Culture

Teff, an ancient grain originally from Ethiopia, is a staple crop for 50 million people in the country. It is also increasingly popular worldwide, touted as a superfood for its gluten-free, high fiber and protein, and low-sugar properties.

Yet dramatic temperature increases projected in Ethiopia by 2070, could force farmers to grow it only in mountainous areas at higher altitudes, driving down production at a time when food is already scarce and the population is rising.

Teff, however, has secrets hidden within its DNA. For the first time, scientists have mapped the grain's massive diversity, consisting of 3,850 known types. Each has unique characteristics, or "traits," allowing them to cope with different environmental conditions.

The study was published in Agriculture, Ecosystems & Environment.

Depending on where they are grown, varieties might be heat or drought-tolerant; or produce more grain. Now, that information has been pinpointed by researchers and stored in individual "passports" for each type, which can be used to breed more resilient varieties.

"The moment you know what is in the grain, you can fast-track breeding of particular types," said Carlo Fadda, a co-author from Alliance of Bioversity International and CIAT. "For example, combining low-yielding types cultivated in hot areas, with highly productive types grown in cold areas, to get a highly productive, heat-tolerant grain."

"Understanding this massive genetic diversity within teff opens up a huge possibility to breed new climate-resilient varieties naturally, within a shorter timeframe of 5-10 years, compared with hundreds of years in the wild," Fadda said.

The grain can withstand temperature extremes from 2°C to 38°C; some can cope with almost 2,000 mm of annual rainfall; others only tolerate 542mm. There are red, brown and white types, each containing varied nutrients and flavors that are used for different dishes.

"No other country growing this crop has this level of genetic diversity, which makes Ethiopia unique," said Fadda. "This diversity can be used to increase production for local demand, or even for export, despite weather conditions."

Ethiopia produces over 90 percent of the world's teff, and as the country of origin, it has the highest teff diversity in the world. In the country, Teff production involves about seven million households and covers some 3 million hectares.

Its growing popularity has led to cultivation in Australia, China, India, South Africa and the United States.

Export potential

Scientists conducted the study entirely in Ethiopia without exporting any seed. Co-authors included researchers from the Institute of Life Sciences at the Scuola Superiore Sant'Anna in Pisa, Italy and the Amhara Regional Agricultural Research Institute (ARARI) in Bahir Dar, Ethiopia.

"A remarkable thing with teff is that Ethiopia is not among the biggest teff exporters in the world. This is due to manifold reasons, one of which is the fact that teff cultivation is not yet at par with modern means of production," said Ermias Abate Desta, a co-author from ARARI.

"Assuming compliance with international regulations for access and benefit-sharing (e.g., Nagoya protocol), Ethiopia would benefit from the spread of teff as a global crop because it has an enormous reservoir of teff traits that are not present anywhere else in the world," he added.

The teff research is part of a broader interaction between Bioversity, Scuola Sant'Anna, and Ethiopian institutions that includes other crops. Research focuses on smallholder farmer agriculture in Ethiopia.

Compared to globally important crops, teff is understudied and is considered an "orphan" or underutilized crop. But teff research is attracting the attention of international institutions and scientists, including from Italy's Scuola Superiore Sant'Anna.

Ongoing teff research is aimed at characterizing the genetic diversity of a core collection of teff landraces - or farmer-selected varieties that have evolved over generations - and better understand their agronomic potential as it relates to traits desired by farmers.

This includes breeding new teff varieties with increased yield, resistance to pests and climatic and other abiotic stresses, and traits desired by local farmers.

"These actions involve public and private breeding efforts as well as national and international bodies concerned with the conservation of agrobiodiversity of teff in the wake of climate change," said Matteo Dell'Acqua, a co-author from Scuola Superiore Sant'Anna.

Newly unearthed, surprisingly well-preserved conifer fossils from Patagonia, Argentina, show that an endangered and celebrated group of tropical West Pacific trees has roots in the ancient supercontinent that once comprised Australia, Antarctica and South America, according to an international team of researchers.

"The Araucaria genus, which includes the well-known Norfolk Island pine, is unique because it's so abundant in the fossil record and still living today," said Gabriella Rossetto-Harris, a doctoral student in geosciences at Penn State and lead author of the study. "Though they can grow up to 180 feet tall, the Norfolk Island pine is also a popular houseplant that you might recognize in a dentist's office or a restaurant."

Araucaria grew all around the world starting about 170 million years ago in the Jurassic period. Around the time of the dinosaur extinction 66 million years ago, the conifer became restricted to certain parts of the Southern Hemisphere, said co-author Peter Wilf, professor of geosciences and associate in the Earth and Environmental Systems Institute (EESI).

Today, four major groups of Araucaria exist, and the timing of when and where these living lineages evolved is still debated, Rossetto-Harris said. One grows in South America, and the other three are spread across New Caledonia, New Guinea and Australia, including Norfolk Island. Many are now endangered or vulnerable species. The Norfolk pine group, the most diverse with 16 species, is usually thought to have evolved near its modern range in the West Pacific well after the Gondwanan supercontinent split up starting about 50 million years ago, Rossetto-Harris added.

Researchers from Penn State and the Museo Paleontológico Egidio Feruglio, Chubut, Argentina, found the fossils at two sites in Patagonia - Río Pichileufú, which has a geologic age of about 47.7 million years, and Laguna del Hunco, with a geologic age of about 52.2 million years. They analyzed the fossil characteristics and compared them to modern species to determine to which living group the fossils belonged. Then they developed a phylogenetic tree to show the relationships between the fossil and living species. They reported their findings in a recent issue of the American Journal of Botany.

Unlike the monkey puzzle trees of the living South American group of Araucaria, which have large, sharp leaves, the Patagonian conifer fossils have small, needle-like leaves and cone remains that closely resemble the Australasian Norfolk Island pine group, according to the researchers. They also found a fossil of a pollen cone attached to the end of a branch, which is also characteristic of the group.

"The new discovery of a fossil pollen cone still attached to a branch is rare and spectacular," said Rossetto-Harris, who is also an EESI Environmental Scholar. "It allows us to create a more complete picture of what the ancestors of these trees were like."

The researchers used 56 new fossils from Río Pichileufú to expand the taxonomic description of Araucaria pichileufensis, a species first described in 1938 using only a handful of specimens.

"Historically, scientists have lumped together the Araucaria fossils found at Río Pichileufú and Laguna del Hunco as the same species," Rossetto-Harris said. "The study shows, for the first time, that although both species belong to the Norfolk pine group of Araucaria, there is a difference in conifer species between the two sites."

The researchers named the new species from Laguna del Hunco Araucaria huncoensis, for the site where it was found. The fossils are about 30 million years older than many estimates for when the Australasian lineage evolved, according to Rossetto-Harris.

The findings suggest that 52 million years ago, before South America completely separated from Antarctica, and during the first few million years after separation was underway, relatives of Norfolk Island pines were part of a rainforest that stretched across Australasia and Antarctica and up into Patagonia, said Rossetto-Harris.

The change in the Araucaria species from the older Laguna del Hunco site to the younger Río Pichileufú site may be a response to the climatic cooling and drying that occurred after South America first became isolated.

"We're seeing the last bits of these forests before the Drake Passage between Patagonia and Antarctica began to really widen and deepen and set forth a lot of big climatic changes that would eventually cause this version of Araucaria to go extinct in South America, but survive in the Australian rainforest and later spread and thrive in New Caledonia," Rossetto-Harris said.

The study shows how tiny details can provide the definition needed to reveal big, important stories about the history of life, Wilf added.

Up to now, patients with inoperable anal cancer, a rare disease, have not had a standard-of-care treatment; palliative care has been the routine for them. Now, results from InterAAct, the first international prospective randomized trial in advanced anal cancer, are published by the Journal of Clinical Oncology. The trial compared two conventional chemotherapy treatments in 91 patients. The objective response rate (ORR), the primary endpoint, was the same between treatments. The ORR for cisplatin plus 5-fluorouracil (5FU) was 57% versus 59% for carboplatin plus paclitaxel. However, cisplatin-5FU was associated with significantly more adverse events (62%) versus carboplatin-paclitaxel (36%). Additionally, carboplatin-paclitaxel was associated with improved overall survival (20 months) compared to cisplatin-5FU (12.3 months).

"The InterAAct trial identifies carboplatin-paclitaxel as the optimal chemotherapy regimen in the first-line setting for inoperable anal cancer," said lead United States investigator Cathy Eng, MD (Vanderbilt-Ingram Cancer Center). "Carboplatin-paclitaxel was associated with less toxicity and a trend towards improved survival, which suggests that it should become the standard of care for these patients, and the backbone for future phase three trials."

Anal cancer is rare and accounts for less than three percent of all gastrointestinal cancers. Advanced, inoperable anal cancer is even rarer, accounting for about 10 percent of those cases. For these patients, the prognosis is poor, with relative five-year survival rates of approximately 30 percent.

The study enrolled 91 patients between December 2013 and November 2017 in Australia, Germany, Norway, the United Kingdom, and the United States. Due to the rarity of the disease, it was necessary to establish a global network of investigators to design and conduct trials for metastatic anal cancer patients, provide patients with access to these new strategies, and to enroll patients in a timely manner. The International Rare Cancers Initiative (IRCI) formed the Anal Cancer Working Group, a global collaborative network, to achieve these goals.

Established in 2011, the founding members of IRCI include the US National Cancer Institute, UK National Institute for Health Research, Cancer Research UK, and European Organisation for Research and Treatment of Cancer. Subsequently, the French National Cancer Institute, Canadian Cancer Trials Group, Japan Clinical Oncology Group, and Clinical Oncology Society of Australia have all joined.

"The Anal Cancer Working Group has proven to be a successful global collaborative network for research in this rare disease," said Al B. Benson, III, MD (Northwestern University-Robert H. Lurie Comprehensive Cancer Center and co-chair of the IRCI Anal Cancer Working Group). "With the successful completion of the InterAAct trial in a timely way, the Anal Cancer Working Group has established its feasibility and will pursue future trials."

In the United States, ECOG-ACRIN Cancer Research Group led the trial with funding from the National Cancer Institute (NCI) through its National Clinical Trials Network. The NCI is part of the National Institutes of Health.

Patients who had not received prior systemic chemotherapy for locally recurrent inoperable or metastatic anal cancer were eligible to participate in the InterAAct trial. The 91 patients enrolled in the trial were randomly assigned in a one-to-one fashion: 46 patients to receive intravenous cisplatin 60mg/m2 (day 1) 5FU 1000mg /m2 (days 1-4) every 21 days, and 45 patients to receive carboplatin (AUC=5, day 1) paclitaxel (80mg/m2 days 1, 8, 15) every 28 days. Median follow up for all patients was 28.6 months. Patients remained on treatment until disease progression, intolerable toxicity, or withdrawal of consent.

A case of pink eye is now reason to be tested for COVID-19, according to University of Alberta researchers.

Coughing, fever and difficulty breathing are common symptoms of the illness, but a recent case study involving an Edmonton woman and published in the Canadian Journal of Ophthalmology has determined that conjunctivitis and keratoconjunctivitis can also be primary symptoms.

In March, a 29-year-old woman arrived at the Royal Alexandra Hospital's Eye Institute of Alberta with a severe case of conjunctivitis and minimal respiratory symptoms. After the patient had undergone several days of treatment with little improvement--and after it had been determined that the woman had recently returned home from Asia--a resident ordered a COVID-19 test. The test came back positive.

"What is interesting in this case, and perhaps very different to how it had been recognized at that specific time, was that the main presentation of the illness was not a respiratory symptom. It was the eye," said Carlos Solarte, an assistant professor of ophthalmology at the U of A.

"There was no fever and no cough, so we weren't led to suspect COVID-19 at the beginning. We didn't know it could present primarily with the eye and not with the lungs."

According to Solarte, academic studies at the outset of the pandemic identified conjunctivitis as a secondary symptom in about 10 to 15 per cent of COVID-19 cases. Since then, scientists have gained greater knowledge of how the virus can transmit through and affect the body's mucous membrane system, of which the conjunctiva--the clear, thin membrane that covers the front surface of the eye--is an extension.

While the finding provides important new health information for the public, it also makes eye exams more complicated for ophthalmologists and staff.

"The patient in this case eventually recovered well without any issues. But several of the residents and staff who were in close contact with the patient had to be under quarantine," said Solarte. "Fortunately, none who were involved in her care also tested positive."

Patients coming into an eye clinic with conjunctivitis and keratoconjunctivitis are now treated as potential cases of COVID-19 and extra precautions are taken by staff. Workers performing an eye exam are strongly advised to wear personal protective equipment to minimize potential exposure to the illness.

"It's important to ensure that everyone is well protected. Our residents are now using gloves, gowns and facial masks every time they see one of these patients," said Solarte. "We need to be really careful about protective measures to examine these patients."

Over the past few decades, computers have seen dramatic progress in processing power; however, even the most advanced computers are relatively rudimentary in comparison with the complexities and capabilities of the human brain.

Researchers at the U.S. Army Combat Capabilities Development Command's Army Research Laboratory say this may be changing as they endeavor to design computers inspired by the human brain's neural structure.

As part of a collaboration with Lehigh University, Army researchers have identified a design strategy for the development of neuromorphic materials.

"Neuromorphic materials is a name given to the material categories or combination of materials that provide both computing and memory capabilities in devices," said Dr. Sina Najmaei, a research scientist and electrical engineer with the laboratory.

Najmaei and his colleagues published a paper, Dynamically reconfigurable electronic and phononic properties in intercalated Hafnium Disulfide (HfS2), in the May 2020 issue of Materials Today.

The neuromorphic computing concept is an in-memory solution that promises orders of magnitude reductions in power consumption over conventional transistors, and is suitable for complex data classification and processing. The limited power efficiency in conventional transistors is a fundamental technology shortcoming impeding future progress in computing.

Neuromorphic materials research conducted over the past 10 years has focused on understanding the unique properties of 2-D materials and their van der Waals multilayered structures.

"The findings show great promise for these materials in electronic applications, but also show the unique interfaces in these materials provide an unprecedented opportunity for design of material properties," Najmaei said.

Over the past four years, the team conducted an effort focused on the design of material properties for high-performance electronic applications.

"Our research led to our Materials Today paper, which expands this effort to design of reconfigurable properties in these materials based on van der Waal/organometallic hybrid systems and neuromorphic material design," Najmaei said.

Neuromorphic computing processes information using new models of computing similar to the brain's cognitive processes.

"In order to process and make rational inferences from the input, information and a new paradigm of computing is needed," Najmaei said. "Neuromorphic hardware with in-memory computer capabilities promises to bridge this ever-growing technology gap."

This research is an important stepping stone towards development of in-memory computing in hybrid devices with unique functional properties for integration in cognitive sensory devices and overcomes significant technical challenges that impede a bottom up approach for streamlining of brain-inspired computing hardware, he said.

If the researchers can ultimately develop a computer that can behave like the brain, it would be extremely useful to the warfighter, Najmaei said.

Neuromorphic computing, like a neural system, would offer computing capability complete with perks, such as robustness to damage, ability to learn, adaptability to change and others. It would have the potential to reduce operational power by a magnitude of 1,000 to 1 million times in comparison to today's computing paradigms.

This level of processing would be highly desirable for image recognition in autonomous systems, and for artificial intelligence in general. Given the significance of AI and autonomous systems in modern day warfare, neuromorphic computing may very well be a cornerstone for a wide range of future leap-ahead warfighting capabilities, Najmaei said.

Plant experts at UC Davis have defined the genetic basis of sex determination in grapevines, one of the oldest and most valuable crops worldwide.

In new research published in the journal Nature Communications, viticulture and enology professor Dario Cantu and Mélanie Massonnet, lead author and postdoctoral researcher in Cantu's lab, propose a novel model of sex evolution before and during grapevine domestication nearly 8,000 years ago. Their work could have broad application in breeding grapes and other plant species.

All wild species of grapes (genus Vitus) are dioecious, which means that male and female flowers are located on separate plants. Male individuals bear flowers with reduced pistils and female vines have flowers with reflexed anthers and stamens that produce sterile pollen grains.

Just one Vitis species, the cultivated grapevine Vitis vinifera ssp. vinifera, has reverted to hermaphroditism, leading to the advent of vines bearing perfect flowers with both functional pistils and stamens.

"It has always been a major challenge to identify the genes and mutations that lead to plant sexual differentiation," Cantu noted. "We show how the pivotal domestication trait of hermaphroditic flowers in grapevine is likely determined by the action of two separate genes contained within a sex-linked locus."

Comparing sex determination genes in wild and domestic grapes

To unveil the molecular mechanisms associated with sex determination, researchers constructed the genomes of two female and three male wild grapes, and five hermaphroditic domesticated accessions, including the chromosome-scale genome of Cabernet Sauvignon (the most widely planted wine grape cultivar in the world). They compared the structure of the sex determination locus, its sequence and genes between male, female and hermaphrodite individuals.

"The unprecedented amount of data generated here supports a model for sex determination in which recessive male- and dominant female-sterility mutations in ancestral hermaphrodite individuals gave rise to dioecious extant wild species, and a rare recombination event during domestication that led to hermaphroditism in cultivated grapevines," Cantu said. "From our findings, we propose that female individuals arise from a recessive deletion in a gene necessary for pollen germination, while male vines emerge from a dominant mutation in a second gene, resulting in female sterility."

The findings and the methods applied are particularly valuable for grape breeding efforts and to advance the understanding of sex determination in grapes and other plant species.

As nuclear fusion engines, most stars live placid lives for hundreds of millions to billions of years. But near the end of their lives they can turn into crazy whirligigs, puffing off shells and jets of hot gas. Astronomers have employed Hubble's full range of imaging capabilities to dissect such crazy fireworks happening in two nearby young planetary nebulas. NGC 6302 is dubbed the Butterfly Nebula because of its wing-like appearance. In addition, NGC 7027 resembles a jewel bug, an insect with a brilliantly colorful metallic shell.

The researchers have found unprecedented levels of complexity and rapid changes in jets and gas bubbles blasting off of the stars at the centers of both nebulas. Hubble is allowing the researchers to converge on an understanding of the mechanisms underlying the chaos.

"When I looked in the Hubble archive and realized no one had observed these nebulas with Hubble's Wide Field Camera 3 across its full wavelength range, I was floored," said Joel Kastner of Rochester Institute of Technology, Rochester, New York, leader of the new study. "These new multi-wavelength Hubble observations provide the most comprehensive view to date of both of these spectacular nebulas. As I was downloading the resulting images, I felt like a kid in a candy store."

By examining this pair of nebulas with Hubble's full, panchromatic capabilities -- making observations in near-ultraviolet to near-infrared light -- the team has had several "aha" moments. In particular, the new Hubble images reveal in vivid detail how both nebulas are splitting themselves apart on extremely short timescales -- allowing astronomers to see changes over the past couple decades. Some of this rapid change may be indirect evidence of one star merging with its companion star.

"The nebula NGC 7027 shows emission at an incredibly large number of different wavelengths, each of which highlights not only a specific chemical element in the nebula, but also the significant, ongoing changes in its structure," said Kastner. The research team also observed the Butterfly Nebula, which is a counterpart to the "jewel bug" nebula: Both are among the dustiest planetary nebulas known and both also contain unusually large masses of gas because they are so newly formed. This makes them a very interesting pair to study in parallel, say researchers.

Hubble's broad multi-wavelength views of each nebula are helping the researchers to trace the nebulas' histories of shock waves. Such shocks typically are generated when fresh, fast stellar winds slam into and sweep up more slowly expanding gas and dust ejected by the star in its recent past, generating bubble-like cavities with well-defined walls.

Researchers suspect that at the hearts of both nebulas are -- or were -- two stars circling around each other, like a pair of figure skaters. Evidence for such a central "dynamic duo" comes from the bizarre shapes of these nebulas. Each has a pinched, dusty waist and polar lobes or outflows, as well as other, more complex symmetrical patterns.

A leading theory for the generation of such structures in planetary nebulas is that the mass-losing star is one of two stars in a binary system. The two stars orbit one another closely enough that they eventually interact, producing a gas disk around one or both stars. The disk is the source of outflowing material directed in opposite directions from the central star.

Similarly, the smaller star of the pair may merge with its bloated, more rapidly evolving stellar companion. This also can create outflowing jets of material that may wobble over time. This creates a symmetric pattern, perhaps like the one that gives NGC 6302 its "butterfly" nickname. Such outflows are commonly seen in planetary nebulas.

"The suspected companion stars in NGC 6302 and NGC 7027 haven't been directly detected because they are next to, or perhaps have already been swallowed by, larger red giant stars, a type of star that is hundreds to thousands of times brighter than the Sun," said team member Bruce Balick of the University of Washington in Seattle. "The hypothesis of merging stars seems the best and simplest explanation for the features seen in the most active and symmetric planetary nebulas. It's a powerful unifying concept, so far without rival."

The Butterfly Nebula

Imagine a lawn sprinkler spinning wildly, tossing out two S-shaped streams. At first it appears chaotic, but if you stare for a while, you can trace its patterns. The same S-shape is present in the Butterfly Nebula, except in this case it is not water in the air, but gas blown out at high speed by a star. And the "S" only appears when captured by the Hubble camera filter that records near-infrared emission from singly ionized iron atoms.

"The S-shape in the iron emission from the Butterfly Nebula is a real eye-opener," Kastner said. The S-shape directly traces the most recent ejections from the central region, since the collisions within the nebula are particularly violent in these specific regions of NGC 6302. "This iron emission is a sensitive tracer of energetic collisions between slower winds and fast winds from the stars," Balick explained. "It's commonly observed in supernova remnants and active galactic nuclei, and outflowing jets from newborn stars, but is very rarely seen in planetary nebulas."

"The fact that the iron emission is only showing up along these opposing, off-center directions implies that the source of the fast flows is wobbling over time, like a spinning top that's about to fall," added Kastner. "That's another tell-tale sign of the presence of a disk, which directs the flow, and also a binary companion."

The 'Jewel Bug' Nebula

The planetary nebula NGC 7027 had been slowly puffing away its mass in quiet, spherically symmetric or perhaps spiral patterns for centuries -- until relatively recently. "In some respects, the changes within this nebula are even more dramatic than those within the Butterfly," Kastner said. "Something recently went haywire at the very center, producing a new cloverleaf pattern, with bullets of material shooting out in specific directions."

The research team's new images of NGC 7027 show emission from singly ionized iron that closely resembles observations made by NASA's Chandra X-ray Observatory in 2000 and 2014 as part of earlier research by Kastner, team member Rodolfo Montez Jr. of the Center for Astrophysics | Harvard & Smithsonian, and collaborators. The iron emission traces the southeast-to-northwest-oriented outflows that also produce the X-ray-emitting shocks imaged by Chandra. "We have a sneaking suspicion that this nebula is a great example of what happens when a red giant star abruptly swallows a companion," Montez Jr. said.

Sports leagues may want to consider calling a timeout on reopening their doors to fans, based on new West Virginia University-led research that links an uptick in seasonal flu deaths to U.S. cities with pro sports teams.

Analyzing Centers for Disease Control and Prevention data from 1962 to 2016, WVU economists found that flu deaths increased by between 5 and 24 percent during the NFL, NBA, NHL and MLB seasons, with the largest increase for NHL games.

Given that COVID-19 is believed to be more contagious and deadlier, Economics Professor Brad Humphreys has a message for sports leagues until a vaccine is available or herd immunity exists: "Don't let the fans back into the games."

"Opening pro sports games to fans is probably a terrible idea, in terms of public health," said Humphreys, one of the authors of the paper "Professional Sporting Events Increase Seasonal Influenza Mortality in U.S. Cities." "You're right on top of people and everybody's yelling, screaming, high-fiving and hugging. And you've got people eating and drinking. You could be putting the virus right into your mouth. The bottom line is we need to be very careful if we're considering opening up games to the fans."

Humphreys' WVU co-authors include Jane Ruseski, associate professor of economics, and Alexander Cardazzi, a Ph.D. student.

Researchers examined cities that introduced a new sport franchise from the big four leagues over the 54-year timeframe. Welcoming new teams in all leagues led to an increase in flu mortality, according to the report.

"We found data that reported flu mortality by city by week dating back to the 1960s," Humphreys said. "We decided the best experiment was to try to look at what happened when a city got a new pro sports team compared to cities that didn't. As it turned out, after a new professional sports team came into a city, that flu season and every flu season afterward had more people dying of the flu.

"It isn't one or two people dying. This is closer to 30 or 40 additional flu deaths over the course of flu season. When you blow it up to a virus that's more fatal like COVID-19, we could be talking about hundreds of additional deaths because of these games."

The study also showed a decline in flu deaths in U.S. cities during season stoppages. That means cities reported fewer flu deaths during the 2011 NBA lockout and the 1982 NFL strike.

Research began in March when organizations, such as the NBA, suspended play due to the COVID-19 outbreak in the U.S. Humphreys was further intrigued after reading about a soccer game in Italy that was believed to have been a catalyst in spiking that country's positive cases.

On Feb. 19, the day of a soccer match between Atalanta and Valencia, there were only three confirmed cases in the country of Italy. Two weeks later, that number jumped to 997 - just in Bergamo, northeast of Milan and home to the Atalanta team.

"At the time, they had the highest death rate anywhere in the world," Humphreys said. "That game served as a super-spreader event."

The NBA and NHL both plan to resume their seasons this summer, but without fans in attendance. In fact, NBA players will have the option of wearing an Oura smart ring that detects early signs of the novel coronavirus - which is part of research from the WVU Rockefeller Neuroscience Institute.

Details of the upcoming MLB and NFL seasons remain uncertain.

The economists hope this timely research will not only help inform sports league reopening policy decisions, but mass gatherings in general such as concerts, conferences and conventions.

"You'll have some people say, 'Oh, but everybody can wear a mask,'" Humphreys said. "But you've seen how people are complying with that, right? And if these arenas are at full capacity, social distancing isn't happening."

A COVID-19 model formerly used by the White House projects that more than 200,000 American could die from the virus by October. As of late Wednesday, 119,000 people have died of the novel coronavirus in the U.S., with a total of 2.2 million positive cases.

"Our results reveal that bringing fans back to games would be a huge mistake," Humphreys said. "Imagine someone going to a game and sitting in the stands and then they go see grandma at the nursing home. Let's wait til we have a vaccine or reach herd immunity."

DURHAM, N.C. -- A single press release naming a company that has violated workplace health and safety regulations can result in a 73 percent improvement in compliance by other facilities, a Duke researcher finds.

The study appears in the June issue of American Economic Review.

Beginning in 2009, the federal Occupational Health and Safety Administration (OSHA) sent press releases to the local newspaper near a facility, detailing serious health and safety violations found during an inspection.

The study found that after one of these press releases was sent to the local newspaper, compliance by other nearby facilities improved more than if OSHA had inspected each of those facilities directly.

"OSHA would have to conduct an additional 210 inspections to elicit the same improvement in compliance as sparked by a single press release about severe violations," said researcher Matthew S. Johnson, assistant professor at Duke's Sanford School of Public Policy.

Workplace injuries cost an estimated $250 billion each year. There were 3.7 million work-related injuries and illnesses in 2015. Concerns about worker safety and health have become especially pronounced during the COVID-19 pandemic: Many workers are facing elevated health risks, but numerous reports indicate that employers are not providing the protective measures workers need.

Ratings and scores of a company's performance are increasingly common. Some are created by media or advocacy groups, while others are created by regulatory agencies. Revealing poor performance, or "shaming" a company, creates pressure for the company to improve its behavior.

"We have lots of evidence that these ratings and scores motivate companies to do better," Johnson said. "But this is one of the first papers to show that these kinds of disclosures have a ripple effect on the behavior of other companies and to provide new insight into what drives companies to comply with regulations."

Traditionally, OSHA -- like other regulatory agencies -- relied on inspections as its main tool to promote compliance and safety. Inspections are effective: Prior studies have shown that facilities go on to improve their compliance after being inspected. However, inspections are costly, and the agency's resources enable it to inspect only a tiny fraction of the facilities it regulates.

In 2009, OSHA began issuing press releases following an inspection with a large fine of more than $40,000.

The policy was intended to both publicize OSHA's enforcement activity and to reveal to the public those companies with high violations. OSHA sent the press releases to local media and trade publications; as a result, other local companies in the same industry were made aware of the fines and the publicity.

Johnson linked the archive of OSHA's press releases to data on OSHA inspections to analyze the extent to which press releases about one facility affected the subsequent compliance and safety behavior of nearby facilities in the same industry.

Johnson found that the press releases had a strikingly large effect:

A press release leads to 73 percent fewer OSHA violations at peer facilities within a 3 mile radius (5 kilometers) of the publicized facility.

A press release has a smaller effect on compliance of facilities located further away, but effects persist for facilities up to 31 miles (50 kilometers) away.

Press releases also led to fewer workers getting injured and killed on the job.

The press releases might have created pressure on peer companies to proactively improve their safety performance.

For example, one week after a flavoring manufacturer was the subject of an OSHA press released that detailed widespread safety violations, Starbucks ended its relationship with that manufacturer.

"Presumably, other flavoring manufacturers -- seeing the costs of being the subject of a press release -- would seek to avoid such a fate," said Johnson.

"The former director of OSHA said that company lawyers told him their clients were more worried about seeing their names in an OSHA press release than about being fined," he said.

Publicizing severe violations is a powerful tool for regulatory agencies that can increase the impact of inspections, he said.

"Given the enormous social costs of workplace injuries, these estimates reveal that press releases created a large social benefit for a small cost," Johnson said.

Imagine if scientists could stop the coronavirus infection in its tracks simply by diverting its attention away from living lung cells? A new therapeutic countermeasure, announced in a Nano Letters study by researchers from Boston University's National Emerging Infectious Diseases Laboratories (NEIDL) and the University of California San Diego, appears to do just that in experiments that were carried out at the NEIDL in Boston.

The breakthrough technology could have major implications for fighting the SARS-CoV-2 virus responsible for the global pandemic that's already claimed nearly 450,000 lives and infected more than 8 million people. But, perhaps even more significantly, it has the potential to be adapted to combat virtually any virus, such as influenza or even Ebola.

"I was skeptical at the beginning because it seemed too good to be true," says NEIDL microbiologist Anna Honko, one of the co-first authors on the study. "But when I saw the first set of results in the lab, I was just astonished."

The technology consists of very small, nanosized drops of polymers--essentially, soft biofriendly plastics--covered in fragments of living lung cell and immune cell membranes.

"It looks like a nanoparticle coated in pieces of cell membrane," Honko says. "The small polymer [droplet] mimics a cell having a membrane around it."

The SARS-CoV-2 virus seeks out unique signatures of lung cell membranes and latches onto them. When that happens inside the human body, the coronavirus infection takes hold, with the SARS-CoV-2 viruses hijacking lung cells to replicate their own genetic material. But in experiments at the NEIDL, BU researchers observed that polymer droplets laden with pieces of lung cell membrane did a better job of attracting the SARS-CoV-2 virus than living lung cells.

By fusing with the SARS-CoV-2 virus better than living cells can, the nanotechnology appears to be an effective countermeasure to coronavirus infection, preventing SARS-CoV-2 from attacking cells.

"Our guess is that it acts like a decoy, it competes with cells for the virus," says NEIDL microbiologist Anthony Griffiths, co-corresponding author on the study. "They are little bits of plastic, just containing the outer pieces of cells with none of the internal cellular machinery contained inside living cells. Conceptually, it's such a simple idea. It mops up the virus like a sponge."

That attribute is why the UC San Diego and BU research team call the technology "nanosponges." Once SARS-CoV-2 binds with the cell fragments inside a nanosponge droplet--each one a thousand times smaller than the width of a human hair--the coronavirus dies. Although the initial results are based on experiments conducted in cell culture dishes, the researchers believe that inside a human body, the biodegradable nanosponges and the SARS-CoV-2 virus trapped inside them could then be disposed of by the body's immune system. The immune system routinely breaks down and gets rid of dead cell fragments caused by infection or normal cell life cycles.

There is also another important effect that the nanosponges have in the context of coronavirus infection. Honko says nanosponges containing fragments of immune cells can soak up cellular signals that increase inflammation. Acute respiratory distress, caused by an inflammatory cascade inside the lungs, is the most deadly aspect of the coronavirus infection, sending patients into the intensive care unit for oxygen or ventilator support to help them breathe.

But the nanosponges, which can attract the inflammatory molecules that send the immune system into dangerous overdrive, can help tamp down that response, Honko says. By using both kinds of nanosponges, some containing lung cell fragments and some containing pieces of immune cells, she says it's possible to "attack the coronavirus and the [body's] response" responsible for disease and eventual lung failure.

At the NEIDL, Honko and Griffiths are now planning additional experiments to see how well the nanosponges can prevent coronavirus infection in animal models of the disease. They plan to work closely with the team of engineers at UC San Diego, who first developed the nanosponges more than a decade ago, to tailor the technology for eventual safe and effective use in humans.

"Traditionally, drug developers for infectious diseases dive deep on the details of the pathogen in order to find druggable targets," said Liangfang Zhang, a UC San Diego nanoengineer and leader of the California-based team, according to a UC San Diego press release. "Our approach is different. We only need to know what the target cells are. And then we aim to protect the targets by creating biomimetic decoys."

When the novel coronavirus first appeared, the idea of using the nanosponges to combat the infection came to Zhang almost immediately. He reached out to the NEIDL for help. Looking ahead, the BU and UC San Diego collaborators believe the nanosponges can easily be converted into a noninvasive treatment.

"We should be able to drop it right into the nose," Griffiths says. "In humans, it could be something like a nasal spray."

Honko agrees: "That would be an easy and safe administration method that should target the appropriate [respiratory] tissues. And if you wanted to treat patients that are already intubated, you could deliver it straight into the lung."

Griffiths and Honko are especially intrigued by the nanosponges as a new platform for treating all types of viral infections. "The broad spectrum aspect of this is exceptionally appealing," Griffiths says. The researchers say the nanosponge could be easily adapted to house other types of cell membranes preferred by other viruses, creating many new opportunities to use the technology against other tough-to-treat infections like the flu and even deadly hemorrhagic fevers caused by Ebola, Marburg, or Lassa viruses.

"I'm interested in seeing how far we can push this technology," Honko says.

DALLAS, June 18, 2020 -- People living in rural areas are less likely to get the most advanced treatments for stroke and are more likely to die in the hospital than those treated for stroke at hospitals in urban areas, according to new research published today in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.

"There are so many challenges facing rural America right now - higher rates of chronic disease, poverty and joblessness - and cardiovascular and other health outcomes are much worse in rural areas. This study shines light on one area where changes in care, such as the introduction of telehealth or other programs, could really make a difference," said Karen E. Joynt Maddox, M.D., M.P.H., senior author of the study and assistant professor of medicine at Washington University School of Medicine in St. Louis, Missouri.

Researchers examined national data on more than 790,000 adults (the majority over age 64, 53% female) hospitalized with stroke between 2012-2017, from the National Inpatient Sample (NIS) database, the largest publicly available, all-payer inpatient health care database in the U.S. Compared with patients living in urban areas, stroke patients treated at rural hospitals were:

about half as likely to receive clot-busting medication (such as intravenous alteplase) to treat clot-caused strokes;

about one-third less likely to undergo a procedure (such as an endovascular thrombectomy) to remove a stroke-causing clot; and

more likely to die of any type of stroke before leaving the hospital (6.87% vs 5.82%), with no improvement in the rural-urban disparity over the 5-year period.

"The magnitude of the differences in risk of death and the lack of improvement over time were striking. One would think that recent improvements in technology and in telehealth would mean that we could, as a system, deliver optimal care no matter where people live. That turns out to not yet be the case for stroke care," Joynt Maddox said.

As well as their lack of access to advanced therapies, rural patients also had significantly lower rates of access to specialists.

"The lack of access to specialists is often a limiting factor in adequate care for rural stroke patients, and in this case, that could mean a neurologist to guide the initial care, an interventional neurologist or radiologist to do a procedure, or having a neurosurgeon available for backup in case of any complications," said Gmerice Hammond, M.D., M.P.H., first author of the study and a cardiology fellow at Washington University School of Medicine in St. Louis, Missouri. "Clinicians need to work to improve access to high-quality stroke care for individuals in rural areas. That means partnerships between hospitals for rapid transfer, as well as telehealth when appropriate. And clinical leaders and policymakers should prioritize improving access, care and outcomes for stroke in rural communities."

Meanwhile, residents in rural areas can take steps to protect themselves. "Be aware of signs and symptoms of stroke, and seek care urgently if any symptoms develop. To the extent possible, be as aggressive as you can with preventive efforts like blood pressure control. The best way to survive a stroke is to not have one in the first place," Hammond said.

According to the American Stroke Association, the most common symptoms of stroke are known as F.A.S.T., face drooping, arm weakness, speech and time to call 9-1-1. Bystanders should call 911 for immediate help even if the symptoms go away.

The study was limited in not having information on the severity of stroke or on factors that determine who is eligible for advanced therapies (such as the size of clot, where it is located, and the length of time between the onset of stroke and the patient arriving at the hospital).

"Future studies using more detailed clinical data will be important to follow up on our findings and to determine why patients in rural areas aren't receiving advanced therapies. Is it because their stroke severity is different? Or because delays in getting to the hospital meant they weren't eligible by the time they arrived? Those questions can't be answered with administrative data, but they're very important to look into so that we can develop effective solutions," Joynt Maddox said.

Glenview, IL, June 18, 2020 - A new study appearing in the journal CHEST®, published by Elsevier, documents an increased incidence of silicosis, which progressed rapidly to massive pulmonary fibrosis in a significant proportion of patients who had previously worked artificial stone (AS), also called artificial quartz agglomerate or conglomerate, a popular new countertop material, despite cessation of exposure after diagnosis.

AS is composed of finely crushed stone mixed with synthetic resins and has a high silica content. It emits respirable crystalline dust (RCS) while it is being fabricated and in cutting, shaping, and finishing in small industries, which can cause permanent and severe lung damage if it is inhaled.

The study reports on the results of follow-up exams of 106 AS workers in southern Spain who were diagnosed with silicosis or severe pulmonary fibrosis between 2009 and 2018. The investigators first reported the link between their illnesses and AS RCS in a study published in 2014.

"While 6.6 percent of the AS workers were initially diagnosed with massive pulmonary fibrosis, 37.7 percent had more advanced disease at the follow-up exam, even though they had left their jobs and were no longer exposed to the harmful dust. In a quarter of the patients, the rate of decline in lung capacity progressed very rapidly," explained lead investigator, Antonio León-Jiménez, PhD, Pulmonology, Allergy and Thoracic Surgery Department, Puerta del Mar University Hospital; and Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain. On a positive note, four years after exposure ended, the annual decrease of lung capacity appeared to slow down.

Silicosis, probably the most ancient occupational disease, has been traditionally related to mining or quarry work. It is caused by inhalation of crystalline silica dust that produces permanent lung scarring (pulmonary fibrosis). Its incidence had decreased in high income countries following the reduction of mining activities and implementation of better protective measures for workers and dust control.

However, over the past decade, the increasing popularity of AS for use in kitchen and bathroom countertops because of its design and attractive colors has supplanted traditional materials like granite and marble. Unfortunately, working with AS has resulted in a resurgence of cases of silicosis identified among fabricators. Despite following protective measures used for handling natural stone, these workers were nonetheless injured by the higher level of crystallized silica contained in AS (93 percent) than in natural stone (five percent-30 percent).

Measures adopted to reduce the concentration of respirable dust, such as the use of water suppression and exhaust ventilation techniques, have been implemented, but harmful levels of RCS are still documented in workplaces, generally in small factories

The investigators call for more aggressive engineering controls and new treatments to be developed and tested, "Avoiding the continued inhalation of silica is essential but is not enough. The majority of patients are young people and the progression of the disease, in a significant number of them, foreshadows an uncertain future. Our findings emphasize the need to maximize protective measures in active patients and to find new treatments that may delay or curb the progression of the disease," cautioned Dr. León-Jiménez.

The worldwide demand for engineered quartz countertops continues to soar (estimates project the 2013 levels will triple by 2024). Although the first patients were described ten years ago in Spain and Israel, the number of cases has been increasing throughout the world. In Australia, the situation was considered an occupational epidemic in 2019, and the emergence of new cases in the United States and China warns that it is a global problem that likely has only just begun.

In an accompanying editorial, Robert A. Cohen, MD, and Leonard H.T. Go, MD, both affiliated with the University of Illinois at Chicago School of Public Health, Chicago, IL, USA, add an even stronger cautionary note, "Given the toxicity of this material and the rising human cost of its use, if engineering controls cannot limit worker exposure to hazardous concentrations of RCS, a ban on AS needs to be considered. Colorful countertops are not worth the price paid by these workers."

WASHINGTON--Diabetic ketoacidosis is a common and potentially fatal complication in hospitalized patients with COVID-19, according to a new clinical perspective published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

Diabetic ketoacidosis almost always requires special care in the hospital which usually takes place in the intensive care unit (ICU). It is caused by insufficient insulin circulating in the bloodstream, which is more likely to occur during a serious infection like COVID-19. Diabetic ketoacidosis causes a buildup of acids in the blood, leading to serious illness characterized by dehydration and sometimes difficulty breathing.

"People with diabetes who are infected with COVID-19 are at increased risk of severe disease, which in some cases is accompanied by diabetic ketoacidosis," said the paper's corresponding author Marie McDonnell, M.D., of Brigham and Women's Hospital and Harvard Medical School in Boston, Mass. "Hospitals and clinicians need to be able to quickly identify and manage diabetic ketoacidosis in COVID patients to save lives. This involves determining the options for management (including when less intensive subcutaneous insulin is indicated) and understanding how to guide patients on avoiding this serious complication."

The authors outline simpler methods of diabetic ketoacidosis management with the goal of keeping ICU beds available for severe COVID-19 cases. They advocate, in select cases, for diabetic ketoacidosis protocols that use subcutaneous insulin therapy outside of the ICU instead of IV insulin therapy in the ICU to protect nurses from having to deliver frequent bedside care to COVID-infected patients.

Other topics include the importance of recognizing euglycemic ketoacidosis in those taking SGLT2-inhibitor agents and the recognition that unique approaches, including telemedicine, may be needed to help the highest risk patients avoid ketoacidosis.

As the COVID-19 pandemic sweeps across the globe, people are beginning to understand, at a very personal level, the ways in which infectious diseases can devastate life. But disease outbreaks are not confined to just humans or to life on land.

"We are perhaps more alert than ever to the catastrophic impacts of infectious disease in both humans and animals. Our task now is to begin to understand what drives these events, particularly in species like marine mammals, where our knowledge is even more limited," said Claire Sanderson, a research associate in the Department of Fish and Wildlife Conservation within the College of Natural Resources and Environment and the research coordinator of the Center for African Resources: Animals, Communities, and Land Use (CARACAL).

In 2000, over 10,000 endangered Caspian seals died in less than a four-month span. Researchers later discovered that the culprit behind this devastating mass mortality event was canine distemper virus.

Infectious disease-induced mass mortality events are known to afflict a variety of species, including invertebrates, birds, fish, and both land and aquatic mammals. However, these events in aquatic mammals are understudied compared to their land-dwelling counterparts.

To help fill in the knowledge gaps, Sanderson worked with Kathleen Alexander, a professor in the Department of Fish and Wildlife Conservation and co-founder of CARACAL, to evaluate the factors influencing the occurrence of these events in marine mammals. They published their findings in Global Change Biology.

Sanderson and Alexander defined a mass mortality event as a "devastating number of fatalities within the same species over a brief period of time," which is also dependent on the species' conservation status and population size. Beyond the deaths of individual animals, mass mortality events can initiate a cascade of events with severe ecological repercussions. Affected populations are often at a greater risk of local extinction, and changes in community structure can upset an ecosystem's balance.

By conducting extensive literature searches, Sanderson and Alexander discovered that infectious disease-induced mass mortality events occurred in 14 percent of marine mammal species between 1955 and 2018. Viruses were responsible for 72 percent of these events and caused 20 times the number of deaths than bacterial outbreaks. Specifically, morbillivirus and influenza A outbreaks were the most commonly recorded. Due to their life cycles, both viruses can infect multiple hosts since they have the potential to be transmitted between various species.

To determine which factors influenced the occurrence of infectious disease-induced mass mortality events in marine mammals, Sanderson and Alexander evaluated key life history traits and environmental variables.

To evaluate the role of life history traits, they focused on sociality, trophic level (a species' position on the food chain), and habitat breadth. While sociality and trophic level did not appear to be associated with mass mortality events in marine mammals, habitat breadth did. More than half of the species experiencing mass mortality events were pinnipeds, an order of semi-aquatic species that includes seals, sea lions, and walruses.

"Pinnipeds bridge the terrestrial and aquatic interfaces and may have a greater exposure to pathogens that occur across these land types," Sanderson said. For instance, seals and sea lions are often observed on beaches, rocky shorelines, and docks, but they also spend a significant part of their lives in water.

In contrast to life history traits, environmental variables -- such as season and sea surface temperature anomalies -- were significantly associated with disease outbreaks in marine mammals.

One of the most indicative measures of climate change is fluctuating sea surface temperatures. Sanderson and Alexander found that 61 percent of mass mortality events in marine mammals occurred during periods in which regional sea surface temperature anomalies occurred. The study suggested that the incident rate of an infectious disease-induced mass mortality event increases by nearly 12 percent for "every unit increase in global sea surface temperature anomalies."

"As climate change intensifies, this may set off a complex chain of events that dramatically alter these ecosystems, affecting marine populations living in these environments," said Alexander an affiliated faculty member of the Fralin Life Sciences Institute. Climate change effects on sea ice and ocean salinity also have implications for the spread of disease.

In polar regions, sea ice is melting more quickly due to increasing air temperature, but various species of pinnipeds need sea ice to give birth, rest, mate, escape predators, and molt. As the ice melts away, pinnipeds are forced to congregate onto smaller, shrinking ice sheets. At higher densities, increased contact between individuals can allow pathogens to be transmitted more readily through a population and region.

The chemical balance of the ocean is also changing. In polar regions, melting sea ice dilutes the salty ocean water in a process called freshening. This can result in decreased prey abundance, since species like fish, mollusks, and crustaceans are sensitive to small changes in the environment. With less food to feed on, marine mammals may suffer from nutritional stress, resulting in decreased immune function and a greater susceptibility to disease.

"Marine mammals represent important sentinels of aquatic health by providing information essential for managing threats to these vulnerable ecosystems," said Sanderson. "Addressing the root causes of climate change will be of critical importance as we chart a path forward in managing these species."

Of all the marine mammal species that suffered an infectious disease-induced mass mortality event, the study found that 37 percent were listed as endangered or vulnerable to extinction.

"This work underscores the critical threat infectious disease can pose to marine species and the potential importance of climate change as a wide reaching driver of this process. Here, our role is complex as we contribute directly to our changing climate, increasing pathogen pollution, and habitat degradation. But we also have the power to change things, address climate change, protect species and environments through effort and innovation -- humanity at its best," Alexander said.

A new study shows that residents of long-term care facilities with lower nurse staffing levels, poorer quality scores, and higher concentrations of disadvantaged residents suffer from higher rates of confirmed COVID-19 cases and deaths.

"In nursing homes, quality and staffing are important factors, and there already exists system-wide disparities in which facilities with lower resources and higher concentrations of socio-economically disadvantaged residents have poorer health outcomes," said Yue Li, Ph.D., a professor in the University of Rochester Medical Center (URMC) Department of Public Health Sciences and lead author of the study which appears in the Journal of the American Geriatrics Society. "These same institutional disparities are now playing out during the coronavirus pandemic."

Residents of long-term care facilities have been shown to be highly vulnerable to respiratory disease outbreaks, such as influenza or other common human coronaviruses. Current evidence suggests that COVID-19 disproportionately impacts older adults and individuals with chronic health conditions. These factors are more concentrated in nursing homes where residents are characterized by advanced age, more frequent and complex chronic disease patterns, and highly impaired physical, cognitive, and immune system functions, putting these populations at greater risk for more severe COVID-19 infections.

This phenomenon first came to light in a skilled nursing facility in the Seattle area in February during the early stages of the pandemic, where more than half of the residents in the facility became infected and a third died. Since that time, 50,000 coronavirus-related deaths, approximately 40 percent of the total, have been linked to nursing homes across the U.S.

The new study examined nursing home level data published on the Connecticut Department of Health and Human Services website. At the time of the study, Connecticut was one of the few states that made this information publically available. This information was compared to data from the Center for Medicare & Medicaid Service's (CMS) Nursing Home Compare website, which tracks quality, staffing, and health outcomes for nursing homes nationwide.

Analyses of the data showed that long-term care facilities with higher concentrations of disadvantaged residents, including Medicaid residents and racial and ethnic minorities, lower nurse staffing levels, particularly registered nurses (RN), and lower scores on CMS five-star quality measures, had higher rates of confirmed COVID-19 cases and deaths. Higher nurse staffing ratios in particular was strongly associated with fewer cases and deaths.

"In most nursing homes, RNs are the linchpin for the assessment and provision of medical care, including early identification of and response to emergencies and life threatening situations," said Li. "Our findings of the strong negative association between RN staffing and the number of COVID-19 cases and deaths in nursing homes are consistent with research that has demonstrated that increased nursing levels are key to an institution's ability to respond to outbreaks of emerging infections."

Similar patterns in nursing homes have since been observed in other states, including California. In April, the federal Centers for Disease Control and Prevention (CDC) required all nursing homes to submit COVID-19 data. A preliminary analysis of the CDC data showed similar associations between nursing home quality and staffing and coronavirus infection rates and deaths.

The authors suggest that the findings should be used to recalibrate the nation's efforts to control infection rates in nursing homes. Efforts to date have concentrated in facilities located in areas with high infection rates. The authors contend that, going forward, regulators and state nursing home inspectors should also target homes with lower RN staffing levels and quality ratings.