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Sunday, May 29, 2022

Spines of life: Fast-breeding sea urchin provides new model for genetic research

Researchers from the University of Tsukuba establish a sea urchin species, Temnopleurus reevesii, as a new model for genetic research

Peer-Reviewed Publication

UNIVERSITY OF TSUKUBA

a new model for genetic research — IMAGE: PROVIDE GENETIC INFORMATION AND ESTABLISH A PORTAL SITE FOR WEST PACIFIC SEA URCHIN GENETIC DATA view more
CREDIT: UNIVERSITY OF TSUKUBA

Tsukuba, Japan—Many people may not realize that the humble sea urchin is a titan when it comes to the study of biology. Now, researchers from Japan have discovered that sea urchins could help biological studies go further than ever before.

In a study published in this month in Development, Growth and Differentiation, researchers from the University of Tsukuba have revealed that a particular species of sea urchin may be a game changer, opening up new avenues for genetic research.

Sea urchins have been used for over a hundred year as a model for understanding how biological systems work. These organisms have enabled the identification of mechanisms underlying biological phenomena, ranging from gene regulatory networks to the proteins involved in cell cycles. However, there is a catch—the model species used so far take 2 years to reach reproductive maturity, making them unsuitable for genetic studies.

"To be able to study genetics in sea urchins, we need to find species with short breeding cycles, or to speed up the cycles of the current model species," says senior author of the study, Professor Shunsuke Yaguchi. "In our study, we looked for a species with a short reproductive cycle."

The researchers identified Temnopleurus reevesii as a candidate species because it only takes 6 months to produce the next generation, and eggs and sperm can be collected continuously throughout the year when kept at a temperature over 20°C. Most other model sea urchins don't have these features, which make this species useful for culturing in a lab.

The team assembled a draft genome of T. reevesii and constructed two genome databases, TrBase and the Western Pacific Sea Urchin Genome Database (WestPac-SUGDB), the latter containing genomic information on T. reevesii and another model urchin species, Hemicentrotus pulcherrimus. The aim of creating these databases was to provide genetic information and establish a portal site for West Pacific sea urchin genetic data. WestPac-SUGDB also has search programs for comparing the two datasets.

"We predict that these databases will contribute not only to sea urchin genetic research, but also to evolutionary research and comparative genomics," says Professor Yaguchi.

The results of this study have opened up the possibility of using T. reevesii as a new model species for research in a number of fields, including cell, developmental, experimental, and evolutionary biology. Additionally, the researchers suggest that investigations in the near future will identify another sea urchin species as an improved model organism for medicine and the life sciences.

Original Paper:

The article, "TrBase: A genome and transcriptome database of Temnopleurus reevesii," was published in Development, Growth and Differentiation at DOI: 10.1111/dgd.12780

Correspondence:

Associate Professor YAGUCHI Shunsuke
Faculty of Life and Environmental Sciences, University of Tsukuba

DOI

10.1111/dgd.12780

ARTICLE TITLE

TrBase: A genome and transcriptome database of Temnopleurus reevesii

Reshaping global policies for circular economy

Peer-Reviewed Publication

TSINGHUA UNIVERSITY PRESS

Circular economy linking forward and reverse logistics towards circularity — IMAGE: THE PROGRESSIVE INDUSTRIAL REVOLUTION OF THE PAST TWO CENTURIES RELIED ON THE EXTRACTION OF NATURAL RESOURCES FROM THE LITHOSPHERE, AND THEN THEY ARE PROCESSED AND TRANSFORMED INTO DESIRED PRODUCTS, WHICH AT THE END OF THEIR USEFUL LIFE (EOL) BECAME WASTES OF UNCERTAIN ENVIRONMENTAL FATE. IN THIS ONE-DIRECTIONAL LOGISTICS, MOST MATERIALS FLOW TO SINKS, AT WHICH THE NOTORIOUS SUBSTANCES CONTAMINATE THE ENVIRONMENT. IT HAS BEEN RECOGNIZED THAT SOME MATERIALS IN EOL PRODUCTS MAY BE TRANSFORMED INTO USEFUL PRODUCTS AGAIN, IN A PROCESS KNOWN AS REVERSE LOGISTICS (WASTE RECLAMATION), THROUGH THE COLLECTION, COMPONENT HARVESTING, REFURBISHMENT, REUSE, REMANUFACTURING, RECYCLING, AND MATERIAL EXTRACTION PROCESS, ALL POSITIONED WITHIN THE CIRCULAR ECONOMY FRAMEWORK TO DECREASE EXTERNALIZED WASTE. view more
CREDIT: ZENG AND LI, 2021, REPRINTED WITH PERMISSION © THE AUTHOR(S)

Circular economy may not always be effective or even desirable owing to the spatiotemporal dimensions of environmental risk of materials, and variability of global policies. Circular flows involving toxic materials may impose a high risk on the environment and public health such that overemphasis on anthropogenic circularity is not desirable. Moreover, waste flows at a global scale might result in an uneven distribution of risks and costs associated with a circular economy. Challenges remain in implementing and enforcing international policies across national boundaries. The United Nations Basel Convention on the Transboundary Movement of Hazardous Waste and their disposal is used here as an example to illustrate the challenges and to propose a way forward for anthropogenic circularity.

A paper describing the results appeared in the journal Circular Economy on 19 May 2022. (DOI 10.1016/j.cec.2022.100003)

Circular economy remains the following challenges and opportunities in implementing and enforcing international policies across national boundaries.

Controlling toxic releases across material lifecycles. Despite attempts to use policies and economic incentives to avoid toxic releases and exposures during the lifecycle of such products, fugitive emissions occur and vulnerable populations and environment are impacted adversely. Insufficient investments in environmental protection in low- and middle-income countries have resulted in a high burden of toxic pollution-related mortality rates. Therefore, it may be more desirable to eliminate some toxic materials from the circular economy of products to avoid the disincentive of diminishing returns on investments in collection and recycling. Another vital aspect of circular economy is the issue of mixing materials in recycling which can compromise the quality of the products.

International flow of materials and products. The illegal transboundary flow of e-waste occurred frequently in the 2000s from affluent industrialized nations to poorer countries. The improper recycling in poverty regions resulted in disastrous environmental quality and public health consequences. The sustainability of long-distance transportation of materials and waste are depending on fluctuations of transportation cost, potential for leakage, energy expenditure, carbon footprint, and supply chain logistics. Thus, lifecycle thinking includes acknowledgment of trade-off subject to subjective values of stakeholders within the circular economy.

Harmonization of international policies and regulation. Globally, the Basel Convention focus on protecting human health and the environment against the adverse effect of hazardous wastes, which were notoriously and unfairly traded across national boundaries due to the imbalance and diversity of policies. The EU, Japan, and China are leading in e-waste regulation and policy, but most countries with economies in transition are still in the early stages. Within individual countries such as China, regulation and policy have stipulated the rigorous governance for products and components. Two major gaps exist in the existing regulation: lack of adequate attention to the recovered materials and substances and no control of substances to avoid toxic metals which are manufactured in new products.

Classification of anthropogenic resources. Secondary raw materials from anthropogenic resources are getting more attention in the context of climate protection and circular economy. The initiatives for classifying anthropogenic resources facilitate the development of recovery projects but are challenged by essential differences between natural and anthropogenic resources. In analogy to geogenic resources, the classification of anthropogenic resources enables comparable estimates of anthropogenic and geogenic resource availabilities. It facilitates sustainable recovery project development and national resource management if environmental, social, and governance criteria are considered. These factors can be integrated into the United Nations Framework Classification (UNFC) in order to communicate the viability of recovery projects to governments, investors, industry, and the public.

Although spatiotemporal, geographic, and international dimensions pose major challenges to the effectiveness of circular economy, there are opportunities to transition from a linear model of material and energy flows, including innovations in technology and policy capacities. Despite many economic, environmental, and social challenges, the harmonization and compatibility of regulations and policies among the countries, regions, and even provinces are needed in the circular economy policy support framework so that the updating and revising of circular economy implementation in the US, the EU, Japan, and China can be achieved without delay.

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About Circular Economy

Circular Economy is an international journal serving as a sharing and communication platform for novel contributions and outcomes on innovative techniques, systematic analysis, and policy tools of global, regional, national, local, and industrial park's waste management system to improve the reduce, reuse, recycle, and disposal of waste in a sustainable way.

Circular Economy is a fully open access journal. It is co-published by Tsinghua University Press and Elsevier, and academically supported by the School of Environment, Tsinghua University, and the Circular Economy Branch, Chinese Society for Environmental Sciences. At its discretion, Tsinghua University Press will pay the Open Access Fee for all published papers from 2022 to 2024.

About Tsinghua University Press

Established in 1980, belonging to Tsinghua University, Tsinghua University Press (TUP) is a leading comprehensive higher education and professional publisher in China. Committed to building a top-level global cultural brand, after 41 years of development, TUP has established an outstanding managerial system and enterprise structure, and delivered multimedia and multi-dimensional publications covering books, audio, video, electronic products, journals and digital publications. In addition, TUP actively carries out its strategic transformation from educational publishing to content development and service for teaching & learning and was named First-class National Publisher for achieving remarkable results.

JOURNAL

Circular Economy

DOI

10.1016/j.cec.2022.100003

ARTICLE TITLE

Reshaping global policies for circular economy

Siberian tundra could virtually disappear by mid-millennium

AWI study shows: only ambitious climate protection measures can still save a third of the tundra

Peer-Reviewed Publication

ALFRED WEGENER INSTITUTE, HELMHOLTZ CENTRE FOR POLAR AND MARINE RESEARCH

Cotton grass — IMAGE: COTTON GRASSES ON THE BANKS OF THE LOWER ILERNEY, RUSSIA view more
CREDIT: ALFRED-WEGENER-INSTITUT / STEFAN KRUSE

Due to global warming, temperatures in the Arctic are climbing rapidly. As a result, the treeline for Siberian larch forests is steadily advancing to the north, gradually supplanting the broad expanses of tundra which are home to a unique mix of flora and fauna. Experts from the Alfred Wegener Institute have now prepared a computer simulation of how these woods could spread in the future, at the tundra’s expense. Their conclusion: only consistent climate protection measures will allow roughly 30 percent of the Siberian tundra to survive to mid-millennium. In all other, less favourable scenarios, the unique habitat is projected to disappear entirely. The study was just released in the journal eLife.

The climate crisis can especially be felt in the Arctic: in the High North, the average air temperature has risen by more than two degrees Celsius over the past 50 years – far more than anywhere else. And this trend will only continue. If ambitious greenhouse-gas reduction measures (Emissions Scenario RCP 2.6) are taken, the further warming of the Arctic through the end of the century could be limited to just below two degrees. According to model-based forecasts, if the emissions remain high (Scenario RCP 8.5), we could see a dramatic rise in the average summer temperatures in the Arctic – by up to 14 degrees Celsius over today’s norm by 2100.

“For the Arctic Ocean and the sea ice, the current and future warming will have serious consequences,” says Prof Ulrike Herzschuh, Head of the Polar Terrestrial Environmental Systems Division at the Alfred Wegener Institute, Helmholtz Centre for Polar and Marine Research (AWI). “But the environment on land will also change drastically. The broad expanses of tundra in Siberia and North America will be massively reduced, as the treeline, which is already slowly changing, rapidly advances northward in the near future. In the worst-case scenario, there will be virtually no tundra left by the middle of the millennium. In the course of our study, we simulated this process for the tundra in northeast Russia. The central question that concerned us was: which emissions path does humanity have to follow in order to preserve the tundra as a refuge for flora and fauna, as well its role for the cultures of indigenous peoples and their traditional ties to the environment?”

The tundra is home to a unique community of plants, roughly five percent of which are endemic, i.e., can only be found in the Arctic. Typical species include the mountain avens, Arctic poppy and prostrate shrubs like willows and birches, all of which have adapted to the harsh local conditions: brief summers and long, arduous winters. It also offers a home for rare species like reindeer, lemmings and insects like the Arctic bumblebee.

For their simulation, Ulrike Herzschuh and AWI modeller Dr Stefan Kruse employed the AWI vegetation model LAVESI. “What sets LAVESI apart is that it allows us to display the entire treeline at the level of individual trees,” Kruse explains. “The model portrays the entire lifecycle of Siberian larches in the transition zone to the tundra – from seed production and distribution, to germination, to fully grown trees. In this way, we can very realistically depict the advancing treeline in a warming climate.”

The findings speak for themselves: the larch forests could spread northward at a rate of up to 30 kilometres per decade. The tundra expanses, which can’t shift to colder regions due to the adjacent Arctic Ocean, would increasingly dwindle. Since trees aren’t mobile and each one’s seeds can only reach a limited distribution radius, initially the vegetation would significantly lag behind the warming, but then catch up to it again. In the majority of scenarios, by mid-millennium less than six percent of today’s tundra would remain; saving roughly 30 percent would only be possible with the aid of ambitious greenhouse-gas reduction measures. Otherwise, Siberia’s once 4,000-kilometre-long, unbroken tundra belt would shrink to two patches, 2,500 kilometres apart, on the Taimyr Peninsula to the west and Chukotka Peninsula to the east. Interestingly, even if the atmosphere cooled again in the course of the millennium, the forests would not completely release the former tundra areas.

“At this point, it’s a matter of life and death for the Siberian tundra,” says Eva Klebelsberg, Project Manager Protected Areas and Climate Change / Russian Arctic at the WWF Germany, with regard to the study. “Larger areas can only be saved with very ambitious climate protection targets. And even then, in the best case there will ultimately be two discrete refuges, with smaller flora and fauna populations that are highly vulnerable to disrupting influences. That’s why it’s important that we intensify and expand protective measures and protected areas in these regions, so as to preserve refuges for the tundra’s unparalleled biodiversity,” adds Klebelsberg, who, in collaboration with the Alfred Wegener Institute, is an advocate for the establishment of protected areas. “After all, one thing is clear: if we continue with business as usual, this ecosystem will gradually disappear.”

Original publication:

Stefan Kruse, Ulrike Herzschuh: Regional opportunities for tundra conservation in the next 1000 years. eLife (2022). DOI: 10.7554/eLife.75163

JOURNAL

eLife

DOI

10.7554/eLife.75163

ARTICLE TITLE

Regional opportunities for tundra conservation in the next 1000 years

ARTICLE PUBLICATION DATE

24-May-2022

Choking local funding prevents terrorism

Research by Nicola Limodio, Bocconi University, Milan, supports the use of financial counterterrorism. Terrorists depend on local funding availability, as they struggle to move money around, and we should limit their ability to access financing

Peer-Reviewed Publication

BOCCONI UNIVERSITY

Choking Local Funding Prevents Terrorism — IMAGE: RESEARCH BY NICOLA LIMODIO, BOCCONI UNIVERSITY, MILAN, SUPPORTS THE USE OF FINANCIAL COUNTERTERRORISM. TERRORISTS DEPEND ON LOCAL FUNDING AVAILABILITY, AS THEY STRUGGLE TO MOVE MONEY AROUND, AND WE SHOULD LIMIT THEIR ABILITY TO ACCESS FINANCING view more
CREDIT: WEIWEI CHEN

Terrorist attacks are highly responsive to local funding availability, and financial counter-terrorism can, thus, be effective in reducing terrorism casualties, according to new research by Nicola Limodio (Department of Finance, Bocconi University) forthcoming in Econometrica.

There has been a record number of terrorist attacks in the past decade. Many scholars agree that this might be driven by increases in the ability of terrorist organizations to secure funding and recruit new members. As a response, several financial counter-terrorism measures were launched. These are often efforts to ‘follow the money’ and freeze bank accounts of potential terrorists and their supporters. But financial counter-terrorism has been criticized as not only very costly but also ineffective, as terrorist organizations may be able to swiftly dissipate their funds through affiliates in several locations and to use it where and when they wish.

Nicola Limodio challenges the critics of financial counter-terrorism, offering evidence on the financial frictions faced by terrorist groups and the role of counterterrorism in further tightening these frictions. In his recent paper “Terrorism Financing, Recruitment and Attacks,” Prof. Limodio provides a pioneering quantitative assessment of terrorism, recruitment and financing. He shows that terrorist attacks are sensitive to local funding: terrorist organizations launch attacks where and when they receive funds. This is of clear policy relevance. If terrorism depends on local funding availability, financial counter-terrorism can be effective insofar as it limits the ability of terrorist organizations to access funds.

To arrive at this finding, Prof. Limodio studied the variation in funding to terrorist groups across time and place in Pakistan and the effects on the incidence of terrorist attacks. He did this via a rather unexpected channel: the Zakat, a practice whereby Muslims make a charitable donation to the poor during the period of the Ramadan. Unfortunately, lack of oversight and the fact that many extremist groups have a legal charity branch imply that some of these funds end up in the hands of terrorists.

In the same period, the Pakistani government collects, from Sunni Muslims, a Zakat levy (to be used in aid to the vulnerable population after Ramadan) equal to 2.5% of individual bank deposits above a certain threshold. Such a threshold corresponds to the price of 612.32 grams of silver. Therefore, when the price of silver is higher, a smaller part of the deposits is levied, and people have more money to donate in the Zakat. Indeed, Limodio finds that a higher price of silver leads to more donations. Thus, changes in the price of silver affect how much funding goes to terrorist organizations and allows us to observe how funding affects the decisions of terrorist groups to launch attacks.

Prof. Limodio finds that more funding driven by higher prices of silver leads to more terrorist attacks in cities with a Sunni majority (the group that is subject to the levy on deposits). Terrorist attacks are thus sensitive to funding: if a terrorist group receives more funds in a given city, it will increase attacks in this city. And this happens only for capital-intense terrorist activities such as bombs and heavily armed assaults. Terrorist events with low financing are not responsive to variations in funding.

Additionally, Prof. Limodio uses AI to obtain measures of terrorist recruiting in online forums and using this measure, he finds that in periods of strong terrorist recruitment, the effect of additional funding on attacks is even stronger.

These results give us an important insight about the role and importance of financing in terrorist organizations. If such organizations had no constraints in moving funds across time and space, more funding in a given place wouldn’t necessarily lead to more attacks there. Thus, Prof. Limodio’s research provides evidence that terrorist organizations are indeed limited in their ability to move funds. As Limodio mentions “showing the existence of financial frictions through data is crucial to understand the behaviour of terrorist groups and study the most effective policies to empower financial counterterror to lower attacks and casualties”.

Nicola Limodio, “Terrorism Financing, Recruitment and Attacks,” Econometrica, Forthcoming Papers.

JOURNAL

Econometrica

ARTICLE TITLE

Terrorism Financing, Recruitment and Attacks

Lack of affordable childcare is still a burden for plastic surgery residents – Especially women

Peer-Reviewed Publication

WOLTERS KLUWER HEALTH

May 27, 2022 – Plastic surgery residents face persistent barriers accessing affordable childcare, with high costs and a major impact on surgical training – with most of the burden falling on women residents, reports a paper in the June issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). Plastic and Reconstructive Surgery® is published in the Lippincott portfolio by Wolters Kluwer.

"Training institutions are not meeting the childcare needs of plastic surgery trainees," according to the survey study by Chelsea Cernosek Wallace, MD, and colleagues of University of Kentucky, Lexington. "If we wish to recruit and retain the top applicants, we must improve the childcare accommodations for residents."

Childcare carries high costs and impacts training for plastic surgery trainees

The researchers sent an anonymous survey to current plastic surgery residents. The survey focused on current childcare accommodations and availability, along with attitudes and issues surrounding childrearing during residency.

Of 32 residents responding to the survey, 21 were women. Thirty-eight percent of respondents had at least one child. Of these, 75% of men reported that their spouse was the primary source of childcare, compared to 12% of women.

"One hundred percent of respondents with children reported childcare creates a financial burden," Dr. Wallace and colleagues write. Median costs of childcare per child were $2,150 per month, or $25,800 per year. For married residents, median gross household income was $109,000 per year – thus these couples were paying nearly one-fourth of their income for childcare. Because of their inflexible work hours and the limited hours of daycare facilities, many residents had to use a nanny or other in-home child care.

None of the residents with children said their institution provided access to on-site childcare – but 75% said they would use this service if it were available. Most residents said that their institution didn't provide flexibility to accommodate childcare needs. Women residents were twice as likely to miss work due to problems with childcare arrangements, compared to men.

Two-thirds of women residents said that if they were choosing a plastic surgery training program, the availability of on-site childcare would influence their decision. One fourth of women residents with children said they had seriously considered leaving their residency program due to difficulties with childcare accommodations.

The challenges of raising children during plastic surgery residency have long been recognized. A 1994 editorial in Plastic and Reconstructive Surgery highlighted the need for adequate childcare facilities to promote a productive return to work. "Unfortunately, [more than] 25 years later, the lack of accessible and affordable childcare remains a dilemma faced by many plastic surgery trainees," the researchers write.

Noting the disproportionately high burden on women residents, Dr. Wallace and colleagues conclude: "[F]ailing to provide adequate access to affordable, reliable childcare truly creates a gender disparity, resulting in a negative impact on plastic surgery training....All institutions with plastic surgery residency programs should provide affordable, accessible childcare that accommodates the 24-hour natures of both patient care and parenthood."

Click here to read “Parenting in Plastic Surgery Residency“

DOI: 10.1097/PRS.0000000000009134

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About Plastic and Reconstructive Surgery

For over 75 years, Plastic and Reconstructive Surgery® (http://www.prsjournal.com/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer reported 2020 annual revenues of €4.6 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,200 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

For more information, visit www.wolterskluwer.com, follow us on Twitter, Facebook, LinkedIn, and YouTube.

JOURNAL

Plastic and Reconstructive Surgery Global Open

Comparing cancer-related spending, mortality rates in high-income countries

THE MOST EXPENSIVE HEALTHCARE MONEY CAN BUY

JAMA Health Forum

Peer-Reviewed Publication

JAMA NETWORK

About The Study: Researchers found in this study of 22 high-income countries that cancer care spending in 2020 was not associated with age-standardized cancer mortality rates, and that although the United States spent more on cancer care than any other country, this expenditure was not associated with substantially lower cancer mortality rates.

Authors: Cary P. Gross, M.D., of the Yale School of Medicine in New Haven, Connecticut, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamahealthforum.2022.1229)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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About JAMA Health Forum: JAMA Health Forum has transitioned from an information channel to an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health and health care. The journal publishes original research, evidence-based reports and opinion about national and global health policy; innovative approaches to health care delivery; and health care economics, access, quality, safety, equity and reform. Its distribution will be solely digital and all content will be freely available for anyone to read.

JOURNAL

JAMA Health Forum

FOR PROFIT HEALTHCARE USA

Analysis of household catastrophic health care expenditures associated with chronic disease

JAMA Network Open

Peer-Reviewed Publication

JAMA NETWORK

About The Study: Changes in catastrophic health care expenditures associated with chronic diseases in U.S. households from 2008 to 2018 were evaluated in this study.

Authors: Young-Rock Hong, Ph.D., M.P.H., of the University of Florida in Gainesville, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamanetworkopen.2022.14923)

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

JOURNAL

JAMA Network Open

Examining association of registered nurse staffing with mortality risk of older patients with sepsis

JAMA Health Forum

Peer-Reviewed Publication

JAMA NETWORK

About The Study: The results of this analysis of 1,958 acute care hospitals and 702,000 patients suggest that hospitals that provide more registered nurse hours of care could likely decrease the likelihood of mortality in Medicare patients with sepsis.

Authors: Jeannie P. Cimiotti, Ph.D., of Emory University in Atlanta, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamahealthforum.2022.1173)

# # #

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Legislation focused on obscenity and indecency will not help to keep children safe online, expert warns

Meeting Announcement

UNIVERSITY OF EXETER

Laws that are premised on the traditional notions of obscenity and indecency will not help to keep children safe online, a leading expert has warned.

Existing laws that are reliant on a standard of ‘morality’ and obscenity have proven to be ineffective for regulating adult pornography on the internet. They should instead be based around child protection and keeping them away from adult online content, Professor Abhilash Nair from the University of Exeter Law School said at the euCONSENT conference in Athens.

Regulation of lawful adult pornography should focus on access rather than content, he told delegates.

Professor Nair said: “Attempting to transpose traditional laws that centre on the obscenity and indecency of images is simply inappropriate for the internet. Laws that rely on moralistic notions of obscenity and indecency of images will not command the obedience or respect of cyberspace communities.

“We need to prevent children’s access to adult content. Any regulatory framework that has content controls premised on notions of obscenity and indecency, that interferes with the right of adults to consume content, will not succeed in cyberspace.

“The primary purpose of the law should be to ensure children do not access adult content, without hindering the rights of adults to access lawful pornography. It is a delicate balance that the law has failed to strike for nearly three decades in cyberspace. This balance can be achieved only by access-focused regulation, rather than content-focused regulation.”

Professor Nair is currently leading the academic research for the European Commission-funded euCONSENT research project, which aims to create an interoperable solution for age verification and parental consent for child protection on the internet.

At the conference he also warned the lack of regulation on adult pornography in the USA means there is little chance for other countries to rely on traditional obscenity laws to exert any meaningful control to regulate its access within their local jurisdictions.

Professor Nair’s research suggests age verification, whilst envisaged as one of the legitimate measures of protecting children online from harmful content in European legislation (Audiovisual Media Services Directive), has not been effectively used so far and children continue to have unfettered access to pornography, pointing to a potential lacuna in the law.

He said: “Age verification is not a silver bullet for child protection or a substitute for parental/carer responsibility. The law envisages that other appropriate measures are in place to facilitate parental control, such as age ratings, age-gating options or filters, for content that poses a lower risk to children, but harmful content such as pornography calls for stricter measures encompassing age verification. It is also crucially important that age verification solutions are privacy preserving and secure so that adults can continue to exercise their rights to consume lawful pornography online.”

Critical race theory at center of UW study of unequal access to treatment for opioid addiction

Grant and Award Announcement

UNIVERSITY OF WASHINGTON

Opioid use disorder is an addiction crisis in the United States that has become increasingly lethal during the COVID-19 pandemic. To preserve access to life-saving treatment during the pandemic, federal drug agencies loosened requirements on physicians for treating these patients, including moving patient evaluations away from in-person exams to telemedicine.

This federal policy change focused primarily on buprenorphine, a highly effective treatment for opioid use disorder and one that is much less onerous and stigmatizing than methadone, the other most common but heavily monitored treatment.

With a $2.5 million National Institutes of Health grant, researchers at the University of Washington will explore one of the most important questions related to this emergency policy change: whether those changes helped with another opioid-related crisis — the unequal access experienced by Black and Latinx patients to buprenorphine.

“There are a lot of clinical champions these days who think buprenorphine should be offered routinely in primary care to people who have opioid use disorder, and this policy change helps that,” said Emily Williams, professor of health systems and population health in UW School of Public Health. “However, we’ve seen systematically that Black and Latinx patients were much less likely to get the less-stigmatized buprenorphine than white patients.”

Williams and co-principal investigator Jessica Chen, assistant professor of psychiatry and behavioral sciences at the UW School of Medicine, want to find out if this inequity remained, improved or potentially got worse under the new policies since telemedicine itself can be a barrier to access. The researchers, who also have appointments at the Denver-Seattle Center of Innovation for Veteran-Centered Value-Driven Care, will use national data from U.S. Veterans Affairs to explore this question.

“I work primarily in a chronic pain clinic. We’ve known for a long time that pain is undertreated among certain racial minority populations. That’s really clear,” said Chen. “And what is becoming increasingly obvious to us as a country is that opioid use disorder is a huge epidemic, and what I am seeing is that the life-saving treatments we have for opioid use disorder are also being under-received by patients of color and other minoritized groups.”

To understand how and why these disparities exist, the researchers will undertake a unique study effort to use critical race theory and its related public health praxis developed by Chandra Ford, UCLA, and Collins Airhihenbuwa, Georgia State University, to “examine the structural mechanisms of disparities” in treating opioid use disorder, the researchers stated in their grant application.

“This situation provides an excellent opportunity to begin applying critical race theory and the practice of ‘centering the margins’ into a research design that focuses on the lived experiences of marginalized populations,” Williams said. “A lot of research focuses on what is happening for minoritized groups relative to white people and then figuring out those mechanisms. But when we center the margins, we’re caring specifically about what’s happening to these minoritized groups that are not getting what they need.”

The researchers plan to conduct phone interviews with Black and Latinx patients for this part of the study. They intend to look beyond the health care system and into patients’ communities to learn more about the policies society has enacted that affect them. For example, the war on drugs is a policy initiated by President Nixon in 1971 that has differentially impacted minoritized communities, including in ways that serve as barriers to adequate substance use treatment.

“One of the key variables we are looking at is differential police presence in communities as one of the things that might modify community members’ ability to access buprenorphine versus methadone,” said Chen. “The more that any specific behavior is criminalized, the more that we expect that people will go through the court system and a treatment pathway that involves a lot of monitoring, as methadone does. Then of course that treatment itself becomes more disruptive of the person’s life, which then has impacts for family, as well as economic and occupational opportunities.”

The researchers hope their findings will show who benefited from easier access to buprenorphine and whether those temporary policy changes to access should be made permanent. They also hope to encourage the larger health care system to review and change the social policies that have such a big impact on individual outcomes.

“There are just so many horrible and sad ways that our society is structured to limit access to resources for some groups and to privilege others,” Williams said, “And the way that trickles into health care and in particular care for stigmatized conditions like opioid use disorder is, for me, heartbreaking.”

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For more information, contact Williams at emwilli@uw.edu and Chen at chenj4@uw.edu.