Culture

As the number of young adults infected with the coronavirus surges throughout the nation, a new study by researchers at UCSF Benioff Children's Hospitals indicates that youth may not shield people from serious disease.

The study looked at data drawn from a nationally representative sample of approximately 8,400 men and women ages 18 to 25 and concluded that overall "medical vulnerability" was 33 percent for males and 30 percent for females. The impact of smoking surpassed other less common risks, the UCSF researchers reported in their study, which publishes in the Journal of Adolescent Health on July 13, 2020.

Data from the U.S. Centers for Disease Control and Prevention (CDC), not included in the UCSF study, indicates that while patients over 65 are significantly more likely to be hospitalized than younger people, the gap is narrowing. For the week ending April 18, there were 8.7 hospitalizations per 100,000 of the population for the 18-to-29 age bracket, compared with 128.3 per 100,000 of the population for patients over 65. By the week ending June 27, the figures were 34.7 and 306.7 respectively, representing a 299 percent increase in hospitalizations for young adults, versus a 139 percent increase in hospitalizations for older adults.

The researchers, led by first author Sally Adams, PhD, of the UCSF Division of Adolescent and Young Adult Medicine, determined vulnerability by referencing indicators identified by the CDC. These included heart conditions, diabetes, current asthma, immune conditions (such as lupus, gout, rheumatoid arthritis), liver conditions, obesity and smoking within the previous 30 days. Additionally, the researchers added e-cigarettes to tobacco and cigar use, which the CDC had included, stating that all three were associated with adverse effects on respiratory and immune function.

Since there was no data on the relative impact of each of the CDC risk factors, the researchers used an overall medical vulnerability estimate of having at least one of the indicators as the outcome variable, rather than a cumulative score of indicators. Thus, medical vulnerability was assessed according to each indicator, so that among smokers for example, 100 percent were vulnerable for severe COVID-19.

Most notable among their results was that medical vulnerability stood at 16.1 percent for the 6,741 non-smokers, versus 31.5 percent for the full sample of 8,405 young adults, which included smokers.

Smoking Linked to Progression of COVID-19

"Recent evidence indicates that smoking is associated with a higher likelihood of COVID-19 progression, including increased illness severity, ICU admission or death," said Adams. "Smoking may have significant effects in young adults, who typically have low rates for most chronic diseases."

Recent research also shows that young adults are starting to smoke at higher rates than adolescents, a reversal of previous trends, she noted.

The study, which used data from the National Health Interview Survey, found that over the previous 30 days, 10.9 percent had smoked a cigarette, 4.5 percent had smoked a cigar product and 7.2 percent had smoked an e-cigarette. The number of smokers - 1,664 or 19.8 percent - was higher than the number of people with asthma (8.6 percent), obesity (3 percent) and immune disorders (2.4 percent). Additionally, 1.2 percent had diabetes, 0.6 percent had a liver condition and 0.5 percent had a heart condition.

"The risk of being medically vulnerable to severe disease is halved when smokers are removed from the sample," said senior author Charles Irwin Jr., MD, of the UCSF Division of Adolescent and Young Adult Medicine. "Efforts to reduce smoking and e-cigarette use among young adults would likely lower their vulnerability to severe disease."

Gender differences were noted in five vulnerability indicators. Women were more likely to have asthma, (10 percent versus 7.3 percent), to be obese (3.3 percent versus 2.6 percent) and to have immune conditions (3.2 percent versus 1.6 percent). But significantly fewer young women smoked, which resulted in overall medical vulnerability of 29.7 percent compared with 33.3 percent for young men.

Nuclear physicists affiliated with the U.S. Department of Energy's Lawrence Berkeley National Laboratory (Berkeley Lab) played a leading role in analyzing data for a demonstration experiment that has achieved record precision for a specialized detector material.

The CUPID-Mo experiment is among a field of experiments that are using a variety of approaches to detect a theorized particle process, called neutrinoless double-beta decay, that could revise our understanding of ghostly particles called neutrinos, and of their role in the formation of the universe.

The preliminary results from the CUPID-Mo experiment, based on the Berkeley Lab-led analysis of data collected from March 2019 to April 2020, set a new world-leading limit for the neutrinoless double-beta decay process in an isotope of molybdenum known as Mo-100. Isotopes are forms of an element that carry a different number of uncharged particles called neutrons in their atomic nuclei.

The new result sets the limit on the neutrinoless double-beta decay half-life in Mo-100 at 1.4 times a trillion-trillion years (that's 14 followed by 23 zeros), which is a 30% improvement in sensitivity over the Neutrino Ettore Majorana Observatory 3 (NEMO 3), a previous experiment that operated at the same site from 2003-2011 and also used Mo-100. A half-life is the time it takes for a radioactive isotope to shed half of its radioactivity.

The neutrinoless double-beta decay process is theorized to be very slow and rare, and not a single event was detected in CUPID-Mo after one year of data-taking.

While both experiments used Mo-100 in their detector arrays, NEMO 3 used a foil form of the isotope while CUPID-Mo used a crystal form that produces flashes of light in certain particle interactions.

Larger experiments that use different detector materials and that operate for longer periods of time have achieved greater sensitivity, though the reported early success of CUPID-Mo sets the stage for a planned successor experiment called CUPID with a detector array that will be 100 times larger.

Berkeley Lab's contributions to CUPID-Mo

No experiment has yet confirmed whether the neutrinoless process exists. Existence of this process would confirm that neutrinos serve as their own antiparticles, and such proof would also help explain why matter won out over antimatter in our universe.

All of the data from the CUPID-Mo experiment - the CUPID acronym stands for CUORE Upgrade with Particle IDentification, and "Mo" is for the molybdenum contained in the detector crystal - is transmitted from Modane Underground Laboratory (Laboratoire souterrain de Modane) in France to the Cori supercomputer at Berkeley Lab's National Energy Research Scientific Computing Center.

Benjamin Schmidt, a postdoctoral researcher in Berkeley Lab's Nuclear Science Division, led the overall data analysis effort for the CUPID-Mo result, and was supported by a team of Berkeley Lab-affiliated researchers and other members of the international collaboration.

Berkeley Lab also contributed 40 sensors that enabled readout of signals picked up by CUPID-Mo's 20-crystal detector array. The array was supercooled to about 0.02 kelvin, or minus 460 degrees Fahrenheit, to maintain its sensitivity. Its cylindrical crystals contain lithium, oxygen, and the isotope Mo-100, and produce tiny flashes of light in particle interactions.

The international effort to produce the CUPID-Mo result is remarkable, Schmidt said, given the context of the global pandemic that had cast uncertainty over the continuing operation of the experiment.

"For a while it looked like we would have to shut down the CUPID-Mo experiment prematurely due to the outbreak of COVID-19 in Europe at the beginning of March and the associated difficulties in supplying the experiment with required cryogenic liquids," he said.

He added, "Despite this uncertainty and the changes associated with the closure of office spaces and schools, as well as restricted access to the underground laboratory, our collaborators made every effort to keep the experiment running through the pandemic."

Schmidt credited the efforts of the data-analysis group that he led for finding a way to work from home and produce the results from the experiment in time to present them at Neutrino 2020, a virtual International Conference on Neutrino Physics and Astrophysics hosted by Fermi National Accelerator Laboratory. Members of the CUPID-Mo collaboration are planning to submit the results for publication in a peer-reviewed science journal.

Tuning up ultrasensitive detectors

A particular challenge in the data analysis, Schmidt said, was in ensuring that the detectors were properly calibrated to record the "extremely elusive set of events" that are predicted to be associated with a signal of neutrinoless double-beta decay.

The neutrinoless decay process is expected to generate a very-high-energy signal in the CUPID-Mo detector and a flash of light. The signal, because it is at such a high energy, is expected to be free from interference by natural sources of radioactivity.

To test CUPID-Mo's response to high-energy signals, researchers had placed other sources of high-energy signals, including Tl-208, a radioactive isotope of thallium, near the detector array. The signals generated by the decay of this isotope are at a high energy, but not as high as the energy predicted to be associated with the neutrinoless decay process in Mo-100, if it exists.

"Hence, a big challenge was to convince ourselves that we can calibrate our detectors with common sources, in particular Tl-208," Schmidt said, "and then extrapolate the detector response to our signal region and properly account for the uncertainties in this extrapolation."

To further improve the calibration with high-energy signals, nuclear physicists used Berkeley Lab's 88-Inch Cyclotron to produce a wire containing Co-56, an isotope of cobalt that that has a low level of radioactivity, as soon as the cyclotron reopened last month following a temporary shutdown in response to the COVID-19 pandemic. The wire has been shipped to France for testing with the CUPID-Mo detector array.

Preparing for next-gen experiment in Italy

While CUPID-Mo may now lag behind the sensitivity in measurements achieved by some other experiments - which use different detector techniques and materials - because it is smaller and hasn't yet gathered as much data, "With the full CUPID experiment, which will use about 100 times more Mo-100, and with 10 years of operation, we have excellent prospects for the search and potential discovery of neutrinoless double-beta decay," Schmidt said.

CUPID-Mo was installed at the site of the Edelweiss III dark matter search experiment in a tunnel more than a mile deep in France, near the Italian border, and uses some Edelweiss III components. CUPID, meanwhile, is proposed to replace the CUORE neutrinoless double-beta decay search experiment at Gran Sasso National Laboratory (Laboratori Nazionali del Gran Sasso) in Italy. While CUPID-Mo contains just 20 detector crystals, CUPID would contain more than 1,500.

"After CUORE finishes data-taking in two or three years, the CUPID detector could take four or five years to build," said Yury Kolomensky, U.S. spokesperson for the CUORE collaboration and senior faculty scientist at Berkeley Lab, which is leading CUORE's U.S. collaboration. "CUPID would be a relatively modest upgrade in terms of cost and technical challenges, but it will be a significant improvement in terms of sensitivity."

Physics data-taking for CUPID-Mo wrapped up June 22, and new data that weren't considered in the latest result represent about a 20% to 30% growth in overall data. CUPID-Mo is supported by a group of French laboratories, and by laboratories in the U.S., Ukraine, Russia, Italy, China, and Germany.

NERSC is a DOE Office of Science user facility.

The CUPID-Mo collaboration brings together researchers from 27 institutions, including the French laboratories Irfu/CEA and IJCLab in Orsay; IP2I in Lyon; and Institut Néel and SIMaP in Grenoble, as well as institutions in the U.S., Ukraine, Russia, Italy, China, and Germany.

The experiment is supported by the U.S. Department of Energy Office of Science's Office of Nuclear Physics, Berkeley Research Computing program, Agence Nationale de la Recherche, IDEATE International Associated Laboratory (LIA), Russian Science Foundation, National Academy of Sciences of Ukraine, National Science Foundation, the France-Berkeley Fund, the MISTI-France fund, and the Office for Science & Technology of the Embassy of France in the U.S.

Ever wonder how some leaders in business or politics who appear selfish, manipulative and domineering still manage to amass a following? A recent study in the Journal of Leadership & Organizational Studies by San Francisco State University Assistant Professor of Management Dayna Herbert Walker found a connection between a person's childhood family environment and the types of leaders they're drawn to as grown-ups.

Using data from the Fullerton Longitudinal Study, a long-term study that began tracking families in 1979, Herbert Walker and three other researchers noticed a correlation between adolescents who reported a high level of conflict at home and those who later identified socially undesirable traits as ideal leadership qualities.

"We see it all the time -- where the obnoxious leader rises to the top, but we don't know much about why," Herbert Walker said. "Tyrants, whether they be in the boardroom or in politics, wouldn't have the power they do if followers didn't support them. We often look to leaders to explain leadership, but we should also be looking to followers."

The survey, which tracked 130 individuals at various points of their life, gave researchers details about participants' home lives and the leadership traits they valued most. Researchers studied data gathered in 1996, when participants were 17 years old. Two decades later, as part of another round of data collection for the Fullerton Longitudinal Study, researchers asked the same individuals questions about ideal leadership qualities.

The 1996 survey asked participants about their family dynamics, such as whether people at home raised their voices, criticized one another or were physically violent. Twenty years later, those respondents were asked to measure on a scale whether 10 qualities researchers defined as tyrannical (domineering, pushy, dominant, manipulative, power-hungry, conceited, loud, selfish, obnoxious and demanding) were characteristics present in their image of an ideal leader.

"It's critical that we asked about ideal leadership and not just leadership in general," Herbert Walker said, "because we really wanted to get at a person's favored leadership image, the characteristics they ideally want to see in their leaders."

Herbert Walker and the study's other authors then compared the data from 2016 and 1996 and found a strong positive connection between those who reported living with a high level of conflict at home and those whose ideal image of a leader possessed these negative traits. A person who experiences high conflict in adolescence is 20% more likely than chance to prefer a tyrannical model of leadership, controlling for other known factors that shape leadership preferences like sex and personality. When adolescent family environments contain a high amount of dysfunctional conflict, it's likely that some tyrannical behavior is on display and that role modeling can shape the way a person views leadership, Herbert Walker explains.

The findings shed new light on what ideal leadership can look like for some followers, illuminating why some of us are drawn to tyrants despite their harsh approach.

Herbert Walker says another group could learn important lessons from the findings, as well: bad bosses. For instance, a manager who believes leaders should be overbearing or manipulative could end up acting out those traits.

"The first step is getting them to question their assumptions about why they do what they do," she said. "Maybe they'll realize that they believe this, because that's how their dad behaved and he was successful in business. And so they believe that's how they're supposed to act."

Marked racial disparities exist in confirmed COVID-19 cases and deaths, investigators say, and highlight urgent needs to ensure adequate testing and treatment are available to African Americans and safer working and living conditions are in place so they can better protect themselves.

Also, more complete surveillance data is needed that always includes race, ethnicity and gender to better identify those most at risk and enable better treatment and prevention strategies that target at-risk neighborhoods and engage trusted, faith-based community leaders to help, Medical College of Georgia investigators write in the American Journal of Public Health.

"A colorblind approach to public health surveillance and response cannot bring about equity when both the health care system and the structural conditions that inform it are so weak," corresponding author Dr. Steven S. Coughlin, interim chief of the Division of Epidemiology in the MCG Department of Population Health Sciences, and his colleagues write.

Poverty, lack of health insurance and decreased access to health care are factors that likely contribute, as are past transgressions that have left many African Americans distrustful of government and the health care system, they write.

"To mitigate racial disparities in COVID-19 infection and mortality, safer working conditions and living environments (also) are needed that include provisions for personal protective equipment, social distancing, and hand/surface hygiene," they add.

In reality, a higher percentage of African Americans work in jobs where it's difficult or impossible to work from home or maintain a safe social distance at work, Coughlin says. Additionally, many of these jobs don't offer paid leave or health insurance, which means individuals may delay being tested and even present at the hospital sicker, he says.

In New York City, for example, which became a COVID-19 epicenter in the United States, reports based on U.S. Census Bureau statistics indicate that about 75% of the frontline workers in the city -- those who work in grocery, convenience and drug stores; public transit; trucking, warehouse and postal services; health care; childcare, homeless, food and family services; and building cleaning services -- are African American. A large percentage of these workers have to travel long distances to their work and a significant percentage live at or below twice the poverty line.

When looking at statistics on who got COVID-19 and where, as recently as late April, the investigators found that a lot of states did not release confirmed cases and deaths broken down by race, and the data was often limited on the states that did, Coughlin says.

But the information that was available from select cities and states painted a clear picture that African Americans throughout the nation are disproportionately impacted by both infection rates and death, Coughlin says of statistics primarily available from predominantly bigger cities in the Midwest and Northeast like Chicago, Milwaukee, Philadelphia and New York.

In Wisconsin, for example, African Americans comprise 6% of the state's population but 25% of COVID-19 cases and 39% of deaths. In Georgia, as of April 23, African Americans accounted for 31% of COVID-19 cases and 52% of the deaths in a state that is nearly 31% black. In Washington D.C. about 46% of the population is African American but their rate of COVID-19 deaths is 62.5%. Nationally, the Centers for Disease Control and Prevention was reporting that 1 in 3 people who become sick enough to require hospitalization were African American while they make up about 13% of the population.

In fact, some studies indicate the infection rate in predominately black counties is three times higher than predominately white ones and death rates are six times higher.

The first cases of COVID-19 in the United States were reported in January 2020, and rates began to take off late March and early April, Coughlin says.

"Throughout this period, half the states had not released information about cases and deaths broken down by ethnicity," he says.

By mid-April, 21 states had not released racial or ethnic breakdowns of those infected and 26 states had not released breakdowns of fatalities, the investigators write. Subsequently some testing and treatment forms have been modified to include race and ethnicity but there are a lot of gaps in existing data as well, he says.

The official word was there was a bureaucratic lapse because things were moving so rapidly, says Dr. Joseph Hobbs, chair emeritus of the MCG Department of Family Medicine and a senior author on the paper, who was shocked both by race often not being noted and by the disproportionate number of African Americans that were noted among COVID-19 related deaths. "The lack of information is still there," Hobbs adds, and would help strategize how best to move forward.

"You can't test the whole world but you can test segments where you know there are potential problems ... if you are able to document those problems, then you can divert resources to those communities to try to work on processes that make the community more aware of the things they could do to support each other with regard to stopping transmission of the disease," Hobbs says.

"Black churches can serve as testing and triage centers, health action zones to bridge government resources with community resources, and serve as a platform to overcome trust issues related to health care," they write.

"Our editorial calls for improved public health surveillance data to monitor the COVID-19 epidemic in different, diverse communities," Coughlin says, noting that other people of color, like the Navajo population, are also disproportionately impacted by the novel coronavirus. Improved surveillance includes more testing as well as more contact tracing once positive individuals have been identified, he says, noting targeted testing initiatives in disadvantaged neighborhoods in New York state and culturally appropriate PSAs in Las Vegas and South Carolina.

Longer-term goals include addressing the structural problems at the heart of the issue, Coughlin says.

The investigators say structural problems, including poverty, unemployment, household and neighborhood crowding and otherwise substandard housing, account for the pronounced disparities they see in available data.

Coughlin notes that structural problems, that also include food deserts and lack of safe/affordable places to exercise, also likely play a major role in increased rates of chronic conditions like hypertension and diabetes that also are risk factors for novel coronavirus infection and death.

These structural conditions first expose a population disproportionately, says Hobbs, and the chronic conditions put African Americans at increased risk of dying from the infection.

"These are the individuals who end up in the hospital disproportionately," says Hobbs. "These are the ones who are going to have the most complex clinical courses in the hospital and they comprise a disproportionate percentage of the people who will die," the family medicine physician says.

"Some commentators have drawn an analogy between what happened after Katrina like in the lower Ninth Ward of New Orleans and what is happening now with disparities and COVID-19," Coughlin says of a predominately black area of the city that was pummeled by the 2005 Category 3 hurricane and was the last to have power and water restored.

"The poverty and substandard living conditions existed in New Orleans for hundreds of years, but the hurricane brought them to light," Coughlin says. "Here we have another national emergency and it is shedding light on long-existing structural problems like redlining and segregated neighborhoods," he says of the historical lending practice of limiting mortgages in communities of color.

As of mid-June, racial and ethnic information was available for only about 35% of the total deaths in the US, although it was clear that blacks and other disadvantaged groups are experiencing infection and death rates that are disproportionately high for their share of the total population, according to Dr. Lisa A. Cooper, Bloomberg Distinguished Professor at the Johns Hopkins Bloomberg School of Public Health and School of Medicine, and director of the Johns Hopkins Center for Health Equity. The university's COVID-19 Testing Insights Initiative provides a national perspective on COVID-19 testing, results and other insight.

The introduction of standardised packaging for cigarettes in the UK, combined with stricter taxation measures on cheaper cigarettes, has led to a significant fall in sales for cigarettes, according to new analysis from researchers at the University of Bath.

By analysing sales data over three years from May 2015 to April 2018, the researchers from the Tobacco Control Research Group found that pre-legislation, cigarette sales (calculated by individual cigarettes) declined on average by 12 million a month; after legislation, this decrease accelerated sharply to 20 million a month.

The team behind the new study, published today (Monday 13 July) in the BMJ journal Tobacco Control, suggest their findings demonstrate the public health benefits that standardised packaging coupled with taxation can bring in reducing tobacco consumption. They hope their findings can provide important evidence to policymakers around the world of the effectiveness of standardised packaging.

The UK was the second country in the world to implement standardised packaging for cigarettes and the first where comprehensive sales data are available to analyse the impact. At the point when standardised packaging was fully implemented, May 2017, a new tax on cheaper cigarettes (the minimum excise tax - MET) was also introduced.

Principal Investigator and Director of the Tobacco Control Research Group, Professor Anna Gilmore explains: "The combination of tax increases and standardised packaging has led to a significant decline in tobacco sales. The underlying rate of decline in tobacco sales almost doubled after these policies were implemented."

Study findings also suggest that the tobacco industry's net revenue (which is an indication of profits once taxes have been paid) fell by 13% after implementation, from £231M to £198M per month.

Professor Gilmore comments: "Governments around the world considering plain packaging can be reassured that this policy works and that the real reason the industry opposes this legislation so vehemently is because it threatens its profitability. With coronavirus already posing a threat to tobacco company sales, and plain packaging of tobacco taking off in other jurisdictions, our findings are more bad news for tobacco companies."

Previous research from the group showed that prices of the cheapest cigarette brands rose around May 2017 as the tobacco industry adjusted to manage the incoming MET. This latest analysis suggests that as these cheapest brands increased in price, they became less appealing and growing sales ended.

Lead researcher on the new study, Dr Rosemary Hiscock also from the Tobacco Control Research Group at the University, adds: "Falling tobacco industry revenues suggest the new legislation has played a role in stopping formerly lucrative brand differentiation. For many years, the tobacco industry had used packaging to signal the difference between premium and cheap cigarette brands, with smokers often willing to pay markedly more for premium brands.

"This allowed the tobacco industry to make enough profit on premium brands to subsidise its cheap brands, keeping them cheap enough for young people to afford to start smoking and to prevent price conscious smokers from being incentivised to quit. Standardised packaging has weakened the appeal of premium brands, on which the tobacco companies made more profits, and the MET has forced cheap brands to become more expensive. This implies that the legislation should play a role in reducing the prevalence of smoking and its consequences (illness and premature death)."

Additional findings from the study suggest that sales of roll-your-own (RYO) tobacco have been growing steadily but this growth was not enough to compensate for the decline in cigarette sales.

In view of the continuing imbalance between taxes on cigarettes and roll-your-own tobacco, economist, tobacco tax expert and author on the study, Dr Rob Branston, adds: "Now that the MET has addressed cheaper factory-made cigarettes, the government also needs to increase RYO taxes. Currently, price-sensitive smokers can still switch to using cheap RYO cigarettes instead of quitting. These are just as deadly as factory-made cigarettes but are currently taxed at a significantly lower rate. There is no evidence that the resulting higher prices would cause RYO smokers to turn to illicit products."

Sarah Bullock, Policy Advisor for Cancer Research UK said: "Smoking continues to be the leading preventable cause of cancer in the world. This study suggests that increasing tobacco taxes and introducing standardised "plain" packaging has helped to reduce the number of cigarettes smoked in the UK. Measures like these, which reduce the use of this deadly product and ultimately save lives, should be a priority for all governments."

Strategies for the safe reopening of low and middle-income countries (LMICs) from months of strict social distancing in response to the ongoing COVID-19 pandemic must recognise that preserving people's health is as important as reviving the economy, argue an international team of researchers.

The team also say that strategies need to be based on local epidemic growth rate at the time, social and economic costs, existing health systems capabilities and detailed plans to implement and sustain the strategy.

The COVID-19 pandemic has been responsible for over half a million deaths globally. Many LMICs responded to the pandemic by introducing a number of measures from physical distancing to strict social distancing.

These measures have proved relatively successful in containing the disease and limiting the number of deaths in places where the risk of transmission is high, public health systems and usage are suboptimal and awareness of disease prevention practices is low. However, they have often come with tremendous negative social, economic and psychological effects.

To prevent further negative impacts of lockdown, many countries are now looking to 'reopen', risking population health, especially given shortcomings in surveillance infrastructure and poor diagnostic capabilities.

In a paper published in the European Journal of Epidemiology, a team of epidemiologists from the University of Cambridge, the University of Bern, BRAC University and the National Heart Foundation in Bangladesh, have examined three community-based exit strategies, and recommend their scopes, limitations and the appropriate application in the LMICs.

Dr Rajiv Chowdhury from the University of Cambridge, lead author of the paper, said: "Successfully re-opening a country requires consideration of both the economic and social costs. Governments should approach these options with a mind-set that health and economy both are equally important to protect - reviving the economy should not take priority over preserving people's health."

The three approaches considered are:

*Sustained mitigation

Sustained 'mitigation-only' approaches such as those adopted in the United Kingdom, Switzerland and other European countries, involve basic prevention measures such as mask wearing, physical distancing and the isolation of positive cases after testing.

However, the researchers point out that the relative success and ease of implementation of these approaches in high-income settings was aided by a number of factors. For example, high-income countries have the capacity to implement mass testing, population surveillance and case isolation to contain the epidemic, in addition to a high number of trained contact tracers operating in a relatively small and sparse population and high levels of adherence to the measures, including home quarantine and hygiene advice.

By contrast, in LMICs, a sustained mitigation-only approach may be unfeasible due to poor or absent nationwide population surveillance, contact tracing, testing infrastructure and critical care. For example, LMICs generally have limited supply of ventilators (around 48,000 for India's 1.3 billion people), personal protective equipment, trained healthcare personnel and safe working conditions, compromising the healthcare system's effectiveness.

*Zonal lockdowns

Zonal lockdowns involve identifying and 'cordoning off' new outbreak clusters with a high number of cases, keeping contact between zones low and containing the disease within a small geographic area.

However, the authors point out that any successful implementation of zonal lockdown requires regular data feedback operations in real time to identify hotspots, including information on newly confirmed cases, updated region-specific reproduction and growth rates, and deaths by age. This may be especially difficult to introduce in LMICs due to the absence of widespread population surveillance on random selections of the population and poor reporting and testing capabilities - for example, Pakistan conducts only 0.09 tests daily per 1,000 individuals compared to 0.52 in France.

Additionally, control of transmission within zones may be an enormous undertaking. In India, where this approach has been employed, the infection size within a cordoned zone can be as high as 100-200 times that outside the zone.

Countries seeking to introduce such measures should establish within the lockdown zone public health measures, including house-to-house surveillance and case-referral systems, and emergency services. They should also create buffer zones to reduce the rates of transmission from outside the zone. Such measures may only be effective when overall population transmission is relatively low and reducing.

*Rolling lockdowns

Intermittent rolling lockdowns are now advocated by the World Health Organization in various LMICs. These involve implementing strict social distancing for a set number of days before a period of relaxation. Rolling lockdowns may be particularly useful in LMICs with dense populations, where this is a high potential for contact, weak health systems and poor contact tracing.

A modelling study published by the team in May showed that a system involving 50 days of strict lockdown followed by 30 days of relaxation, enabling the economy to 'breathe' and recuperate, could reduce the reproduction number to 0.5, reduce the strain on health systems and considerably reduce the number of deaths compared to a situation with no lockdown.

Professor Oscar Franco, of the University of Bern and senior author of the paper, said: "Rolling lockdowns need be flexible and tailored to the specific country. The frequency and duration of the lockdowns or relaxed periods should be determined by the country based on local circumstances. They don't necessarily need to be nationwide - they can also involve a large zone or province with very high incidence of COVID-19."

Dr Shammi Luhar of the University of Cambridge and co-author of the paper, added: "These three strategies should not be considered as one or the other. A country should further adapt and could combine them as needed."

For the first time, physicians can examine the systemic burden of inflammatory arthritis simultaneously across all joints and organ systems, using the high-sensitivity, high-resolution uEXPLORER total-body positron emission tomography/computed tomography (TB-PET/CT) scanner. Results of the first in-human TB-PET/CT scans conducted in the arthritic population were presented at the Society of Nuclear Medicine and Molecular Imaging 2020 Virtual Annual Meeting.

Inflammatory arthritic conditions, such as rheumatoid arthritis or psoriatic arthritis, are considered systemic disorders, affecting the whole body. Yet current evaluation--mostly via anatomical imaging, such as x-ray or CT imaging--is conducted for only a few joints of the body, such as those of the wrist and hand. In the past, 18F-FDG PET scans have been used infrequently in this population due to spatial resolution and sensitivity limitations as well as radiation dose concerns.

The total-body coverage, high resolution and high sensitivity of the TB-PET/CT scanner, however, offers new imaging options for inflammatory arthritis. "In our research, we sought to examine the feasibility of assessing glucose metabolism both in normal and diseased joint tissues across the body as a means for quantifying systemic inflammatory burden for these conditions," stated Yasser Abdelhafez, MBBCh, MSc, MD, FEBNM, a postdoctoral researcher in Abhijit Chaudhari's laboratory at the University of California, Davis, in Sacramento, California.

The ongoing, prospective study enrolled 14 participants with established rheumatoid arthritis, psoriatic arthritis or osteoarthritis who underwent a single-timepoint TB-PET/CT scan for 20 minutes. The participants received an injection of 75.5 MBq of 18F-FDG, which is approximately 20 percent of the conventional 18F-FDG dose. Qualitative findings and different patterns for the three conditions were analyzed.

Participants with rheumatoid arthritis showed multiple, rather symmetric joint involvement, most commonly in the hands; joints of the feet appeared to be less frequently affected. Other notable features of this group included radiotracer uptake patterns consistent with inflammation of the joint synovium. All participants with psoriatic arthritis had positive findings in large joints and demonstrated multiple sites of enthesitis (inflammation where a tendon or ligament attached to a bone), which affected the tendons of the hand and fingers, including the nail beds. Osteoarthritic participants showed unilateral enhanced FDG uptake in at least one large joint (shoulder, elbow or knee), and occasionally in a few small joints of the hand and feet and the quadriceps femoris tendon.

"Systemic joint evaluation of patients with inflammatory arthritis is indeed feasible with this TB-PET/CT scanner, and feasible with low radiation dose," stated Abdelhafez. "The evaluation of arthritic disease activity at all joints of the body could have direct implications for disease staging, risk stratification, treatment selection and monitoring of treatment response. Furthermore, the impact of arthritis on other tissues of the body can be studied to better understand systemic disease burden."

He continued, "Total-body molecular imaging could provide currently unavailable, systemic, objective biomarkers that could help address the significant clinical challenges in managing inflammatory arthritic populations. These biomarkers may also have clear potential to accelerate arthritic drug discovery and development."

This work was supported by the National Institutes of Health (grants R01 AR076088 and R01 CA206187) and the National Psoriasis Foundation.

Abstract 331. "Total-body 18F-FDG PET/CT in patients with inflammatory arthritis: initial findings using the uEXPLORER system," Yasser Abdelhafez, Nuclear Medicine Unit, South Egypt Cancer Institute, Assiut University, Assiut, Egypt, and Radiology, University of California, Davis, Sacramento, California; Heather Hunt, Mike Nguyen, Denise Caudle, Lorenzo Nardo, Ramsey Badawi and Abhijit Chaudhari, Radiology, University of California, Davis, Sacramento, California; Soumajyoti Sarkar, Internal Medicine, University of California Davis, Sacramento, California; Simon Cherry, Biomedical Engineering and Radiology, University of California, Davis, Davis, California; and Siba Raychaudhuri, Internal Medicine, University of California, Davis, Sacramento, California and Sacramento Veterans Affairs Medical Center, Mather, California. SNMMI's 67th Annual Meeting, July 11-14, 2020.

A team of researchers from Kazan Federal University, Russia, led by Dr. Igor Sedov, reported an application of capillary differential scanning calorimetry technique for the study of the binding of albumin, a plasma transport protein, with different drug ligands.

The processes of binding of various biologically active ligands to proteins can be quantitatively characterized by the values of thermodynamic binding constants, which determine the ratio between the concentrations of free and bound ligand. Accurate determination of these quantities is not an easy task. Presently, a fairly sensitive and robust isothermal titration calorimetry method is most commonly used; however, it does not allow to study the processes with very high binding constants or separate binding steps.

The differentl scanning calorimetry (DSC) method, based on monitoring changes in the heat capacity of a heated sample, is widely used to study protein denaturation. A shift of the denaturation peak to higher temperatures in the presence of a ligand is a sign of protein-ligand binding. However, the relationship between the shift magnitude and the binding constant cannot be described by a simple mathematical formula. Therefore, only a few attempts were made to use DSC thermograms for the quantitative ligand binding studies. The authors of the paper developed a program that takes into account the denaturation and ligand binding equilibria and allows one to predict the DSC curve from the known binding constants and protein and ligand concentrations. Then the values of the constants can be optimized to provide the best fit of the calculated curves to the experimental ones.

The application of this approach to albumin is complicated by the mechanism of denaturation of this protein, which is usually considered to be two-stage. However, the authors showed that the two-state model of protein denaturation used in the program gives the results consistent with other experimental methods. Moreover, the analysis of DSC thermograms helps measure very high binding constants, as well as weak binding constants with the second molecule of a ligand, and the stoichiometry of a complex at the large excess of ligand, when simultaneous binding to several centers, including those with low affinity, occurs.

Albumin is the main transport protein in blood plasma and can bind to a wide variety of molecules. Albumin has a two-domain structure with at least two high-affinity and several low-affinity binding sites. The binding affinity of drugs to plasma proteins influences the fraction of the free drug in plasma, which, in turn, is one of the major factors governing drug permeability through physiological barriers. Only unbound drugs can cross these barriers. As an example, the studied strong albumin binders - naproxen and ibuprofen - have limited brain bioavailability due to low permeability through the blood-brain barrier. On the other hand, slowly metabolized drugs with weak plasma binding have increased clearance, which may result in lower efficacy. The binding constant values can give the idea about the fraction of an unbound drug in blood plasma, while the knowledge of sequential binding constants is important for the studies of competition between drugs and other substrates or between two different drugs for albumin binding centers. In the case when the strongest binding center is occupied by another molecule, the unbound fraction of the drug will be determined by its affinity to the other binding sites. The interest in albumin binding also arises from the prospective use of drug delivery systems based on albumin nanoparticles.

The DSC-based method has potential applications to a wide range of proteins and bioactive ligands and can be useful in drug development and protein science.

This work was supported by the Russian Science Foundation (grant 19-73-00209).

Venus flytraps catch spiders and insects by snapping their trap leaves. This mechanism is activated when unsuspecting prey touch highly sensitive trigger hairs twice within 30 seconds. A study led by researchers at the University of Zurich has now shown that a single slow touch also triggers trap closure - probably to catch slow-moving larvae and snails.

The Venus flytrap (Dionaea muscipula) is perhaps the most well-known carnivorous plant. It catches its prey, mostly spiders and insects, using a sophisticated trapping mechanism. Its distinct leaves have three highly sensitive trigger hairs on each lobe. These hairs react to even the slightest touches - e.g. when a fly crawls along the leaf - by sending out an electrical signal, which quickly spreads across the entire leaf. If two signals are triggered in a short time, the trap snaps within milliseconds.

New trigger for trapping mechanism

The physiological reactions on which this trapping mechanism is based have been studied for over 200 years. The consensus has been that every sufficiently strong touch of a trigger hair causes an electrical signal, and that two signals within 30 seconds result in the closing of the trap. A new study from the University of Zurich (UZH) and ETH Zurich has now found another triggering mechanism. "Contrary to popular belief, slowly touching a trigger hair only once can also cause two signals and thus lead to the snapping of the trap," says co-last author Ueli Grossniklaus, director of the Department of Plant and Microbial Biology at UZH.

First, the interdisciplinary team of researchers determined the forces needed to trigger the plant's trapping mechanism. They did this by using highly sensitive sensors and high-precision microrobotic systems developed by the team of co-last author Bradley J. Nelson at the Institute of Robotics and Intelligent Systems at ETH Zurich. This enabled the scientists to deflect the trigger hairs to a precise angle at a pre-defined speed in order to measure the relevant forces. These experiments confirmed the previous theory. If the chosen parameters approximate the touch of regular prey, it takes two touches for the trap to snap.

From the collected data, the researchers at the ETH Institute for Building Materials developed a mathematical model to determine the range of angular deflection and velocity thresholds that activate the snapping mechanism. "Interestingly, the model showed that at slower angular velocities one touch resulted in two electrical signals, such that the trap ought to snap," says Grossniklaus. The researchers were subsequently able to confirm the model's prediction in experiments.

Catching slow prey

When open, the lobes of the Venus flytrap's leaves are bent outwards and under strain - like a taut spring. The trigger signal leads to a minute change in the leaves' curvature, which makes the trap snap instantaneously. The electrical signals are generated by ion channels in the cell membrane, which transport atoms out of and into the cell. "We think that the ion channels stay open for as long as the membrane is mechanically stretched. If the deflection occurs slowly, the flow of ions is enough to trigger several signals, which causes the trap to close," explains co-first author Hannes Vogler, plant biologist at UZH. The newly discovered triggering mechanism could be a way for the Venus flytrap to catch slow-moving prey, such as larvae or snails.

A new single-cell RNA sequencing analysis of more than 59,000 cells from three different patient cohorts provides a detailed look at patients' immune responses to severe cases of COVID-19. The results suggest that patients with severe COVID-19 experience increased regulation of the type I interferon (IFN-I) inflammation-triggering pathway - a signature that the researchers also observed in patients hospitalized with severe cases of influenza. Their findings suggest that anti-inflammatory treatment strategies for COVID-19 should also be aimed toward the IFN-I signaling pathway, in addition to targeting inflammatory molecules such as TNF, IL-1?, and IL-6 that have been implicated in COVID-19. Seong Seok Lee and colleagues sequenced the RNA from a total of 59,572 blood cells obtained from four healthy donors, eight patients with mild or severe COVID-19, and five patients with severe influenza. Patients in both the mild and severe COVID-19 cohorts all showed increased regulation of the TNF/IL-1ß-driven inflammatory response, while patients with severe COVID-19 also exhibited an increased IFN-I response. By comparison, patients with severe flu showed increased expression of various IFN-stimulated genes, but did not experience TNF/IL-1ß responses as seen in COVID-19 patients. Unlike the flu cohort, patients in the severe COVID-19 cohort exhibited the IFN-I signature concurrently with TNF/IL-1ß-driven inflammation - a combination also not seen in patients with milder cases of COVID-19. Based on their results, the scientists propose that the IFN-I response exacerbates inflammation in patients with severe COVID-19. Their results, along with past mouse studies that highlight how the timing of IFN-I expression is critical to determining the outcome of SARS-CoV-2 infection, support targeting IFN-I as a potential treatment strategy for severe COVID-19.

In a pioneer study published in Cell Host & Microbe - Researchers at Osaka City University and The Institute for Medical Science, The University of Tokyo, reported intestinal bacterial and viral metagenome information from the fecal samples of 101 healthy Japanese individuals. This analysis, leveraging host bacteria-phage associations, detected phage-derived antibacterial enzymes that control pathobionts. As proof-of-concept, phage-derived endolysins are shown to regulate C. difficile infection in mice.

Abnormalities in human intestinal microflora, known as dysbiosis, are connected to various diseases. Altered microbial diversity impairs the beneficial effects of host intestinal microflora, which cause some symbiotic commensal bacteria to acquire virulence traits, proliferate, and become directly involved in the development of disease. These bacteria are referred to as "pathobionts", which are distinct from opportunistic pathogens.

C. difficile, which is a Gram-positive, spore-forming anaerobic bacterium, is a pathobiont and the representative cause of nosocomial diarrhea following antibiotic treatment. Since antibiotic usage has the risk of killing beneficial bacteria and promoting dysbiosis, the development of methods to specifically manipulate intestinal pathobionts is essential.

"Phages were sure to be applicable as a highly specific therapy for intestinal pathobiont elimination", believed Professor Satoshi Uematsu. The infectious associations between phages and bacteria in the human intestine is essential information for the development of phage therapies. Known as "viral dark matter" as it had yet to be understood, researchers obtained metagenome information about bacteria-phage associations from the fecal samples of 101 healthy individuals through the development of a virome analysis pipeline. Based on this information, researchers screened C. difficile-specific phages and identified novel antibacterial enzymes, both in vitro and in vivo.

"The accumulation of more metagenomic information on intestinal phages and bacteria will open up the possibility of developing treatments for a variety of dysbiosis-related diseases", say Dr. Kosuke Fujimoto and Prof. Seiya Imoto.

The most vulnerable residents of the nation's 10th most populous state say their health improved significantly after they enrolled in Michigan's expanded Medicaid program, a new study finds.

Michiganders with extremely low incomes, those who live with multiple chronic health problems, and those who are Black, got the biggest health boosts year over year among all those enrolled in the safety-net health coverage program, the study shows.

But participants of almost all ages, backgrounds and in all geographic regions reported improvements in health over time.

Writing in the new issue of JAMA Network Open, a team from the University of Michigan reports the results of a survey that asked more than 3,000 enrollees in the Healthy Michigan Plan about their health, at two time points a year apart.

The new paper adds to a growing body of evidence about the impacts of Michigan's Medicaid expansion, compiled by a team from the U-M Institute for Healthcare Policy and Innovation with funding from the Michigan Department of Health and Human Services.

The IHPI team just unveiled a summary of findings based on the final report from the first five years of their evaluation of the Healthy Michigan Plan. The new paper is the latest in a series of peer-reviewed, data-driven articles that the team has published in academic journals based on their evaluation work.

Michigan's experience might inform states where Medicaid has not yet been expanded, or is about to be - including Missouri which has a ballot proposal up for a vote in early August, Oklahoma, whose voters just approved expansion last week, and Nebraska, which is preparing to start its program this fall. Twelve other states have not expanded their Medicaid programs.

Reductions in poor health

The new paper's lead author is Minal Patel, Ph.D., M.P.H., an associate professor at the U-M School of Public Health who analyzed data from the longitudinal survey of participants who had been enrolled in the Healthy Michigan Plan for at least a year before the first time they were surveyed.

The percentage of respondents who called their health fair or poor dropped from nearly 31% in 2016 to 27% in 2017. Larger decreases were seen among those with the very lowest incomes, those who were Black, those who had two or more chronic conditions, and those who live in the Detroit metropolitan area.

Additional survey data contained in a new report showed that the percentage who said their health was fair or poor dropped further, to 25.6% by 2018.

The average number of days in the past month when the respondents said they had been in poor physical health dropped by more than a day in many groups, including those with two or more chronic health conditions. But there was no significant change in days of poor mental health or days when respondents said their health interfered with their usual activities.

Nearly one quarter of respondents who answered in 2016 were no longer enrolled in the program when surveyed in 2017.

Enrollees had incomes below or just above the federal poverty line, but 57% said they were employed or self-employed. Just over half had incomes less than 35% of the federal poverty level, which was $11,880 for a single adult in 2016.

"Our study showed that sub-groups who would benefit the most from greater access to care through Michigan's Medicaid expansion reported improved health over time," says Patel. "Better access is indeed translating to better health."

The emphasis that the Healthy Michigan Plan places on primary care and prevention, as well as the inclusion of dental and vision care that can address long-unmet needs, likely played a role, she adds.

"It is rare to find a change in health policy that actually improves health of a target population in merely one year," says Susan D. Goold, M.D., MHSA, M.A., study co-author and professor of internal medicine at U-M. "The Healthy Michigan Plan model of expansion, which emphasized both insurance coverage and primary care, built on what we have learned from health systems around the globe."

Five years in, some key findings

The economic effects of COVID-19 have likely led more Michiganders to seek coverage from the safety net of the Healthy Michigan Plan. As of this week, more than 751,000 people are enrolled in the plan, up from 675,000 in February before COVID-19 struck Michigan.

"This new study adds to the large body of evidence on Medicaid expansion that our team at the University of Michigan has developed over the past five years," says IHPI director and study co-author John Z. Ayanian, M.D., M.P.P.

Some other key findings documented in the five-year summary brief:

Before enrolling in the Healthy Michigan Plan, half of those surveyed said they had a doctor or clinic they could see for regular care. By 2018, that had climbed to 83%.

The percentage who said that emergency rooms were their usual source of care dropped from 12% to 3%.

85% of enrollees had seen a primary care provider in the last year, 84% had received a preventive medical service such as a cancer screening, and nearly half had seen a dentist.

40% of enrollees surveyed said their dental health had improved since enrolling

85% of enrollees said they had fewer problems paying medical bills since they enrolled

The percentage of enrollees who said they were employed or enrolled as a student grew to 61% in 2018, up from 55% in 2016.

43% of enrollees said they had completed a Health Risk Assessment, a special feature of the Healthy Michigan Plan. Of these, 91% said it motivated them to be more responsible for their health.

Enrollees with incomes above the poverty level pay a contribution of 2% of their household income for their Healthy Michigan Plan coverage. Some services have co-pays. 88% of enrollees said that the amount they pay for their coverage seems fair. Among those who were billed for contributions or copays, the average quarterly statement amount was $16.85.

The IHPI team continues to study the impacts of Medicaid expansion on Michigan's enrollees. Learn more about IHPI's Healthy Michigan Plan evaluation: https://ihpi.umich.edu/featured-work/healthy-michigan-plan-evaluation

The GRACE-FO (Gravity Recovery and Climate Experiment-Follow-On) satellites launched in May 2018 are able to quantify the water mass deficit in Central Europe. Relative to long-term climate development, the water mass deficits during the two consecutive summer droughts of 2018 and 2019 amounted to 112 Gt in 2018 and even 145 Gt in 2019, according to a research team from the German Research Centre for Geosciences GFZ and the University of Potsdam led by Eva Börgens. The deficits in 2018 and 2019 are thus 73 percent and 94 percent of the average fluctuation in seasonal water storage. In other words, compared with the average value, it would take about twice the increase in water over the winter to compensate for this deficit. The changes are so serious that a recovery within one year is not to be expected. The water shortage in the years 2018 and 2019 is thus the largest in the entire GRACE and GRACE-FO measurement campaign of almost 20 years. The results were published in the journal Geophysical Research Letters.

The GRACE-FO pair of satellites records the movement of water on Earth based on variations of the Earth's gravitational field triggered by this movement. These variations can be determined from high-precision distance measurements using microwave signals emitted by the two satellites flying behind each other. GRACE-FO is the successor project of GRACE. The two GRACE satellites had completed their mission in 2017 after 15 years of operation.

On the whole, the data show no offset between the two missions, which confirms the successful continuation of GRACE by GRACE-FO and thus the reliability of the observation of extreme events in Central Europe. According to the researchers, this allows a joint evaluation of the four Central European droughts in the years 2003, 2015, 2018 and 2019: Compared to 2003 and 2015, 2018 and 2019 were significantly drier. In 2019 the water shortage was so severe that a recovery of water supplies within one year is not expected, especially since the winter of 2019/2020 brought only a very slight recovery.

In order to be able to draw a comparison between GRACE and GRACE-FO drought observations and other parts of the water balance, such as soil moisture or surface water, the data were converted into drought indices. In contrast to other data sources, the data of GRACE-FO and GRACE allow to cover the entire water balance in lakes, rivers, soils and groundwater. Measurements on surface waters such as Lake Constance, on the other hand, can be strongly influenced by local or regional factors.

"The study shows how important the long time series of observations from the GRACE and GRACE-FO missions are for classifying current climatic events," says study leader Eva Börgens. "Whether the drought years 2015, 2018 and 2019 are the first signs of longer-term change in Central Europe or merely statistical outliers will only be known in the future. However, initial data from 2020 suggest that the drought will continue."

PHYSICS The cold, famine and unrest in ancient Rome and Egypt after the assassination of Julius Caesar in 44 BCE has long been shrouded in mystery. Now, an international team, including researchers from the University of Copenhagen, has found evidence suggesting that the megaeruption of an Alaskan volcano may be to blame.

Dark times befell upon the Mediterranean around the time of Julius Caesar's assassination in 44 BCE. Written accounts describe the region as severely impacted by unusual cooling, failed harvests, famine and disease, all of which combined to contribute to the fall of the Roman Republic and Ptolemaic Kingdom. While researchers long suspected that a volcanic eruption was to blame, they were unable to pinpoint exactly where and when such an eruption might have occurred.

The brightness of the sun was darkened, the disc was pale for a year and the sun did not rise with its usual brilliance and force. It gave but slight heat. For this reason, the crops brought forth were so poor and immature that they rotted in the cold air.

Greek Roman philosopher Plutarch describing the weather in the wake of Julius Caesar's death

Now, an international team, including researchers from the University of Copenhagen's Niels Bohr Institute, the Desert Research Institute in Reno, Nevada and the University of Bern has analysed volcanic ash in Greenlandic ice core samples, which together with historical accounts, can be linked to an inexplicable cooling event in the Mediterranean region during this crux in the history of Western civilization.

The ash comes from the remote Okmok volcano in Alaska's Aleutian Island Chain. According to the ice core tests, the volcano experienced a two-year megaeruption that began in early 43 BCE, one that filled Earth's atmosphere with enough smoke and ash to significantly impact climate.

"The eruption is regarded as one of the largest volcanic eruptions of the past 2,500 years. Using the ice core samples, climate models and historical records, we are quite certain that the eruption is linked to the violent climatic changes noted around the Mediterranean and in Rome," says Jørgen Peder Steffensen, professor of ice, climate and geophysics at the Niels Bohr Institute and one of the researchers behind the discovery.

Coldest years in the Northern Hemisphere

In an extensive collaboration with historians and others, researchers collected prehistoric climate data from around the planet to confirm the likelihood that this particular eruption was responsible for widespread climate change. The sources of evidence include tree ring archives from Scandinavia, Austria and California and a Chinese cave formation.

The researchers' extensive analysis of climate during this ancient era demonstrates that the years after the Okmok eruption were some of the coldest in the northern hemisphere over the past 2,500 years. The researchers' climate models indicate that temperatures were roughly seven degrees Celsius below normal during the summer and autumn after the eruption in 43 BCE.

"Historical accounts describe how wet and extremely cold weather led to poorer harvests, as well as how the Nile overflowed its banks--destroying crops and leading to famine--all of which correlates with our results," says Jørgen Peder Steffensen.

While the researchers believe that a variety of factors contributed to the fall of the Roman Republic and Ptolemaic Kingdom, they maintain that Okmak's eruption played an unmistakably large role and that their discovery serves to fill in gaps which have been missing in history books dealing with the era.

The research was recently published in the journal Proceedings of the National Academy of Sciences (PNAS)

Facts:

The Niels Bohr Institute's Ice and Climate Group has been working on the "Caesar Volcano" since the 1980's. The group was the first in the world to systematically use the counting of annual layers in ice cores to date volcanic eruptions.

The group also invented the ECM-method (Electric Conductivity Method) to find volcanic ash in ice cores. ECM consists of placing two electrodes along fresh ice cores and measuring resistance. Sulphuric acid from volcanoes changes the resistance in the ice, making it quite easy to identify volcanic layers.

The new research article is the latest in more than 40 years of work on the volcano.

Consuming protein at night increases blood sugar level in the morning for healthy people, according to new research presented this week at The Physiological Society's virtual early career conference called Future Physiology 2020.

Having high blood sugar levels after eating is linked to health problems, such as diabetes, heart disease and obesity. Previous research has shown that a snack a few hours before a meal can help control blood sugar levels, which may partly explain why the first thing we eat each day (i.e. breakfast) tends to increase blood sugars more than other later meals.

This study investigated whether waking-up at night to consume some protein might keep blood sugars lower the next morning. Surprisingly, the blood sugar response to breakfast was higher when participants had consumed protein rather than plain water at 4 am.

These unexpected findings may be informative for people trying to improve their control of blood sugar levels.

One explanation for the result is that the body does not expect or need much food to be consumed during the night and so the protein itself was turned into sugar. This may result in the body having more carbohydrate already available upon waking such that the energy in the breakfast can less easily be used or stored, so it builds-up more in the blood.

The researchers at the University of Bath studied fifteen healthy young men and women (8 females and 7 males). The participants were woken up at 4 am to drink 300 ml of a water solution, either with or without 63 grams of whey protein.

They then went back to sleep and at 9 am were provided with a standard amount of porridge for breakfast, with blood samples collected for 2 hours afterwards to check the blood glucose response.

The participants then returned to the lab to do the same again a week or so later, but were provided with the other drink at night (4 am) so that we could compare the glucose response to the same breakfast in the same person and see the effects of the night-time protein.

Eleanor Smith, who presented the work, said:
"Future research will look at whether this applies to older and overweight people who tend to have more problems controlling their blood sugar levels. It would also be interesting to know to what extent our findings are due to eating at an unusual time or the type of protein consumed."