Pediatric heart transplant method developed by U of A doctors allows for more surgeries, better outcomes: Study

Blood type-incompatible heart transplant surgery for infants under the age of two pioneered in Canada, now used worldwide

UNIVERSITY OF ALBERTA FACULTY OF MEDICINE & DENTISTRY

Research News

 

IMAGE: U OF A RESEARCHER SIMON URSCHEL WITH PATIENT GEORGE KEMP, WHO RECEIVED A HEART TRANSPLANT AS A BABY AND IS NOW FOUR YEARS OLD. (PHOTO TAKEN PRE-COVID-19) view more 

CREDIT: LINDSEY KEMP

A pediatric heart transplant procedure pioneered by Canadian doctors--once deemed impossible--has been shown to be at least as effective as the traditional approach, according to newly published research in The Lancet Child & Adolescent Health.

ABO-incompatible heart transplantation was developed in the mid-1990s, after a Canadian transplant team led by Lori West realized that infants under the age of two have immature immune systems that would allow them to accept life-saving replacements for their defective hearts from donors with incompatible blood types.

"It's really important to see it has not only helped these very sick babies to get transplants faster, but also to live as long, with no more rejections, and better outcomes with regards to infections, as children who received a matched blood group heart," said principal investigator Simon Urschel, associate professor of pediatrics in the University of Alberta's Faculty of Medicine & Dentistry, director of pediatric cardiac transplantation at the Stollery Children's Hospital and member of the Women and Children's Health Research Institute (WCHRI).

ABO-incompatible heart transplantation is now routinely carried out in Canada and some other countries, but not everywhere. That should change thanks to these new study results, Urschel said.

"For example, Eurotransplant (the agency responsible for transplants in eight European countries) still considers it an inferior option to be used with caution," he said. "That concern will probably be relieved in those last places that were reluctant to do it, now that we have shown it is safe."

About 50 per cent of the population is born with type O blood, while 35 per cent has A type and 15 per cent has B or AB type blood. Organs from a donor with type O blood can be accepted by anyone, but adult type O patients can receive only type O organs. The development of ABO-incompatible pediatric heart transplantation meant that twice as many organs would be available to type O infants born with heart defects.

Urschel and his team analyzed data from more than 2,200 infant transplant recipients in Canada, the United Kingdom and the United States from 1999 to 2018. The records were from the Pediatric Heart Transplant Society registry, an international research collaboration that collects data from 58 transplant centres. This resulted in more than 11,000 cumulative patient-years of observation, by far the largest study of its kind.

Three hundred sixty-four of the babies received ABO-incompatible transplants, while 1,842 received ABO-compatible hearts. "We wanted to compare apples with apples, so the children were matched by characteristics such as their underlying disease and the age at which they underwent surgery," Urschel said.

The researchers found the survival rate was the same between the two groups, as were the rates of acute and chronic organ rejection and the risk of developing leukemia after transplant. They also examined the rates of post-transplant bacterial, viral and fungal infections, which they were concerned might be higher among the ABO-incompatible transplant recipients.

"Interestingly, we found that there were fewer of the infections that we were worried about in the ABO-incompatible patients," Urschel said.

Earlier work by Urschel's research team showed that wait times for these patients were significantly shortened, with the average time to transplant being about 50 per cent shorter thanks to the innovative transplant technique.

"It's easier and faster to find a heart for these patients, which is crucial because they are extremely sick, often on mechanical heart support devices or on ventilators in intensive care units," he said. "This gives them a chance not only to survive, but to stay healthier and be in better condition before and after transplantation."

The pioneering pediatric heart surgeons who started it all in 1996--West and Ivan Rebeyka--refined their method after being recruited to join the U of A faculty, with help from other faculty members such as Urschel. Urschel and West's work has received funding from the Stollery Children's Foundation through WCHRI.

CAPTION

Pediatric heart surgeon Lori West led a team that pioneered ABO-incompatible heart transplants after realizing that infants' immature immune systems wouldn't reject organs from donors of a different blood type.

CREDIT

Laughing Dog Photography

The "rule" requiring ABO-compatible donors was instituted for older patients and had never been revisited from the perspective of the immunologic immaturity of infants, said West, now Canada Research Chair (Tier 1) in Cardiac Transplantation, and director of the Alberta Transplant Institute and the Canadian Donation and Transplantation Research Program.

"This, in combination with an extremely high mortality for infants on our transplant waiting list, is why we instituted the first ABO-incompatible transplant protocol," she said.

"Transplantation has always been about pushing the boundaries of risks in order to offer reasonable options to patients who would otherwise have no options."

Urschel will continue his work to understand the mechanism in infant immune systems that allows them to accept blood type-incompatible hearts, in hopes of being able to one day use what is learned to help older transplant recipients. He is also involved in projects to improve the quality of life of young transplant patients and their families.

"It's a real lesson in the need for scientific vigour to guide our operationalization of clinical protocols, not just the blind adoption of previously accepted regulations," said West.

The fact that heart transplant recipients can now survive with a normal lifespan is a credit to both West and Rebeyka, who has a clinical faculty position with the U of A's Cardiovascular Research Centre, said Urschel, who continues to provide clinical care for teenage and young adult patients who received ABO-incompatible transplants as babies.

"It's just amazing to see them, knowing that at one time they were so sick in the intensive care unit that they might not make it to the next day," Urschel said.

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ABSTINENCE KILLS

Carrying naloxone can save lives but newly abstinent opioid users resist

UNIVERSITY OF CALIFORNIA - SAN DIEGO

Research News

Opioids are the main driver of fatal drug overdoses in the United States, according to the Centers for Disease Control and Prevention, resulting in 46,802 deaths in 2018, usually because the person stops breathing.

Naloxone -- a Food and Drug Administration-approved medication used to reverse overdoses from opioids, such as heroin, morphine and oxycodone -- works by restoring normal respiration to a person whose breathing has slowed or stopped.

"Opioid overdoses cause the largest number of accidental and avoidable deaths," said Peter Davidson, PhD, associate professor in the Department of Medicine at University of California San Diego School of Medicine. "The human toll of drug addiction is devastating. Using naloxone to prevent opiate overdoses can and has saved many lives."

In a study published in the March 23, 2021 online edition of the International Journal of Drug Policy, Davidson and an international group of researchers, found that opioid users who participate in a 12-step abstinence program and recently stopped using drugs refused to take home naloxone, even if having it on hand might save lives.

For the study, trained interviewers visited areas known for high drug use in three Southern California counties: San Diego, Orange and Ventura. Forty-four participants were asked questions about drug use initiation, overdose experiences, both their own and observed and past treatments.

"In our research, individuals who were newly abstinent from opioid use believed that carrying naloxone symbolically tied them to a drug-use identity that they were trying to leave behind," said first author Jeanette Bowles, DrPH, who is now a postdoctoral fellow with the Centre on Drug Policy Evaluation in Toronto, Canada, but was a UC San Diego School of Medicine postdoctoral fellow at the time of the study.

"Twelve-step programs promote abstinence through social behaviors that include staying away from people, places and things considered to be tied to drug use. Naloxone was seen as an item linked to their drug use and clashing with these sober behaviors and their goal of abstinence."

To reduce the stigma associated with naloxone, researchers suggest reframing the meaning of carrying naloxone to represent a commitment to group safety and the wellbeing of those "who still suffer" and relabeling naloxone training programs in substance use disorder treatment settings as "overdose first aid."

In addition, researchers propose focusing on the lifesaving impact those trained to administer naloxone can have on their peers, and re-targeting naloxone distribution efforts to include persons at any phase of their drug use, including abstinence.

"It is very important that people understand that after periods of abstinence, the body is less tolerant if an individual resumes drug use, making them physiologically more vulnerable to overdose and death," said Davidson, co-corresponding author and principal investigator. "If someone is experiencing an opioid overdose, it is important to recognize the signs and respond quickly to prevent death."

In the United States, laws now allow people to access and use naloxone to respond to overdose with protection from liability.

The Addiction Recovery and Treatment Program at UC San Diego Health provides patients with outpatient behavioral treatment for substance use, such as cannabis, alcohol and opioids.

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Co-authors include: L.R. Smith, M.L. Mittal, E. Copulsky, and G. Hennessy, all of UC San Diego; R.W. Harding and K.D. Wagner, University of Nevada, Reno; and A. Dunkle, Solace Foundation.

 

COVID-19: A retrospective by the numbers

Godot is in sight

SOCIETY FOR DISASTER MEDICINE AND PUBLIC HEALTH, INC.

Research News

 

Presents a brief overview of the eight COVID-19 editorials published in DMPHP over the past year and using them as a framework to follow the evolution of the Pandemic over time. A review of the salient epidemiological and clinical dimensions of COVID-19 over time is given as well as a discussion of the medical and public health impacts of the disease and the interventions and policies put in place to contain and mediate the virus.

The concluding discussion questions the validity of the criteria used in selection of priority groups for vaccination in the US and notes that had a uniform program supporting the immunization of all over age 65 (accounting for 80% of COVID-19 deaths), the most lives would be spared while simultaneously cutting across all socio-economic and ethnic groups. Continuing this line of reasoning globally would provide an opportunity for the US to reburnish its humanitarian image through a vaccine diplomacy initiative with a goal to vaccinate the over 65 of every nation. To date, almost 500 million doses of vaccine have been administered; had they been targeted to the over 65 global population of some700 million, we would be well on our way to a return to the old normal.

THIRD WORLD USA

Rural US has more heart failure deaths than urban areas

Greatest increases are in Black men under 65 years old

NORTHWESTERN UNIVERSITY

Research News

 

• 'A persistent and troubling rural disadvantage'
• Strategies needed to support rural Americans

CHICAGO ---Heart failure deaths are persistently higher in rural areas of the United States compared with urban areas, reports a new Northwestern Medicine study. The research also showed race disparities in heart failure are prevalent in rural and urban areas with greatest increases among Black adults under 65 years old.

Heart failure deaths have been increasing nationally since 2011, but there is significant geographic variation in these patterns based on race.

"This work demonstrates a persistent and troubling rural disadvantage with significantly higher rates of death in rural areas compared with urban areas," said lead study author Dr. Sadiya Khan, an assistant professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine cardiologist.

The study was published in the journal PLOS ONE this month.

Possible factors for the disparities are higher levels of adverse social factors (e.g., lower income), risk factors such as obesity and diabetes in rural areas and fewer physicians, specifically cardiologists.

"Research is needed to identify barriers and define best strategies to prevent heart failure and optimize guideline-directed medical therapies, once heart failure develops," Khan said.

This is the first study that:

• Focuses on geographic heterogeneity in heart failure mortality rates by rural or urban area

• Demonstrates patterns of heart failure mortality are changing unfavorably with increases since 2011 in both rural and urban areas; these increases are greater among younger adults under age 65 years with greatest increases among Black men younger than 65.

The study used national death certificate data from the Centers for Disease Control that capture all deaths that occur in the U.S. Investigators identified cardiovascular deaths related to heart failure that occurred since 2011 and calculated annual age-adjusted mortality rates and trends in rural and urban areas, overall, by age groups and by race and sex.

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Other Northwestern authors include Jacob Pierce, Nilay Shah, Lucia Petito, Lindsay Pool, Dr. Donald M. Lloyd-Jones and Joe Feinglass.

This work was supported by grants from National Institutes of Health's National Center for Advancing Translational Sciences Grant Number KL2TR001424 and the American Heart Association.

 

Face masks associated with reducing healthcare workers' risk of acquiring COVID-19

Early action to protect team members maximized Henry Ford's ability to care for patients during onset of COVID-19 pandemic

HENRY FORD HEALTH SYSTEM

Research News

DETROIT - A study published in the Journal of Occupational and Environmental Medicine from researchers at Henry Ford Health System has found that Henry Ford's early implementation of a universal mask policy in the COVID-19 pandemic was associated with reducing the risk of healthcare workers at Henry Ford acquiring COVID-19.

Through retrospective analysis of an internal hospital quality metric reporting analytics database that was not associated with electronic medical records, researchers discovered a correlation between the implementation of Henry Ford's universal mask policy and a significant drop in the rate at which its Healthcare workers tested positive for SARS-CoV-2. As COVID-19 diagnoses and hospitalizations across the State of Michigan continued to rise through late March 2020, the cases among Henry Ford's healthcare workers began to fall. By the time the first peak in COVID-19 cases occurred in the general population, the rate of cases among Henry Ford healthcare workers was already trending downward.

"This research reinforces the fact that mask wearing is effective in reducing the risk of acquiring COVID-19 and validated our decision early on to implement the universal mask policy, not only to protect our team members, but also to ensure they are able to care for members of the community who had contracted COVID-19," said Steven Kalkanis, M.D., CEO of Henry Ford Medical Group. "At Henry Ford Health System, our universal mask policy issued on March 26, 2020 ensured all staff, both clinical and non-clinical, received surgical or procedural masks and mandated that staff wear a mask at work while also following all other personal protective equipment requirements. Our hope is that the findings of this study continue to encourage members of the community to wear a mask in line with Centers for Disease Control and Prevention recommendations."

Healthcare workers have a threefold increased risk of reporting testing positive for SARS-CoV-2, the virus that causes COVID-19, compared to the general population, according to a study published in Lancet Public Health. As of March 22, 2021, the Centers for Disease Control and Prevention (CDC) has reported more than 450,000 SARS-CoV-2 infections among healthcare workers in the U.S. since the onset of the pandemic, and nearly 1,500 COVID-19 related deaths among healthcare workers.

From March 12 - August 10, 2020, 19.2% of healthcare workers at Henry Ford were symptomatic for COVID-19 and underwent SARS-CoV-2 testing. Before March 28-30 - the single changepoint in the data when the rate of new cases began to trend downward - the odds of a tested healthcare worker having a positive SARS-CoV-2 test result doubled every 4.5 - 7.5 days. After March 30, the odds of a tested healthcare worker having a positive result reduced by half every 10.5 - 13.5 days.

"This effort would not have been possible without the leadership of our executive team, including our president and CEO Wright Lassiter, III, Dr. Steven Kalkanis, chief clinical officer Dr. Adnan Munkarah, and chief operating officer Bob Riney," said Dee Dee Wang, M.D., Director of Structural Heart Imaging at Henry Ford Hospital and principal investigator of the study. "At a time when much was unknown about the novel coronavirus, this initiative truly helped keep our healthcare workers safe. I would also like to acknowledge Dr. Betty Chu, our associate chief clinical officer and chief quality officer; Dr. William O'Neill, director of our Center for Structural Heart Disease; Dr. Geehan Suleyman, medical director of Infection Control; Dr. Marcus Zervos, chief of our Infectious Disease division; and so many others who were instrumental in the creation and successful implementation of our universal mask policy."

With the arrival of COVID-variants in the community, even with COVID-19 vaccines now being rolled out, healthcare workers and community members should remain vigilant and continue to wear a mask in accordance with CDC recommendations.

Henry Ford is providing onsite expertise and oversight for the vaccine administrations, medical care and operations at the Ford Field mass vaccination site. Vaccines administered at Ford Field are in addition to Michigan's regular statewide vaccine allotment. Key facts to know:

- Will operate seven days a week from 8 a.m. - 8:30 a.m. for eight weeks

- The U.S. Air Force will provide vaccination support

- 68 vaccination pods will be set up on the Concourse at Ford Field. Vaccinations are open to those who meet the Michigan Department of Health and Human Services vaccine guidelines.

Registration and appointment scheduling are being managed by Meijer. People may register in the following ways:

- Online at clinic.meijer.com/register/CL2021

- Text EndCOVID to 75049

- Call the State of Michigan COVID hotline at 888-535-6136 (Press 1) Monday-Friday 8 a.m. - 5 p.m. and Saturday/Sunday 8 a.m. - 1 p.m.

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About Henry Ford Health System

Founded in 1915 by Henry Ford himself, Henry Ford Health System is a non-profit, integrated health system committed to improving people's lives through excellence in the science and art of healthcare and healing. Henry Ford Health System includes Henry Ford Medical Group, with more than 1,900 physicians and researchers practicing in more than 50 specialties at locations throughout Southeast and Central Michigan. Acute care hospitals include Henry Ford Hospital in Detroit, MI and Henry Ford Allegiance Health in Jackson, MI - both Magnet® hospitals; Henry Ford Macomb Hospital; Henry Ford West Bloomfield Hospital; and Henry Ford Wyandotte Hospital.

The largest of these is Henry Ford Hospital in Detroit, a quaternary care research and teaching hospital and Level 1 Trauma Center recognized for clinical excellence in cardiology, cardiovascular surgery, neurology, neurosurgery, and multi-organ transplants. The health system also provides comprehensive, best-in-class care for cancer at the Brigitte Harris Cancer Pavilion, and orthopedics and sports medicine at the William Clay Ford Center for Athletic Medicine - both in Detroit.

As one of the nation's leading academic medical centers, Henry Ford Health System annually trains more than 3,000 medical students, residents, and fellows in more than 50 accredited programs, and has trained nearly 40% of the state's physicians. Our dedication to education and research is supported by nearly $100 million in annual grants from the National Institutes of Health and other public and private foundations.

Henry Ford's not-for-profit health plan, Health Alliance Plan (HAP), provides health coverage for more than 540,000 people.

Henry Ford Health System employs more than 33,000 people, including more than 1,600 physicians, more than 6,600 nurses and 5,000 allied health professionals.

 

The case of the cloudy filters: Solving the mystery of the degrading sunlight detectors

NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY (NIST)

Research News

 

IMAGE: TWO EUV FILTERS THAT WERE USED IN A SPACE FLIGHT. THE WRINKLY LOOKING FILTER ON TOP IS MADE OF ZIRCONIUM; THE SMOOTHER BOTTOM FILTER IS MADE OF ALUMINUM. EACH FILTER... view more 

CREDIT: ANDREW JONES/LASP

More than 150 years ago, the Sun blasted Earth with a massive cloud of hot charged particles. This plasma blob generated a magnetic storm on Earth that caused sparks to leap out of telegraph equipment and even started a few fires. Now called the Carrington Event, after one of the astronomers who observed it, a magnetic storm like this could happen again anytime, only now it would affect more than telegraphs: It could damage or cause outages in wireless phone networks, GPS systems, electrical grids powering life-saving medical equipment and more.

Sun-facing satellites monitor the Sun's ultraviolet (UV) light to give us advance warning of solar storms, both big ones that could cause a Carrington-like event as well as the smaller, more common disturbances that can temporarily disrupt communications. One key piece of equipment used in these detectors is a tiny metal filter that blocks out everything except the UV signal researchers need to see.

But for decades, there has been a major problem: Over the course of just a year or two, these filters mysteriously lose their ability to transmit UV light, "clouding up" and forcing astronomers to launch expensive annual recalibration missions. These missions involve sending a freshly calibrated instrument into space to make its own independent observations of the sunlight for comparison.

A leading theory has been that the filters were developing a layer of carbon, whose source is contaminants on the spacecraft, that blocked incoming UV light. Now, NIST scientists and collaborators from the Laboratory for Atmospheric and Space Physics (LASP) in Boulder, Colorado, have found the first evidence indicating that carbonization is not the problem, and it must be something else, such as another possible stowaway from Earth. The researchers describe their work in Solar Physics today.

"To my knowledge, it's the first quantitative, really solid argument against carbonization as the cause of the filter degradation," said NIST physicist Charles Tarrio.

What Are They Good For? Absolutely Everything

Most of the light produced by the Sun is visible and includes the rainbow of colors from red (with a wavelength of around 750 nanometers) to violet (with a wavelength of about 400 nm). But the Sun also produces light with wavelengths too long or short for the human eye to see. One of these ranges is extreme ultraviolet (EUV), extending from 100 nm down to just 10 nm.

Only about a tenth of a percent of sunlight is in the EUV range. That tiny EUV signal is extremely useful because it spikes in tandem with solar flares. These eruptions on the surface of the Sun can cause changes to Earth's upper atmosphere that disrupt communications or interfere with GPS readings, causing your phone to suddenly think you are 40 feet away from your true location.

Satellites that measure EUV signals help scientists monitor these solar flares. But the EUV signals also give scientists a heads-up of hours or even days before more destructive phenomena such coronal mass ejections (CMEs), the phenomenon responsible for the Carrington Event. Future CMEs could potentially overload our power lines or increase radiation exposure for airline crew and passengers traveling in certain locations.

And nowadays, the satellites do more than merely give us warnings, said LASP senior research scientist Frank Eparvier, a collaborator on the current work.

"In the past few decades we've gone from just sending out alerts that flares have happened to being able to correct for solar variability due to flares and CMEs," Eparvier said. "Knowing in real time how much the solar EUV is varying allows for the running of computer models of the atmosphere, which can then produce corrections for the GPS units to minimize the impacts of that variability."

The Mystery of the Cloudy Filters

Two metals are particularly useful for filtering out the massive amounts of visible light to let through that small but important EUV signal. Aluminum filters transmit EUV light between 17 nm and 80 nm. Zirconium filters transmit EUV light between 6 nm and 20 nm.

While these filters begin their lives transmitting a lot of EUV light in their respective ranges, the aluminum filters, in particular, quickly lose their transmission abilities. A filter might start by allowing 50% of 30-nm EUV light through to the detector. But within just a year, it only transmits 25% of this light. Within five years, that number is down to 10%.

"It's a significant issue," Tarrio said. Less light transmitted means less data available -- a little like trying to read in a dimly lit room with dark sunglasses.

Scientists have long known that carbon deposits can build up on instruments when they are subjected to UV light. Sources of carbon on satellites can be everything from fingerprints to the materials used in the construction of the spacecraft itself. In the case of the mysteriously cloudy UV filters, researchers thought carbon might have been deposited on them, absorbing EUV light that would otherwise have passed through.

However, since the 1980s, astronomers have been carefully designing spacecraft to be as carbon-free as possible. And that work has helped them with other carbonization problems. But it didn't help with the aluminum EUV filter issue. Nevertheless, the community still suspected carbonization was at least partially responsible for the degradation.

Make-Your-Own Space Weather

To test this in a controlled setting, NIST researchers and collaborators used a machine that effectively lets them create their own space weather.

The instrument is NIST's Synchrotron Ultraviolet Radiation Facility (SURF), a room-sized particle accelerator that uses powerful magnets to move electrons in a circle. The motion generates EUV light, which can be diverted via specialized mirrors to impact targets -- in this case, the aluminum and zirconium satellite filters.

Each filter was 6 millimeters by 18 mm, smaller than a postage stamp, and only 250 nm thick, about 400 times thinner than a human hair. The sample filters were actually slightly thicker than real satellite filters, with other small changes designed to prevent the SURF beam from literally burning holes into the metals. During a run, the back side of each filter was exposed to a controlled source of carbon.

To speed up the testing process, the team blasted the filters with the equivalent of five years' worth of space weather in a mere hour or two. Incidentally, getting that kind of beam power was no sweat for SURF.

"We turn SURF down to about half a percent of its normal power in order to expose the filters to a reasonable amount of light," Tarrio said. "The satellites are 92 million miles away from the Sun, and the Sun's not putting out an awful lot of EUV to begin with."

Finally, after exposure, researchers tested each filter to see how much EUV light in the correct wavelength range was able to pass through.

The team found that transmission was not significantly different after exposure versus before exposure, for either the aluminum or the zirconium. In fact, the difference in transmission was just a fraction of a percent, not nearly enough to explain the kind of clouding that happens in real space satellites.

"We were looking for a 30% decrease in transmission," Tarrio said. "And we just didn't see it."

As an extra test, the scientists gave the filters even larger doses of light -- the equivalent of 50 years' worth of ultraviolet radiation. And even that didn't produce much of a light transmission problem, growing just 3 nm of carbon on the filters -- 10 times less than researchers would have expected if carbon was responsible.

So If It's Not Carbon ...

The real culprit hasn't yet been identified, but researchers already have a different suspect in mind: water.

Like most metals, aluminum naturally has a thin layer on its surface of a material called an oxide, which forms when aluminum binds with oxygen. Everything from aluminum foil to soda cans has this oxide layer, which is chemically identical to sapphire.

In the proposed mechanism, the EUV light would pull atoms of aluminum out of the filter and deposit them on the filter's exterior, which already has that thin oxide layer. The exposed atoms would then react with the oxygen in water from Earth that has hitched a ride on the spacecraft. Together, the exposed aluminum and water would react to form a much thicker oxide layer, which could theoretically be absorbing the light.

Further SURF experiments scheduled for later this year should answer the question of whether the problem really is water, or something else. "This would be the first time that people have looked at the deposition of aluminum oxide in this context," Tarrio said. "We're looking into it as a serious possibility."

-- Reported and written by Jennifer Lauren Lee

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Where do the gender differences in the human pelvis come from?

A comparison with chimpanzees provides surprising insights

UNIVERSITY OF VIENNA

Research News

 

IMAGE: PHOTO OF A FEMALE HUMAN PELVIS AND SKULL OF A NEWBORN BABY. (© BARBARA FISCHER) view more 

CREDIT: PHOTO OF A FEMALE HUMAN PELVIS AND SKULL OF A NEWBORN BABY. (© BARBARA FISCHER)

Fossil remains of the human pelvis are rare because the pelvic bones do not preserve very well. Therefore, it has remained unclear when human sex differences in the pelvis evolved: jointly with upright walking, or later, together with the large human brains. "We have discovered that the pattern of sex differences in the human pelvis is probably much older than previously thought", says evolutionary biologist Barbara Fischer.

A team of biologists from the University of Vienna, the KLI for Evolution and Cognition Research, and the University of Calgary compared pelvic sex differences in humans with those in chimpanzees, the most closely-related living species to modern humans. Chimpanzees have much easier births than humans, because their fetuses are smaller. "We analyzed 3D data of pelves for these two species and found that they show the same pattern of sex differences, despite large overall species differences," says Fischer. Yet, the magnitude of the differences was only half as large in chimpanzees, compared to humans. The striking similarity of the pattern of pelvic sex differences in humans and chimpanzees strongly suggests that it was already present in the common ancestor of the two species. This implies that all the extinct hominin (human-like) species, including e.g., the Neandertals, probably had the same pattern.

Many mammals give birth to larger fetuses, relative to the birth canal of their mothers, compared to humans, e.g., bats and certain primates. These animals possess adaptations in their pelves to facilitate birth of large babies. At the same time, there are other mammals with tiny neonates, e.g., cats and opossums, which also have subtle sex differences in their pelves that resemble the human pattern. This suggests that these similarities in the pattern of pelvic sex differences reflect an old and evolutionarily conserved mammalian pattern. "We think that modern humans did not evolve this pattern de novo, but that we inherited it from earlier mammals that faced the same problem, namely having to give birth to relatively large fetuses," says Fischer. When our brains became increasingly large over the course of human evolution, the magnitude of pelvic sex differences was therefore able to increase rather rapidly, as the pelvic pattern and the underlying genetic and developmental machinery were already in place and did not have to evolve anew.

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Publication in Nature Ecology & Evolution:
Barbara Fischer, Nicole D.S. Grunstra, Eva Zaffarini, Philipp Mitteroecker (2021)
Sex differences in the pelvis did not evolve de novo in modern humans. Nature Ecology & Evolution, in print.
DOI: 10.1038/s41559-021-01425-z

Most US Covid deaths ‘could have been mitigated’ after first 100,000, Birx says

Richard Luscombe 

The “vast majority” of the almost 550,000 coronavirus deaths in the US could have been prevented if Donald Trump’s administration had acted earlier and with greater conviction, according to one of the public health experts charged with leading the pandemic response at the time.

© Photograph: Jim Watson/AFP/Getty Images Dr Deborah Birx listens during a coronavirus taskforce briefing at the White House on 18 April 2020.

Dr Deborah Birx was the White House coronavirus taskforce coordinator in the Trump administration and is among six leading medical experts involved in the then government’s efforts to fight the outbreak who will assess errors, missteps and moments of success, during a CNN documentary to be broadcast on Sunday night.

Birx, who last week took a controversial new private-sector job as medical adviser to an air cleaning company in California, will point to the Trump administration’s failure to learn from or respond quickly to the first wave of infections that swept the country in early spring 2020.

“I look at it this way. The first time we have an excuse,” Birx tells CNN’s Sanjay Gupta in the programme entitled Covid War: The Pandemic Doctors Speak Out.

She goes on: “There were about 100,000 deaths that came from that original surge. All of the rest of them, in my mind, could have been mitigated or decreased substantially.”




Trump was criticised for downplaying the seriousness of the virus, making numerous false claims, including that its effects were no worse than flu, predicting Covid-19 would “just disappear” and referring to it in racist terms. He pressed for cities and states to reopen through last summer as a second wave pushed the death toll higher.

He also ridiculed the wearing of masks and made outlandish claims such as suggesting injecting disinfectant into the body could be a legitimate coronavirus treatment, which experts slammed at the time as dangerous.

A Columbia University study last year found 84% of deaths could have been prevented with an earlier shutdown, CNN reported.

Birx, who often praised Trump, claimed in January she had been “censored” by the White House and had considered quitting. But her decision to speak out in tonight’s documentary was criticised by other prominent pandemic experts.

“This happened on her watch,” Jonathan Reiner of George Washington University told CNN, adding that Birx had “a duty to stand up and speak up”.

Birx also recounted that after last August she said publicly that the virus was “extraordinarily widespread” and spreading in rural areas, and because of the “clarity that I brought about the epidemic” she was subject to “horrible pushback” from the White House and received aggressive phone calls from Trump.

Another doctor featured in the documentary, Robert Redfield, the former director of the Centers for Disease Control and Prevention (CDC), appears to repeat Birx’s claims of censorship by the administration.

Stating he was “allowed to have opinions now”, Redfield will claim, without evidence, that he believes Covid-19 was created in a Chinese laboratory.

“If I was to guess, this virus started transmitting somewhere in September, October in Wuhan,” he said. “That’s my own feelings, and only opinion.”

The World Health Organization has called the assertion “extremely unlikely”, while Dr Anthony Fauci, the US government’s head of infectious diseases, also downplayed it in a White House briefing on Friday.

“Obviously, there are a number of theories. Dr Redfield was mentioning that he was giving an opinion as to a possibility, but again, there are other alternatives, others that most people hold by,” Fauci said.

Birx and Redfield are not serving in Joe Biden’s administration, while Fauci has been retained by the new administration’s White House team, as the leading infectious diseases adviser to the president.

The programme will air as the CDC reports more than 50 million Americans are now fully vaccinated and Biden targets 200m vaccinations in his first 100 days in office. The CDC, however, remains “deeply concerned” about rising infections even as vaccinations set daily records.

Fauci will tell Gupta that his push to go “all out” on pursuing a vaccine as early as January 2020 “may have been the best decision I have ever made”.

Manitoba had very little snow this winter, which has some worried we're in for a drought

Sarah Petz 

CBC

3/28/2021

 

© Marina von Stackelberg/CBC It's been a dry fall and winter for Winnipeg and many parts of southern Manitoba, and that could spell bad news for farmers wanting to plant their crops.

It's been one of the driest years on record for Manitoba, and that has some people, particularly farmers, worried the province will face a drought this year.

Parts of southwestern Manitoba have seen less than 20 millimetres of precipitation since Nov. 1, which is close to 30 per cent less than normal, said Rob Paola, a retired Environment Canada meteorologist who runs the popular website and Twitter account @robsobs.

Winnipeg had its third driest winter on record, with only about 25 millimetres of precipitation in December, January and February, he said.

"We've had almost no snowstorms the entire winter, and now as we get into spring, that storm track is still kind of bypassing us to the south, and we're missing out on these big weather systems," he said.

This is concerning heading into warmer months as it leads to increased risk of wildfires, grass fires and even forest fires if it gets into central and northern Manitoba, he said.

For farmers, it means less soil moisture as they plant their crops.

Bill Campbell, president of Keystone Agricultural Producers, said crop production will be compromised if Manitoba doesn't see some timely rains.

"It's a huge concern, because I would say our subsoil moisture is gone and that bank account of moisture will not be there to kind of get us through the tough times if we have that scenario of no moisture through the summer," he said.

It's a huge investment for farmers to plant their crops, and there's no guarantee that there will be sufficient moisture through the spring and summer to allow the crops to grow properly, he said.

"And when we seed it, we don't get it back. Like, you can't go and say, 'Well God, I'd like to get some of that investment back, please. Can I get it out of the dirt?'" he said.

"It's an investment that you rely on Mother Nature to provide the moisture in the right environment so that we have a crop to harvest."

Another concern is feed for livestock. If cattle can't feed on grass, that means farmers have to purchase feed, Campbell said. If there's no feed to purchase, farmers will have to sell their livestock.

It has a huge impact on the Manitoba economy, he said.

Still, the situation can turn around quickly if the province sees even an inch of rain in April, he said.

"An inch of rain would get us a lot more comfortable," he said.

The first provincial flood forecast of the year said spring flooding is very unlikely and Manitoba is looking at a drier spring.

New York lawmakers agree to legalize recreational marijuana

ALBANY, N.Y. — New York is poised the join the growing number of states that have legalized marijuana after state lawmakers reached a late-night deal to allow sales of the drug for recreational use.

© Provided by The Canadian Press

Democrats who now wield a veto-proof majority in the state Legislature have made passing it a priority this year, and Democratic Gov. Andrew Cuomo’s administration has estimated legalization could eventually bring the state about $350 million annually.

“My goal in carrying this legislation has always been to end the racially disparate enforcement of marijuana prohibition that has taken such a toll on communities of colour across our state, and to use the economic windfall of legalization to help heal and repair those same communities,” Sen. Liz Krueger, Senate sponsor of the bill and chair of the Senate’s finance committee, said.

At least 14 other states already allow residents to buy marijuana for recreational and not just medical use, but New York’s past efforts to pass marijuana legalization have failed in recent years.

The legislation would allow recreational marijuana sales to adults over the age of 21, and set up a licensing process for the delivery of cannabis products to customers. Individual New Yorkers could grow up to three mature and three immature plants for personal consumption, and local governments could opt out of retail sales.

The legislation would take effect immediately if passed, though sales wouldn’t start until New York sets up rules and a proposed cannabis board. Assembly Majority Leader Crystal Peoples-Stokes estimated Friday it could take 18 months to two years for sales to start.

Adam Goers, a vice-president of Columbia Care, a New York medical marijuana provider that’s interested in getting into the recreational market, said New York’s proposed system would “ensure newcomers have a crack at the marketplace” alongside the state’s existing medical marijuana providers.

“There’s a big pie in which a lot of different folks are going to be able to be a part of it,” Goers said.

New York would set a 9% sales tax on cannabis, plus an additional 4% tax split between the county and local government. It would also impose an additional tax based on the level of THC, the active ingredient in marijuana, ranging from 0.5 cents per milligram for flower to 3 cents per milligram for edibles.

New York would eliminate penalties for possession of less than three ounces of cannabis, and automatically expunge records of people with past convictions for marijuana-related offences that would no longer be criminalized. That’s a step beyond a 2019 law that expunged many past convictions for marijuana possession and reduced the penalty for possessing small amounts.

And New York would provide loans, grants and incubator programs to encourage participation in the cannabis industry by people from minority communities, as well as small farmers, women and disabled veterans.

Proponents have said the move could create thousands of jobs and begin to address the racial injustice of a decades-long drug war that disproportionately targeted minority and poor communities.

“Police, prosecutors, child services and ICE have used criminalization as a weapon against them, and the impact this bill will have on the lives of our oversurveiled clients cannot be overstated,” Alice Fontier, managing director of Neighborhood Defender Service of Harlem, said in a statement Saturday.

New York's Legal Aid Society also hailed the agreement. “This landmark legislation brings justice to New York State by ending prohibition, expunging conviction records that have curtailed the opportunities of countless predominately young Black and Latinx New Yorkers, and delivers economic justice to ensure that communities who have suffered the brunt of aggressive and disparate marijuana enforcement are first in line to reap the economic gain,” the group said in a news release Sunday.

Melissa Moore, the Drug Policy Alliance’s director for New York state, said the bill "really puts a nail in the coffin of the drug war that’s been so devastating to communities across New York, and puts in place comprehensive policies that are really grounded in community reinvestment.”

Cuomo has pointed to growing acceptance of legalization in the Northeast, including in Massachusetts, Maine and most recently, New Jersey.

Past efforts to legalize recreational use have been hurt by a lack of support from suburban Democrats, disagreements over how to distribute marijuana sales tax revenue and questions over how to address drivers suspected of driving high.

It also has run into opposition from law enforcement, school and community advocates, who warn legalization would further strain a health care system already overwhelmed by the coronavirus pandemic and send mixed messages to young people.

“We are in the midst of the COVID-19 pandemic, and with the serious crisis of youth vaping and the continuing opioid epidemic, this harmful legislation is counterintuitive,” said an open letter signed by the Medical Society of the State of NY, New York State Parent Teacher Association, New York Sheriff’s Association and several other organizations March 11.

New York officials plan to launch an education and prevention campaign aimed at reducing the risk of cannabis among school-aged children, and schools could get grants for anti-vaping and drug prevention and awareness programs.

And the state will also launch a study due by Dec. 31, 2022, that examines the extent that cannabis impairs driving, and whether it depends on factors like time and metabolism.

“One of the things that no country in the world has and everybody wants is a way to quickly and easily figure out if someone’s high or impaired on cannabis,” University of Buffalo psychologist and professor of community health and health behaviour R. Lorraine Collins said. “Research is being done to find systems that can do that. But I think those efforts will not come to fruition for awhile.”

The bill also sets aside revenues to cover the costs of everything from regulating marijuana, to substance abuse prevention.

State police could also get funding to hire and train more so-called “drug recognition experts.”

But there’s no evidence that drug recognition experts can tell whether someone is high or not, according to Collins, who was appointed to Cuomo’s 2018 working group tasked with drafting cannabis regulations.

“I think it’s very important that we approach that challenge using science and research and not wishes or unsubstantiated claims,” Collins said.

Collins pointed to a 2020 report from the American Civil Liberties Union that found that Blacks are almost four times more likely to be arrested for marijuana possession compared to Whites, based on FBI statistics.

“Every New Yorker should be concerned about how these laws will be implemented or how those ways of examining drivers will be implemented in different communities,” Collins said. “It’s not likely to be equal.”

The bill allows cities, towns and villages to opt out of allowing adult-use cannabis retail dispensaries or on-site consumption licenses by passing a local law by Dec. 31, 2021 or nine months after the effective date of the legislation. They cannot opt out of legalization.

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Peltz reported from New York City.

Marina Villeneuve And Jennifer Peltz, The Associated Press