Providing more low-value care doesn't lead to higher patient experience ratings

New study challenges the assumption that offering patients more tests and procedures will lead to higher patient experience ratings

IN FACT SO CALLED HIGH VALUE SERVICE IS NOT FOR THE PATIENT IT IS ABOUT MAKING $$$$ FOR INSURANCE COMPANIES

UNIVERSITY OF CHICAGO MEDICAL CENTER

Research News

 

As hospitals, insurance companies and policy makers seek to improve healthcare quality and reduce rising medical costs, one important metric used to assess clinicians hinges on how patients feel about their healthcare experience. Many healthcare providers and policy makers fear that increased pressure to please patients -- and ensure high satisfaction ratings as a result -- could lead to overuse of low-value care that doesn't provide any clinical benefit while unnecessarily ratcheting up medical bills.

But new research from the University of Chicago and Harvard Medical School may alleviate some of those concerns. The study, published May 28 in JAMA Internal Medicine, found no relationship between favorable patient ratings and exposure to more low-value care.

"Some believe that much low-value care is provided by doctors because they feel like they have  toappease patients. This worry has become bigger as patient ratings are increasingly used in new payment models and public reporting of healthcare rankings," said lead author Prachi Sanghavi, PhD, Assistant Professor of Public Health Sciences at UChicago. "For example, if a patient asks for extra testing or screening when it's not medically indicated, should doctors worry they will be rated poorly if they don't comply? At the same time, physicians feel pressure to reduce unnecessary testing and procedures when possible, because they are wasteful and can lead to harm downstream."

At least one often-cited study supports the concern that a focus on patient ratings will lead to more low-value care, finding patients with higher satisfaction ratings had higher odds of inpatient admission, higher healthcare and prescription drug costs and higher mortality. This study implied that catering to patient satisfaction may lead to worse outcomes. But, Sanghavi says, these results are likely a reflection of the methods used in the study.

"The past research didn't adequately adjust for certain key factors, like how sick a patient might be, which could be a confounding factor," said Sanghavi. "For example, people who are chronically or terminally ill may use more care and may develop closer relationships with their doctors, which could in turn lead to higher patient satisfaction ratings."

In their new study, Sanghavi and her team examined data from the federal Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, which uses patient-provided observations to measure things like communication with a physician, timeliness of scheduling an appointment and time spent in the waiting room. They also analyzed Medicare claims to measure the amount of low-value care received by a physician's patient panel. Unlike past studies, the researchers' approach relied on sampling independence and little overlap between the patients in the CAHPS and claims datasets. With this innovative methodology, the researchers were able to eliminate patient-level, unconnected factors that could influence the results and gain a less-biased look at the relationship between patient satisfaction and low-value care exposure.

"While we found a wide range of low-value care across physician patient panels, there was no systematic association between low-value care exposure and favorable patient ratings," said Sanghavi. "So the physicians whose patients get more low-value care are not getting higher ratings."

These results, the investigators say, should help ease the concern that reducing the number of unnecessary care offerings will negatively impact patients' opinions of their physicians or healthcare organizations.

"In short, the concern is overblown," said study co-investigator Michael McWilliams, Professor of Health Care Policy at Harvard Medical School and a general internist at Brigham and Women's Hospital. "Whether it's because less wasteful physicians are adept at informing patients why a requested test or procedure is unnecessary, or because most low-value care is due to provider practice patterns and not patient demand, we should be reassured that we can tackle waste in the system without great patient backlash or flunking providers on their 'scorecards.'"

The researchers said they weren't surprised by the findings, since previous studies relied so heavily on anecdotal evidence.

"In fact, it is not settled whether patients even advocate for low-value services," Sanghavi said. "Either way, it is reasonable to imagine patients base their experience ratings on a range of quality dimensions and not just on how well their physicians give in to demands, should they be making them."

Understanding how patient experiences and ratings are impacted by the types of care they receive has important implications for future policies and funding models geared at reducing wasteful healthcare spending while improving the overall quality of care.

"These results should help alleviate the stress that physicians may feel around possibly leaving patients dissatisfied because they didn't do something the patient asked for," said Sanghavi. "It should also relieve pressure to provide unnecessary care in order to boost ratings."

###

The study, "Association of Low-Value Care Exposure with Health Care Experience Ratings Among Patient Panels," was supported by the National Institute for Health Care Management Foundation and the National Institute on Aging (P01AG032952). Additional authors include Aaron L. Schwartz of the Perelman School of Medicine and Alan Zaslavsky of Harvard Medical School.

About the University of Chicago Medicine & Biological Sciences

The University of Chicago Medicine, with a history dating back to 1927, is one of the nation's leading academic health systems. It unites the missions of the University of Chicago Medical Center, Pritzker School of Medicine and the Biological Sciences Division. Twelve Nobel Prize winners in physiology or medicine have been affiliated with the University of Chicago Medicine. Its main Hyde Park campus is home to the Center for Care and Discovery, Bernard Mitchell Hospital, Comer Children's Hospital and the Duchossois Center for Advanced Medicine. It also has ambulatory facilities in Orland Park, South Loop and River East as well as affiliations and partnerships that create a regional network of care. UChicago Medicine offers a full range of specialty-care services for adults and children through more than 40 institutes and centers including an NCI-designated Comprehensive Cancer Center. Together with Harvey-based Ingalls Memorial, UChicago Medicine has 1,296 licensed beds, nearly 1,300 attending physicians, over 2,800 nurses and about 970 residents and fellows.

Visit UChicago Medicine's health and science news blog at http://www.uchicagomedicine.org/forefront.

Twitter @UChicagoMed
Facebook.com/UChicagoMed
Facebook.com/UChicagoMedComer

Exposure to Family Member Incarceration and Adult Well-being in the United States

Ram Sundaresh, MD, MS¹; Youngmin Yi, PhD²; Tyler D. Harvey, MPH³; et alBrita Roy, MD, MPH, MHS^4,5; Carley Riley, MD, MPP, MHS^6,7; Hedwig Lee, PhD⁸; Christopher Wildeman, PhD^9,10; Emily A. Wang, MD, MAS^3,4

Author Affiliations Article Information

JAMA Netw Open. 2021;4(5):e2111821. doi:10.1001/jamanetworkopen.2021.11821

Original Investigation 

Public Health

May 28, 2021

Key Points

Question  Is the incarceration of a family member associated with well-being and projected life expectancy?

Findings  In this cross-sectional study including 2815 individuals, any family member incarceration was associated with lower well-being and a projected 2.6-year reduction in life expectancy compared with no family member incarceration experience. Among those with any family incarceration, Black respondents had an estimated 0.5 fewer years of projected life expectancy compared with White respondents.

Meaning  These findings suggest that efforts to decarcerate may improve population-level health and well-being by reducing racial disparities and detrimental outcomes associated with incarceration for nonincarcerated family members.

Abstract

Importance  More than half of the adult population in the United States has ever had a family member incarcerated, an experience more common among Black individuals. The impacts of family incarceration on well-being are not fully understood.

Objective  To assess the associations of incarceration of a family member with perceived well-being and differences in projected life expectancy.

Design, Setting, and Participants  This nationally representative cross-sectional study used data from the 2018 Family History of Incarceration Survey to examine how experiences of family member incarceration were associated with a holistic measure of well-being, including physical, mental, social, financial, and spiritual domains. Well-being was used to estimate change in life expectancy and was compared across varying levels of exposure to immediate and extended family member incarceration using logistic regression models to adjust for individual and household characteristics. Data were analyzed from October 2019 to April 2020.

Exposures  Respondents’ history of family member incarceration, including immediate and extended family members.

Main Outcomes and Measures  The main outcome was self-reported life-evaluation, a measure of overall well-being from the 100 Million Healthier Lives Adult Well-being Assessment. Respondents were considered thriving with a current life satisfaction score of 7 or greater and a future life optimism score of 8 or greater, each on a scale of 0 to 10. Other outcomes included physical health, mental health, social support, financial well-being, and spiritual well-being, each measured with separate scales. Additionally, life expectancy projections were estimated using population-level correlations with the Life Evaluation Index. All percentages were weighted to more closely represent the US population.

Results  Of 2815 individuals included in analysis, 1472 (51.7%) were women, 1765 (62.8%) were non-Hispanic White, and 868 (31.5%) were aged 35 to 54 years. A total of 1806 respondents (45.0%) reported having an immediate family member who was incarcerated. Compared with respondents with no family incarceration, any family member incarceration was associated with lower well-being overall (thriving: 69.5% [95% CI, 65.0%-75.0%] vs 56.9% [95% CI, 53.9%-59.9%]) and in every individual domain (eg, physical thriving: 51.1% [95% CI, 46.2-56.0] vs 35.5% [95% CI, 32.6%-38.3%]) and with a mean (SE) estimated 2.6 (0.03) years shorter life expectancy. Among those with any family incarceration, Black respondents had a mean (SE) estimated 0.46 (0.04) fewer years of life expectancy compared with White respondents.

Conclusions and Relevance  These findings suggest that family member health and well-being may be an important avenue through which incarceration is associated with racial disparities in health and mortality. Decarceration efforts may improve population-level well-being and life expectancy by minimizing detrimental outcomes associated with incarceration among nonincarcerated family members.

READ ON/DOWNLOAD PDF

Exposure to Family Member Incarceration and Adult Well-being in the United States | Health Disparities | JAMA Network Open | JAMA Network

USA/UK

Data from 45 million mobile users further shows poorer people less able to stay at home COVID rules

Low earners generally either simply can't afford to stay at home, or work in professions in which working from home is not possible

TAYLOR & FRANCIS GROUP

Research News

 

People living in deprived, less affluent neighborhoods spent less time indoors at home during lockdown, according to a study that tracked data from millions of mobile phone users across the United States.

The study, published in the journal Annals of the American Association of Geographers, adds to growing evidence that low earners are less likely to comply with stay-at-home orders, either because they simply can't afford to, or because they work in professions in which working from home is not possible.

The finding is concerning given the fact that vulnerable groups are already at greater risk from COVID.

In March 2020, the US like many countries in the world entered a state of lockdown, with its citizens advised to stay at home to curb the spread of Coronavirus. Non-essential businesses closed, with people asked to work from home.

To investigate levels of compliance with these orders, researchers analyzed anonymous tracking data from 45 million mobile phone users across the United States. The authors calculated how much time residents in New York, Los Angeles, Chicago, Dallas, Houston, Washington D.C., Miami, Philadelphia, Atlanta, Phoenix, Boston, and San Francisco spent at home in the period between 1 January 2020 to 31 August 2020.

They then compared this with demographic information about the neighborhoods in which people lived, collected through The American Community Survey (ACS), a demographics survey program conducted by the U.S. Census Bureau.

The findings revealed that people living in areas with a higher percentage of wealthy residents, and with a higher average household income level tended to spend more time at home under the stay-at-home orders than people living in poor communities. This finding was valid across all cities that the researchers looked at.

The study also showed that education was correlated with compliance, as people who lived in neighborhoods with a high percentage of postgraduates tended to spend longer at home.

"Our study reveals the luxury nature of stay-at-home orders, which lower-income groups cannot afford to comply with," says author Xiao Huang, Assistant Professor of Geosciences at the University of Arkansas.

"This disparity exacerbates long-standing social inequality issues present in the United States, potentially causing unequal exposure to a virus that disproportionately affects vulnerable populations."

In the UK, too, it has been well-documented that those in more deprived and ethnically diverse communities are at greater risk from the virus.

Data from the Office for National Statistics (ONS) shows that those living in the most deprived neighbourhoods have been more than twice as likely to die from COVID as those in the least deprived. One of the reasons for this is thought to be that low-income workers typically have jobs that cannot be done from home, placing them at greater risk of contracting COVID-19.

They are also more likely to have insecure 'zero hours' contracts, making them worry that if they do not go into work they might not have a job to return to.

Previous research by SAGE has also shown that people who earn less than £20,000, or who have savings of less than £100 are three times less likely to self-isolate.

The authors of the study argue that more needs to be done to protect vulnerable groups from the effects of COVID.

"We must confront systemic social inequality and call for a high-priority assessment of the long-term impact of COVID-19 on geographically and socially disadvantaged groups," says Xiao Huang.

 

Solving a double murder arouses international interest

Getting the conclusive lead with investigative genetic genealogy - A successful case study of a 16 year old double murder in Sweden

LINKÖPING UNIVERSITY

Research News

 

IMAGE: ANDREAS TILLMAR, DOCENT AND ADJUNCT SENIOR LECTURER IN FORENSIC GENETICS AT THE DEPARTMENT OF BIOMEDICAL AND CLINICAL SCIENCES, LINKÖPING UNIVERSITY. view more 

CREDIT: EDIS PORTORI

The technology using DNA-based genealogy that solved a double murder in Linköping opens completely new possibilities in investigating serious crime. LiU researchers are now involved in spreading new knowledge about the technology, which brings hope to police forces and has aroused major international interest.

"We want to tell others about the problems that we faced when working with this pilot case, and how we dealt with them. We can prevent others reinventing the wheel, and make sure that the knowledge available is extended and improved", says Andreas Tillmar.

He is forensic geneticist at the National Board of Forensic Medicine, and adjunct senior lecturer in the Department of Biomedical and Clinical Sciences at Linköping University. His research is focussed on developing methods to obtain genetic information from low-quality DNA samples, such that they give sufficient information, for example, to allow searches in genealogical databases. His methods contributed to the murders in Linköping in 2004 being solved.

Together with colleagues from the Swedish Police Authority and the National Forensic Centre, among others, Andreas Tillmar has published an article in the prestigious scientific journal Forensic Science International: Genetics. The article is a case study of a double murder in October 2004, in which an eight-year-old boy and a 56-year-old woman were stabbed to death. The case was finally solved in June 2020.

The Police Authority conducted a legal inquiry early in 2019 which concluded that the double murder was to be used as a pilot case to test the DNA-based genealogy method. After this, it took 1.5 years of collaboration between researchers and authorities before the murderer could be arrested. The successful resolution was a result of the police being able to use commercial genealogy databases and in this way gain access to a significantly larger selection of people to search.

The article describes the technical, legal and ethical aspects that it was necessary to solve during the work, and how the joint work finally gave a solution.

When the Swedish pilot case started in 2019, the technology of DNA-based genealogical research had been used only to a very limited extent. The first known case, from 2018, had resulted in a serial killer known as the Golden State killer being arrested and convicted in the US.

"This case aroused much attention in the media, but the knowledge behind the arrest was never published, since the technology had been managed by a private company. It wanted to keep the knowledge to itself for commercial reasons. It's different in our case: we have knowledge that is in strong demand and we want to spread it", says Andreas Tillmar.

The article describes not only the painstaking work that resulted in improved DNA-based methods: it also gives examples of legal and ethical questions.

The legal questions concern such matters as the current legislation on personal privacy. It is not obvious that detectives are to be able to use genetic information from commercial DNA-based genealogy databases. "It's a grey area. Technology is often one step ahead of the law."

Ethical dilemmas that arise with this type of DNA analysis include the fact that the police obtain the DNA information of individuals and in this way insight into their private lives. This includes kinship relationships, and their risk of developing certain genetic diseases.

"Thus, there is a risk of a conflict between that two important principles: the right of the individual to privacy against the aspiration of society to solve serious crime", says Andreas Tillmar.

He points out that the solution to the double murder has aroused considerable international interest.

"As far as we know, we are the first outside the US to use the technology. We hope that others can benefit from our work, and that we can improve these DNA-based methods through, for example, international collaboration," says Andreas Tillmar.

###

The article: "Getting the conclusive lead with investigative genetic genealogy - A successful case study of a 16 year old double murder in Sweden", Andreas Tillmar, Siri Aili Fagerholm, January Staaf, Peter Sjölund and Ricky Ansell, (2021), Forensic Science International: Genetics, published online 8 May 2021, doi: 10.1016/j.fsigen.2021.102525

 

Next-gen electric vehicle batteries: These are the questions we still need to answer

University of Michigan researchers lay out hurdles for tech that could double EV range

UNIVERSITY OF MICHIGAN

Research News

 

The next generation of electric vehicle batteries, with greater range and improved safety, could be emerging in the form of lithium metal, solid-state technology.

But key questions about this promising power supply need to be answered before it can make the jump from the laboratory to manufacturing facilities, according to University of Michigan researchers. And with efforts to bring electric vehicles to a larger part of the population, they say, those questions need answering quickly.

Jeff Sakamoto and Neil Dasgupta, U-M associate professors of mechanical engineering, have been leading researchers on lithium metal, solid-state batteries over the past decade. In a perspective piece in the journal Joule, Sakamoto and Dasgupta lay out the main questions facing the technology. To develop the questions, they worked in close collaboration with leaders in the auto industry.

Major automakers are going all-in on electric vehicles this year, with many announcing plans to phase out internal-combustion engine cars in the coming years. Lithium-ion batteries enabled the earliest EVs and they remain the most common power supply for the latest models coming off assembly lines.

Those lithium-ion batteries are approaching their peak performance in terms of the EV range on a single charge. And they come with the need for a heavy and bulky battery management system--without which there is risk of onboard fires. By utilizing lithium metal for the battery anode along with a ceramic for the electrolyte, researchers have demonstrated the potential for doubling EV range for the same size battery while dramatically reducing the potential for fires.

"Tremendous progress in advancing lithium metal solid-state batteries was made over the last decade," Sakamoto said. "However, several challenges remain on the path to commercializing the technology, especially for EVs."

Questions that need to be answered to capitalize on that potential include:

How can we produce ceramics, which are brittle, in the massive, paper-thin sheets lithium metal batteries require?

Do lithium metal batteries' use of ceramics, which require energy to heat them up to more than 2,000 degrees Fahrenheit during manufacturing, offset their environmental benefits in electric vehicles?

Can both the ceramics and the process used to manufacture them be adapted to account for defects, such as cracking, in a way that does not force battery manufacturers and automakers to drastically revamp their operations?

A lithium metal solid-state battery would not require the heavy and bulky battery management system that lithium-ion batteries need to maintain durability and reduce the risk of fire. How will the reduction in mass and volume of the battery management system--or its removal altogether--affect performance and durability in a solid-state battery?

The lithium metal needs to be in constant contact with the ceramic electrolyte, meaning additional hardware is needed to apply pressure to maintain contact. What will the added hardware mean for battery pack performance?

Sakamoto, who has his own startup company focused on lithium metal solid-state batteries, says the technology is having a moment right now. But the enthusiasm driving the moment, he says, must not get ahead of itself.

###

Rigorous testing and data analysis, along with transparency in research, are needed, according to the U-M team. That group includes Michael Wang, now a postdoctoral researcher at MIT, and Eric Kazyak, a research fellow in mechanical engineering at U-M.

Images

Study abstract: Transitioning solid-state batteries from lab to market: Linking electro-chemo-mechanics with practical considerations

The Sakamoto Group

The Dasgupta Group

###

 

UM research suggests social factors important for human-wildlife coexistence

THE UNIVERSITY OF MONTANA

Research News

 

IMAGE: ONE THING BEARS AND PEOPLE HAVE IN COMMON? THEIR LOVE OF A TASTY SNACK. HERE, A BLACK BEAR WANDERS IN THE NINEMILE VALLEY OF MONTANA. view more 

CREDIT: CHARLIE DURRANT

MISSOULA - In bear country, it's normal to find bruins munching down on temptations left out by humans - from a backyard apple tree to leftovers in the trash bin - but these encounters can cause trouble for humans and bears alike. One method to reduce human-bear conflicts is to secure attractants like garbage and livestock feed.

While effective when implemented, this approach requires people to change their behavior, and that makes things a little more complicated.

University of Montana researchers recently published a new study in the Journal of Wildlife Management analyzing why landowners do or don't secure attractants in bear country. The results suggest that collective or socially motivated factors may be a missing and important piece of the puzzle for encouraging voluntary steps to secure attractants and improve wildlife-human coexistence. The researchers also offer suggestions for how wildlife managers might help increase these behaviors through improved messaging and outreach.

Social scientists in UM's Human Dimensions Lab, housed in UM's W. A. Franke College of Forestry and Conservation, classify human-wildlife interactions as a public-good, collective-action problem - a problem where solutions require contributions from many people and where people's actions affect others. For the study, they applied this theory in Montana's black bear and grizzly bear ranges to investigate how individual and collective factors work together to influence whether landowners secure bear attractants on their land.

"A collective-action problem requires the efforts of two or more individuals to solve," said Holly Nesbitt, a doctoral candidate in the College of Forestry and Conservation and the study's lead author. "We're arguing that securing bear attractants - that coexistence with wildlife - is a collective-action problem because you need multiple people - land owners specifically - to pull it off. Their actions protect themselves and their neighbors."

Nesbitt and her coauthors analyzed data from a 2018 survey of Montana landowners meant to understand their attitudes and behaviors related to bears. Among other questions, the survey asked people about their willingness to secure different attractants, like using bear-resistant garbage bins and removing bird feeders.

Researchers found that the most important factor in determining if a landowner would secure attractants was whether that landowner had talked to a wildlife professional.

"We think that landowners who have talked to a wildlife professional have received information more easily than those who haven't," Nesbitt said. "In theory, they have reduced the time costs of securing attractants, so we think that's why they are more likely to use bear-proof garbage cans, for example."

Other collective factors, like whether their neighbors secure attractants, and the existence of discussion networks (for example, how much social influence an individual has) were equally as important as individual factors like beliefs, age or gender.

"The fact that this is a collective-action problem - that we're in it together, that it needs all of us to solve it, that our behavior has impact on our neighbors, too - leads us to the conclusion that what people are doing around us matters and influences our own behavior," says UM Assistant Professor Alex Metcalf, a coauthor on the study.

The researchers hope the results help wildlife managers reimagine how they communicate with landowners.

For example, wildlife managers and outreach coordinators could potentially increase attractant securing behavior by emphasizing collective factors in addition to individual factors.

"With any sort of outreach or messaging to landowners, there's maybe another opportunity to lean on these other collective factors and include more normative messaging. It might be more effective," Nesbitt said. "Instead of saying, 'Bears are dangerous. Secure your attractants,' say, 'It's really important to your neighbors that you secure your attractants. Your neighbor is doing it, too.' Our data suggests that kind of messaging is likely to be more effective at promoting voluntary behaviors."

The researchers also say, based on the findings, that wildlife agencies would be justified in increasing their efforts to connect with landowners in person, as well as with members of the public who play an important role in discussion networks.

"Our wildlife professionals are critical in connecting with the public, playing an integral role in educating, listening and empowering landowners," said co-author Libby Metcalf, UM's Joel Meier Distinguished Professor of Wildland Management.

While large carnivore populations are decreasing across most of the globe, grizzly and black bear populations are increasing in Montana, offering a unique locale to study how humans and wildlife interact. Nesbitt and her co-authors say understanding how to manage conflict with large carnivores has never been more pressing.

"We need a more comprehensive understanding of how people behave in these situations, and it's often not as simple as we think," Alex Metcalf said.

###

 

Pollen-sized technology protects bees from deadly insecticides

CORNELL UNIVERSITY

Research News

 

IMAGE: A BEEMMUNITY EMPLOYEE, ABRAHAM MCCAULEY, APPLIES A POLLEN PATTY CONTAINING MICROSPONGES TO A HIVE AS PART OF COLONY TRIALS. view more 

CREDIT: NATHAN REID

ITHACA, N.Y. - A Cornell University-developed technology provides beekeepers, consumers and farmers with an antidote for deadly pesticides, which kill wild bees and cause beekeepers to lose around a third of their hives every year on average.

An early version of the technology ¬- which detoxified a widely-used group of insecticides called organophosphates - is described in a new study, "Pollen-Inspired Enzymatic Microparticles to Reduce Organophosphate Toxicity in Managed Pollinators," published in Nature Food. The antidote delivery method has now been adapted to effectively protect bees from all insecticides, and has inspired a new company, Beemmunity, based in New York state.

Studies show that wax and pollen in 98% of hives in the U.S. are contaminated with an average of six pesticides, which also lower a bee's immunity to devastating varroa mites and pathogens. At the same time, pollinators provide vital services by helping to fertilize crops that lead to production of a third of the food we consume, according to the paper.

"We have a solution whereby beekeepers can feed their bees our microparticle products in pollen patties or in a sugar syrup, and it allows them to detoxify the hive of any pesticides that they might find," said James Webb, a co-author of the paper and CEO of Beemmunity.

First author Jing Chen is a postdoctoral researcher in the lab of senior author Minglin Ma, associate professor in the Department of Biological and Environmental Engineering in the College of Agriculture and Life Sciences (CALS). Scott McArt, assistant professor of entomology in CALS, is also a co-author.

The paper focuses on organophosphate-based insecticides, which account for about a third of the insecticides on the market. A recent worldwide meta-analysis of in-hive pesticide residue studies found that, under current use patterns, five insecticides posed substantial risks to bees, two of which were organophosphates, McArt said.

The researchers developed a uniform pollen-sized microparticle filled with enzymes that detoxify organophosphate insecticides before they are absorbed and harm the bee. The particle's protective casing allows the enzymes to move past the bee's crop (stomach), which is acidic and breaks down enzymes.

Microparticles can be mixed with pollen patties or sugar water, and once ingested, the safe-guarded enzymes pass through the acidic crop to the midgut, where digestion occurs and where toxins and nutrients are absorbed. There, the enzymes can act to break down and detoxify the organophosphates.

After a series of in vitro experiments, the researchers tested the system on live bees in the lab. They fed a pod of bees malathion, an organophosphate pesticide, in contaminated pollen and also fed them the microparticles with enzyme. A control group was simultaneously fed the toxic pollen, without the enzyme-filled microparticles.

Bees that were fed the microparticles with a high dose of the enzyme had a 100% survival rate after exposure to malathion. Meanwhile, unprotected control bees died in a matter of days.

Beemmunity takes the concept a step further, where instead of filling the microparticles with enzymes that break down an insecticide, the particles have a shell made with insect proteins and are filled with a special absorptive oil, creating a kind of micro-sponge. Many insecticides, including widely-used neonicotinoids, are designed to target insect proteins, so the microparticle shell draws in the insecticide where it is sequestered inert within the casing. Eventually, the bees simply defecate the sequestered toxin.

The company is running colony-scale trials this summer on 240 hives in New Jersey and plans to publicly launch its products starting in February 2022. Products include microparticle sponges in a dry sugar medium that can be added to pollen patties or sugar water, and consumer bee feeders in development.

"This is a low-cost, scalable solution which we hope will be a first step to address the insecticide toxicity issue and contribute to the protection of managed pollinators," Ma said.

###

Jin-Kim Montclare, a researcher at New York University's Tandon School of Engineering, is a co-author.

The technology is licensed through Cornell's Center for Technology Licensing (CTL). Ma and McArt are advisors for Beemmunity.

The study was funded by the U.S. Department of Agriculture's National Institute of Food and Agriculture, the National Institutes of Health and the National Science Foundation.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases

Japan's hands-off formula in disciplining schoolchildren works. Is it worth a try elsewhere?

A look at Japan's mimamoru approach suggests that adults' non-intervention in kids' fights allows children to nurture social and interpersonal skills on their own. Is it worth a try in other countries?

THEY DO NOT HAVE THE SAME CULTURAL ECOLOGY AS JAPAN

HIROSHIMA UNIVERSITY

Research News

 

IMAGE: ZERO TO MINIMAL INTERVENTION DURING CONFLICT AMONG CHILDREN IS A CHARACTERISTIC OF THE MIMAMORU APPROACH PRACTICED IN JAPANESE SCHOOLS TO FOSTER THE VOLUNTARY PARTICIPATION OF KIDS IN THEIR LEARNING. view more 

CREDIT: PEXELS

A study examining Japanese schools' hands-off approach when children fight showed it could create opportunities for autonomy and encourage ownership of solutions, suggesting a new strategy in handling kids squabbles in other countries.

Called mimamoru, the pedagogical strategy is a portmanteau of the Japanese words mi, meaning watch, and mamoru, meaning guard or protect. It is generally understood as "teaching by watching" -- where adults, including early childhood educators, intentionally let kids handle disagreements on their own to promote their learning through voluntary exploration and actions. While not an official part of Japan's early childhood education and care (ECEC) curriculum, it is treated as an implicit guideline. The approach reflects Japanese socialization practices at home and school, where it is a norm for grownups to wait for children to respond to problems and guide them to take ownership of their learning.

"This study aims to understand the reason why Japanese early childhood educators tend not to intervene, and how and in what contexts they do," said study author Fuminori Nakatsubo, ECEC specialist and associate professor at Hiroshima University's Graduate School of Humanities and Social Sciences.

The researchers said insights gleaned from exploring the mimamoru approach could provide educators with fresh perspectives on disciplinary practices, particularly in countries where direct and immediate intervention is prioritized.

Maximizing learning through minimal intervention

A total of 34 Japanese and 12 US early childhood educators participated in focus groups that used modified video-cued multi-vocal ethnography methods to scrutinize the non-intervention strategy. After watching a three-minute clip showing it in action at a private preschool in western Japan, the international mix of educators discussed non-verbal cues exhibited by the students and teachers and the timing of intervention. Their findings are published in the Early Childhood Education Journal.

It may seem counterintuitive to just stand by when youngsters are in a tussle. But the approach sees conflicts as a valuable opportunity for learning which adults can rob kids from gaining if they immediately intercede. Stepping in and judging kids' behaviors may also inadvertently set them up as good and bad, impacting relationships negatively.

The study noted that allowing children to experience a feeling of "It hurts!" (physical pain) or "Oh no, I shouldn't have done it!" (guilt) can be a teachable moment that physical fights do not solve any problem.

Mimamoru's three major characteristics

The researchers, however, clarified that "watching" doesn't mean that adults ignore the safety of children. Japanese educators intervene when the risk of physical harm caused by fighting is greater than the benefit for children to learn.

Japanese and US educators highlighted mimamoru's three major characteristics: temporary, minimal intervention to reduce the immediate risk of physical harm; non-intervention or staying out of the fight to encourage kids to solve their problem; and non-presence or leaving the children by themselves once determined that they can sort out their dilemma without adult support.

Selecting which to apply among these three relies heavily on an educator's patience in balancing benefits vis-a-vis threats, careful observation of behaviors, and trust in the children's capacity to learn from their own experiences.

"Although the mimamoru approach looks passive, it rather challenges educators to remain patient, watching and waiting for children to think and act on their own. An underlying assumption of this Japanese practice is adults' trust in children's inherent goodness, more specifically, their ability to learn through everyday social interactions," the researchers explained.

"In other words, children learn through their exploration of autonomy under the protection of adults."

US participants in the study raised how policies to protect children from any physical harm may not allow educators in their country to wait for kids to solve their own problems. But they recognized that it might be worth trying it out in their classrooms once they secured parental consent and applied some modifications that fit with the country's educational and policy contexts.

Nakatsubo said he hopes their research revealed the "hidden strengths" inherent in the approach of Japanese educators.

###

Plant flowering in low-nitrogen soils: A mechanism revealed

HOKKAIDO UNIVERSITY

Research News

 

IMAGE: ARABIDOPSIS PLANTS USED IN ONE OF THE EXPERIMENTS DURING THE STUDY (PHOTO: TAKEO SATO). view more 

CREDIT: TAKEO SATO

Scientists from Japan, Europe and the USA have described a pathway leading to the accelerated flowering of plants in low-nitrogen soils. These findings could eventually lead to increases in agricultural production.

Nitrogen is one of the three macronutrients required by plants for growth and development, along with phosphorus and potassium. Nitrogen-rich condition induces plant growth, particularly the growth of stems and leaves, while delaying flowering. On the other hand, in some plants, low-nitrogen conditions lead to a change from growth mode to reproductive mode, therefore accelerating flowering. However, the molecular mechanisms that regulate flowering under these conditions are not known.

A team of scientists led by Associate Professor Takeo Sato of Hokkaido University's Graduate School of Life Science has revealed the molecular mechanism responsible for the acceleration of flowering in Arabidopsis under low nitrogen conditions. Their findings were published in the journal Proceedings of the National Academy of Sciences of the United States of America (PNAS).

Arabidopsis, a cruciferous plant, is well known as a model plant in biology and has an extensive database of its protein expression. In the current study, the team first identified a set of proteins involved in flowering that became active as a result of changes in nitrogen level. One of these was the gene regulation factor FLOWERING BHLH 4 (FBH4). Through experiments using FBH4 deficient plants, this protein was found to be responsible for accelerated flowering under low-nitrogen conditions.

Further investigation suggested that FBH4 is extensively phosphorylated by another protein called SnRK1. Low-nitrogen conditions suppress SnRK1 activity, which in turn results in the dephosphorylation of FBH4. The dephosphorylated FBH4 moves to the nucleus to activate genes responsible for flowering. Dephosphorylated FBH4 is also responsible for controlling the expression of other genes vital for plant survival under low nitrogen conditions, particularly those related to nitrogen recycling and remobilization.

The scientists concluded that, in response to inadequate nitrogen, Arabidopsis plants appear to precisely control gene expression related to developmental and metabolic processes required for flowering through FBH4. "The FBH family of genes is present in major crop plants," says Takeo Sato. "Crop plants exhibit early flowering under low-nitrogen conditions; if we can control FBH activities in these crop plants, it might be an effective way to sustainably increase agricultural production."

CAPTION

FBH4 is necessary for accelerated flowering in Arabidopsis. Accelerated flowering is only seen in the wild type(left), but not in FBH4 deficient plants (right) plants, under low-nitrogen conditions (Miho Sanagi, et al. Proceedings of the National Academy of Sciences of the United States of America. May 11, 2021).

CAPTION

Takeo Sato, with Arabidopsis plants in the culture room (Photo: Takeo Sato).

CREDIT

Takeo Sato