Culture

The individual mix of microorganisms in the human gastrointestinal tract provides vital clues as to how any future incidence of type 2 diabetes can be predicted, prevented and treated. This is demonstrated in a population study led from the University of Gothenburg. Sweden.

That a person's gut microbiota can contribute to type 2 diabetes has been shown in previous research, led by Fredrik Bäckhed, Professor of Molecular Medicine at Sahlgrenska Academy, University of Gothenburg.

The present study, now published in the journal Cell Metabolism, describes newly discovered clues in the microbiota to how bacteria may contribute to type 2 diabetes and potentially predict who will develop disease based individual's gut microbiota.

By studying people who have not yet developed type 2 diabetes, the researchers were able to rule out the possibility that the gut microbiota was affected by the disease or its treatment. The majority of previous studies in this field have compared healthy individuals with patients.

What has emerged is that in individuals with raised fasting blood glucose levels or reduced glucose tolerance, a condition known as prediabetes, as well as in people with untreated type 2 diabetes, the gut microbiota is changed. Accordingly, the findings show that the gut microbiota can be used to identify individuals with diabetes.

The study also shows that, in the gut microbiota of study participants with prediabetes or who had developed type 2 diabetes, the potential to produce butyrate (a fatty acid that promotes hormone production in the gastrointestinal tract and controls inflammation) was reduced. This substance is formed mainly by beneficial bacteria in intestines as they digest dietary fibers. One possible implication is that altering individuals fiber intake and perhaps matching fiber types to specific microbiota, or development of next generation probiotics to add missing bacteria, may enable the development of novel diabetes prevention or therapeutics.

"Our study shows clearly that the composition of the gut microbiota may have a great potential for helping us to understand the risks of developing type 2 diabetes, and therefore improve our chances of detecting, preventing and treating the disease," Bäckhed says.

The results confirm the picture that the gut microbiota interacts with the body's functions and internal conditions. The intestinal tract contains more than a kilogram of bacteria that are important for our health, and the kinds of gut bacteria found in people with type 2 diabetes seem to differ from those in healthy people.

"We hope to find patterns and identify which components of the gut microbiota identify individuals whose risk of developing type 2 diabetes is elevated. In the future, perhaps we'll be able to prescribe individualized dietary changes, or develop new types of probiotic that can prevent or perhaps even treat the disease," Bäckhed says.

The research now published builds on a population-based study that has been underway at the University of Gothenburg and Sahlgrenska University Hospital since 2013. It covered some 5,000 randomly selected people who were invited to take part in the study, and its purpose was to investigate which factors may entail an increased risk of type 2 diabetes. To confirm and verify the findings, the researchers also analyzed samples collected from the Swedish Cardiopulmonary Bioimage Study (SCAPIS), a nation-wide population study.

Netflix, which provides an online streaming service around the world, has 42 million videos and about 160 million subscribers in total. It takes just a few seconds to download a 30-minute video clip and you can watch a show within 15 minutes after it airs. As distribution and transmission of high-quality contents are growing rapidly, it is critical to develop reliable and stable semiconductor memories.

To this end, POSTECH research team has developed a memory device using a two-dimensional layered-structure material, unlocking the possibility of commercializing the next-generation memory device that can be stably operated at a low power.

POSTECH research team consisting of Professor Jang-Sik Lee of the Department of Materials Science and Engineering, Professor Donghwa Lee of the Division of Advanced Materials Science, Youngjun Park, and Seong Hun Kim in the PhD course succeeded in designing an optimal halide perovskite material (CsPb2Br5) that can be applied to a ReRAM*1 device by applying the first-principles calculation*2 based on quantum mechanics. The findings were published in Advanced Science.

The ideal next-generation memory device should process information at high speeds, store large amounts of information with non-volatile characteristics where the information does not disappear when power is off, and operate at low power for mobile devices.

The recent discovery of the resistive switching property in halide perovskite materials has led to worldwide active research to apply them to ReRAM devices. However, the poor stability of halide perovskite materials when they are exposed to the atmosphere have been raised as an issue.

The research team compared the relative stability and properties of halide perovskites with various structures using the first principles calculation2. DFT calculations predicted that CsPb2Br5, a two-dimensional layered structure in the form of AB2X5, may have better stability than the three-dimensional structure of ABX3 or other structures (A3B2X7, A2BX4), and that this structure could show improved performance in memory devices.

To verify this result, CsPb2Br5, an inorganic perovskite material with a two-dimensional layered structure, was synthesized and applied to memory devices for the first time. The memory devices with a three-dimensional structure of CsPbBr3 lost their memory characteristics at temperatures higher than 100 °C. However, the memory devices using a two-dimensional layered-structure of CsPb2Br5 maintained their memory characteristics over 140 °C and could be operated at voltages lower than 1V.

Professor Jang-Sik Lee who led the research commented, "Using this materials-designing technique based on the first-principles screening and experimental verification, the development of memory devices can be accelerated by reducing the time spent on searching for new materials. By designing an optimal new material for memory devices through computer calculations and applying it to actually producing them, the material can be applied to memory devices of various electronic devices such as mobile devices that require low power consumption or servers that require reliable operation. This is expected to accelerate the commercialization of next-generation data storage devices."

Cystic fibrosis, one of the most common genetic diseases in Switzerland, causes severe respiratory and digestive disorders. Despite considerable therapeutic advances, this disease still reduces life expectancy, in particular due to life-threatening respiratory infections. Scientists from the University of Geneva (UNIGE) have discovered the reason for this large number of lung infections: a protein, Vav3, promotes these infections by creating a "bacterial docking station" on airways' surface. Inhibiting this protein might prevent bacteria from docking on airways' surface and causing recurrent infections. These results, to be read in the journal Cell Reports, pave the way of interesting therapeutic prospects for limiting respiratory complications in people with cystic fibrosis.

Cystic fibrosis, affecting more than 700,000 people worldwide, is one of the most common genetic diseases in Switzerland. It stems from mutations in the gene responsible for a protein that participates in the secretion of mucus, making it abnormally thick. The alteration of this single gene leads to severe respiratory and digestive problems and limits both life quality and life expectancy of those affected. In lungs for example, hyperviscous mucus stagnates and obstructs airways.

Recurrent infections

Mucus accumulation does not only obstruct airways, it also promotes persistent lung infections. Despite major therapeutic advances, these lung infections remain frequent and serious. They are mostly due to a bacterium known for its resistance to antibiotics, Pseudomonas aeruginosa. "While it is known that mucus viscosity plays a role in trapping bacteria, the reason why they anchor so easily to airways was unknown," explains Marc Chanson, Professor at the Department of Cell Physiology and Metabolism of the Faculty of Medicine of the UNIGE. "Anchoring of Pseudomonas aeruginosa to airways' cells is the starting point for these often fatal infections. Understanding this process could help preventing their occurrence."

A bacterial docking station

UNIGE researchers compared airway cells from sick people with healthy cells. "The whole project began when we found that the protein Vav3, which had not been shown to be involved in this disease until now, was over-expressed in sick cells," enthuses Mehdi Badaoui, researcher in Prof. Marc Chanson's team and first author of this work. After numerous in vitro analyses, scientists discovered the key role of this protein: it directs the construction of a true bacterial docking station. In concrete terms, Vav3 forces two other proteins, fibronectin and integrin b1, to associate with it on cell surface and create a complex that promotes Pseudomonas aeruginosa infections. "This is the first time that a mechanism creating a favourable microenvironment for a bacterium before it even arrives has been observed," says Marc Chanson. "This might explain the high number of chronic lung infections in people with cystic fibrosis."

Inhibiting Vav3 to limit respiratory infections

How to build on this mechanism to develop therapeutic options? By inhibiting Vav3 in sick cells, scientists succeeded in preventing the expression of the two other proteins that make up the docking station. "And, indeed, the absence of this structure limits the adhesion of Pseudomonas aeruginosa", adds Mehdi Badaoui. Although the exact link between the protein Vav3 and the genetic defect that causes cystic fibrosis has yet to be determined, this discovery is a promising therapeutic target for limiting respiratory complications.

This work has been made possible, in particular, thanks to the support of the Swiss National Science Foundation (SNSF) and the Swiss Society for Cystic Fibrosis.

Apathy offers an important early warning sign of dementia in individuals with cerebrovascular disease, but depression does not, new research led by the University of Cambridge suggests.

Depression is often thought to be a risk factor for dementia but this may be because some depression scales used by clinicians and researchers partially assess apathy, say scientists from the universities of Cambridge, King's College London, Radboud and Oxford.

The study, published on 11 July in the Journal of Neurology, Neurosurgery & Psychiatry is the first to examine the relationships between apathy, depression, and dementia in individuals with cerebral small vessel disease (SVD). SVD may occur in one out of three elderly individuals, causes about a quarter of all strokes, and is the most common cause of vascular dementia.

The team studied two independent cohorts of SVD patients, one from the UK and the other from the Netherlands.* Across both cohorts, they found that individuals with higher baseline apathy, as well as those with increasing apathy over time, had a greater risk of dementia. In contrast, neither baseline depression nor change in depression had any detectable influence on dementia risk.

These findings were consistent despite variation in the severity of participants' symptoms, suggesting that they could be generalised across a broad spectrum of SVD cases. The relationship between apathy and dementia remained after controlling for other well-established risk factors for dementia including age, education, and cognition.

Lead author, Jonathan Tay, from Cambridge's Department of Clinical Neurosciences said: "There has been a lot of conflicting research on the association between late-life depression and dementia. Our study suggests that may partially be due to common clinical depression scales not distinguishing between depression and apathy."

Apathy, defined as a reduction in 'goal-directed behaviour', is a common neuropsychiatric symptom in SVD, and is distinct from depression, which is another symptom in SVD. Although there is some symptomatic overlap between the two, previous MRI research linked apathy, but not depression, with white matter network damage in SVD.

Jonathan Tay said: "Continued monitoring of apathy may be used to assess changes in dementia risk and inform diagnosis. Individuals identified as having high apathy, or increasing apathy over time, could be sent for more detailed clinical examinations, or be recommended for treatment."

Over 450 participants - all with MRI-confirmed SVD - recruited from three hospitals in South London and Radboud University's Neurology Department in the Netherlands, were assessed for apathy, depression and dementia over several years.

In the UK cohort, nearly 20% of participants developed dementia, while 11% in the Netherlands cohort did, likely due to the more severe burden of SVD in the UK cohort. In both datasets, patients who later developed dementia showed higher apathy, but similar levels of depression at baseline, compared to patients who did not.

The study provides the basis for further research, including the mechanisms that link apathy, vascular cognitive impairment, and dementia. Recent MRI work suggests that similar white matter networks underlie motivation and cognitive function in SVD. Cerebrovascular disease, which can be caused by hypertension and diabetes, can lead to network damage, resulting in an early form of dementia, presenting with apathy and cognitive deficits. Over time, SVD-related pathology increases, which is paralleled by increasing cognitive and motivational impairment, eventually becoming severe enough to meet criteria for a dementia state.

Jonathan Tay says: "This implies that apathy is not a risk factor for dementia per se, but rather an early symptom of white matter network damage. Understanding these relationships better could have major implications for the diagnosis and treatment of patients in the future."

Critically ill COVID-19 patients who received a single dose of a drug that calms an overreacting immune system were 45% less likely to die overall, and more likely to be out of the hospital or off a ventilator one month after treatment, compared with those who didn't receive the drug, according to a new study by a team from the University of Michigan.

The lower risk of death in patients who received intravenous tocilizumab happened despite the fact that they were also twice as likely to develop an additional infection, on top of the novel coronavirus.

The study is published in the peer-reviewed journal Clinical Infectious Diseases after being available as a preprint last month.

It suggests a benefit from timely and targeted efforts to calm the "cytokine storm" caused by the immune system's overreaction to the coronavirus. Tocilizumab, originally designed for rheumatoid arthritis, has already been used to calm such storms in patients receiving advanced immunotherapy treatment for cancer.

The researchers base their conclusions on a thorough look back at data from 154 critically ill patients treated at Michigan Medicine, U-M's academic medical center, during the first six weeks of the pandemic's arrival in Michigan from early March to late April. The analysis looked at patients' records through late May.

During that time, when little was known about what would help COVID-19 patients on ventilators, about half of the studied patients received tocilizumab and half did not. Most received it within the 24-hour period surrounding their intubation.

This created a natural opportunity for comparing the two groups' outcomes in an observational study, though clinical trials are still needed to truly see if the drug provides a benefit, the authors say.

Promising result

Lead author Emily Somers, Ph.D., Sc.M., an epidemiologist who has studied both rheumatologic and immunologic diseases, says the research team went into their analysis uncertain whether they would find a benefit, a risk, or no clear effect associated with tocilizumab in the patients with life-threatening COVID-19. But they knew it was a critically important question that they were uniquely positioned to answer at that point in the pandemic.

"One role of epidemiology is to rigorously evaluate real-world data on treatment effects, especially when evidence from clinical trials is not available. We kept trying to prove ourselves wrong as signals of benefit emerged in the data, both because of the immediate implications of these data, and in part because of concern about the supply of the medication for other patients," she says. "But the difference in mortality despite the increase in secondary infection is quite pronounced, even after accounting for many other factors."

Somers is an associate professor in the U-M Medical School's Department of Internal Medicine and member of the U-M Institute for Healthcare Policy and Innovation. She co-leads the COVID-19 Rapid Response Registry, which is supported by the Michigan Institute for Clinical and Health Research.

The paper's co-first author is Gregory Eschenauer, Pharm.D., a clinical pharmacist at Michigan Medicine and clinical associate professor at the U-M College of Pharmacy. He and senior author Jason Pogue, Pharm.D., are members of the Michigan Medicine Antimicrobial Stewardship Program.

The ASP group developed treatment guidelines provided to Michigan Medicine physicians in mid-March that identified tocilizumab as a potentially beneficial therapy for the most severely ill COVID-19 patients. Those guidelines also pointed out its risks and the lack of evidence for its use in COVID-19, and recommended a dose of 8 milligrams per kilogram.

This led some physicians to choose to use it, while others did not - setting the stage inadvertently for a natural comparison.

More research needed

Pogue, clinical professor at the U-M College of Pharmacy and an infectious disease pharmacist at Michigan Medicine, notes that more robust data released in June from a large randomized controlled trial in the United Kingdom has led him to recommend the steroid dexamethasone as the first choice to treat critically ill COVID-19 patients.

"For a retrospective, single-center study, our data are robust. But at this time, due to the lack of randomized controlled trial data and the much higher cost, we recommend reserving tocilizumab for the treatment of select patients who decompensate while on or after receiving dexamethasone or in patients where the risks of adverse events from steroid therapy outweigh the potential benefits" says Pogue.

"Further studies of tocilizumab, which is more targeted than dexamethasone in addressing the hyperinflammatory process, could include combining these agents or comparing them head-to-head," he adds.

Pogue notes that a single dose of tocilizumab is roughly 100 times more expensive than a course of dexamethasone. He also notes that another drug that aims to treat cytokine storm by targeting the interleukin-6 (IL-6) receptor - one called sarilumab - appears to have failed to improve outcomes in a clinical trial in COVID-19 patients including those on ventilators.

Michigan Medicine had been participating in the sarilumab study at the time the patients in the current study were treated, but not all patients qualified because of the timing of their admission or issues around testing for COVID-19. The current study does not include any patients who received sarilumab.

If the evidence around IL-6 targeting bears out in further studies, the authors note that it will be important to select the dose and timing carefully, to address the cytokine storm without interfering with IL-6's other roles in activating the body's response to infections and its processes for repairing tissue.

More about the study

The majority of the patients were transferred to U-M from Detroit-area hospitals after diagnosis with COVID-19, and those who received tocilizumab were less likely overall to have been transferred while already on a ventilator.

By the end of the 28-day period after patients went on a ventilator, 18% of those who received tocilizumab had died, compared with 36% of those who had not. When adjusted for health characteristics, this represents a 45% reduction in mortality. Of those still in the hospital at the end of the study period, 82% of the tocilizumab patients had come off the ventilator, compared with 53% of those who didn't receive the drug.

In all, 54% of the tocilizumab patients developed a secondary infection, mostly ventilator associated pneumonia; 26% of those who didn't receive tocilizumab developed such infections. Such "superinfections" usually reduce the chance of survival for COVID-19 patients.

Hydroxychloroquine was included in the treatment guidelines for COVID-19 inpatients at Michigan Medicine for the first two and a half weeks of the study period, before being removed as evidence of its lack of benefit and risks emerged. In all, it was used in one-quarter of the patients who received tocilizumab and one-fifth of those who didn't. Similar percentages of the two patient groups received steroids, though none received dexamethasone.

The patients in the two groups were similar in most ways except for a slightly higher average age in the non-tocilizumab group, and lower rates of chronic obstructive pulmonary disease and chronic kidney disease among the tocilizumab patients.

The United Kingdom has a unique opportunity to start rebuilding its fish stocks by taking advantage of the slowdown in commercial fishing caused by the COVID-19 pandemic and ongoing Brexit negotiations, new research has shown.

A study by the University of Southampton, the GEOMAR Helmholtz Centre for Ocean Research and the Sea Around Us initiative at the University of British Columbia sets out how the UK Government can take a new approach to managing its fishing waters.

After Brexit the UK will no longer be bound by the Common Fisheries Policy and therefore has the chance to develop a new policy focused on sustainability and preserving the livelihoods of fishing communities. Furthermore, the reduction in fishing activity caused by the COVID-19 pandemic has seen pressure on some threatened species fall to levels not seen since World War II, giving opportunities to help fish populations recover and increase the potential economic returns for fishers.

"Several stocks targeted by UK fishers are in a degraded and precarious state, with around 40 per cent that will continue to be overfished when normal activity resumes," said Professor Paul Kemp, lead author of the study and a researcher at the University of Southampton. "One of the reasons for this is that fishing quotas - or how much of each species can be caught in a certain area by each country - are set by the EU at levels higher than those that would enable the recovery of the populations."

To regulate the ongoing harvest beyond sustainable limits, the researchers propose fishing targets be set to levels in which fishers leave more fish in the water than the minimum required to generate maximum sustainable yields.

"Maximum Sustainable Yield or MSY is defined as the highest catch that can be continuously taken from a stock under existing environmental conditions," said Rainer Froese, co-author of the study and senior scientist at GEOMAR. "Smart fisheries management, such as applied in Australia, aims for a little less than MSY. That reduces the risk of unintentional overfishing and ensures close to maximum catches, year after year."

"This will allow fish populations to recover to levels that are higher than those that can produce MSY to ensure large and diverse populations that will be better prepared for climate change, stabilize ecosystems, and at the same time maximize fishers' profits," said Daniel Pauly, co-author of the study and principal investigator of the Sea Around Us initiative at the University of British Columbia. "The opportunity to do this is now because of the slowdown caused by COVID-19 and because after Brexit, the UK will be in a position to insist in its negotiations with the EU that fishing quotas advised by scientists not be exceeded."

As an additional safeguard for sustainable and highly profitable fishing in the post-Brexit and post-COVID-19 world, the researchers propose further creation of a "blue belt" of Marine Protected Areas around the UK coast, and enforcement of their protected status, something that up until now has been seriously lacking.

"The establishment of MPAs is one of the most cost-effective ways to restore overexploited stocks and habitats on which fish depend, to the mutual benefit of the fishing industry who experience increased catches in grounds immediately outside of MPAs," Pauly said.

The researchers warn that strong conviction will be required to ensure these areas are suitably protected as there are likely to be disputes with EU members who may regard this as a challenge to their perceived historic fishing rights.

"Brexit divided the UK and the whole world has been challenged by the global health pandemic" added Professor Kemp. "However, regardless of how people voted, UK politicians have the chance to bring people together over a common goal that supports fishing communities, wider society and environmental sustainability. The opportunity is there but it will require political vision; with the necessary strength of character the negotiators can deliver a positive outcome from the combined systemic shocks of Brexit and COVID19."

Concurrent failures of federal drinking water standards and Michigan's emergency manager law reinforced and magnified each other, leading to the Flint water crisis, according to a University of Michigan environmental policy expert.

Flint's experience offers lessons during the COVID-19 pandemic, which has exacerbated local financial challenges while highlighting the importance of access to clean, safe drinking water, said U-M's Sara Hughes, an assistant professor at the School for Environment and Sustainability.

"As we wrestle to combat the coronavirus, we should keep in mind that building healthy communities starts with a renewed commitment to investing in 21st-century drinking water systems and supporting cities as they navigate systemic financial challenges," Hughes said. "Learning from the Flint water crisis requires counteracting and confronting the marginalizing effects of infrastructure underinvestment and urban austerity measures."

The Flint water crisis resulted from simultaneous failures of the federal Safe Drinking Water Act and Michigan's Local Financial Stability and Choice Act, Hughes writes in an article published July 13 in the journal Perspectives on Politics. Also known as Public Act 436, the Michigan law places cities deemed by the state to be experiencing fiscal distress under the control of a state-appointed emergency manager.

Both policies rationalize complex problems--safe drinking water and municipal financial distress--by providing purely technical solutions, and the weaknesses of each reinforced and magnified the harmful consequences of the other for the residents of Flint, according to Hughes.

For nearly 18 months, from April 2014 to October 2015, the city of Flint delivered inadequately treated Flint River water to residents, exposing thousands to elevated lead levels and other contaminants. Poor children and families were particularly affected.

At both the state and federal levels, the primary response to the Flint water crisis has been to strengthen drinking water safety standards and monitoring practices, Hughes said. But providing safe drinking water to city residents is only partly a technical problem.

Much less attention has been paid to funding and supporting local governments in ways that ensure their capacity to build and maintain infrastructure, provide reliable services, and sustain meaningful dialogue and engagement with their residents, according to Hughes.

Failure to address these longstanding problems will complicate efforts to recover from the coronavirus pandemic, especially in hard-hit places like Southeast Michigan, which has the state's highest concentration of COVID-19 cases.

"If addressed, these policy failures would mitigate against the disproportionate and unequal patterns emerging in the coronavirus outbreak," Hughes said. "But absent change, poor and minority cities remain vulnerable to the marginalizing effects of these multiple and reinforcing rationalized policy domains."

By a rationalized policy Hughes means one that is presented as purely technical in nature and politically neutral. Techno-rational approaches to policy hold out the promise of more effective, unbiased decision-making, but they often cloak decisions and priorities in the language of rationality and science while failing to consider the public's preferences, according to Hughes.

Rationalized policy approaches were at the heart of the Flint water crisis, involving both the federal drinking water act and the state emergency manager law.

Flint first came under emergency management in 2011 through the law that preceded Public Act 436, then in 2012 through the provisions of PA 436, which was developed and championed by former Michigan Gov. Rick Snyder. Flint's state-appointed emergency managers made or forced decisions about the city's water supplies and treatment protocols that were ostensibly made with the goal of cutting costs.

The second policy failure implicated in the Flint water crisis involves the federal Safe Drinking Water Act's Lead and Copper Rule. The LCR provides two important sets of criteria: water quality standards and treatment/testing protocols for lead and copper in drinking water systems.

The law requires that local water utilities monitor and test their water supplies and report their results to the state government, which in turn reports all data to the U.S. Environmental Protection Agency. The EPA is ultimately responsible for ensuring compliance.

When Flint switched its drinking water source to the Flint River in April 2014, the state environmental quality department failed to require the city to treat the water for corrosion, as would be necessary to meet federal Safe Drinking Water Act (SDWA) standards.

Federal standards for lead in drinking water are 15 parts per billion. Lead levels of up to 1,000 ppb were detected in Flint homes during the water crisis, yet enforcement actions were not triggered.

"The fact that such systemic and prolonged noncompliance, and clear evidence of a threat to public health, failed to trigger regulatory action by EPA calls into question the adequacy of public protections embedded in the SDWA and LCR," Hughes said.

In much the same way that Michigan's emergency manager law represents a rationalized approach to municipal financial distress, the federal Lead and Copper Rule is a rationalized approach to protecting human health, according to Hughes.

"The provisions and standards in the LCR create a policy environment that facilitates decision-making that is reactionary, prioritizes cost-effectiveness, excludes the public and tolerates risk," she said. The LCR has no enforceable health-based standard "and does not protect any individual or household from exposure to elevated lead levels."

In 2018, the state of Michigan passed its own set of stricter standards for lead, shifting to a lower 12 ppb standard and requiring that communities replace 5% of lead service lines annually. At the national level, the EPA has submitted proposed revisions to the LCR to the Office of Management and Budget, but they have yet to take effect.

Critically, the policy changes resulting from the Flint water crisis have not extended to a reevaluation of how municipal financial distress is addressed and prevented, according to Hughes. Michigan's emergency manager law remains unchanged. Poor, minority U.S. communities consistently receive lower-quality drinking water, and lead contamination cases fit a pattern of low-income, unequal and largely black cities, according to Hughes.

The study is based on interviews with local activists, decision-makers, scientists, journalists and scholars working in or with the city of Flint, as well as a review of reports, testimony, newspaper articles and secondary demographic and financial data.

The COVID-19 lockdown has had a disproportionate economic impact on Black, Asian and Minority Ethnic (BAME) migrants in the UK, new research, which also calls for racial justice, reveals today (13 July 2020).

BAME migrants are 3.1 times more likely than white British to lose their jobs during the pandemic, while BAME British are 40% less likely to benefit from employee protection such as furloughing.

As a result, white British in work before the pandemic were 5.7 times more likely to experience furlough than job loss (18.9% vs. 3.3%), the rate was as low as 1.4 times for BAME migrants (16.3% vs. 11.4%).

'Intersecting ethnic and native-migrant inequalities in the economic impact of the COVID-19 pandemic in the UK' by Dr Yang Hu, of Lancaster University, is published open access in 'Research on Social Stratification and Mobility' - an official journal of the International Sociological Association.

The report also highlights:

While BAME migrants are 35% less likely to reduce their work hours than white British, they are 1.3 times more likely to experience income loss due to COVID-19.

Compared with white British, BAME migrants are 2.2 times more likely to experience an increase in financial strain, such as keeping up to date with bills (e.g. utility, credit card, etc.), during the COVID-19 lockdown.

White British (28.8%) are 1.4 times more likely than BAME migrants (20.9%) to report leading a financially comfortable life during the pandemic. In contrast, BAME migrants (11.1%) are 1.5 times more likely than white British (7.2%) to report experiencing financial difficulty during the pandemic.

BAME migrants (26.6%) are 1.3 times more likely than white British (20.2%) to experience an increase in their perceived level of financial hardship during the lockdown.

Dr Hu, a Senior Lecturer in Sociology and Data Science, presents nationwide evidence based on the analysis of data from the Understanding Society COVID-19 survey--an initiative funded by the UK Research and Innovation.

The initiative collected data from a national sample of more than 10,000 people from both before the pandemic and in April, the 'prime time' of the COVID lockdown in the UK.

"As the information was collected from the same people, it provides a very clear and effective comparison of the impact of COVID-19," said Dr Hu, an expert in the study of how socio-economic, political and institutional developments and cultural changes impact on everyday family and intimate lives.

"The findings show that as the pandemic hits BAME migrants particularly hard, it widens entrenched racial disparities in people's labour market participation and economic well-being. They urge policy makers to place racial justice at the centre of the government's immediate and long-term response to the pandemic.

"As we enter the third decade of the 21st century, the COVID-19 pandemic and the global rise of racism and anti-racism movements are two of the most prominent developments to define people's lives in many countries."

As many countries start to ease and lift lockdown measures, Dr Hu said it would also be crucial to examine and tackle inequalities in people's long-term economic recovery from the pandemic.

UNIVERSITY PARK, Pa. -- Deaths from COVID-19 will have a ripple effect causing impacts on the mental health and health of surviving family members. But the extent of that impact has been hard to assess until now. Every death from COVID-19 will impact approximately nine surviving family members, according to a study.

In a study of kinship networks in the United States, the researchers said that approximately nine surviving close family members will be affected by each death from the virus in the country. For example, if the virus kills 190,000 people, 1.7 million will experience the loss of a close relative, said Ashton Verdery, associate professor of sociology, demography and social data analytics, and an affiliate of the Population Research Institute and Institute for Computational and Data Sciences, Penn State.

A kinship network includes grandparents, parents, siblings, spouses and children.

According to Verdery, the multiplier could serve as an indicator to help raise awareness about the scale of the disease and the ripple effects that the disease may have on a community, as well as prepare officials and business leaders to manage those effects.

"It's very helpful to have a sense of the potential impacts that the pandemic could have," said Verdery. "And, for employers, it calls attention to policies around family leave and paid leave. At the federal level, it might inform officials about possible extensions for FMLA (Family and Medical Leave Act). There could also be some implications for caretaking. For example, a lot of children grow up in grandparent-led houses and they would be impacted."

The researchers, who released their findings in the current issue of the Proceedings of the National Academy of Sciences, said some slight differences in the bereavement multiplier exist between white and black Americans. For white Americans, the median multiplier is estimated at 8.86, while it is 9.18 for black Americans, said Verdery.

The researchers also suggest that people may be facing the loss of a close loved one at a younger age because of the virus, according to Verdery, who worked with Emily Smith-Greenaway, associate professor of sociology, USC; Rachel Margolis, associate professor of sociology, the University of Western Ontario and Jonathan K. Daw, associate professor of sociology and demography, Penn State.

"There are a substantial number of people who may be losing parents that we would consider younger adults and a substantial number of people may be losing spouses who are in their 50s or 60s," he said.

While there are some limitations, the indicator could help local officials understand the waves of grief that may affect specific areas and regions of the country.

"Our statistics are based on national averages, so it might not translate perfectly, but you could imagine that this could serve as a baseline level to go forward to understand the differences between areas where the outbreaks are severe and places where the outbreaks may not be so severe," said Verdery. "There are regional differences in some of these kinship statistics that would make it less than perfect, but it would be a reasonable first approximation."

For this study, the team built on previous investigations that happened soon after the virus began to spread worldwide.

"The big challenge with the former work was that we used a certain percentage of infections and a certain percentage of deaths," said Verdery. "In that model, there is an inherent prediction that if so many people are infected, there would be a certain number of people who would die and, then, the model estimated how many people will be affected by those deaths. But, thinking through this, we wanted to create a statistic that is easy to understand and one that doesn't rely on specific predictions about death counts."

The researchers undertook a computational analysis of COVID-19 mortality in kinship networks of white and black Americans. The demographic data was drawn from the historical record or recent Census Bureau national projections to create a complete kinship network, from which the researchers analyzed grandparents, parents, siblings, spouses and children.

In the future, the researchers plan to investigate how the bereavement factor during other mortality spikes, such as the opioid epidemic, changes over time and how to better understand when that factor becomes broadly felt across the community.

A billion years ago, a single-celled eukaryote engulfed a cyanobacterium--an organism capable of converting the sun's energy into food in the form of carbohydrates. In one of the single most pivotal events in the history of life, instead of the bacterium being digested, an endosymbiosis was formed, with the bacterial cell persisting inside the host eukaryote for millennia and giving rise to the first photosynthetic eukaryotes. The descendants of this merger include plants, as well as a large number of single-celled eukaryotes that are collectively referred to as algae (i.e. kelp, nori). The remnants of the cyanobacterium eventually evolved into an organelle known as a plastid or chloroplast, which allows photosynthetic eukaryotes to produce their own food--and thus to provide food to animals like us. Despite the importance of this event, a variety of aspects of plastid evolution have long remained shrouded in mystery. In a review in Genome Biology and Evolution, Shannon Sibbald and John Archibald highlight emerging genome data in this field and provide new insight into plastid evolution.

Plastids can be found patchily distributed across a number of eukaryotic lineages, often nested within groups that are otherwise non-photosynthetic. This irregular distribution has historically made it difficult for scientists to uncover the evolutionary origin and history of plastids and to trace their transfer from branch to branch on the eukaryotic tree. Both biochemical and molecular data point to a single origin of plastids from the engulfment of a member of the β-cyanobacteria by the single-celled ancestor of the Archaeplastida, a group consisting of all green algae (including land plants), red algae, and glaucophyte algae.

Secondary, tertiary, and higher order acquisitions of plastids are thought to have occurred when a eukaryotic cell containing a plastid was then engulfed by another eukaryote, which was then engulfed by yet another eukaryote, and so on. This type of plastid acquisition appears to have involved green algal endosymbionts on at least two occasions and perhaps even more often with red algae, giving rise to so-called "complex" plastids. According to Archibald, "Multigene phylogenies have gradually improved our understanding of the structure of the eukaryotic tree, and, consequently, the field has started to shift--the emerging consensus is that secondary/tertiary endosymbiosis is more common than previously assumed." However, co-author Sibbald points out that this does not mean that the puzzle has been solved. "We still don't know how many secondary, tertiary, and higher endosymbiotic events gave rise to the plastid diversity we see today or, in many cases, who the host and endosymbiont partners were."

Even more confusing, recent data show that the majority of eukaryotes with plastids acquired from red or green algae (i.e. complex red or green plastids) actually harbor a mosaic of genetic material from both red and green algae in their nuclear genomes. This has led to the "shopping bag" model of plastid evolution, which suggests that multiple red and green algae may have been transiently housed by various eukaryotic lineages over time before the establishment of the permanent (or at least current) resident plastid. Indeed, a number of lineages participate in a practice known as "kleptoplasty", in which they consume plastid-containing algae and steal their plastids, harboring them for several weeks to months and benefiting from the carbohydrates they produce before replenishing them with new ones. Thus, while it seems at least plausible that some lineages may have harbored a mix of both red and green algae before one eventually became more permanently established, Archibald notes that "understanding the evolutionary significance of this 'red-green' mosaicism in modern-day algae remains a particularly challenging task."

Additional difficulties in tracing plastid evolution arise from the loss of photosynthesis in some lineages, which can be accompanied by the further loss of the plastid genome and, in a few cases, complete loss of the plastid itself. For example, most apicomplexans like the malaria parasite Plasmodium contain a relict plastid-like organelle known as the apicoplast, which still carries out a number of biosynthetic processes. In the closely related human parasite Cryptosporidium parvum, however, the plastid has been completely lost (or was never present), and key metabolites are instead scavenged from the host. There are also a number of plants that have lost the ability to photosynthesize and instead parasitize other plants or rely on fungi to provide nutrients, such as the parasitic flowering plant Rafflesia.

Perhaps most interestingly, the tenet that all plastids stem from a single eukaryotic-cyanobacterial endosymbiosis has even been called into question by recent data showing that the freshwater shell-building amoeba Paulinella chromatophora possesses photosynthetic organelles derived from an independent acquisition of an α-cyanobacterium, which is thought to have occurred only a hundred million years ago. This suggests that more widespread sampling may reveal other lineages with independently derived plastid-like organelles. These more recent events may provide new insight into the mechanisms by which a cyanobacterium evolves into a plastid within the host cell.

Rather than answering the decades-old questions in the field of plastid evolution, it appears that recent genomic data have for now revealed even more unknowns. As Archibald notes, "It is sobering to consider that as we have collected more sequence data, the picture of plastid evolution has become less and less clear." Answering these questions will require addressing what Archibald describes as "a longstanding challenge in the field": integrating data from independent lines of inquiry, including phylogenetics, biochemistry, and membrane biology.

Hershey, Pa. -- Penn State researchers have developed a new method for studying key moments in brain development. Yongsoo Kim, assistant professor of neural and behavioral sciences at Penn State College of Medicine, is using the method to understand how oxytocin receptor expression changes in normally developing mice and mouse models of autism spectrum disorder.

The technique allows scientists to create maps of developing mouse brains that can display how much of certain cell types are present in different regions -- and it is a critical first step in being able to study neurodevelopmental disorders in the brain.

"Key neural connections form during early development," said Kim. "We can apply this mapping method to study changes of different brain cell types in developing mouse brains to understand neurodevelopmental disorders at a cellular level."

Kim and his colleagues created maps to help them understand how oxytocin, a neurotransmitter produced by the brain, is utilized by the brain during the course of early development. Previous research revealed that oxytocin plays a role in regulating social behavior, but there is little information on how the receptors that mediate oxytocin's effect across the brain's neural networks are present in different parts of the brain across time during development.

The research team hypothesized that different brain regions would have different expression levels of oxytocin receptor (OTR) as individual brain areas mature. Previous studies investigating oxytocin receptor expression used methods where only select regions of the brain could be analyzed in portions.

Kim's new technique is able to image whole mouse brains at a cellular resolution using serial two-photon tomography and machine learning-based algorithms to detect fluorescently-labeled neurons that express oxytocin receptors.

The team created template brains from different early postnatal development periods -- 7, 14, 21 and 28 days after birth. The templates were created by generating averages of brain images and labelling key anatomy. They served as a reference point for imaging, detecting and quantifying the oxytocin receptors during different phases of development.
The results of the study were recently published in Nature Communications.

Kim and colleagues found that OTR expression reached its peak in mouse brains 21 days after birth, which is equivalent to early childhood in humans. OTR expression in the hypothalamus continued to increase until adulthood, indicating that oxytocin signaling may play a role in generating sex-specific behavior. They also studied mice who were unable to produce oxytocin receptors and noted that there was significantly reduced synaptic density -- indicating that oxytocin plays a key role in wiring the brain.

Kim says the same method used to study OTR in this study could be applied to other brain cell types in order to understand their spatial arrangement across time. The research team built a web-based platform to host and display the new images for other researchers to access.

"These images will serve as an essential baseline to compare OTR expression in various mouse models of brain disorders," Kim said. "We were able to study OTR expression in a mouse model of autism and will build on these findings by further studying functional and anatomical changes of different brain cell types and how genetic and environmental factors may affect brain development in early childhood."

An adenovirus infection can be potentially life-threatening, especially for children after a stem cell transplant. Virologists at the Technical University of Munich (TUM) and the German Research Center for Environmental Health Helmholtz Zentrum München have successfully shown that a previously approved medication used in cancer treatment could help inhibit this virus infection. Due to the special mechanism of action, the virus cannot develop defence strategies.

Human adenoviruses cause conjunctivitis, gastrointestinal illnesses and pneumonia, among other things. In most cases however an infection exhibits no symptoms or only mild symptoms in healthy adults. "Generally speaking, every adult has probably had several adenovirus infections already," says Dr. Sabrina Schreiner. She works at the TUM Institute of Virology and the German Research Center for Environmental Health Helmholtz Zentrum. In the past human viruses, of which more than 85 different variants are currently known, were not considered to be particularly dangerous.

No medication or vaccine available as yet

However, for individuals with immune system deficiencies the course of the infection can have serious effects or even be fatal. An infection is particularly dangerous for children following a stem cell transplant. In this case the mortality rate for infected patients can be as high as 80 percent.

"We've known that adenovirus infections in healthy patients can also cause severe pneumonia ending in death since 2006," says Schreiner. However, as yet there is still no medication that is specifically effective against adenoviruses, and there is also no vaccine for the general population.

Protein complexes with antiviral effects

Schreiner and her team are investigating how the virus reproduces in the cell. They observed marked changes in what are called PML nuclear, complexes made up of several proteins within the cell, in cases of adenovirus infection.

These structures, which are otherwise round, dissolve and form elongated fibrils. "We assume that the PML bodies have an antiviral effect," says Schreiner. "The viruses destroy the round structures of the protein complexes and then make use of this cellular manipulation for their own reproduction."

Body's own defenses strengthened

The scientists noticed in cancer patients that the structures of the PML bodies were also dissolved. But when the patients were treated with arsenic trioxide (ATO) the round structures reformed. "ATO is a known active ingredient which has already been approved and is currently in clinical use for leukemia patients," Schreiner explains.

The researchers tested the efficacy of ATO in cell cultures infected with adenoviruses. Here too the PML bodies once again reformed into round structures and the virus concentration dropped. "So we can actually restore the endogenous antiviral factories which then fight the virus," says Schreiner.

No direct attack

Following laboratory testing, in the next step the medication will be used on patients with adenovirus infections. The virologists are in close contact with pediatricians in Munich hospitals. Since the medication has already been approved, it can be used in treatment immediately. "This compound contains arsenic, but there are no cytotoxic side-effects in the concentrations in which it is used and for which it has already been approved," says Schreiner.

The special thing about this medication is that it affects the cell's own structures instead of directly attacking the virus. "Viruses often become resistant to medications which attack them directly," explains Schreiner. "For example they can mutate in such a way that they are no longer recognized by the medication. But in this case, since the virus has no direct interaction with the active ingredient, it can't develop any defense mechanisms."

Superheavy elements are intriguing nuclear and atomic quantum systems that challenge experimental probing as they do not occur in nature and, when synthesized, vanish within seconds. Pushing the forefront atomic physics research to these elements requires breakthrough developments towards fast atomic spectroscopy techniques with extreme sensitivity. A joint effort within the European Union's Horizon 2020 Research and Innovation program and led by Dr. Mustapha Laatiaoui from Johannes Gutenberg University Mainz (JGU) culminated in an optical spectroscopy proposal: The so-called Laser Resonance Chromatography (LRC) should enable such investigations even at minute production quantities. The proposal has recently been published in two articles in Physical Review Letters and Physical Review A.

Superheavy elements (SHEs) are found at the bottom part of the periodic table of elements. They represent a fertile ground for the development of understanding on how such exotic atoms can exist and work when an overwhelming number of electrons in atomic shells and protons and neutrons in the nucleus come together. Insights into their electronic structure can be obtained from optical spectroscopy experiments unveiling element-specific emission spectra. These spectra are powerful benchmarks for modern atomic-model calculations and could be useful, for example, when it comes to searching for traces of even heavier elements, which might be created in neutron-star merger events.

LRC approach combines different methods

Although SHEs have been discovered decades ago, their investigation by optical spectroscopy tools lack far behind the synthesis. This is because they are produced at extremely low rates at which traditional methods simply do not work. So far, optical spectroscopy ends at nobelium, element 102 in the periodic table. "Current techniques are at the limit of what is feasible," explained Laatiaoui. From the next heavier element on, the physicochemical properties change abruptly and impede providing samples in suitable atomic states."

Together with research colleagues, the physicist has therefore developed the new LRC approach in optical spectroscopy. This combines element selectivity and spectral precision of laser spectroscopy with ion-mobility mass spectrometry and merges the benefits of a high sensitivity with the "simplicity" of optical probing as in laser-induced fluorescence spectroscopy. Its key idea is to detect the products of resonant optical excitations not on the basis of fluorescent light as usual, but based on their characteristic drift time to a particle detector.

In their theoretical work, the researchers focused on singly charged lawrencium, element 103, and on its lighter chemical homolog. But the concept offers unparalleled access to laser spectroscopy of many other monoatomic ions across the periodic table, in particular of the transition metals including the high-temperature refractory metals and elements beyond lawrencium. Other ionic species like triply-charged thorium shall be within reach of the LRC approach as well. Moreover, the method enables to optimize signal-to-noise ratios and thus to ease ion mobility spectrometry, state-selected ion chemistry, and other applications.

Dr. Mustapha Laatiaoui came to Johannes Gutenberg University Mainz and the Helmholtz Institute Mainz (HIM) in February 2018. In late 2018, he received an ERC Consolidator Grant from the European Research Council (ERC), one of the European Union's most valuable funding grants, for his research into the heaviest elements using laser spectroscopy and ion mobility spectroscopy. The current publications also included work that Laatiaoui had previously carried out at GSI Helmholtzzentrum für Schwerionenforschung in Darmstadt and at KU Leuven in Belgium.

This work was conducted in cooperation with Alexei A. Buchachenko from the Skolkovo Institute of Science and Technology and the Institute of Problems of Chemical Physics, both in Moscow, Russia, and Larry A. Viehland from Chatham University, Pittsburgh, USA.

Ann Arbor, July 13, 2020 -- New research and guidance in the American Journal of Preventive Medicine, published by Elsevier, focus on critical topics pertaining to community and individual health during the COVID-19 epidemic.

Researchers issue a transdisciplinary "Call to Action" to strengthen pandemic behavioral science to overcome COVID-19
The only evidence-based strategy currently available to halt the transmission of COVID-19 is population-wide behavior change. Although information about COVID-19 protective behaviors such as hand washing, mask wearing, and social distancing has been widely disseminated in the United States by federal and local governments, research has shown significant gaps in the public's understanding and behavior, maybe because of inconsistency and lack of optimal tailoring. Researchers say the narrative is missing the behavioral science expertise that is central to achieving protective behaviors. "Fighting this pandemic will require new 'weapons' and a new resolve on the part of the government and the public," says lead author John Allegrante, PhD, Columbia University's Teachers College and the Mailman School of Public Health, New York, NY, USA. "A national historic commitment is needed in which behavior change methodology is a dominant weapon in the nation's public health arsenal." The researchers say there is an urgent need for accurate data about the public understanding of COVID-19 risk and preferred sources for obtaining information about how to stay safe. Better utilization of digital technology would enable more efficient targeting of at-risk individuals and tailoring of behavioral interventions. And, to drive these changes now and for the future, pandemic behavioral science, methodology, and evidence need to be updated and expanded.

"Preventing COVID-19 and Its Sequela: "There is No Magic Bullet . . . It's Just Behaviors," by John P. Allegrante, PhD, M. Elaine Auld, MPH, and Sundar Natarajan, MD, MSc (https://doi.org/10.1016/j.amepre.2020.05.004). Journalists wishing to speak with the authors should contact John Allegrante at jpa1@tc.columbia.edu.

Perception of the risk of contracting or dying from COVID-19 strongly influences people's decision to take protective actions, a national survey finds

As coronavirus began to spread across the United States, researchers conducted a cross-sectional national online survey between March 10 and March 31, 2020 asking participants to assess their risk of COVID-19 infection and fatality. They were also asked about behaviors they had taken to protect themselves from infection such as washing hands or avoiding public spaces and crowds. Individuals disagreed about the risks, and those perceiving higher risk were significantly more likely to engage in protective actions. Risk perceptions for getting COVID-19 and people's willingness to act upon them grew stronger in responses provided after March 13, 2020, when many states declared school closures and bans on large gatherings, and the US declared a state of emergency and implemented travel bans. "Our findings suggest that to motivate protective actions, clear and consistent risk messages are needed. This was the case when states were closing down in March 2020. It will likely also be important when states open up again," observes lead investigator Wändi Bruine de Bruin, PhD, Sol Price School of Public Policy, Dornsife Department of Psychology, Schaeffer Center for Health Policy and Economics; and Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA.

"Relationships Between Initial COVID-19 Risk Perceptions and Protective Health Behaviors: A National Survey," by Wändi Bruine de Bruin, PhD, and Daniel Bennett, PhD (https://doi.org/10.1016/j.amepre.2020.05.001). Journalists wishing to speak to the authors should contact Stephanie Hedt at hedt@healthpolicy.usc.edu.

Financial strain associated with COVID-19 hospitalization may be felt most by younger patients with lower premium, higher deductible health plans

Out-of-pocket spending associated with hospitalizations for respiratory conditions similar to those caused by COVID-19 from January 2016 through August 2019 were significantly higher for patients who have a consumer-directed health plan (CDHP) that features lower premiums but higher deductibles compared with patients who had a traditional, low deductible plan. The difference was largest for those under 21 years old, and decreased as age increased. The largest increase was in the first half of the year when, the researchers note, younger people have likely not exceeded their deductibles. Although some insurers are waiving cost-sharing payments for a hospitalization related to COVID-19, self-insured employers are exempt. "Congress is now debating whether or not to require all plans to waive cost sharing related to COVID-19 treatment. Our findings suggest they might want to take action on cost-sharing waivers, because those out-of-pockets costs are otherwise going to be high for many people," says lead investigator Matthew Eisenberg, PhD, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

"Financial Risk for COVID-19 Respiratory Hospitalizations in Consumer-Directed Health Plans," by Matthew D. Eisenberg, PhD, Colleen L. Barry, PhD, MPP, Cameron Schilling, MPH, and Alene Kennedy-Hendricks, PhD (https://doi.org/10.1016/j.amepre.2020.05.008). Journalists wishing to speak with the authors should contact Caitlin Hoffman choffman@jhu.edu.

Researchers warn that a lack of a racial/ethnic identifier in health records and medical data may lead to worse health outcomes for Arab Americans during the COVID-19 crisis and beyond

There are increasing calls to better understand the inequities populations of color face in the United States with regard to COVID-19, including increased infection rates, more severe disease, and greater risk of death. Potential health disparities for Arab Americans may never be recognized, however, because most medical data and surveys do not include an option to identify as Arab American. Author Nadia N. Abuelezam, ScD, Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA, observes that Arab Americans are asked to identify as non-Hispanic white, despite the fact that their health outcomes are significantly different. Arab Americans may be at increased risk for COVID-19 due to xenophobia and stigma, pre-existing conditions, crowded living conditions, lack of social support for new immigrants, and poor adoption of prevention behavior. "Arab Americans have long been 'invisible' in the medical and public health literature due to a lack of an ethnic identifier," explains Dr. Abuelezam. "The COVID-19 crisis has forced the medical and public health community to reimagine the ways that healthcare can be provided and data can be collected in real time. In this moment of reimagination and creativity, we can embrace and enhance our racial and ethnic reporting measures to ensure we are collecting data on all ethnic and racial subgroups in the US."

"Health Equity During COVID-19: The Case of Arab Americans," by Nadia Abuelezam (https://doi.org/10.1016/j.amepre.2020.06.004). Journalists wishing to speak to Dr. Abuelezam may contact her at nadia.abuelezam@bc.edu.

AUSTIN, Texas-- More than one in five women at risk of an unplanned pregnancy in the U.S. would use a different method of contraception if cost were not a factor, says a new study from the Texas Policy Evaluation Project (TxPEP) published in Contraception X. Uninsured women (one in three) and publicly insured women (one in four) were more likely to prefer a different method than privately insured women (one in five), indicating the importance of insurance coverage in ensuring access to the contraceptive methods women desire. The U.S. Supreme Court recently ruled in Little Sisters of the Poor v. Pennsylvania that employers can refuse to cover birth control for religious or moral reasons. Out-of-pocket costs for contraception will rise for many U.S. women, and they will be less likely to get the birth control they want.

"Whether people are able to afford the type of birth control they want to use is a strong indicator of the quality of reproductive healthcare in the U.S.," says Dr. Kari White, principal investigator of TxPEP and Associate Professor of Social Work and Sociology at The University of Texas at Austin. "The Supreme Court's ruling, along with other recent policies that have limited publicly funded services for low-income women, will likely reverse some of the gains in access and affordability we have seen in recent years."

Affordable access to contraception in the U.S. improved over the last 7 years as a result of the Affordable Care Act (ACA) contraceptive coverage mandate, which made all Food and Drug Administration-approved contraceptive methods available for no charge to women enrolled in most private insurance plans. The Court's ruling will impact an estimated 70,500 - 126,400 women of childbearing age who will now need to pay out-of-pocket for their birth control, and some of the most effective methods, such as female sterilization, IUDs and implants, are very expensive in the U.S. Some women who lose coverage may look for a new provider at a publicly funded health center that offers low-cost contraception. These facilities, which receive federal Title X family planning funds or other federal and state funding to serve low-income women, will likely not be able to meet the demand of new patients, leaving more women with cost barriers to using the birth control method they desire.

The new TxPEP study, based on data collected after the implementation of the ACA, also showed that Black and Hispanic women and those of other races/ethnicities were less likely to be using the birth control they wanted compared with white women, reflecting the structural disadvantage women of color face in the U.S. healthcare system. "Black women can face additional barriers accessing affordable contraceptive care that is free of bias, and affording contraception may be especially challenging for recent and undocumented immigrants, many of whom are Hispanic, due to limited insurance coverage options," says Kristen Burke, a doctoral student in sociology and graduate research associate at TxPEP. "The COVID-19 pandemic has highlighted incredible racial disparities in health outcomes, including access to reproductive health services, and the Court's decision will likely exacerbate these gaps in care."

The study used data from the 2015-2017 National Survey of Family Growth, focusing on sexually active women of reproductive age in the United States who were neither pregnant nor trying to become pregnant. Previous studies by TxPEP have shown that women often prefer to use more effective methods such as the IUD, implant, and sterilization, which may not be readily available at publicly funded or private health care providers.