Portland State study finds bike lanes provide positive economic impact

PORTLAND STATE UNIVERSITY 

 

Despite longstanding popular belief, bicycle lanes can actually improve business. At worst, the negative impact on sales and employment is minimal, according to a new study from Portland State's Transportation Research and Education Center (TREC).

The report is part of a larger National Street Improvements Study, conducted by Portland State University, with support from consulting firm Bennett Midland and the cycling-advocacy nonprofit PeopleForBikes. The study was funded by The Summit Foundation and the National Institute for Transportation and Communities.

Researchers studied 14 corridors in 6 cities -- Portland, Seattle, San Francisco, Memphis, Minneapolis and Indianapolis -- and found such improvements had either positive or non-significant impacts on sales and employment. Essentially, adding improvements like bike lanes largely boosted business and employment in the retail and food service sectors.

"I think that it is very significant that we found that positive business outcomes to the food service and retail industries on these corridors are persistent, even when we looked at different data metrics on employment or sales or when different analytical methods are utilized," said Jenny Liu, associate professor in the Toulan School of Urban Studies & Planning.

Past studies examined the effects of street improvement corridors within specific cities, but this study is among the first to apply consistent and robust analytical approaches across multiple corridors and multiple cities.

The findings also provide policymakers and planners with an analytical framework and further evidence to support investment in non-motorized transportation infrastructure.

"The Street Improvement Study supports with data what we have seen in many communities: adding bicycle infrastructure boosts a neighborhood's economic vitality," said Zoe Kircos, director of grants and partnerships at PeopleForBikes. "Our collaboration with Portland State University and Bennett Midland on this research gives us more resources to share with cities across the U.S. that are eager to make bicycling safer and easier for everyone."

Liu added that the partnership between PSU, PeopleForBikes and Bennett Midland contributed significantly to the end products that are directly targeted to planners and policymakers. The study produced in-depth reports for Portland, Seattle, San Francisco, Memphis, Minneapolis and Indianapolis.

Nationally, the study found the food service industry benefits most often from the addition of transportation infrastructure.

Even in cases where a motor vehicle travel lane or parking was removed to make room for a bike lane, food sales and employment tended to go up, according to the report.

"There is tremendous potential to expand on what we learned in this research project to additional cities and corridors, and to provide policymakers with the opportunity to evaluate street improvement projects before implementation or to collect additional economic/business metrics before and after implementation," Liu said.

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USA
Staying at One’s Job to Maintain Employer-Based Health Insurance Among Cancer Survivors and Their Spouses/Partners

Erin E. Kent, PhD, MS¹; Janet S. de Moor, PhD, MPH²; Jingxuan Zhao, MPH³; et alDonatus U. Ekwueme, PhD, MS⁴; Xuesong Han, PhD³; K. Robin Yabroff, PhD³

Author Affiliations Article Information

JAMA Oncol. Published online April 23, 2020. doi:10.1001/jamaoncol.2020.0742

Many cancer survivors experience challenges related to employment, including limitations in ability to work.¹ Given that most health insurance coverage for working-age individuals in the US is employer-based, a challenge is the inability to freely leave a job given limitations on health insurance portability, also called job lock.² Job lock can negatively affect career trajectory and quality of life.³ Likewise, spouse/partner job lock can also affect family well-being.⁴ We examined job lock prevalence among cancer survivors and their spouses/partners and associated factors in the US.

Methods

This study identified cancer survivors who responded to questions about job lock (ever having stayed at a job out of concern for losing health insurance) from the 2011, 2016, and 2017 Medical Expenditure Panel Survey Experiences With Cancer questionnaire. Separate multivariable logistic regression models examined the association of job lock in survivors and spouses/partners with self-reported survivor characteristics, including current age, sex, educational attainment, race/ethnicity, years since last cancer treatment, current marital status, comorbidities, and household income as a percentage of the federal poverty level (FPL). The study was determined to be exempt from institutional review by the National Cancer Institute. Weighted logistic regression modeling was used. P-values were determined to be significant at 0.05 (two-tailed test). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines were used. Analyses were conducted using SAS version 9.4 (SAS Institute) and SAS-callable SUDAAN version 11.0.0 (RTI International).

Results

Of 1340 survivors, 526 (42.2%) were men and 814 (57.8%) were women. There were 365 respondents (26.1%) between the ages of 18 and 54 years, 387 (29.6%) between 55 and 64 years, 389 (30.1%) between 65 and 74 years, and 199 (14.4%) older than 75 years. Of 1340 surveyed cancer survivors overall, 266 (19.6%) (95% CI, 17.1%-22.3%) reported job lock. Of 1593 partners of survivors, 677 (44.4%) were men and 916 (55.6%) were women. There were 320 (18.9%) respondents between the ages of 18 and 54 years, 372 (24.0%) between 55 and 64 years, 475 (31.2%) between 65 and 74 years, and 426 (25.9%) older than 75 years. Of 1593 spouses/partners surveyed, 171 (10.7%) (95% CI, 8.4%-11.9%) reported job lock. Of 1094 respondents, 374 (32.3%) (95% CI, 29.1%-35.6%) reported any job lock for either themselves or their spouse/partner. Of 628 women, 235 (35.9%) (95% CI, 31.7%-40.3%, 235/628) reported any job lock and of 466 men, 139 (27.9%) (95% CI, 23.5%-32.8%) reported any job lock (Figure).

Characteristics significantly associated with survivor job lock included younger age and earning income between 138% and 400% of the FPL (Table). Spouse/partner job lock was more common among survivors who were women vs men (12% vs 8%), married vs unmarried (11% vs 7%), and nonwhite vs non-Hispanic white (16% vs 9%). Survivors with 3 or more vs no comorbidities were more likely to report spouse/partner job lock (14% vs 6%). Younger survivors (under 75 years) were more likely to report spouse/partner job lock, as were those earning between 138% and 400% of the FPL.

Discussion

In this study, approximately 1 in 3 cancer survivors in the US reported job lock for themselves or their spouses/partners, suggesting that job lock is common and has implications for the well-being and careers of both survivors and their families. Given higher prevalence of job lock among younger survivors and those with incomes near the poverty level, it is important to note that those earning between 138% and 400% of the FPL are ineligible for Medicaid and may have fewer employment alternatives with comprehensive health benefits. Clinicians, social workers, and navigators have opportunities to identify job lock and other employment concerns throughout treatment/survivorship care and connect survivors with employment and health insurance counseling.⁵

One long-term study of childhood cancer survivors from 2018⁶ found that 23% of survivors reported job lock. The present study demonstrates consistent findings in a nationally representative population of adult cancer survivors and also provides data on the prevalence of spousal/partner job lock. The Patient Protection and Affordable Care Act eliminated preexisting condition exclusions and created Marketplace exchanges for purchasing insurance coverage outside of work; whether these provisions will reduce job lock over time is unknown.

Study limitations include the cross-sectional design, lack of a control group, self-report of measures, and lack of information on cancer stage or course of treatment. Response rates ranged from 44% to 55%, comparable with other national household surveys. Sample weights help address nonresponse. Study strengths include it being a large, nationally representative sample and assessment of job lock experiences.

The present study found that 32% of cancer survivors reported job lock in either themselves or their spouses/partners. Additional research, particularly prospective, longitudinal, and qualitative studies, can help elucidate downstream consequences that may vary by sex and develop interventions to increase availability of insurance coverage regardless of employment.

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Article Information

Accepted for Publication: February 27, 2020.

Corresponding Author: Erin E. Kent, PhD, MS, Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, 1102-B McGavran-Greenberg Hall, CB # 7411, Chapel Hill, NC 27599-7411 (erin.kent@unc.edu).

Published Online: April 23, 2020. doi:10.1001/jamaoncol.2020.0742

Author Contributions: Dr Kent had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Kent, deMoor, Zhao, Ekwueme, Yabroff.

Acquisition, analysis, or interpretation of data: Kent, deMoor, Ekwueme, Han, Yabroff.

Drafting of the manuscript: Kent, deMoor, Ekwueme, Yabroff.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Kent, Ekwueme, Yabroff.

Administrative, technical, or material support: Kent, Zhao.

Supervision: Kent.

Conflict of Interest Disclosures: None reported.

Funding/Support: Drs Han and Zhao received funding from AstraZeneca unrelated to this study.

Role of the Funder/Sponsor: AztraZeneca had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The findings and conclusions in this article represent those of the authors and do not necessarily represent the official position of the National Cancer Institute, National Institutes of Health, the US Centers for Disease Control & Prevention, or the American Cancer Society.

References

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Mehnert  A .  Employment and work-related issues in cancer survivors.   Crit Rev Oncol Hematol. 2011;77(2):109-130.PubMedGoogle ScholarCrossref

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Rashad  I , Sarpong  E .  Employer-provided health insurance and the incidence of job lock: a literature review and empirical test.   Expert Rev Pharmacoecon Outcomes Res. 2008;8(6):583-591.PubMedGoogle ScholarCrossref

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Stengård  J , Bernhard-Oettel  C , Berntson  E , Leineweber  C , Aronsson  G .  Stuck in a job: being “locked-in” or at risk of becoming locked-in at the workplace and well-being over time.   Work Stress. 2016;30(2):152-172.PubMedGoogle ScholarCrossref

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Repetti  R , Wang  SW .  Effects of job stress on family relationships.   Curr Opin Psychol. 2017;13:15-18.PubMedGoogle ScholarCrossref

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de Moor  JS , Alfano  CM , Kent  EE ,  et al.  Recommendations for research and practice to improve work outcomes among cancer survivors.   J Natl Cancer Inst. 2018;110(10):1041-1047.PubMedGoogle ScholarCrossref

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Kirchhoff  AC , Nipp  R , Warner  EL ,  et al.  “Job lock” among long-term survivors of childhood cancer: a report from the childhood cancer survivor study.   JAMA Oncol. 2018;4(5):707-711.
ArticlePubMedGoogle ScholarCrossref

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COVID-19 coronavirus could cost the US billions in medical expenses

Study shows hospitalizations, ventilators, and other health resources that patients would require could cost $654 billion if a majority of the population gets infected
CUNY GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY

ESTIMATED COVID-19 CORONAVIRUS HEALTH CARE COSTS BASED ON PERCENT OF US POPULATION INFECTED view more CREDIT: CUNY SPH
One of the major concerns about the COVID-19 coronavirus pandemic has been the burden that cases will place on the health care system. A new study published April 23 in the journal Health Affairs found that the spread of the virus could cost hundreds of billions of dollars in direct medical expenses alone and require resources such as hospital beds and ventilators that may exceed what is currently available. The findings demonstrate how these costs and resources can be cut substantially if the spread of COVID-19 coronavirus can be reduced to different degrees.

The study was led by the Public Health Informatics, Computational, and Operations Research (PHICOR) team at the City University of New York (CUNY) Graduate School of Public Health and Health Policy (CUNY SPH) along with the Infectious Disease Clinical Outcomes Research Unit (ID-CORE) at the Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center and Torrance Memorial Medical Center. The team developed a computer simulation model of the entire U.S. that could then simulate what would happen if different proportions of the population end up getting infected with the COVID-19 coronavirus. In the model, each infected person would develop different symptoms over time and, depending upon the severity of those symptoms, visit clinics, emergency departments, or hospitals. The resources each patient would require such as health care personnel time, medication, hospital beds, and ventilators would then be based on the health status of each patient. The model then tracks the resources invovled, the associated costs, and the outcomes for each patient.

For example, if 20 percent of the U.S. population were to become infected with the COVID-19 coronavirus, there would be an average of 11.2 million hospitalizations and 1.6 million ventilators used, costing an average of $163.4 billion in direct medical costs during the course of the infection. The study shows the factors that could push this amount up to 13.4 million hospitalizations and 2.3 million ventilators used, costing an average of $214.5 billion. If 50 percent of the U.S. population were to get infected with the COVID-19 coronavirus, there would be 27.9 million hospitalizations, 4.1 million ventilators used and 156.2 million hospital bed days accrued, costing an average of $408.8 billion in direct medical costs during the course of the infection. This increases to 44.6 million hospitalizations, 6.5 million ventilators used and 249.5 million hospital bed days (general ward plus ICU bed days) incurred, costing an average of $654 billion during the course of the infection if 80 percent of the U.S. population were to get infected. The significant difference in medical costs when various proportions of the population get infected show the value of any strategies that could reduce infections and, conversely, the potential cost of simply letting the virus run its course.

"Some have suggested herd immunity strategies for this pandemic," explained Sarah Bartsch, project director at PHICOR and the study's lead author. "These strategies consist of allowing people to get infected until herd immunity thresholds are reached and the virus can no longer spread. However, our study shows that such strategies could come at a tremendous cost."

"This also shows what may occur if social distancing measures were relaxed and the country were to be 're-opened' too early," said CUNY SPH Professor Bruce Y. Lee, executive director of PHICOR and the study's senior author. "If the virus is still circulating and the infection rates surge as a result, we have to consider the resulting health care costs. Such costs will affect the economy as well because someone will have to pay for them. Any economic argument for re-opening the country needs to factor in health care costs."

The study shows how costly the COVID-19 coronavirus is compared to other common infectious diseases. For example, a single symptomatic COVID-19 coronavirus infection costs an average of $3,045 in direct medical costs during the course of the infection alone. This is four times higher than a symptomatic influenza case and 5.5 times higher than a symptomatic pertussis case. Factoring in the costs from longer lasting effects of the infection such as lung damage and other organ damage increased the average cost to $3,994.

"This is more evidence that the COVID-19 coronavirus is very different from the flu," said Bartsch. "The burden on the health care system and the resources needed are very different."

"Factoring in the costs incurred after the infection is over also adds to the costs. It is important to remember that for a proportion of the people who get infected, health care costs don't end when the active infection ends," Lee warned. "This pandemic will have its lasting effects and taking care of those who will suffer contuing problems is one of them."






A continuing concern is that the U.S. health care system will become overloaded with the surge of COVID-19 coronavirus cases and will subsequently not have enough person-power, ventilators, and hospital beds to accommodate the influx of patients. This study shows that even when only 20 percent of the population gets infected, the current number of available ventilators and ICU beds will not be suffient. According to the Society of Critical Care Medicine, there are approximately 96,596 ICU beds and 62,000 full-featured mechanical ventilators in U.S., substantially lower than what would be needed when only 20 percent of the population gets infected.

"Of course, the actual capacity used will depend on the timing of when patients need them," said Bartsch. "But showing that there are orders of magnitude differences between what is currently available and what may be needed is concerning."

While health care professionals and public health officials have expressed concerns about ventilator and hospital bed shortages, the model can quantify in a more detailed manner what specifically will be required at different phases of the pandemic and what to expect when more people are infected.


"The Potential Health Care Costs and Resource Use Associated with COVID-19 Coronavirus in the United States" was written by Sarah M. Bartsch, Marie C. Ferguson, James A. McKinnell, Kelly J. O'Shea, Patrick T. Wedlock, Sheryl S. Siegmund and Bruce Y. Lee.

This work was supported in part by CUNY SPH, the Agency for Health care Research and Quality (AHRQ) via grant R01HS023317, United States Agency for International Development (USAID) under agreement number AID-OAA-A-15-00064, Global Obesity Prevention Center (GOPC) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the Office of the Director, National Institutes of Health (OD) under award number U54HD070725. It was also supported by NICHD via grant U01HD086861 and 5R01HD086013-02 and by National Institute of General Medical Sciences (NIGMS) via the Models of Infectious Disease Agent Study (MIDAS) network under grant 1 R01 GM127512-01A1. The funders did not have any role in the study design, collection, analysis and interpretation of data, writing the report, and the decision to submit the report for publication. The authors of this manuscript are responsible for its content, including data analysis. Statements in the manuscript do not necessarily represent the official views of, or imply endorsement by, National Institute of Health, AHRQ or HHS.

About CUNY SPH

The CUNY Graduate School of Public Health and Health Policy is committed to teaching, research, and service that creates a healthier New York City and helps promote equitable, efficient, and evidence-based solutions to pressing health problems facing cities around the world.

About PHICOR

Since 2007, PHICOR has been developing computational methods, models, and tools to help decision makers better understand and address complex systems in health and public health. Follow @PHICORTeam for updates.

Falling visibility shows African cities suffering major air pollution increases -- study

UNIVERSITY OF BIRMINGHAM 

Falling visibility in three major African cities reveals that air pollution has increased significantly over the last 45 years - leaving citizens facing further short-term increases in man-made pollution due to increasing urbanization and economic development, a new study reveals.

Africa is not well-equipped with air quality monitoring, so scientists have used visibility data for capital cities in Ethiopia, Kenya and Uganda as a substitute measurement.

They discovered a significant reduction in visibility since the 1970s, where Nairobi shows the greatest loss (60%), compared to Kampala (56%) and Addis Ababa (34%) - due to increased particulate matter (PM) emissions from vehicles and energy generation.

Correspondingly, PM pollution levels in the three cities are estimated to have increased by 182%, 162% and 62% respectively since the 1970s to the current period.

University of Birmingham experts published their findings in Environmental Research Letters. They are now calling for a systematic approach to understand the causes and effects of air pollution in urban East Africa - allowing improvements in air quality to co-exist with sustainable future economic development.

Report co-author Dr. Ajit Singh commented: "Evidence indicates that ambient air quality in urban African locations is often poor, because of high rates of urbanisation and population growth leading to large-scale construction, increased energy use, vehicle emissions and industrialisation.

"PM air pollution is a major concern in East Africa because of its impact on human health. There are few air quality monitoring networks, resulting in little long-term air quality data, but visibility measured at major cities can be used as a proxy for PM pollution.

"We're tremendously proud of our work in East Africa and the analysis techniques we developed to study Nairobi, Kampala and Addis Ababa are translatable to other parts of the world where air quality data is limited."

The Birmingham team's work is funded by the UK Department for International Development (DFID) through the East Africa Research Fund (EARF) grant 'A Systems Approach to Air Pollution (ASAP) East Africa' and Digital Air Quality (DAQ) - East Africa funded via EPSRC Global Challenges Research Fund.

Co-author Dr. William Avis commented: "Air pollution poses a major health, economic and social threat to cities around the world - inextricably linked to how we plan, manage and live in urban areas. East Africa is no exception to this, but lacks robust air quality data."

Co-author and ASAP lead Professor Francis Pope said: "We need to understand the causes and effects of air pollution in these three cities, which are rapidly developing and will likely experience further increases in PM. Poor air quality acts as a brake on development through increasing expenditure on health, loss of labour productivity, and the impact of illness on education.

"To date, no studies have been able to assess the role of socio-economic factors upon the evolution of air pollution in East Africa. Our work provides data that helps us understand this relationship and provides a much needed baseline for East African urban air quality that can help assess future air quality improvement interventions in the region."

The researchers compared changes in pollution to population growth and GDP statistics - finding increased PM levels linked to increases in national GDP and populations in all three study cities.

They also discovered distinct variations in seasonal visibility, which are largely explained by changing PM sources and sinks in rainy and dry seasons. Visibility was lowest during the dry months and highest in wet months. At all study sites, visibility was higher on Sundays - due to reduced traffic and industrial emissions.

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* 'Visibility as a proxy for air quality in East Africa' - Ajit Singh, William R. Avis and Francis D. Pope is published in Environmental Research Letters. A copy of the research paper can be downloaded at https://iopscience.iop.org/article/10.1088/1748-9326/ab8b12 - please feel free to include this link to the paper in any online article.

New study takes the pulse of a sleeping supervolcano



UPPSALA UNIVERSITY

THE LLAMAS OF THE ANDES' HIGH PLATEAU ARE UNAWARE OF THE ENORMOUS AMOUNT OF MAGMA BELOW THEIR HOOVES. view more  CREDIT: OSVALDO GONZÁLEZ-MAUREL
Under the volcanoes in the Andes where Chile, Argentina and Bolivia meet, there is a gigantic reservoir of molten magma. For several million years, it has been there without fully solidifying or causing a supervolcanic eruption. Geologists have long wondered how this is possible. Researchers from Uppsala University, among others, have now discovered that the secret may be hidden tributaries of hot magma from inside the Earth.

The study is published in the journal Scientific Reports.

"Huge volcanic eruptions from so-called supervolcanoes are very unusual, but when they happen they are extremely devastating. It's incredibly important for volcanologists to clarify what keeps this sleeping giant alive and what can cause it to awaken," says Valentin Troll, Professor of Petrology at the Department of Earth Sciences at Uppsala University.

The giant so-called Altiplano-Puna magma body is estimated to contain 500,000 cubic kilometers of molten and semimolten magma. In order to provide a picture of how much volume is involved, it can be said that the entire island of Gran Canaria would fit inside - more than ten times over. The last really large volcanic eruption here occurred 4 million years ago and was the last in a series of very large explosive eruptions that began 10 million years ago. Some of them can be classified as supervolcanic eruptions.

In order to look for answers as to how the magma could stay molten for millions of years, the researchers studied lavas that were ejected from the magma reservoir during smaller volcanic eruptions after the last major eruption. The chemical composition of such material can provide an indication of how a magma reservoir works, how far down from inside the Earth the material originates, how long it remained in the reservoir and what different processes the magma underwent before it was ejected by the volcano.

In this case, the researchers wants to find out if new magma forces its way into the reservoir and therefore needed to find material that, after forming in the Earth's mantle, was not affected by interaction with the magma that was already in the reservoir.

"This was a demanding task. Under these particular volcanoes in the Central Andes is the Earth's thickest crust, 70 kilometers thick, which means that the magma is given many chances to change and react with the material it comes into contact with when it forces its way up to the surface," says Frances Deegan, a researcher at Uppsala University.

The researchers therefore searched several years for lava that was as "original" as possible. Finally, they found what they were looking for. They have now analyzed the composition of the oxygen isotopes in their samples to find out how lavas were formed and where they originate from. The results showed that the lavas came from deep within the Earth and that they represent the material that feeds the volcanoes of the Central Andes, keeping them alive.

This new knowledge is important to understanding how large, complex volcanoes work.

"Supervolcanic eruptions can cause gigantic disasters. The last one that happened on the Earth was Toba's super eruption in Indonesia 73,000 years ago and it is considered to have almost led to the extinction of mankind. Even if we can't prevent a super eruption from happening, it would be smart to use the time until the next eruption to learn as much as possible to increase the chances for our communities to survive such an event," says Valentin Troll.

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For further information, please contact:

Valentin Troll, professor at Department of Earth Sciences, Natural Resources and Sustainable Development
Phone: +46 18 471 25 70
Email: Valentin.Troll@geo.uu.se

Hummingbirds show up when tropical trees fall down



UNIVERSITY OF ILLINOIS COLLEGE OF AGRICULTURAL, CONSUMER AND ENVIRONMENTAL SCIENCES

HUMMINGBIRDS LIKE THIS ONE APPEARED IN DROVES AFTER A TREEFALL GAP OPENED UP IN THE PANAMANIAN FOREST. view more CREDIT: PHOTO BY HENRY POLLOCK, UNIVERSITY OF ILLINOIS.

URBANA, Ill. - When the tree fell that October in 2015, the tropical giant didn't go down alone. Hundreds of neighboring trees went with it, opening a massive 2.5-acre gap in the Panamanian rainforest.

Treefalls happen all the time, but this one just happened to occur in the exact spot where a decades-long ecological study was in progress, giving University of Illinois researchers a rare look into tropical forest dynamics.

"I've been walking around that tree for 30 years now. It was just humongous," says Jeff Brawn, Professor and Stuart L. and Nancy J. Levenick Chair in Sustainability in the Department of Natural Resources and Environmental Sciences at Illinois. "Here we are, running around on this plot for years and all of a sudden I couldn't even find my way around. We just lucked into it."

What's lucky is that Brawn and his colleagues had amassed decades of data on the bird community in that exact spot, meaning they had a clear before-and-after view of what a treefall could mean for tropical birds.

This particular gap meant hummingbirds. Lots and lots of hummingbirds.

"After the treefall, we saw a very large spike in the total number of hummingbird species," says Henry Pollock, a postdoctoral scholar working with Brawn and lead author on a study published in the Journal of Field Ornithology. "Within the previous 25 years of the study, we had only documented three or four hummingbird species, and they were usually present in low numbers. There was one species, the snowy-bellied hummingbird, which we had never captured on either of our two plots in 25 years of sampling. The year after the treefall happened, we got 16 unique individuals of this one species, and total diversity of hummingbirds more than doubled."

The gap also attracted fruit-eating birds. The researchers documented a doubling of this group compared to pre-treefall numbers, with certain species being more than three times as abundant. Other species, including the thick-billed seed-finch, which typically inhabits grasslands, appeared as if out of thin air.

"They just swooped in," Brawn says. "It's analogous to a backyard bird feeder. As soon as you put one in, you'll see species you've never seen before."

And then, almost as quickly, the birds disappeared.

Within one to four years, depending on the species, the birds returned to pre-treefall numbers or were not detected again.

"What that suggests is these birds are incredibly mobile and opportunistic," Pollock says. "They are probably just cruising around the landscape prospecting for their preferred food sources and habitats. Given the sheer size of this gap, it acted as a sort of magnet, pulling in species from potentially kilometers away. I mean, 16 snowy-bellied hummingbirds and we've never caught one before? It's pretty astounding."

Treefalls are a common and necessary occurrence in forests all over the world. As sunshine streams in from above, trees hunkered down in the understory finally get their chance to rise. Basking in the suddenly resource-rich environment, tropical trees and other plants produce nectar-filled flowers and fruit, important food sources for birds and other animals.

Previous research has hinted at how important these food sources are for tropical birds, but no one had documented before-and-after differences until now. Instead, researchers typically compared treefall gaps with intact forest areas at a single time point. That approach has its uses, but it can't capture what Brawn and Pollock found: just how quickly the birds arrived on the scene, and how quickly they left.

"I was just really just astonished at how quickly and how efficiently these birds seem to be able to find and exploit a new source of food," Brawn says.

Gaps don't stay open long in the tropics. Understory trees shoot up, elbowing each other out of the way to take the top spot. Soon, there's no evidence a gap - or its riotous array of feathered occupants - was there at all.

As short-lived as they may be, treefall gaps represent critical opportunities for species turnover, especially in the tropics where forest fires are comparatively rare.

"This kind of periodic disturbance is probably necessary for these birds to persist in the landscape matrix," Pollock says. "That's true for many organisms and ecosystems; our study provides evidence to back that up in these birds."


The article, "Rapid colonization and turnover of birds in a tropical forest treefall gap," is published in the Journal of Field Ornithology [DOI: 10.1111/jofo.12328]. Authors include Henry Pollock, Todd Jones, Corey Tarwater, Elise Nishikawa, and Jeffrey Brawn. The Smithsonian Tropical Research Institute supported this research. The Department of Natural Resources and Environmental Sciences is in the College of Agricultural, Consumer and Environmental Sciences at the University of Illinois.

Nursing homes prepared for pandemics, but COVID-19 reveals gaps

Survey of Michigan nursing homes at start of current pandemic suggests great improvement since just before the H1N1 pandemic

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

The COVID-19 pandemic has hit some nursing homes especially hard - including in the hotspot state of Michigan. Hundreds of deaths of residents in homes from Seattle to Boston have raised concerns about how well facilities are protecting the 1.3 million older Americans who live in them. Those concerns have prompted new federal and state requirements about testing and transparency.

But it might have been worse.

New data suggests that at least in Michigan, nursing homes that responded to a survey were far better prepared for this pandemic than they were for the last one. The study includes responses from 130 nursing homes to a survey performed during the week the state announced its first documented case of COVID-19.

It shows that nearly all had a pandemic plan in place. That's compared with just over half of the 280 nursing homes that answered the same survey in 2007. Nearly all said they now have at least one staff member in charge of pandemic preparedness.

The findings are reported in the Journal of the American Geriatrics Society by a team from the University of Michigan that has studied and worked to improve nursing home infection prevention for years.

Members of the team have several other recent publications with direct or indirect relevance to the COVID-19 pandemic, including putting forth recommendations for nursing homes and other housing facilities for older adults to use in planning how they will respond to pandemics such as COVID-19.

Lona Mody, M.D., M.Sc., a geriatrician at Michigan Medicine, U-M's academic medical center, and the VA Ann Arbor Healthcare System, is senior author of both of the new publications. She's a professor of internal medicine, the associate director for clinical and translational research at the U-M Geriatrics Center, and director of the Infection Prevention in Aging research group.

"Our nursing homes house some of the most vulnerable in our society," says Mody. "This virus unfortunately is very contagious, the disease it causes has incredibly poor outcomes in older adults with comorbidities, and nursing homes are communal settings with shared spaces and resource limitations. This creates a perfect storm of sorts. Being novel, we learn as go and have to learn really quickly."

Mody heads the PRIISM, or Preventing Resistance and Infection by Integrating Systems in Michigan, project, which partners with skilled nursing facilities, hospitals and public health agencies across the state to perform research and create and test education and training materials for nursing home staff. The program's website has many free materials for use by nursing homes everywhere.

Pandemic planning

The new survey data show Michigan's nursing homes have done a lot to prepare for pandemics since the last time the U-M team performed the survey. That previous survey was taken before the H1N1 influenza pandemic of 2009, but after the H5N1 "bird flu" pandemic of 2005 raised national awareness of the importance of pandemic preparedness. Mody and colleagues published pandemic preparedness guidance for nursing homes at that time.

In mid-March of this year, 85% of nursing homes said they had stockpiled supplies before COVID-19 hit, compared with 57% after the H5N1 pandemic. Most of those that had stockpiled supplies had focused on surgical masks, gloves and hand sanitizer. Less than half had stockpiled N95 respirator masks, which are recommended by national and global health authorities for health care workers performing certain types of care on a COVID-19 patient.

Still, 42% of the nursing homes that answered a question about COVID-19-specific concerns said they were worried about running short of personal protective gear.

"Although the size and severity of COVID-19 outbreaks in some nursing homes have taken everyone by surprise, just as so much about this pandemic has, in general nursing homes knew exactly what their challenges were going to be in a pandemic - PPE shortages, staff shortages and worries that they did not have the capacity to care for COVID patients after their hospital stay."

Nearly all now said they had trained staff on how their facility would respond in a pandemic, up from 42% in 2007. But only one-third had conducted a pandemic drill. And Mody notes that nursing homes have a much higher rate of staff turnover than hospitals - meaning that training on infection prevention and pandemic response has to be offered whenever a new person joins the organization.

Michigan's nursing homes appear to have gotten better connected to the broader health care system in the past decade, with significantly more saying they now have communication lines established with local hospitals and public health departments.

Many also said they were drawing COVID-19 guidance not just from the Centers for Disease Control and Prevention, but also from state and local health departments. Half also received guidance from their home's corporate parent.

And while half of the nursing homes surveyed this year said they expected significant staff shortages due to COVID-19, most of them said they had a plan to deal with that. Most planned to ask existing clinical staff to work more hours, and to redeploy non-clinical staff. Two-thirds expected they'd need to require staff to work overtime.

The survey also explored the potential for nursing homes to relieve the burden on hospitals. In all, 82% said they'd be willing to take non-pandemic patients from overburdened hospitals now, compared with 53% in 2007. But the percent that said they'd be able to accept patients with the pandemic disease stayed the same, at one-third of responding homes.

Additional guidance

Mody and her colleagues John P. Mills, M.D. and Keith Kaye, M.D. from the U-M Division of Infectious Diseases recently published some recommendations regarding COVID-19 and older adults in the journal JCI Insight. Mody and Kaye are members of the U-M Institute for Healthcare Policy and Innovation.

They note that it's not just nursing homes with long-term residents that need to be ready to care for vulnerable older adults during pandemics.

In fact, the trend over the past decade to use nursing homes more often for short-term stays by patients who have been discharged from a hospital, and to create state and local programs that allow older adults to 'age in place' instead of moving to nursing homes for the long-term, have led to potential gaps for pandemic responses to help older adults.

They call for policymakers to address those gaps, by creating pandemic-specific plans for community-dwelling older adults, especially those with health needs.

As for nursing homes, they recommend that in areas where COVID-19 is spreading widely in the community, facilities should take these steps, and others:

• place patients with known or suspected disease in the same area of the facility, away from others
• perform rapid COVID-19 tests on all patients, both short-stay and long-stay
• screen healthcare workers and other staff for symptoms including checking temperatures
• limit visitors and group activities
• require everyone wear a surgical mask
• require additional protective gear for clinical staff

The limits on group activities tie in to other research by Mody and her colleagues, published in JAGS in December.

That study sampled surfaces, and the hands of patients and staff, in the common areas and rehabilitation gyms with in nursing homes, and looked for drug-resistant bacteria that can cause dangerous infections. Though the team didn't look for the presence of viruses in these areas, they did find that half of the samples taken in rehab gyms contained at least one type of bacteria that was resistant to several types of antibiotics.

In addition to stockpiling PPE and cleaning supplies, the team recommends that nursing homes should use "burn calculators" to predict how quickly they'll use those supplies based on their patient population.

If nursing homes and other residential facilities for older adults haven't already done so, they should establish lines of communication with local health departments in advance of any outbreak of COVID-19 in their facility. They should also focus on staff retention, including providing for generous sick leave policies so that staff can stay home when ill, and hazard pay for those who can come to work.

And, the team says, nursing homes should make sure they have an infection prevention plan in place for staff when a patient has died of COVID-19.

Another gap in preparedness that the COVID-19 pandemic is revealing, Mody says, is a gap in communication with patients and their families. Keeping families informed, and enabling them to connect virtually with their loved ones when they can't visit in person, is crucial, she says.

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Open access hardware & 3D printing can help tackle demand for health supplies

Local communities could use open access hardware to help alleviate the burden of COVID-19 on global health systems, according to Sussex scientists
UNIVERSITY OF SUSSEX

AN EXAMPLE FACE SHIELD MADE USING A LASER CUTTER view more
CREDIT: ANDRÉ CHAGAS, UNIVERSITY OF SUSSEX

Free open source hardware and 3D printing could help to alleviate the burden of Covid-19 on global health systems, according to scientists at the University of Sussex.

Free and open source hardware (FOSH) follows an ethos where blueprints for a tool are made freely available so that anyone can study, learn, modify, customize and commercialize them.

In a study published by PLoS Biology, Professor Tom Baden and Andre Chagas at the University of Sussex have suggested that this could be a viable option to provide our health services with the tools and equipment they so desperately need.

The study provides an overview of the blueprints which are currently available for free online and which could be used to help in the fight against coronavirus, focusing on personal protective equipment, ventilators and test kits.

Although some of the designs still need to be tested, many others have already received suitable verification, having been published in peer reviewed papers. The authors therefore believe that FOSH should be seriously considered as a method of quickly providing equipment where it's needed.

Tom Baden, Professor of Neuroscience, said: "Now is the time that Open Hardware could really shine and it's so important that we get on board quickly.

"Previous studies and experiences have shown that free and open source hardware is a brilliant option in disaster situations. Designs can be shared globally, it has typically lower implementation costs than mass manufacturing and it can be easily adapted to meet local resources.

"But the real power - and the way this could really help to tackle Covid-19 - is that once a tool has been designed and tested, anyone can build it. This bypasses the traditional manufacturing and distribution routes and means that it can become a community driven endeavour where anyone with the capacity to do so can help to produce much-needed equipment and supplies for the healthcare services.

"Anyone with the necessary knowhow, tools and time can build on this knowledge to meaningfully support their community. At a time when global health systems are facing immense pressure and becoming increasingly overburdened, we need a response not just from frontline workers such as medical staff and scientists, but from skilled members of the public who have the time, facilities and knowledge to meaningfully contribute."

The paper describes existing FOSH designs from simple tools like DIY facemasks to 3D printed valves which can regulate airflow in ventilator tubes. Others are far more complex including state-of-the-art scientific instruments for diagnosis, such as an automated pipetting robot, plate readers and a range of other medical tools and supplies.

Some blueprints are already being used to provide support to the NHS. A company in Portslade which produce face visors have recently removed their patent and license and asked for support from anyone with a 3D printer in order to produce more to meet demand and provide protection to NHS staff.

But for those unverified designs, testing and approval can be a lengthy process.

Andre Chagas said: "One thing governments could do right now, is to figure out a process in which we can legitimately fast track the testing and certification of tools which are in short supply."

"For instance, in Spain a group is already testing their ventilator designs with support from the government. While each country will have different rules and certifications to meet, this is a crucial moment for us to get together and figure out a single set of certification so that implementation can move faster."

Prof. Tom Baden added: "If governments can support this through financial support to ramp up production of the best tools, that would be incredibly useful right now.

"But asides from financial support, we also need support from those who actually know about the use of these tools, rather than just their design. To make this equipment properly and safely, we don't just need tech-savvy people building it. We need people in the healthcare sector who know how these tools should work and can actually test them. These people should contact ongoing products to see if they can help."

A team at the University of Sussex team recently finished creating 100 face shields which are to be tested within the NHS. Once the design is approved the University will launch a full-scale production operation, hoping to produce 1000 face shields a day by early May.

Early high school start times adversely affect attendance

NORTH CAROLINA STATE UNIVERSITY

A new study finds that earlier high school start times can have significant adverse consequences for students, including increased rates of tardiness and absenteeism.

"The American Academy of Pediatrics recommends that high schools begin class after 8:30 a.m., but we know that most schools start much earlier," says Melinda Morrill, an associate professor of economics at North Carolina State University and corresponding author of a paper on the work. "We were able to look at five high schools that moved start times from 8:05 a.m. to 7:25 a.m. in order to examine the effect that the change had on students."

The researchers looked at data on seven cohorts of students, with graduation years ranging from 2013 to 2019. Specifically, researchers looked at data from the freshman, sophomore and junior years of each cohort. The change in start times was implemented in the 2012-13 school year. As an additional control group, the researchers also looked at data from 14 other high schools in the same school district that had already adopted a 7:25 a.m. start time.

"There's a growing body of research that suggests earlier start times can hurt test scores," Morrill says. "We looked at that, but the numbers weren't statistically significant one way or the other."

"However, the move to the earlier start times caused a small increase in the number of students who did not advance to 12th grade on time," says John Westall, a Ph.D. candidate at NC State and co-author of the paper. "Specifically, the move from 8:05 to 7:25 was associated with students being 8% more likely not to advance to 12th grade on schedule."

"We also wanted to look beyond testing to see if there were effects on other measures of academic engagement," Morrill says. "And we found a significant increase in both absences and tardiness."

"The change to an earlier start time led to an increase of about one additional absence per year and just over three additional tardy arrivals per year for students," Westall says. "So students were definitely missing more school."

"Looking at all 19 of the schools, we found that historically, the five schools that started at 8:05 had significantly lower rates of absenteeism and tardiness than the 14 schools that started at 7:25," Morrill says. "But once those five schools moved their start time to 7:25, those advantages disappeared.

"The take-home message here is that we need to look at more than just test scores if we want to understand all of the ways that early start times can affect high school students," Morrill says. "We know that school districts have to consider a wide range of issues, such as transportation logistics, student safety, extracurricular activities and school finances. But the more we look, the more the findings suggest that there are significant consequences of early start times for students."

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The paper, "High School Start Times and Student Achievement: Looking Beyond Test Scores," is published in the journal Economics of Education Review. The paper was co-authored by Matthew Lenard, a graduate student at the Harvard Graduate School of Edu