If countries implement Paris pledges with cuts to aerosols, millions of lives can be saved

A strategic approach to reducing both greenhouse gas emissions and air pollution can reap major health and temperature benefits, according to new UC San Diego research

UNIVERSITY OF CALIFORNIA - SAN DIEGO

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IMAGE: THE UC SAN DIEGO TEAM WANTED TO EXPLORE THE TRADEOFFS COUNTRIES WOULD FACE BY TAKING AEROSOLS INTO CONSIDERATION WHILE CONCURRENTLY MAKING CO2 CUTS TO IMPLEMENT PARIS PLEDGES. THEIR MODEL PROVIDES... view more 

CREDIT: UC SAN DIEGO

Aerosol reductions that would take place as countries meet climate goals could contribute to global cooling and prevent more than one million annual premature deaths over a decade, according to a new study from the University of California San Diego.

The landmark Paris Agreement of 2016 does not address emissions of aerosols--fine particulates like soot that cause pollution. Nonetheless, findings from the recent study authored by researchers at UC San Diego's Scripps Institution of Oceanography and the School of Global Policy and Strategy suggests that aerosol accounting should be explicitly incorporated into international climate policy.

It is crucial because as countries implement their greenhouse gas reduction targets under the Paris climate agreement, their choices about which sectors to target will also reduce aerosols that are co-emitted, which will have major impacts to public health and global temperatures.

"Joint consideration of greenhouse gases and aerosols is critical," said Pascal Polonik, a Ph.D. student at Scripps Oceanography and first author of the paper published in Earth's Future. "Polluting particles, known as aerosols, are emitted in tandem with greenhouse gases but aren't accounted for. While all greenhouse gas emissions might be thought of as unambiguously harmful, aerosols are more complicated. All aerosols are harmful to human health but they also often help counteract global warming by cooling the Earth's surface."

It is estimated that emissions of aerosols from burning fossil fuels like coal and diesel are responsible for nine million premature deaths worldwide. Though most aerosols have a cooling effect because they reflect sunlight, certain types, such as black carbon have a warming effect.

The UC San Diego team wanted to explore the tradeoffs countries would face by taking aerosols into consideration while concurrently making CO2 cuts to implement Paris pledges.

Their model provides a country-by-country breakdown of the impacts of aerosol reductions across the eight economic sectors which cause emissions. For each country, the authors consider three scenarios. The first scenario prioritizes air quality, targeting aerosol cuts to the "dirtiest" sectors that emit the most solid particles. The second prioritizes temperatures by targeting industries that emit aerosols that most contribute to warming and the third, dubbed the "politically expedient" approach, reduces emissions from all economic sectors equally.

Preventing as many as one million premature deaths per year by cutting emissions from certain sectors first

Under these three approaches, the authors find that by 2030, the three scenarios would yield prevention of as many as one million premature deaths every year and global temperature differences of the same magnitude as those from greenhouse gas reductions.

The study demonstrates the importance of domestic decisions for reducing emissions because making cuts to certain sectors can produce cleaner air and save more lives, or further reduce warming.

For example, the U.S. could choose to save more lives by targeting aerosol emissions in the industrial production, shipping, or residential/commercial sectors. It could also choose to limit warming more with cuts to the solvents, residential/commercial and waste sectors.

To the authors' surprise, the third scenario, which may be most politically feasible to implement as policy, can lead to both more deaths and less cooling in certain places, such as Africa, China, the Middle East and South America.

"Implementing cuts equally and making each industry do their fair share may be the easiest way to implement climate policy in a democratic society like the U.S. where there are many competing political interests," said co-author Kate Ricke, assistant professor with Scripps Oceanography and the School of Global Policy and Strategy. "However, there are real benefits to being thoughtful about how aerosols factor into climate policy outcomes. There may be big benefits to cutting emissions from certain sectors first."

The research is critical to the U.S., as it is currently renegotiating its Paris agreement climate pledge.

"Our analysis does indicate some considerable tradeoffs between temperature and health outcomes that will need to be contended with in meeting near-term emission reductions goals," said Jennifer Burney, the Marshall Saunders Chancellor's Endowed Chair in Global Climate Policy and Research at the School of Global Policy and Strategy.

In India, for example, emission cuts in the transportation sector could save more lives, while cuts in the residential sector would produce more cooling.

The authors note that because the tradeoffs vary considerably for each region, countries are likely to have different priorities for weighing reduction of warming versus protection of public health when making climate policy decisions.

The conclusion, they emphasize, is that there are many ways to achieve the same magnitude of greenhouse gas reduction pledged in the Paris Agreement, but the aerosol emissions that "ride along" with those cuts may vary a lot depending on which sectors are targeted. As such, the authors write, "we believe that this is a strong case for explicitly considering aerosols when constructing climate policy."

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ANOTHER FIND IN THE MUSEUM STORAGE ROOM

New evidence may change timeline for when people first arrived in North America

IOWA STATE UNIVERSITY

Research News

 

IMAGE: ANDREW SOMERVILLE MADE AN UNEXPECTED DISCOVERY WHILE STUDYING THE ORIGINS OF AGRICULTURE. view more 

CREDIT: CHRISTOPHER GANNON, IOWA STATE UNIVERSITY

AMES, Iowa - An unexpected discovery by an Iowa State University researcher suggests that the first humans may have arrived in North America more than 30,000 years ago - nearly 20,000 years earlier than originally thought.

Andrew Somerville, an assistant professor of anthropology in world languages and cultures, says he and his colleagues made the discovery while studying the origins of agriculture in the Tehuacan Valley in Mexico. As part of that work, they wanted to establish a date for the earliest human occupation of the Coxcatlan Cave in the valley, so they obtained radiocarbon dates for several rabbit and deer bones that were collected from the cave in the 1960s as part of the Tehuacan Archaeological-Botanical Project. The dates for the bones suddenly took Somerville and his colleagues in a different direction with their work.

The date ranges for the bone samples from the base of the cave ranged from 33,448 to 28,279 years old. The results are published in the academic journal Latin American Antiquity. Somerville says even though previous studies had not dated items from the bottom of the cave, he was not expecting such old ages. The findings add to the debate over a long-standing theory that the first humans crossed the Bering Land Bridge into the Americas 13,000 years ago.

"We weren't trying to weigh in on this debate or even find really old samples. We were just trying to situate our agricultural study with a firmer timeline," Somerville said. "We were surprised to find these really old dates at the bottom of the cave, and it means that we need to take a closer look at the artifacts recovered from those levels."

Somerville says the findings provide researchers with a better understanding of the chronology of the region. Previous studies relied on charcoal and plant samples, but he says the bones were a better material for dating. However, questions still remain. Most importantly, is there a human link to the bottom layer of the cave where the bones were found?

To answer that question, Somerville and Matthew Hill, ISU associate professor of anthropology, plan to take a closer look at the bone samples for evidence of cut marks that indicate the bones were butchered by a stone tool or human, or thermal alternations that suggest the bones were boiled or roasted over fire. He says the possible stone tools from the early levels of the cave may also yield clues.

"Determining whether the stone artifacts were products of human manufacture or if they were just naturally chipped stones would be one way to get to the bottom of this," Somerville said. "If we can find strong evidence that humans did in fact make and use these tools, that's another way we can move forward."

CAPTION

One of the rabbit bones dated for the study.

CREDIT

Andrew Somerville, Iowa State University

Year-long journey to even find the bones

Not only was this discovery unexpected, but the process of tracking down the animal bones to take samples was more than Somerville anticipated. The collection of artifacts from the 1960s Tehuacan Archaeological-Botanical Project was distributed to different museums and labs in Mexico and the United States, and it was unclear where the animal bones were sent.

After a year of emails and cold calls, Somerville and his collaborator, Isabel Casar from the National Autonomous University of Mexico, had a potential lead for a lab in Mexico City. The lab director, Joaquin Arroyo-Cabrales, agreed to give Somerville and Casar a tour to help search for the missing collection. The tour proved to be beneficial. Among the countless boxes of artifacts, they found what they were looking for.

"Having spent months trying to locate the bones, we were excited to find them tucked away on the bottom shelf in a dark corner of the lab," Somerville said. "At the time, we felt that was a great discovery, we had no idea it would lead to this."

Once he located the bones, Somerville got permission from the Mexican government to take small samples - about 3/4 inch in length and 1/4 inch in width - from 17 bones (eight rabbits and nine deer) for radiocarbon dating. If closer examination of the bones provides evidence of a human link, Somerville says it will change what we know about the timing and how the first people came to America.

"Pushing the arrival of humans in North America back to over 30,000 years ago would mean that humans were already in North America prior to the period of the Last Glacial Maximum, when the Ice Age was at its absolute worst," Somerville said. "Large parts of North America would have been inhospitable to human populations. The glaciers would have completely blocked any passage over land coming from Alaska and Canada, which means people probably would have had to come to the Americas by boats down the Pacific coast."

###

Isabel Casar, a professor at the National Autonomous University of Mexico, and Joaquín Arroyo-Cabrales, a researcher with the National Institute of Anthropology and History in Mexico, contributed to this research. The work was funded by the National Science Foundation and the Wenner-Gren Foundation.

 F FOR FAKE

Forged books of seventeenth-century music discovered in Venetian library

PENN STATE

Research News

 

IMAGE: THE MANUSCRIPTS INCLUDE ARIAS THAT WERE FOUNDATIONAL IN THE HISTORY OF OPERA -- A GENRE THAT EMERGED IN THE EARLY SEVENTEENTH CENTURY. view more 

CREDIT: MICHEL GARRETT, PENN STATE

UNIVERSITY PARK, Pa. -- In 1916 and 1917, a musician and book dealer named Giovanni Concina sold three ornately decorated seventeenth-century songbooks to a library in Venice, Italy. Now, more than 100 years later, a musicologist at Penn State has discovered that the manuscripts are fakes, meticulously crafted to appear old but actually fabricated just prior to their sale to the library. The manuscripts are rare among music forgeries in that the songs are authentic, but the books are counterfeit.

Uncovering deception was not what Marica Tacconi, professor of musicology and associate director of the School of Music at Penn State, set out to do when she began her research at the Biblioteca Nazionale Marciana of Venice in 2018. While on sabbatical there, she had planned to spend the fall semester studying 'echo effects' in seventeenth-century music -- phrases that are sung by the primary vocalist and then repeated 'in echo' by one or more additional singers.

While searching the library's database for songs incorporating echo effects, Tacconi stumbled upon a peculiar book. Catalogued as being from the seventeenth century, it certainly looked the part. It was bound in worn leather and embellished with brass bosses, or metal knobs that serve to elevate and protect the book from the table surface. Inside, the paper showed some signs of deterioration, including even an occasional worm hole. The first page revealed an elaborate letter 'T,' indicating the opening of the song "Tu mancavi a tormentarmi" by Antonio Cesti. The music itself was written with heart-shaped noteheads, and the bottom of the page displayed the coat of arms of the Contarini family, one of the most prominent and influential Venetian households.

"It was a beautiful, elegantly produced book," said Tacconi. "I was immediately intrigued. But I also sensed that something was off."

Additional research led to the discovery of two more manuscripts, also sold by Concina and very similar in format, design and content. Considered as a set, the three books preserve 61 compositions by 26 Italian composers, all written during the period from 1600 to 1678. According to Tacconi, an expert on the music, art and culture of early modern Italy, typical seventeenth-century music anthologies focus on just one or a few composers.

"The books comprised a strange conglomeration of composers, from very famous ones, like Giulio Caccini, Claudio Monteverdi and Francesco Cavalli, to lesser-known names. This was unusual for the seventeenth century when music anthologies tended to be more monographic in content," she said. "In addition, seventeenth-century scribes would not have had access to such a wide range of music, as many of those pieces had not yet been printed and existed only in manuscripts that did not circulate widely."

CAPTION

Considered as a set, the three books Tacconi found preserve 61 compositions by 26 Italian composers, all written during the period from 1600 to 1678.

CREDIT

Michel Garrett, Penn State

Despite her suspicions about the authenticity of the manuscripts, Tacconi was excited about the music itself.

"The manuscripts include arias that were foundational in the history of opera -- a genre that emerged in the early seventeenth century," she said. "They include musical gems that can tell us a lot about the origins and development of opera."

Upon further close investigation, she realized that much of the music in the manuscripts had been lifted, note for note, from a number of late nineteenth-/early twentieth-century books about music.

"The music copied in the manuscripts showed some strange editorial quirks that you can see in early twentieth-century editions, but that would not have appeared in seventeenth-century sources," said Tacconi, who proceeded to conduct a detailed comparison of the manuscripts with more modern books.

This type of painstaking comparison proved to be particularly fruitful in proving the manuscripts' fabricated nature. Tacconi's knowledge of a little-known twentieth-century book in particular, Hugo Riemann's "Handbuch der Musikgeschichte" (1912), provided verification of her suspicions. For example, one of the fabricated manuscripts included the song "Torna o torna pargoletto" by Jacopo Peri, which originally appeared in Piero Benedetti's "Musiche" -- a collection of songs published in 1611. Riemann included it in his "Handbuch," but with some alterations. Tacconi noticed these small but significant variants -- a wrong note, a misspelling of a word.

"It was obvious that the fabricator copied the music from Riemann's 1912 publication and not from the 1611 print," she said. "This was the 'smoking gun,' the confirmation that these books were indeed forgeries."

CAPTION

Marica Tacconi, professor of musicology and associate director of the School of Music at Penn State, teaches Penn State students about the manuscripts.

CREDIT

Michel Garrett, Penn State

Tacconi noted that the books are unique among music forgeries in that most forgeries falsify the music itself.

"While the music preserved in these books is authentic, the manuscripts themselves are the handiwork of one or more fabricators who, working with several scribes and decorators, went through extraordinary means to make the volumes appear genuine," she said. "The books were clearly designed to look like those created for important Venetian households during the seventeenth century. It's not surprising that the library staff did not recognize them as fakes. At first glance they seem authentic, but once we look closely at the music and notice the editorial quirks, we detect the subtle traces of a twentieth-century fabricator."

Tacconi said that it is impossible to know whether Concina, who died in 1946, was the mastermind behind the forgeries or if he came into possession of the books with no knowledge of their fabricated nature.

Regardless of who generated the forgeries, an important question is "Why did they do it?"

"Monetary gain was probably not the main impetus," said Tacconi, explaining that the library paid Concina the equivalent of about $220 in today's money for one of the manuscripts. "That's a relatively modest sum, which does not really justify all the time and effort that went into producing these books. Instead, what we have is possibly an example of the fabricators engaging in a desire to hoodwink the experts."

In addition, she said, the forgers could have been motivated by a love for the music and the time period. "Imitation is the sincerest form of flattery," after all.

"Twentieth-century musicians and publishers often romanticized the music of the seventeenth century as being particularly elegant, and that elegance is something you see very clearly in the visual aspects of the three manuscripts," said Tacconi. "They're beautiful and ornate; their decorations include butterflies, birds and little cupids; the notes are heart shaped. The fact that the forgers went to such an effort to portray this elegance tells us something about the forgers' attitudes about the music of this time period. Knowing now that these books were created in the early twentieth century, the manuscripts and their contents actually provide an opportunity to study the late-Romantic tradition of so-called 'arie antiche' or 'gemme antiche,' which saw music collectors, musicians and audiences alike drawn to the antiquity of Italian Baroque solo vocal music."

###

Tacconi's findings appear in the Spring 2021 issue of the peer-reviewed Journal of Seventeenth-Century Music, which displays full-color images of the manuscripts (https://sscm-jscm.org/jscm-issues/volume-27-no-1/three-forged-seventeenth-century-venetian-songbooks/). .

SUCKTION

How an elephant's trunk manipulates air to eat and drink

Animal's "Swiss Army Knife" could help build better robots

GEORGIA INSTITUTE OF TECHNOLOGY

Research News

 

IMAGE: ANDREW SCHULZ LED THE STUDY AS A GEORGIA TECH MECHANICAL ENGINEERING PH.D. STUDENT. view more 

CREDIT: ANDREW SCHULTZ, GEORGIA TECH

New research from the Georgia Institute of Technology finds that elephants dilate their nostrils in order to create more space in their trunks, allowing them to store up to nine liters of water. They can also suck up three liters per second -- a speed 50 times faster than a human sneeze (150 meters per second/330 mph).

The Georgia Tech College of Engineering study sought to better understand the physics of how elephants use their trunks to move and manipulate air, water, food and other objects. They also sought to learn if the mechanics could inspire the creation of more efficient robots that use air motion to hold and move things.

While octopus use jets of water to move and archer fish shoot water above the surface to catch insects, the Georgia Tech researchers found that elephants are the only animals able to use suction on land and underwater.

The paper, "Suction feeding by elephants," is published in the Journal of the Royal Society Interface.

"An elephant eats about 400 pounds of food a day, but very little is known about how they use their trunks to pick up lightweight food and water for 18 hours, every day," said Georgia Tech mechanical engineering Ph.D. student Andrew Schulz, who led the study. "It turns out their trunks act like suitcases, capable of expanding when necessary."

Schulz and the Georgia Tech team worked with veterinarians at Zoo Atlanta, studying elephants as they ate various foods. For large rutabaga cubes, for example, the animal grabbed and collected them. It sucked up smaller cubes and made a loud vacuuming sound, or the sound of a person slurping noodles, before transferring the vegetables to its mouth.

To learn more about suction, the researchers gave elephants a tortilla chip and measured the applied force. Sometimes the animal pressed down on the chip and breathed in, suspending the chip on the tip of trunk without breaking it. It was similar to a person inhaling a piece of paper onto their mouth. Other times the elephant applied suction from a distance, drawing the chip to the edge of its trunk.

"An elephant uses its trunk like a Swiss Army Knife," said David Hu, Schulz's advisor and a professor in Georgia Tech's George W. Woodruff School of Mechanical Engineering. "It can detect scents and grab things. Other times it blows objects away like a leaf blower or sniffs them in like a vacuum."

By watching elephants inhale liquid from an aquarium, the team was able to time the durations and measure volume. In just 1.5 seconds, the trunk sucked up 3.7 liters, the equivalent of 20 toilets flushing simultaneously.

An ultrasonic probe was used to take trunk wall measurements and see how the trunk's inner muscles work. By contracting those muscles, the animal dilates its nostrils up to 30 percent. This decreases the thickness of the walls and expands nasal volume by 64 percent.

"At first it didn't make sense: an elephant's nasal passage is relatively small and it was inhaling more water than it should," said Schulz. "It wasn't until we saw the ultrasonographic images and watched the nostrils expand that we realized how they did it. Air makes the walls open, and the animal can store far more water than we originally estimated."

Based on the pressures applied, Schulz and the team suggest that elephants inhale at speeds that are comparable to Japan's 300-mph bullet trains.

Schulz said these unique characteristics have applications in soft robotics and conservation efforts.

"By investigating the mechanics and physics behind trunk muscle movements, we can apply the physical mechanisms -- combinations of suction and grasping -- to find new ways to build robots," Schulz said. "In the meantime, the African elephant is now listed as endangered because of poaching and loss of habitat. Its trunk makes it a unique species to study. By learning more about them, we can learn how to better conserve elephants in the wild."

CAPTION

An elephant grabs lettuce in water.

CREDIT

Andrew Schulz, Georgia Tech

The work was supported by the US Army Research Laboratory and the US Army Research O?ce 294 Mechanical Sciences Division, Complex Dynamics and Systems Program, under contract number 295 W911NF-12-R-0011. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the view of the sponsoring agency.

BECAUSE THE US MILITARY HAS THE BIGGEST BUDGET IN THE WORLD 

CITATION: Schulz AK, et.al., "Suction feeding by Elelphants." (Journal of the Royal Society Interface 20210215) https://doi.org/10.1098/rsif.2021.0215

The Georgia Institute of Technology, or Georgia Tech, is a top 10 public research university developing leaders who advance technology and improve the human condition. The Institute offers business, computing, design, engineering, liberal arts, and sciences degrees. Its nearly 40,000 students representing 50 states and 149 countries, study at the main campus in Atlanta, at campuses in France and China, and through distance and online learning. As a leading technological university, Georgia Tech is an engine of economic development for Georgia, the Southeast, and the nation, conducting more than $1 billion in research annually for government, industry, and society.

Video link: https://www.youtube.com/watch?v=uyiKEjx7yek

THE COST OF PRIVATIZED HEALTHCARE Tens of thousands of women turn to the ER for fibroid symptoms

Study suggests that many women using emergency care for fibroids may be better served in alternative health care settings

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

Research News 

IMAGE: STUDY SUGGESTS THAT MANY WOMEN USING EMERGENCY CARE FOR FIBROIDS MAY BE BETTER SERVED IN ALTERNATIVE HEALTH CARE SETTINGS. view more 

CREDIT: MICHIGAN MEDICINE

ANN ARBOR, Mich. - Fibroid symptoms, such as heavy menstrual bleeding and abdominal pain, are increasingly driving women to the emergency room.

In fact, tens of thousands of women were seen annually in the emergency department for the condition, which involves benign growths in the uterus, over a 12-year period.

But only 1 in 10 of these visits led to a hospital admission, suggesting that many cases may have been managed in an alternative, non-urgent health setting, according to recent Michigan Medicine research.

"Fibroids are often a chronic disease, so we have opportunities to treat this through established care with a trusted health provider. Yet, we've seen a big increase in women using the emergency room for fibroid care," says senior author Erica E. Marsh, M.D., chief of the division of reproductive endocrinology and infertility at the Center for Reproductive Medicine at Michigan Medicine Von Voigtlander Women's Hospital.

"Our study suggests that patients are potentially using the emergency department for care that could and should be obtained in a long-standing trusted environment with a healthcare provider."

Researchers analyzed more than 487 million emergency visits by women ages 18-55 between 2006 and 2017. The number of ED visits for fibroids among this age group more than doubled during the study period, up from 28,732 to 65,685 visits.

Meanwhile, hospital admissions for these types of visits decreased from about 24% to 11%, according to the study in Obstetrics & Gynecology "The Green Journal."

Study findings also reinforced that fibroid care is among the costliest types of ED care, which has been estimated to be generally twice as expensive as other visits among similarly aged women. This is likely to due to imaging studies and other tests to address bleeding.

Over the study period, median ED visit charges for fibroids more than doubled, with the average charge more than $6,000 per visit and a total of $500 million during 2017.

Many of these patients were likely appropriate candidates for outpatient imaging, which potentially could have saved significant costs and resources, Marsh says.

"We should be focused on interventions that improve access to outpatient care for this group of women in order to help mitigate unnecessary, costly ED utilization," Marsh says.

Emergency department visits for fibroids were highest among women who were aged 36-45 years (about 45%) and with lower incomes. Women who came to the ED for bleeding related issues were also 15 times more likely to be admitted.

Marsh notes that while bleeding symptoms should be addressed right away, there are several interventions that can help manage bleeding through regular office visits. Hospital admission was least likely for uninsured patients who came to the ED with fibroid symptoms.

"The apparent disparity in likelihood of admission based on insurance type is concerning and certainly warrants further study," Marsh says.

"We must constantly call out and investigate disparities in care."

Improving equitable fibroid care

Uterine fibroids are the most common benign gynecologic condition in the U.S., affecting up to 70% of all women by age 50 and a disproportionate number of African Americans. Although the majority of fibroids are asymptomatic, between a quarter and half of patients will experience symptoms, most commonly heavy menstrual bleeding and pelvic pain or pressure that can be disruptive to daily life.

Fibroids are also the leading cause of hysterectomies, which is the surgical procedure involving removal of the uterus.

Many potential factors may help explain the ED trends highlighted in the new study, Marsh says. It could be that patients are using the ED because they don't have a primary healthcare home or trusted relationship with an outpatient provider for their gynecological care.

Many women may also delay treatment for uterine fibroids because they think their symptoms are "normal" or are unaware of what types of non-surgical treatments are available.

Insurance gaps and access barriers may also be issues.

"We need to better understand gaps in fibroid care and why so many patients are turning to the ED to receive care for a condition that could be managed in the outpatient setting," Marsh says.

"We have a diverse team looking at these data to identify opportunities to re-envision care for women with fibroids and barriers we can reduce to improve their care in the outpatient setting.

"Ultimately, we want to ensure patient centered and equitable care for all individuals with this chronic condition."

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Paper Cited: "Trends in Emergency Department Utilization Among Women With Leiomyomas in the United States," Obstetrics & Gynecology. DOI: 10.1097/AOG.0000000000004333

 

Improved detection of atrial fibrillation could prevent disabling strokes

Results from clinical trial expected to significantly change how clinicians monitor for atrial fibrillation in Alberta stroke patients

UNIVERSITY OF ALBERTA FACULTY OF MEDICINE & DENTISTRY

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IMAGE: AN IMPLANTABLE DEVICE THAT MONITORS FOR ATRIAL FIBRILLATION OVER 12 MONTHS IS MORE THAN THREE TIMES MORE EFFECTIVE AT DETECTING THE CONDITION THAN STANDARD CARE, AND COULD HELP PREVENT DISABLING... view more 

CREDIT: SUPPLIED

A clinical trial examining the efficacy of two devices to monitor and detect atrial fibrillation (AF), or an irregular heartbeat, in ischemic stroke patients--one an implantable device that monitors over 12 months, the other an external device that monitors over a 30-day period--found the implantable device is more than three times more effective in detecting AF, and both are a significant improvement over the current standard of care in Alberta, Canada.

The Post-Embolic Rhythm Detection With Implantable Versus External Monitoring (PER DIEM) study, led jointly by University of Alberta and University of Calgary researchers, was published today in the journal JAMA. The findings are expected to significantly change practice in how clinicians look for AF in Albertan patients following ischemic stroke.

"We know that (the current method of monitoring) isn't as effective as it could be in picking up atrial fibrillation from this study because regardless of which arm of the study patients went into, we were picking up anywhere from five to 15 per cent extra atrial fibrillation," said Brian Buck, a stroke neurologist and associate professor of medicine at the U of A. "We found in the study there were a lot of patients with undetected atrial fibrillation, even after they received the standard cardiac monitoring."

Atrial fibrillation causes about one in four strokes in Alberta. Detecting it early is key to preventing further disabling strokes in patients who have already experienced ischemic stroke, a type of stroke caused by a blockage in an artery that supplies blood to the brain. If atrial fibrillation is detected, clinicians have treatments--mainly blood thinners--that can reduce the risk of stroke by almost 70 per cent.

The standard test in Alberta for AF is a 24-hour electrocardiogram monitor. In the PER DIEM trial, 300 Albertan patients who had suffered a stroke were randomized to one of two new devices that can monitor for AF for longer durations. The study showed that the implantable device picked up three times more new AF than the 30-day monitor (15 per cent versus five per cent). All of the patients in the clinical trial with new AF were started on blood thinners.

"We didn't expect that we would get such a dramatic increase with the longer recording, even though it intuitively makes sense," said study co-author Michael Hill, professor of neurology at the University of Calgary and senior medical director for stroke with Alberta Health Services' Cardiovascular and Stroke Strategic Clinical Network. "Most people suspected that detection rates apply to only certain subtypes of ischemic stroke. This study showed that theory is not correct."

"We believe that those patients that were identified with atrial fibrillation are now, for the rest of their lives, going to have a much lower risk of having a stroke in the future," added Buck, who is also a member of the U of A's Neuroscience and Mental Health Institute.

One of the patients who took part in the trial was Norman Mayer, the sitting mayor of the central Alberta community of Camrose for the past 32 years. Mayer recalls being admitted to the emergency department about five years ago after not feeling well and experiencing sudden pain. After examination, the clinicians on duty informed him that he had likely experienced a minor stroke.

After being stabilized, Mayer was informed of the clinical trial and given the option of participating. After giving his consent, he was randomly assigned to the group of patients who were given the implantable monitoring device.

"It was the luck of the draw, and the advantage of it was that it's inconspicuous and wearing (an external device) would not have been very appealing to me," said Mayer. "So I had (the implantable device) tucked into my chest. It's there and nobody knows about it except for me and my doctor.

"It gives you a bit of a comfort level, I guess. It's not bothering you. It's just there and a part of life," he added. "It gives you the feeling that if something was to go wrong, somebody's going to be in touch to let you know (what steps need to be taken)."

With better monitoring, clinicians may be able to diagnose much more AF after stroke and dramatically reduce the risk of future disabling stroke. According to the Canadian Coordinating Office for Health Technology Assessment (CADTH), the external device costs about $1,000 per patient to administer, while the implantable device typically costs over $5,000 per patient. The implantable device had the added advantage of remote monitoring, reducing the need for trips to the hospital--an important consideration for rural Albertans. The team says an in-depth cost-benefit analysis is needed to determine the best approach to providing superior care while also providing savings for the health-care system.

"The biggest problem with stroke is that it dramatically impacts people's lives. So you take a healthy, independent person with a big disabling stroke, and they often end up being dependent on others for help with care. So that's terrible for patients and it's very expensive for the system. If you can prevent even a few of those big disabling strokes per year, it helps the person and reduces the burden on the health system," said Buck.

"This new evidence will help guide selection of what strategy is best going forward," added Hill. "We need to go beyond (24-hour monitoring) for Albertan patients. But if the system is going to pay for this technology, we need to know more definitively that patients are going to end up with lower stroke rates in the future."

The researchers say studies to this point have shown a trend in that direction, but more work is needed to prove it definitively. They hope to address those questions in future research.

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The PER DIEM study was conducted as one part of the overarching Performance Evaluation & Rhythm Follow-up Optimization with Remote Monitoring (PERFORM) project led by the University of Calgary's Derek Exner with the Libin Cardiovascular Institute. The research was funded through Alberta Innovates' Partnership for Research and Innovation in the Health System (PRIHS) program and in part through the Alberta Innovates CRIO grant program (QuICR Alberta Stroke Program). Industry partner Medtronic also gave in-kind support to the 

Canadian prescription opioids users experience gaps in access to care

Study suggests people treated for opioid use disorder may face difficulties finding new providers

PLOS

Research News

 

Stigma and high care needs can present barriers to the provision of high-quality primary care for people with opioid use disorder (OUD) and those prescribed opioids for chronic pain. A study published in PLOS Medicine by Tara Gomes at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada and colleagues suggests that people treated for an opioid use disorder were less likely to find a new primary care provider (PCP) within one year of termination of enrolment with the previous physician.

People with substance use disorders often have complex medical needs, requiring regular access to primary care physicians. However, some physicians may be less willing to treat these patients due to stigma, high health care needs, or discomfort prescribing opioids. To assess differences in access to primary care, researchers conducted a retrospective cohort study, analysing records of 154,790 Ontario residents who lost their enrolment with a primary care physician between 2016 and 2017. They assigned individuals to one of three groups based on their history of opioid use: no opioid use, opioid pain therapy, and opioid agonist therapy (for OUD). The authors then analyzed the number of people from each group who had found a primary care provider within a year.

The researchers found that people receiving opioid agonist therapy were 45% less likely to secure another primary care physician in the next year compared to opioid unexposed individuals. The study was limited in that the authors were unable to identify people with OUD if they were not in treatment and could not identify people who received care from walk-in clinics. However, the research is an important step in identifying inequities in access to primary care and management of complex chronic conditions.

According to the authors "Ongoing efforts are needed to address stigma and discrimination faced by people who use opioids within the health care system, and to facilitate access to high quality, consistent primary care services for chronic pain patients and those with OUD".

Dr. Gomes also notes, "There are considerable barriers to accessing primary care among people who use opioids, and this is most apparent among people who are being treated for an opioid use disorder. This highlights how financial disincentives within the healthcare system, and stigma and discrimination against people who use drugs introduce barriers to high quality care".

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Research Article

Peer reviewed; Observational; Humans

In your coverage please use this URL to provide access to the freely available paper: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003631

Funding: This study was funded by grants from the Ontario MOHLTC Health System Research Fund (grant # 06673) and the Canadian Institutes of Health Research (grant #153070). It was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). RG is supported as a Clinician Scientist in Family and Community Medicine at St. Michael's Hospital and the University of Toronto. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests to report: TG and RG have received grant funding from the Ontario Ministry of Health and CIHR. RG serves as a CIHR Scientific Director. DNJ is an unpaid member of Physicians for Responsible Opioid Prescribing (PROP). He is also a member of the American College of Medical Toxicology. Both groups have publicly available positions on this issue. He has received payment for lectures and medicolegal opinions regarding the safety and effectiveness of analgesics, including opioids. MMM has received honoraria for attending Advisory Board meetings for NovoNordisk and Neurocrine Biosciences.

Citation: Gomes T, Campbell TJ, Martins D, Paterson JM, Robertson L, Juurlink DN, et al. (2021) Inequities in access to primary care among opioid recipients in Ontario, Canada: A population-based cohort study. PLoS Med 18(6): e1003631. https://doi.org/10.1371/journal.pmed.1003631

CANCEL HER FINE

Grand Slam leaders pledge to address Naomi Osaka's concerns

Shawna Chen


Photo: TPN/Contributor via Getty Images

Leaders of the four Grand Slam tournaments on Tuesday pledged to address players' concerns about mental health after Naomi Osaka withdrew from the French Open.

Driving the news: Osaka, a four-time major champion and No. 2-ranked player, pulled out of the French Open on Monday amid controversy over her decision to not attend press conferences at the tournament. She wrote in a statement that she experiences "huge waves of anxiety" before meeting with reporters and has "suffered long bouts of depression."

"I'm gonna take some time away from the court now, but when the time is right I really want to work with the Tour to discuss ways we can make things better for the players, press and fans," she added.

What they're saying: "On behalf of the Grand Slams, we wish to offer Naomi Osaka our support and assistance in any way possible as she takes time away from the court. She is an exceptional athlete and we look forward to her return as soon as she deems appropriate," said Tuesday’s joint statement from leaders of the French Open, Wimbledon, U.S. Open and Australian Open.

"Mental health is a very challenging issue, which deserves our utmost attention. It is both complex and personal, as what affects one individual does not necessarily affect another," the statement added.

"We commend Naomi for sharing in her own words the pressures and anxieties she is feeling and we empathize with the unique pressures tennis players may face."

In a separate statement to the AP, International Tennis Federation official Heather Bowler said the sport will "review what needs to evolve" after Osaka "shone a light on mental health issues."

Between the lines: The same four administrators who threatened disqualification or suspension for Osaka all signed on to Tuesday's joint statement, per AP.

The 23-year-old player of Haitian and Japanese descent was fined $15,000 on Sunday after not attending a mandatory press conference.

Go deeper: What to know about Naomi Osaka's French Open withdrawal