1915 Third Century Professor of computer science at Dartmouth and one of the lead researchers of the StudentLife study. "We plan to further analyze how these students adjusted both physically and mentally during remote learning that leads on from this study."

In the research, the team also reported a connection between anxiety and COVID-19 news coverage. The link between depression and news reporting was apparent, but not as strong. As news coverage intensified, there was an increase in sedentary behavior and a longer duration of phone usage.

According to the study, the decrease in the number of locations visited was consistent with the social distancing and shelter-in-place policies implemented by local governments.

The study's findings on the uptake of social distancing recommendations contrasts with other research of college students in which governmental social distancing policies were not followed. Findings in the current study are also contrary to media depictions of college-age students flouting social distancing recommendations during the spring break period.

"Many people wouldn't expect college students to listen to social distancing orders, but these students did. We found that when social distancing was recommended by local governments, students were more sedentary and visited fewer locations on any given day," said Huckins. "Clearly the impact of COVID-19 extends beyond the virus and its direct impacts. An unresolved question is if mental health and physical activity will continue to degrade over time, or if we will see a recovery, and how long that recovery will take."

The research is part of a multiyear study focusing on the mental health of undergraduate students as they progress through their undergraduate careers. The complete study combines smartphone mobile sensing with functional neuroimaging.

"When we set out two years ago to follow 200 students across their college experiences, we could never have anticipated the inflection point in our data as a result of such a catastrophic event as the pandemic," added Campbell.

Upon completion of the full study, researchers will be able to extend their findings on the disruption at the start of the COVID-19 pandemic to the long-term impact of remote learning and social isolation that the students are experiencing.

More information on the StudentLife research program can be found at: https://studentlife.cs.dartmouth.edu/ [https://studentlife.cs.dartmouth.edu/ ]

Credit: 
Dartmouth College

Link confirmed between a healthy diet and prostate cancer prevention

The Canadian Cancer Society estimates that more than 23,000 Canadians will be diagnosed with prostate cancer in 2020. Among other risk factors, more and more studies point to diet as a major factor in the development of prostate cancer, as it is for cardiovascular disease, diabetes, and obesity. Using data from a study conducted in Montreal between 2005 and 2012, a research team led by Professor Marie-Élise Parent of Institut national de la recherche scientifique (INRS) has shown a link between diet and prostate cancer in the article "Dietary Patterns Are Associated with Risk of Prostate Cancer in a Population-Based Case-Control Study in Montreal, Canada", published in Nutrients in June.

Three main dietary profiles analyzed

INRS PhD student Karine Trudeau, the lead author of the study, based her analysis on three main dietary profiles: healthy diet, salty Western diet including alcohol, and sugar-rich Western diet with beverages. The first profile leans heavily towards fruits, vegetables, and plant proteins like tofu and nuts. The salty Western diet with alcohol includes more meat and beverages such as beer and wine. The third profile is rich in pasta, pizza, desserts, and sugary carbonated drinks. The study took age, ethnicity, education, family history, and date of last prostate cancer screening into account.

Marie-Élise Parent and Karine Trudeau found a link between a healthy diet and a lower risk of prostate cancer. Conversely, a Western diet with sweets and beverages was associated with a higher risk and seemed to be a factor in more aggressive forms of cancer. The study did not show any clear link between a Western diet with salt and alcohol and the risk of developing the disease.

Moving away from the typical approach used in epidemiological studies, which involves looking at one nutrient or food group at a time, the researchers collected data from a broader dietary profile. "It's not easy to isolate the effect of a single nutrient," explained Ms. Trudeau. "For example, foods rich in vitamin C, such as citrus fruits, promote iron absorption. Calcium is often found in dairy products, which also contain vitamin D. Our more targeted approach takes this synergy into account to produce more meaningful results that public health authorities can use to formulate recommendations. Rather than counting on one miracle food, people should look at their overall diet."

"For a long time we've suspected that diet might play a role in the development of prostate cancer, but it was very hard to pinpoint the specific factors at play," said Professor Parent. "This study is significant because it looks at dietary habits as a whole. We've uncovered evidence that, we hope, can be used to develop prevention strategies for prostate cancer, the most common cancer among men in Canada and many other countries."

In addition to INRS faculty and students Marie-Élise Parent, Karine Trudeau, Christine Barul, and Marie-Claude Rousseau, Ilona Csizmadi (Cumming School of Medicine) participated in the research. The study was funded by the Canadian Cancer Society (CCS), the Cancer Research Society (CRS), Fonds de la recherche du Québec--Santé (FRQS), and Ministère de l'Économie et de l'Innovation (MEI).

Credit: 
Institut national de la recherche scientifique - INRS

New approach refines the Hubble's constant and age of universe

EUGENE, Ore. - July 27, 2020 - Using known distances of 50 galaxies from Earth to refine calculations in Hubble's constant, a research team led by a University of Oregon astronomer estimates the age of the universe at 12.6 billion years.

Approaches to date the Big Bang, which gave birth to the universe, rely on mathematics and computational modeling, using distance estimates of the oldest stars, the behavior of galaxies and the rate of the universe's expansion. The idea is to compute how long it would take all objects to return to the beginning.

A key calculation for dating is the Hubble's constant, named after Edwin Hubble who first calculated the universe's expansion rate in 1929. Another recent technique uses observations of leftover radiation from the Big Bang. It maps bumps and wiggles in spacetime - the cosmic microwave background, or CMB - and reflects conditions in the early universe as set by Hubble's constant.

However, the methods reach different conclusions, said James Schombert, a professor of physics at the UO. In a paper published July 17 in the Astronomical Journal, he and colleagues unveil a new approach that recalibrates a distance-measuring tool known as the baryonic Tully-Fisher relation independently of Hubble's constant.

"The distance scale problem, as it is known, is incredibly difficult because the distances to galaxies are vast and the signposts for their distances are faint and hard to calibrate," Schombert said.

Schombert's team recalculated the Tully-Fisher approach, using accurately defined distances in a linear computation of the 50 galaxies as guides for measuring the distances of 95 other galaxies. The universe, he noted, is ruled by a series of mathematical patterns expressed in equations. The new approach more accurately accounts for the mass and rotational curves of galaxies to turn those equations into numbers like age and expansion rate.

His team's approach determines the Hubble's constant - the universe's expansion rate - at 75.1 kilometers per second per megaparsec, give or take 2.3. A megaparsec, a common unit of space-related measurements, is equal to one million parsecs. A parsec is about 3.3 light years.

All Hubble's constant values lower than 70, his team wrote, can be ruled out with 95 percent degree of confidence.

Traditionally used measuring techniques over the past 50 years, Schombert said, have set the value at 75, but CMB computes a rate of 67. The CMB technique, while using different assumptions and computer simulations, should still arrive at the same estimate, he said.

"The tension in the field occurs from the fact that it does not," Schombert said. "This difference is well outside the observational errors and produced a great deal of friction in the cosmological community."

Calculations drawn from observations of NASA's Wilkinson Microwave Anisotropy Probe in 2013 put the age of the universe at 13.77 billion years, which, for the moment, represents the standard model of Big Bang cosmology. The differing Hubble's constant values from the various techniques generally estimate the universe's age at between 12 billion and 14.5 billion years.

The new study, based in part on observations made with the Spitzer Space Telescope, adds a new element to how calculations to reach Hubble's constant can be set, by introducing a purely empirical method, using direct observations, to determine the distance to galaxies, Schombert said.

"Our resulting value is on the high side of the different schools of cosmology, signaling that our understanding of the physics of the universe is incomplete with the hope of new physics in the future," he said.

Credit: 
University of Oregon

Flu, pneumonia vaccinations tied to lower risk of Alzheimer's dementia

CHICAGO, JULY 27, 2020 -- Flu (influenza) and pneumonia vaccinations are associated with reduced risk of Alzheimer's disease, according to new research reported at the Alzheimer's Association International Conference® (AAIC®) 2020.

Three research studies reported at AAIC 2020 suggest:

At least one flu vaccination was associated with a 17% reduction in Alzheimer's incidence. More frequent flu vaccination was associated with another 13% reduction in Alzheimer's incidence.

Vaccination against pneumonia between ages 65 and 75 reduced Alzheimer's risk by up to 40% depending on individual genes.

Individuals with dementia have a higher risk of dying (6-fold) after infections than those without dementia (3-fold).

"With the COVID-19 pandemic, vaccines are at the forefront of public health discussions. It is important to explore their benefit in not only protecting against viral or bacterial infection but also improving long-term health outcomes," said Maria C. Carrillo, Ph.D., Alzheimer's Association chief science officer.

"It may turn out to be as simple as if you're taking care of your health in this way -- getting vaccinated -- you're also taking care of yourself in other ways, and these things add up to lower risk of Alzheimer's and other dementias," Carrillo said. "This research, while early, calls for further studies in large, diverse clinical trials to inform whether vaccinations as a public health strategy decrease our risk for developing dementia as we age."

Seasonal Flu Vaccine May Reduce Incidence of Alzheimer's Dementia

Previous research has suggested vaccinations may have a protective factor against cognitive decline, but there have been no large, comprehensive studies focused on the influenza (flu) vaccine and Alzheimer's disease risk, specifically. To address this gap, Albert Amran, a medical student at McGovern Medical School at The University of Texas Health Science Center at Houston, and team, investigated a large American health record dataset (n=9,066).

Amran and team found having one flu vaccination was associated with a lower prevalence of Alzheimer's (odds ratio 0.83, p

The researchers found the protective association between the flu vaccine and the risk of Alzheimer's was strongest for those who received their first vaccine at a younger age -- for example, the people who received their first documented flu shot at age 60 benefitted more than those who received their first flu shot at age 70.

"Our study suggests that regular use of a very accessible and relatively cheap intervention -- the flu shot -- may significantly reduce risk of Alzheimer's dementia," Amran said. "More research is needed to explore the biological mechanism for this effect -- why and how it works in the body -- which is important as we explore effective preventive therapies for Alzheimer's."

Pneumonia Vaccine May Reduce Alzheimer's Risk Later in Life

Repurposing of existing vaccines may be a promising approach to Alzheimer's disease prevention. Svetlana Ukraintseva, Ph.D., Associate Research Professor in the Biodemography of Aging Research Unit (BARU) at Duke University Social Science Research Institute, and team, investigated associations between pneumococcal vaccination, with and without an accompanying seasonal flu shot, and the risk of Alzheimer's disease among 5,146 participants age 65+ from the Cardiovascular Health Study. The team also took into account a known genetic risk factor for Alzheimer's -- the rs2075650 G allele in the TOMM40 gene.

The researchers found that pneumococcal vaccination between ages 65-75 reduced risk of developing Alzheimer's by 25-30% after adjusting for sex, race, birth cohort, education, smoking, and number of G alleles. The largest reduction in the risk of Alzheimer's (up to 40%) was observed among people vaccinated against pneumonia who were non-carriers of the risk gene. Total number of vaccinations against pneumonia and the flu between ages 65 and 75 was also associated with a lower risk of Alzheimer's; however, the effect was not evident for the flu shot alone.

"Vaccinations against pneumonia before age 75 may reduce Alzheimer's risk later in life, depending on individual genotype," Ukraintseva said. "These data suggest that pneumococcal vaccine may be a promising candidate for personalized Alzheimer's prevention, particularly in non-carriers of certain risk genes."

Infection Substantially Increases Mortality in People with Dementia

People living with dementia commonly experience other health conditions including viral, bacterial, and other infections. There is a growing trend in research to investigate whether infections might be worsening, more life-threatening or possibly causing dementia.

Janet Janbek, a Ph.D. student at the Danish Dementia Research Centre, Rigshospitalet and the University of Copenhagen in Denmark, and team, used data from national health registries to investigate mortality in Danish residents over age 65 (n=1,496,436) who had visited the hospital with an infection. They found that people with both dementia and such hospital visits died at a 6.5 times higher rate compared with people who had neither. Study participants with either dementia alone or infection-related contacts alone had a threefold increased rate. The rate of mortality was highest within the first 30 days following the hospital visit.

The researchers also found that for people living with dementia the mortality rates remained elevated for 10 years after the initial infection-related hospital visit, and mortality rates from all infections (including major infections like sepsis to minor ear infections) were higher compared with people without dementia or without an infection-related hospital visit.

"Our study supports the need to investigate these relations even further; to find out why infections are linked to higher mortality in people with dementia, specifically which risk factors and biological mechanisms are involved. This will help advance our understanding of the role of
infections in dementia," said Janbek.

"Our study suggests that the health care system -- as well as relatives of people with dementia -- should have increased awareness of people with dementia who get infections, so they get the medical care they need. People with dementia require more specialized treatment even when their hospital visits are not directly due to their dementia but to what might appear to be an unrelated infection," Janbek added.

Credit: 
Alzheimer's Association

Duke-NUS: Cancer mutations caused by bacterial toxin preventable

Studying DNA mutations in cancers can help clarify how cancers develop and what makes cancer cells different from normal, healthy cells. The team of scientists from Duke-NUS' Cancer and Stem Cell Biology (CSCB) programme, specifically wanted to look more closely at Asian cancers to expand the list of 65 currently known mutation patterns found in cancers. Scientists expect there are still some rare mutation patterns that have yet to be discovered.

The researchers examined 872 colorectal lesions from 201 patients with unexplained, non-inherited polyposis. This condition involves the formation of intestinal polyps that can predispose people to cancer. It is usually caused by a mutation in the Adenomatous polyposis coli (APC) gene. This gene is critical for several cellular processes and acts as a tumour suppressor by preventing cells from growing and dividing uncontrollably. The team found that almost 20 per cent of the patients had tumors with mutations in the APC gene with characteristics similar to those caused by a bacterial toxin known as colibactin, suggesting the toxin's involvement in initiating polyp formation in these individuals.

This study was built upon an earlier study where the team analysed DNA mutations in 36 Asian patients who were treated in Singapore for a mouth cancer called oral squamous cell carcinoma. "We found a very specific pattern of DNA mutations in the oral cancer of patients who also had severe bacterial infection in their mouth. We found that these DNA mutations had been caused by a toxin called colibactin, which is produced by these bacteria," said Dr Arnoud Boot, Senior Research Fellow at the CSCB programme and the lead author of this study.

Colibactin, is produced by a specific group of Escherichia coli bacteria, which normally live in the gut. While exposure to colibactin is difficult to prevent, the research team suggests that regular brushing of teeth might have prevented the bacterial infection that appears to have triggered the cancer-causing DNA mutation in the oral cancer patient who was examined.

"There are bacteria that sometimes live in the human body, making a toxin that contributes to cancer formation. In addition to understanding what causes cancer, our results also indicate that some cancers that are caused by colibactin might be preventable," said Professor Steve Rozen from Duke-NUS' CSCB programme, who is the corresponding author of one of these studies.

"These kinds of investigations by our researchers from the CSCB programme are crucial in better understanding how to prevent cancer by targeting cancer-specific changes," said Prof Patrick Casey, Senior Vice Dean for Research at Duke-NUS.

The team next aims to analyse a larger dataset of cancers that could be associated with colibactin.

Credit: 
Duke-NUS Medical School

"Inchworm" pattern of Indonesian earthquake rupture powered seismic "boom"

image: Snapshots of the slip evolution in a map view. Color contours show the slip rate. Traces of surface ruptures are shown as red lines. The time when each snapshot was taken is denoted at the upper left of each panel. The figure shows that the rupture front propagated from the epicenter (star) toward the south. Stagnation of the slipping patch can be seen at Bend 1 at 6 s, followed by advancement through Bend 2 at 27 s. The transient deceleration and acceleration of the rupture is illustrated as inchworm locomotion.

Image: 
University of Tsukuba

Tsukuba, Japan - Earthquakes are often imagined as originating from a single point where the seismic waves are strongest, the hypocenter underground or the epicenter at the Earth's surface, with seismic energy radiating outward in a circular pattern. But this simplified model fails to account for the complex geometry of the actual fault systems where earthquakes occur. The real situation may be much more complex--and more interesting. In some remarkable cases, a phenomenon called "supershear" rupture can occur, where the earthquake rupture propagates along the fault at a speed faster than the seismic waves themselves can travel--a process analogous to a sonic boom.

In a new study published in Earth and Planetary Science Letters, researchers at the University of Tsukuba investigated a case of supershear rupture, the 2018 Palu earthquake (moment magnitude: 7.6) in Sulawesi, Indonesia, and its relationship with the complex geometry of the fault system.

Study co-author Professor Yuji Yagi explains, "We used globally observed teleseismic wave data and performed finite-fault inversion to simultaneously resolve the spatiotemporal evolution of slip and the complex fault geometry."

The results of this analysis showed that the propagation of supershear rupture of the Palu-Koro fault southward from the earthquake's epicenter was sustained by a pattern of repeated delay and advancement of slip along the fault, associated with the fault system's complex geometry. Areas with particularly high slip rates, referred to as "slipping patches," were identified near the epicenter as well as 60, 100, and 135 km south of the epicenter. In addition, three distinct episodes of rupture after the process initiated were distinguished, with delays in the advancement of the slipping patches between them.

Tracing the surface rupture of the earthquake showed two major bends in the earthquake fault, 10-25 km south of the epicenter and 100-110 km south of the epicenter. Supershear rupture persisted along this geometrically complex fault.

As lead author Professor Ryo Okuwaki describes, "Our study shows that the geometric complexity of a fault can significantly influence the velocity of rupture propagation. Our model of the 2018 Palu earthquake shows a zigzag pattern of slip deceleration and acceleration associated with bends in the fault, which we have named inchworm-like slip evolution. We propose that the geometric complexity of a fault system can promote persistent supershear rupture, enhanced by repeated inchworm-like slip evolution."

These findings may have significant implications regarding assessment of future earthquake impacts and related disasters. For example, the authors suggest that the slipping patch they detected beneath Palu Bay may have contributed to generation of the 2018 Palu tsunami, which added to the devastation of the earthquake.

Credit: 
University of Tsukuba

Photonic amorphous topological insulator

image: a-b, Particle patterns a and the corresponding photonic lattices b with different structural correlations. The crystalline lattice possesses both long-rang and short-range order; the glass-like lattices have strong short-range order; the liquid-like lattice yields weak short-range order. c, Pair correlation function g(r) for the different lattices which quantifies structural correlation. d, Localization lengths (black curves) and transmissions (red curves) for the photonic lattices. The orange regions indicate the frequency windows in which topological edge states can be observed.

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by Peiheng Zhou, Xin Ren, Yihao Yang, Haoran Xue, Lei Bi, Longjiang Deng, Yidong Chong, and Baile Zhang

The paradigm-shifting concept of topology has not only revolutionized condensed matter physics, but has also opened a fundamentally new chapter in photonics, mechanics, acoustics, and many other fields. In photonics, "photonic topological insulators" (PTIs), the photonic analogs of electronic topological insulators, have enabled unprecedented exciting photonic functionalities such as one-way robust photonic transport and topological lasers.

These topological systems, whether based on condensed matter or photonics, typically derive their topological properties from bandstructures based on periodic lattices. On the other hand, photonic amorphous phases without periodic atomic lattices widely exists in nature (e.g., glass, polymer, and gel). The properties of these amorphous systems are determined by the short-range connectivity of their atoms/molecules, rather than the long-range periodicity.

In a new paper published in Light Science & Application, a team of scientists, led by Professor Peiheng Zhou / Professor Longjiang Deng from University of Electronic Science and Technology of China, Professor Yidong Chong and Professor Baile Zhang from Nanyang Technological University have experimentally realized amorphous PTIs that are non-crystalline variants of a Chern-number-based PTI. Their study demonstrates the interesting interplay between topology and short-range order, especially during the glass transition. Chern-number-based PTIs are the first type of PTI ever realized. Their work is the first to study amorphous PTIs using this type of photonic structure. They also find that the extinction of photonic topological edge states refers to the glass transition. These insights may be useful for realizing amorphous topological insulators in other physical settings such as acoustics.

The amorphous PTI consists of gyromagnetic rods that are arranged in computer-generated amorphous lattice patterns, and magnetically biased to break time-reversal symmetry. By performing edge/bulk transmission and near-field distribution measurements to the PTIs in a copper parallel-plate waveguide, the existence of robust topological edge states in the amorphous PTIs are experimentally verified prior to the onset of the glass transition. By further deforming the amorphous lattice into a liquid-like lattice, the closing of the mobility gap and the disappearance of the topological edge states are observed. These scientists summarize the features of their topological system:

"We design an amorphous PTI system with three advantages: (1) the amorphous lattices are realizable in natural materials as they are generated by Molecular Dynamics Methods; (2) the full mapping from crystalline to glass-like amorphous to liquid-like phases yields the whole evaluation of the topology, from emergence to extinction, and clearly captures the role of the glass-liquid transition; and (3) the photonic platform can be immigrated to verify other non-periodic photonic topological materials."

"The topological protection supported by the short-range order in our amorphous PTIs persists remarkable robustness to large defects, e.g. 3 times the characteristic length of the lattices, and 90º bends, all comparable to the crystalline counterparts" they added.

"The presented approach can be used to develop specific amorphous PTIs with desired structural correlations, e. g. the hyperuniform structures studied in bandgap photonic crystals, or monitor other non-periodic PTIs, e.g. the quasi-crystals or metamaterials. Our findings will therefore be highly useful for future works investigating non-crystalline topological photonic materials for novel photonic devices, such as topological random lasers." the scientists forecast.

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Light Publishing Center, Changchun Institute of Optics, Fine Mechanics And Physics, CAS

Study finds increase in number, severity of suicide-related calls to US Poison Control

(COLUMBUS, Ohio) - Over-the-counter (OTC) analgesics like acetaminophen, ibuprofen, and acetylsalicylic acid (aspirin) have long been a staple in households for managing pain, fevers, and other common ailments. However, the accessibility of these medications can make them easy to take in dangerous amounts. In a new study, researchers at the Center for Injury Research and Policy and the Central Ohio Poison Center at Nationwide Children's Hospital analyzed the 549,807 calls made to Poison Control Centers (PCCs) in the US for suicide-related cases involving OTC analgesics from 2000 through 2018 and found that both the overall number and rate of these cases increased significantly by 57% and 34%, respectively, during this period. This trend was driven primarily by the increasing exposures among 6-19-year-old females.

The study, published in Pharmacoepidemiology and Drug Safety, found that children between the ages of 6 and 19 years accounted for half of all suicide-related OTC analgesics cases (50%) and females represented 73% of cases among individuals of all ages.

In addition to the increase in the number and rate of cases, there was also an increase in the severity of the exposures. The proportion of calls resulting in a serious medical outcome or admission to a health care facility increased significantly (a 64% increase and 29% increase, respectively) over the study period. The proportion of cases resulting in a serious medical outcome or admission also increased with increasing age.

"Because they are easy to purchase and can help alleviate a variety of symptoms, many families have over-the-counter pain relievers readily available in their homes, often in large quantities," said Alexandra Funk, PharmD, D.ABAT, co-author of the study and director of the Central Ohio Poison Center at Nationwide Children's. "Unfortunately, the easy access to these medications is likely a big part of the reason that they are used in suicide attempts and deaths. The fact that they are being used more often with more serious outcomes is cause for concern."

Nearly half (48%) of cases involved acetaminophen alone, followed by ibuprofen (33%), and aspirin (19%). Acetaminophen and aspirin disproportionately accounted for 65% and 33% of deaths, respectively. In addition, aspirin resulted in the greatest proportion of serious medical outcomes (36%) and admissions to a health care facility (68%) when compared with the other analgesics. The rates of suicide-related cases involving acetaminophen and ibuprofen increased during the study, while the rate of aspirin cases decreased.

Almost one-third of cases involved exposure to multiple substances (32%), and those cases were twice as likely to have a serious medical outcome and almost twice as likely to be admitted to a health care facility compared with individuals exposed to a single substance.

"An important first step to reduce the suicidal use of over-the-counter analgesics would be to require unit-dose packaging, or 'blister packs,' for all solid forms of acetaminophen and aspirin sold to consumers. Because suicidal ingestion is often a highly impulsive act, this would deter overdoses by limiting the amount of medication that can be extracted at one time," said Gary Smith MD, DrPH, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children's. "In addition, the US should follow the lead of other countries that have successfully reduced suicidal ingestions of these medications by limiting the package size and quantity that can be purchased by an individual at one time." Dr. Smith added, "Remarkably, the top three substance categories associated with suicide-related ingestions in the US are antidepressants, over-the-counter analgesics, and antipsychotics, and of these, over-the-counter analgesics is the only one readily available without a prescription or other restrictions."

Credit: 
Nationwide Children's Hospital

'Selfish and loveless' society in Uganda really is not

image: he Ik society of Uganda, labeled half a century ago as selfish, actually has a culture that encourages sharing with the needy, new study finds.

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Cathryn Townsend

A mountain people in Uganda -- branded as selfish and loveless by an anthropologist half a century ago -- really is not, according to a study led by a Baylor University anthropologist.

The research debunks the assessment of the Ik ethnic group of hunter-gatherers set out in the book "The Mountain People," published by Colin Turnbull in 1972.

Baylor anthropologist Cathryn Townsend, Ph.D., formerly of Rutgers University, lived with and gathered data from the Ik in 2016 to 2018. She found that Turnbull's research, done during a severe famine in the mid-1960s, did not uncover typical behavior of the Ik, and that sharing and cooperating re-emerged once resources were plentiful enough.

"The Ik have been misrepresented by outsiders who gave far too much credence to Turnbull's flawed research," Townsend said. "The Ik people have not yet themselves had much of a chance to talk back to correct this misrepresentation of their culture, but our research shows that associating the Ik with selfishness is a myth and that it is simply wrong.

"Ik culture includes traits that encourage sharing with those in need and a belief in supernatural punishment of selfishness," she said. "The findings confirm the consensus among scholars that humans are remarkably cooperative."

The study, published in the journal Evolutionary Human Sciences, was conducted with co-researchers from Arizona State University, Vrige Universiteit in Amsterdam and Rutgers University.

Turnbull did his fieldwork between 1964 and 1967, going so far as to advocate that the group be rounded up forcibly regardless of age and gender and taken to remote parts of Uganda to stamp out culture traits. His depiction of the Ik attracted attention from such publications as TIME Magazine and The New York Times, inspired a play by Royal Shakespeare Company and was accepted by anthropologist Margaret Mead.

The Ik, who live in villages ranging from 50 to 250 people, believe that the landscape is inhabited by spirits with shadowy human forms. Their religion also incorporates Christianity and the idea of a creator or supreme god. They believe nature spirits bring misfortune to those who fail to share and reward those who are generous.

In the study, Townsend used an instrument commonly used in the human sciences to assess generosity. It includes a theoretical framework in which a person receives money and the opportunity to share some, none or all with an anonymous person in their community.

About 120 Ik individuals were divided into four groups and asked whether they would be willing to share a typical day's wages of 2,000 Ugandan shillings (equal to about 50 cents in the United States).

The scenarios, with varying details about needs and religious beliefs, included:

You will be given 2,000 shillings to decide how to share between yourself and another member of your community. You will not find out who this person is, and they will not find out who you are.

You will be given 2,000 shillings to decide how to share between yourself and another member of your community who is in need. For example, that person may be old and hungry. You will not find out who this person is, and they will not find out who you are.

What do you know of Earth spirits? Do they cause trouble for people who do not share? Do they bring good fortune to those who do? You will be given 2,000 shillings to decide how to share between yourself and another community member. You will not find out who this person is, and they will not find out who you are.

What do you know of Earth spirits? Do they cause trouble for people who do not share? Do they bring good fortune to those who do? You will be given 2,000 shillings to decide how to share between yourself and a community member in need. For example, that person may be old and hungry. You will not find out who this person is, and they will not find out who you are
.

Results showed participants were most likely to be more generous in the scenario that included both a needy recipient and supernatural punishment, as compared with the first scenario. The responses in Scenarios 2 and 3 also were more generous.

"People behaved, on average, very slightly more generously in Scenario 3 -- which referred to supernatural punishment -- than they did in Scenario 2, but the difference is negligible," Townsend said.

In the study, Townsend also observed the people's day-to-day sharing and asked what sharing meant to them. Sharing is based on need and ties of friendship, kinship or clan, but interviewees also talked about the importance of cultivating sharing. Said one man: "If you keep everything in your granary to yourself, you will still run out of food during the hunger season, and then you will suffer because no one will share with you."

In one case, the Ik even accepted a widow and infant who were refugees from a nearby and often hostile group.

In Townsend's interviews with 60 respondents, more than three fourths said Earth spirits caused trouble for people who do not share; nearly half said the spirits bring good fortune to those who do.

In a second analysis, researchers compared the Ik's sharing with generosity assessments of more than 20,000 participants, mostly in Western countries. They found the people's behavior similar to that of other societies.

"While the selfish behavior observed by Turnbull may have been at least partly real, we can conclude that this was due to a severe famine at the time in which people were starving to death, not culture," Townsend said. "The Ik people have experienced many extreme hardships since the famine that Turnbull witnessed in the 1960s, but the resilience of Ik culture traits of generosity should give us all hope that human cooperation ultimately overcomes adversity."

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Baylor University

Wealthier men are more likely to develop high blood pressure

Sophia Antipolis, 27 July 2020: Working men with higher incomes are more likely to develop high blood pressure, reports a study presented at the 84th Annual Scientific Meeting of the Japanese Circulation Society (JCS 2020).

JCS 2020 takes place online from 27 July to 2 August in conjunction with the Asian Pacific Society of Cardiology Congress 2020 (APSC 2020). Joint scientific sessions are being held by the European Society of Cardiology (ESC) and JCS as part of the ESC Global Activities programme.1

"Men with higher incomes need to improve their lifestyles to prevent high blood pressure," said study author Dr. Shingo Yanagiya of the Hokkaido University Graduate School of Medicine, Sapporo, Japan. "Steps include eating healthily, exercising, and controlling weight. Alcohol should be kept to moderate levels and binge drinking avoided."

More than one billion people have high blood pressure worldwide.2 Around 30-45% of adults are affected, rising to more than 60% of people over 60 years of age. High blood pressure is the leading global cause of premature death, accounting for almost 10 million deaths in 2015. Of those, 4.9 million were due to ischaemic heart disease and 3.5 million were due to stroke.

Japan alone has more than 10 million people with high blood pressure, and the number continues to rise. Dr. Yanagiya said: "High blood pressure is a lifestyle-related disease. As a physician seeing these patients I wanted to know if risk varies with socioeconomic class, to help us focus our prevention efforts."

This analysis of the J-HOPE3 study examined the relationship between household income and high blood pressure in Japanese employees. A total of 4,314 staff (3,153 men and 1,161 women) with daytime jobs and normal blood pressure were enrolled in 2012 from 12 workplaces.

Workers were divided into four groups according to annual household income: less than 5 million, 5 to 7.9 million, 8 to 9.9 million, and 10 million or more Japanese yen per year. The researchers investigated the association between income and developing high blood pressure over a two-year period.

Compared to men in the lowest income category, men in the highest income group were nearly twice as likely to develop high blood pressure. Men in the 5 to 7.9 million and 8 to 9.9 million groups had a 50% higher risk of developing high blood pressure compared to men with the lowest incomes, although the positive association did not reach statistical significance in the 8 to 9.9 million group.

The findings were consistent regardless of age, and were independent of baseline blood pressure, worksite, occupation, number of family members, and smoking. The relationships were slightly weakened after accounting for alcohol consumption and body mass index (BMI; kg/m2), both of which were higher for men in the higher income groups.

In women, there was no significant link between income and blood pressure. However, women with higher household income tended to have a lower risk of developing high blood pressure.

"Some previous Japanese surveys have reported that higher household income is associated with more undesirable lifestyles in men, but not in women," said Dr. Yanagiya. "Our study supports this: men, but not women, with higher household incomes were more likely to be obese and drink alcohol every day. Both behaviours are major risk factors for hypertension."

He concluded: "Men with high-paying daytime jobs are at particular risk of high blood pressure. This applies to men of all ages, who can greatly decrease their chance of a heart attack or stroke by improving their health behaviours."

Dr. Yusuke Yoshikawa, public relations coordinator for JCS 2020, said: "Hypertension is one of the most important risk factors of cardiovascular disease in Japan, because the average daily salt intake in Japan (approx. 10 g/day) is much higher than desired. As the current guidelines2 strongly recommend healthy lifestyle to control high blood pressure, this study suggests a potential key to successful intervention for those who are at risk of heart disease and stroke."

Professor Michel Komajda, a Past President of the ESC and course director of the ESC programme at JCS 2020, said: "The ESC is delighted to be part of JCS 2020 in Kyoto. We value our special partnership with JCS and the high quality of Japanese research. Japan is among the top submitters of abstracts to ESC Congress."

ENDS

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European Society of Cardiology

Low plasma 25(OH) vitamin D level associated with increased risk of COVID-19 infection

Vitamin D is recognized as an important co-factor in several physiological processes linked with bone and calcium metabolism, and also in diverse non-skeletal outcomes, including autoimmune diseases, cardiovascular diseases, type 2 diabetes, obesity and cognitive decline, and infections. In particular, the pronounced impact of vitamin D metabolites on the immune system response, and on the development of COVID-19 infection by the novel SARS CoV-2 virus, has been previously described in a few studies worldwide.

The collaborative group of scientists from the Leumit Health Services (LHS) and the Azrieli Faculty of Medicine of Bar-Ilan University aimed to determine associations of low plasma 25(OH)D with the risk of COVID-19 infection and hospitalization. Using the real-world data and Israeli cohort of 782 COVID-19 positive patients and 7,025 COVID-19 negative patients, the groups identified that low plasma vitamin D level appears to be an independent risk factor for COVID-19 infection and hospitalization. The research was just published in The FEBS Journal.

"The main finding of our study was the significant association of low plasma vitamin D level with the likelihood of COVID-19 infection among patients who were tested for COVID-19, even after adjustment for age, gender, socio-economic status and chronic, mental and physical disorders," said Dr. Eugene Merzon, Head of the Department of Managed Care and leading researcher of the LHS group. "Furthermore, low vitamin D level was associated with the risk of hospitalization due to COVID-19 infection, although this association wasn't significant after adjustment for other confounders," he added. "Our finding is in agreement with the results of previous studies in the field. Reduced risk of acute respiratory tract infection following vitamin D supplementation has been reported," said Dr. Ilan Green, Head of the LHS Research Institute.

"According to our analysis, persons that were COVID-19 positive were older than non-infected persons. Interestingly, the two-peak distributions for age groups were demonstrated to confer increased risk for COVID-19: around ages 25 and 50 years old," said Dr. Milana Frenkel-Morgenstern, the leader of the Azrieli Faculty of Medicine research group. "The first peak may be explained by high social gathering habits at the young age. The peak at age 50 years may be explained by continued social habits, in conjunction with various chronic diseases," Dr. Frenkel-Morgenstern continued.

"Surprisingly, chronic medical conditions, like dementia, cardiovascular disease, and chronic lung disease that were considered to be very risky in previous studies, were not found as increasing the rate of infection in our study," noted Prof. Shlomo Vinker, LHS Chief Medical Officer. "However, this finding is highly biased by the severe social contacts restrictions that were imposed on all the population during the COVID-19 outbreak. Therefore, we assume that following the Israeli Ministry of Health instructions, patients with chronic medical conditions significantly reduced their social contacts. This might indeed minimize the risk of COVID-19 infection in that group of patients," explained Prof. Vinker.

Dr. Dmitry Tworowski and Dr. Alessandro Gorohovski. from the Frenkel-Morgenstern laboratory at Bar-Ilan University's Azrieli Faculty of Medicine, suggest that the study will have a very significant impact. "The main strength of our study is its being large, real-world, and population-based," they explained. Now researchers are planning to evaluate factors associated with mortality due to COVID-19 in Israel. "We are willing to find associations to the COVID-19 clinical outcomes (for example, pre-infection glycemic control of COVID-19 patients) to make the assessment of mortality risk due to COVID-19 infection in Israel," said Dr. Eugene Merzon.

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Bar-Ilan University