The space between us

Peer-Reviewed Publication

WASHINGTON UNIVERSITY IN ST. LOUIS

 

IMAGE: A STUDY FROM THE MISSOURI OZARKS HIGHLIGHTS THE IMPORTANCE OF SPATIAL ASPECTS OF BIODIVERSITY FOR HEALTHY FUNCTIONING OF NATURALLY OCCURRING FORESTS. JACQUELINE REU, FIRST AUTHOR OF THE STUDY IN THE JOURNAL ECOLOGY, GRADUATED FROM WASHINGTON UNIVERSITY IN 2019 WITH A DOUBLE MAJOR IN ENVIRONMENTAL BIOLOGY AND IN PHYSICS IN ARTS & SCIENCES. view more 

CREDIT: JONATHAN MYERS, WASHINGTON UNIVERSITY IN ST. LOUIS

A study from the Missouri Ozarks highlights the importance of spatial aspects of biodiversity for healthy functioning of naturally occurring forests.

Biologists from Washington University in St. Louis determined that tree beta diversity — a measure of site-to-site variation in the composition of species present within a given area — matters more for ecosystem functioning than other components of biodiversity at larger scales. The research also shows that the relationship between beta diversity and tree biomass strengthens with increasing spatial scale (the size of an area), a finding that has implications for conservation planning. The study was published in the journal Ecology.

The study was led by Jacqueline Reu, who graduated from Washington University in 2019 with a double major in environmental biology and in physics in Arts & Sciences, as part of her honors thesis in biology. Reu was mentored by Christopher P. Catano, a PhD graduate of Washington University who is now a postdoctoral research associate at Michigan State University, and Jonathan A. Myers, associate professor of biology in Arts & Sciences at Washington University.

The data for Reu’s thesis was collected as part of a large-scale forest ecology project led by Myers’ research team at Tyson Research Center, Washington University’s environmental field station. More than 60 undergraduate students, high school students and research technicians have surveyed more than 30,000 trees for the project.

“A lot of studies have focused only on small scales when they look at biodiversity and ecosystem functioning,” said Reu, first author of the study. “Our study is one of the first that looks at multiple different measures of biodiversity, as well as direct and indirect effects of the environment, on ecosystem functioning as you increase scale in a natural system.”

“Our results back the theory that beta diversity, or the variation in species composition across space, is the best biodiversity measure at larger scales,” she said. “It’s stronger than the other diversity measures that we considered, like local and regional diversity. And its importance increases as you increase spatial scale.”

Studying landscapes in the Ozarks

For this study, researchers identified 14 landscapes of oak-hickory forest, each of which contained at least three major habitat types that are often found in Ozarks forests, including west- or south-facing slopes that tend to be sunnier, drier and nutrient poor; valleys and bottom lands, which are often shady, nutrient-rich and have small streams running through them; and east- and north-facing slopes, which tend to be the most productive in terms of tree cover.

Each landscape included an environmental gradient of nutrient and moisture availability, light availability and a variety of topographic conditions.

Washington University’s Tyson Research Center, located 20 miles southwest of the Danforth Campus, provides rich, collaborative field opportunities for both scientists and students. (Photo: Thomas Malkowicz/Washington University)

The scientists quantified the direct effects of three different diversity components — beta diversity, local diversity (the average number of species present in a small area) and regional diversity (the total number of species in the larger landscape) — and then calculated the strength of the relationship between each diversity component and the aboveground tree biomass, a property of forests related to ecosystem functioning.

Finally, they considered the strength of these relationships across 11 spatial scales within each of the landscapes, ranging from 20×20m to 120×120m. (For comparison, that’s a difference in size ranging from about the size of an end zone in American football to about 2.6 football fields.)

“It’s been a thorny thing in ecology — and most sciences, really — to try to identify the scale that we should use to study a system,” said Catano, who co-led the new study. “It leads to a lot of controversy and a lot of confusion.”

Other studies have drawn similar connections between beta diversity and ecosystem functioning, but those previous studies tended to rely on comparisons drawn on small plots of land.

Understanding how and why the relationship between beta diversity and ecosystem functioning scales up is a high-stakes analysis, in part because scientists are struggling to map out the myriad consequences of biodiversity loss in recent decades.

“It’s not just the gain or the loss and the number of species that matters, it’s also changes in the distribution of these species and where you might find them in an ecosystem,” Catano said. “This study and a few others recently have been pretty consistent, in the sense that they’re showing it’s (species) turnover, or variation across space, that seems to be really critical.

“(Beta diversity) is driving a variety of different functions, as well as the stability of these functions over time, as you scale up from small, local plot-based ecosystems to large, heterogeneous landscapes,” he said.

“This project highlights the utility of large-scale, long-term field research projects,” Myers said. “The study was largely fortuitous, because we had set up the 14 large forest plots across the Tyson landscape for a different project. But the way that we set them up was perfect for addressing questions about how environmental variation and species composition across space contribute to ecosystem functioning.

“One implication is that if you homogenize the environmental conditions, that might also negatively impact ecosystem functioning,” Myers said. “Habitat loss or homogenizing the amount of nutrients and other limiting resources for organisms in an ecosystem could have cascading effects on ecosystem functioning and services. These are indirect effects that are challenging to predict if you don’t consider both environment and diversity together.”

Montioring ecosystem functioning

Since graduating from Washington University, the study’s first author, Reu, has worked as an intern at the Smithsonian Marine Station at Fort Pierce, Fla., and at the Smithsonian Environmental Research Center’s Marine Invasions Lab in Tiburon, Calif. But she continues to be motivated by her work at Tyson Research Center.

“Forests are my favorite ecosystem to be in,” Reu said. “Without plants, nothing else in the food chain would work at all: it wouldn’t exist. And that’s why I find studying them especially fascinating.”

During the hot, humid days of her undergraduate summers, Reu tramped through the forest with a small squad of other Tyson research fellows — identifying trees, measuring their diameters and tagging and mapping them as part of a long-term forest monitoring program. Reu identified seeds collected from seed traps and cleaned, weighed and cataloged seedlings. At night, she taught herself a statistical programming language to help sort through the data she was recording.

“I’ve always liked the math side of things,” Reu said. “For this project, I mostly taught myself to program in R, using YouTube videos.

“It wasn’t the first computer language I’ve learned, but I think it’s the most thorough one I’ve learned so far,” she said. “Then I made some graphics using GIS as well.”

This coming summer, Reu will be doing a project with rare butterflies in New Hampshire while she prepares to apply for graduate school.

“I’ve always had a passion for ecology,” Reu said. “So when I was just looking at different options, Jonathan’s lab really stood out to me. He’s so inventive and they do really thorough work.

“And I love trees, so that definitely helped,” she said. “The work at Tyson was very interesting, partly because it’s part of the Smithsonian Forest Global Earth Observatory (ForestGEO) network. That just opens a lot of doors.”

---

Funding: This work was supported by a grant from the National Science Foundation (DEB 1557094).

---

JOURNAL

Ecology

DOI

10.1002/ecy.3774 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Beta diversity as a driver of forest biomass across spatial scales

Hormone therapy remains most effective treatment for menopause symptoms of hot flashes and night sweats

NAMS video on the 20th anniversary of The Women's Health Initiative helps dispel misconceptions regarding risks of hormones

Business Announcement

THE NORTH AMERICAN MENOPAUSE SOCIETY (NAMS)

CLEVELAND, Ohio (June 1, 2022)—It has been 20 years since The Women’s Health Initiative suggested a link between hormone therapy (HT) and increased risks for breast cancer, heart disease, and stroke. Although much has been learned since 2002, many women still suffer needlessly with menopause symptoms from fear of using HT. A new video from The North American Menopause Society (NAMS) summarizes why HT remains the most effective, safest treatment for menopause symptoms.

The video, Hormone Therapy: Understanding the Risks and Benefits, is hosted by NAMS past-president Dr. Marla Shapiro and features expert insights from Dr. Juliana Kling, chair of Women’s Health, Internal Medicine at the Mayo Clinic in Scottsdale, Arizona.

“Twenty years later, women are still asking about the risks of HT,” says Dr. Kling. “Although they also remain concerned about heart disease and stroke, their top concern is breast cancer, even though more recent studies have demonstrated that the risks of hormones are low and are far outweighed by the benefits.”

According to Dr. Kling, there is overwhelming evidence that HT remains the most effective treatment for an array of menopause symptoms, especially hot flashes and night sweats, two of the most common and burdensome symptoms. Moreover, the associated risk is very low for most women without contraindications for hormones and is primarily associated with the timing of initiation of HT.

“For most women who are aged younger than 60 years or within 10 years of their last menstrual cycle when they initiate HT, the health risks are very low,” says Dr. Kling, who likened the level of risk to that of obesity or a sedentary lifestyle. “Duration of therapy influences that risk, but that doesn’t mean there is a definitive cutoff of 5 years or so for all women. In addition, any potential increased risk related to a longer duration of HT can often be offset by a healthy lifestyle that includes a balanced diet and exercise.”

The video details how the various formulations of HT affect a woman’s risk levels. Women with a uterus who need progesterone to protect against endometrial cancer, for example, may face a slightly increased risk of breast cancer, whereas women on estrogen alone have actually been found to have a lower risk of breast cancer and a lower mortality rate from breast cancer than women on placebo.

“Unfortunately, a lot of women going through the menopause transition are suffering unnecessarily because of misrepresentation of the data from 20 years ago,” says Dr. Stephanie Faubion, NAMS medical director. “It’s important that women be presented with the benefits and risks on the basis of accurate data and then make the decision that is best for their specific situation in collaboration with their healthcare professionals. For most healthy women, HT is the best option for management of disruptive menopause symptoms.”

The video is part of NAMS’ comprehensive video series for women and professionals on important midlife health topics. For more information about menopause and healthy aging, visit www.menopause.org.

Founded in 1989, The North American Menopause Society (NAMS) is North America’s leading nonprofit organization dedicated to promoting the health and quality of life of all women during midlife and beyond through an understanding of menopause and healthy aging. Its multidisciplinary membership of 2,000 leaders in the field—including clinical and basic science experts from medicine, nursing, sociology, psychology, nutrition, anthropology, epidemiology, pharmacy, and education—makes NAMS uniquely qualified to serve as the definitive resource for health professionals and the public for accurate, unbiased information about menopause and healthy aging. To learn more about NAMS, visit www.menopause.org.

Screening every five years safe for women who test negative for HPV, study confirms

Peer-Reviewed Publication

KING'S COLLEGE LONDON

A study of 1.3 million women in England has provided evidence to support the extension of cervical cancer screening intervals from three years to five years for those that have a negative screen result.

The study, published today in the British Medical Journal by researchers from King’s College London and funded by Cancer Research UK, provides reassurance to women and people with a cervix aged 24-49 years who test negative for the human papillomavirus (HPV), that screening at five-year intervals prevents as many cancers as screening at three-year intervals, even if they are not vaccinated against HPV.

The study confirms that women in this age group are much less likely to develop clinically relevant cervical lesions (high-grade cervical intraepithelial neoplasia, which are abnormal changes of the cells that line the cervix and are otherwise known as CIN3+) and cervical cancer, three years after a negative HPV screen compared to a negative smear test. This risk is more than halved.

Lead author Dr Matejka Rebolj, Senior Epidemiologist at King’s College London said: “These results are very reassuring. They build on previous research that shows that following the introduction of HPV testing for cervical screening, a 5-year interval is at least as safe as the previous 3-year interval. Changing to 5-yearly screening will mean we can prevent just as many cancers as before, while allowing for fewer screens.”

Almost all cervical cancers are caused by HPV infection. Usually, the immune system gets rid of the virus on its own, but if it doesn’t HPV can cause abnormal cells to develop in the cervix. If these abnormal cells are not treated, they can turn into cancer. This is a process that often takes 10-15 years, and sometimes even longer.

Before 2019, cytology tests, otherwise known as smear tests, checked cervical cells for abnormalities first. If found, some of the samples would then be tested for HPV. These tests were recommended every three years. In 2019, following expert scientific evidence, the NHS Cervical Screening Programme in England fully implemented primary high-risk HPV testing using cytology as a triage test, whilst keeping the same screening intervals (3 years for those aged 24-49 years). Now samples taken during cervical screening are tested for HPV first. As having HPV infection comes before having abnormal cells, HPV testing detects more women at risk of cervical cancer.

The study shows that the HPV test is more accurate than a cytology test. Researchers from King’s College London, the University of Manchester, and the NHS have analysed data the from the NHS Cervical Screening Programme in England. They followed those attending screening for two rounds, the first from 2013-2016 with a follow up by end of 2019.

Researchers found that people eligible for screening under fifty who had a negative HPV screen in the first round had a lower risk of detection of CIN3+ in the second round compared to cytology. 1.21 in 1000 people had a detection of CIN3+ after a negative HPV screen compared to 4.52 in 1000 people after a negative cytology.

Currently in the UK, where the HPV screen is negative, the NHS Cervical Screening Programme in England invites women and people with a cervix aged 25-49 years to test every three years and people aged 50-64 years to test every five years or three years if they test positive.  Scotland and Wales are the first to implement the new intervals. England has introduced HPV testing but continue to invite those eligible under fifty every three years and over fifty to test every five years. Northern Ireland currently use cytology tests but will switch to HPV primary screening in the future.

Dr Rebolj added: “This monumental study relied on a multidisciplinary team including those in the NHS Cervical Screening Programme in England, working with women undergoing screening and their samples, and our academic partners. This partnership provides evidence that will best serve the millions of women invited for screening throughout most of their adult lives. These promising results show most women and people with a cervix do not need to be screened as frequently as they are now.”

Michelle Mitchell, Cancer Research UK’s chief executive, said: “This large study shows that offering cervical screening using HPV testing effectively prevents cervical cancer, without having to be screened as often. This builds on findings from years of research showing HPV testing is more accurate at predicting who is at risk of developing cervical cancer compared to the previous way of testing. As with any change to a screening programme, this will be monitored to ensure that cervical screening is as effective as possible for all who take part.

“It’s important to remember, screening is for people without symptoms. So, if you notice any unusual changes for you, do not wait for a screening invitation - speak to your doctor.”

ENDS

NOTES TO EDITORS:

About Cervical Screening & HPV

 

High-risk Human Papillomavirus (HPV) DNA is found in over 99% of all cervical cancers. Cervical screening now primarily tests for the presence of this high-risk HPV infection, which is a common virus that most people will get at some point. HPV primary screening is a more sensitive and accurate test than the previous method (cytology alone) and is the best way to find out who is at higher risk of developing the cervical cell changes that over time could potentially lead to cervical cancer.

 

While the risk for people with high-risk HPV of getting cervical cancer is low, any abnormal changes can be identified early. If HPV is detected, the sample is then checked for any changes in the cells of the cervix. Cell changes are easily treated if caught early, so they don’t get a chance to turn into cervical cancer. 

 

For further information about cervical screening, please visit www.nhs.uk/cervicalscreening.   

About extended screening intervals

• The National Screening Committee recommended that, following the introduction of primary HPV screening in the cervical screening programme screening invites should be changed from 3 to 5 years for 24.5 to 49 year olds for anyone that is found not to have high-risk HPV at their routine screening test.
• The NHS in England has not changed cervical screening invites to every five years for eligible people aged 24.5 to 49 years old if their screen shows they don’t have high-risk HPV.
• The NHS Cervical Screening Programme in England invites over 4.5m people each year. NHS Digital is working with NHS England and NHS Improvement at pace to prepare for the safe and smooth transition to a new IT system for cervical screening which would safely and effectively support any changes to the programme. This is a major piece of work which the programme is working closely with NHS Digital, to implement.

King’s College London

 

King's College London is one of the top 35 UK universities in the world and one of the top 10 in Europe (QS World University Rankings, 2020/21) and among the oldest in England. King's has more than 31,000 students (including more than 12,800 postgraduates) from some 150 countries worldwide, and some 8,500 staff.

 

King's has an outstanding reputation for world-class teaching and cutting-edge research. In the 2014 Research Excellence Framework (REF), eighty-four per cent of research at King’s was deemed ‘world-leading’ or ‘internationally excellent’ (3* and 4*).

 

Since our foundation, King’s students and staff have dedicated themselves in the service of society. King’s will continue to focus on world-leading education, research and service, and will have an increasingly proactive role to play in a more interconnected, complex world. Visit our website to find out more about Vision 2029, King's strategic vision to take the university to the 200th anniversary of its founding.

 

World-changing ideas. Life-changing impact: https://www.kcl.ac.uk/news/headlines.aspx

 

About Cancer Research UK

• Cancer Research UK is the world’s leading cancer charity dedicated to saving lives through research, influence and information.
• Cancer Research UK’s pioneering work into the prevention, diagnosis and treatment of cancer has helped save millions of lives.
• Cancer Research UK has been at the heart of the progress that has already seen survival in the UK double in the last 40 years.
• Today, 2 in 4 people survive their cancer for at least 10 years. Cancer Research UK wants to accelerate progress and see 3 in 4 people surviving their cancer by 2034.
• Cancer Research UK supports research into the prevention and treatment of cancer through the work of over 4,000 scientists, doctors and nurses.
• Together with its partners and supporters, Cancer Research UK is working towards a world where people can live longer, better lives, free from the fear of cancer.

For further information about Cancer Research UK's work or to find out how to support the charity, please call 0300 123 1022 or visit www.cancerresearchuk.org. Follow us on Twitter and Facebook. 

---

JOURNAL

BMJ

DOI

10.1136/bmj-2021-068776 

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Extension of cervical screening intervals with primary human papillomavirus testing: observational study of English screening pilot data

Mandating flu jab, but not COVID-19 jab, ethically justified for healthcare staff

Peer-Reviewed Publication

BMJ

Few side effects; cuts infection risks; minimises staff shortages and presenteeism

And professional obligations to patients trump curbs on personal freedom, argue ethicists

Mandating the flu jab for healthcare staff is ethically justified, but the same can’t be said of the COVID-19 jab, argue leading ethicists in an extended essay published online in the Journal of Medical Ethics.

Unlike the COVID-19 jab, the pros outweigh the cons for all age groups: the flu jab is safe and has few side effects; it cuts the risk of infection; and it minimises staff shortages and ‘presenteeism’, they suggest. 

And healthcare workers have professional obligations to protect patients from a virus that is particularly deadly for older people who are overrepresented among hospital patients. Such obligations trump curbs on personal freedom, the authors contend.

In light of the infection control issues raised by the pandemic, and the steps taken by various countries to overcome vaccine hesitancy, the authors compare the ethical criteria for mandating vaccination of healthcare staff against COVID-19 and seasonal flu.

A vaccine mandate for healthcare workers would align with existing professional requirements, based on preventing harm to patients. But not every professional obligation is also a legal requirement. 

Further ethical criteria are therefore required to justify such a policy, the authors explain. These include the pros and cons of the vaccines and the availability of less restrictive alternatives to achieve comparable health benefits.

During the pandemic, several countries mandated COVID-19 vaccination for healthcare workers: France; Italy; many US states; several Canadian provinces; and Australia.

The UK government also planned to do the same, but stopped short amid fears of staff losses and perceived heavy-handedness in light of the emergence of the milder Omicron variant.

However, it did consult on mandating the seasonal flu jab for healthcare workers, around 1 in 4 of whom don’t get vaccinated against the virus. 

Flu kills more than 11,000 people every year in England alone, a toll that rose to more than 22,000 in 2017-18.

Data from London University College hospitals during the 2018–2019 flu season suggest that 15% of inpatients with flu caught the infection while in hospital (nosocomial infection).

In some flu seasons large numbers of unvaccinated staff fall ill, prompting shortages or ‘presenteeism’---where staff with the infection keep on working—so heightening the risk of spreading it to patients and colleagues.

“Vaccine mandates are typically controversial as they entail limitations of individual liberties for the sake of the collective good,” acknowledge the authors. 

“However, when it comes to [healthcare workers], liberty-based counter-arguments are more difficult to apply. Quite simply, [healthcare workers] have an ethical and professional obligation not to harm patients, or to minimise the risk of harm to patients, which other people do not have,” they point out.

“It is already commonly accepted that [healthcare workers] should take on at least some additional health risk for the sake of their patients…The issue at stake is not if this is justified, but how much extra risk is justifiable by contractual and professional obligations,” they add.

COVID-19 vaccines are associated with a small risk of blood clots and myocarditis (inflammation of the heart muscle), and given the relatively low risk of serious illness from COVID-19 among younger staff, the cons may very well outweigh the pros, they suggest.

Nor do the current crop of COVID-19 vaccines seem very effective at preventing spread, while the protection they afford against symptoms tails off within months.

What’s more, COVID-19 illness severity has reduced, due to changes in the circulating form of the virus, high vaccine uptake in those at highest risk, high rates of natural immunity and increasingly more treatments becoming available, point out the authors.

These issues don’t apply to the seasonal flu vaccine, which has been used for decades, has a well established safety profile, and few and mostly minor side effects, they highlight.

Higher flu jab uptake minimises risk of harm to patients, not just by reducing the risk of infection, but also by reducing the risk of staff shortages due to illness. And the evidence suggests that compulsory flu jabs increase uptake more than less severe measures, say the authors.

But the question remains as to what level of coercion is ethically acceptable. “One way to strike a balance between individual freedom and patients’ interests is to make vaccination a condition of entry into the profession rather than mandating those already employed, and adopt a conditional mandate if at all possible for those already in the profession,” they write. 

“Ultimately, there is an ethical balance to be drawn between protecting patients (including their own right to not acquire serious but preventable nosocomial infections) and coercing some healthcare professionals into having a vaccine that they would prefer not to receive.”

They conclude: “For reasons that we have given above, the balance of risks and benefits suggests that an influenza vaccine mandate, but not a COVID-19 mandate, would currently be ethically proportionate.”

But they caution: “Mandates should be introduced on a disease-specific and vaccine-specific basis. The problem must be a significant one; the vaccines must be safe and effective at preventing illness and/or transmission; mandatory measures must be superior to less coercive alternatives; and the costs in loss of liberty and risk to health professionals must be proportionate in professional terms to the benefits to patients.”

 

---

JOURNAL

Journal of Medical Ethics

DOI

10.1136/medethics-2022-108229 

METHOD OF RESEARCH

Commentary/editorial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Vaccine mandates for healthcare workers beyond COVID-19

Violent incidents at GP practices double in five years, BMJ investigation finds

Peer-Reviewed Publication

BMJ

The number of violent incidents recorded by police forces at UK general practices has almost doubled in the past five years, finds an investigation published by The BMJ today.

Worryingly these figures also show a near doubling of assaults that cause physical harm, causing some GPs and their staff to leave their jobs, reports Gareth Iacobucci.

GP leaders said the “appalling” figures highlighted how assaults, harassment, and other forms of abuse aimed at doctors and their staff had worsened during the pandemic, as services have been under increased pressure and some sections of the media have perpetuated the notion that GP services were “closed.” 

The BMJ sent freedom of information requests to the 45 police forces in the UK asking for the number of recorded crimes committed at general practices and how each crime was categorised. A total of 42 forces (93%) had sent responses by the time of publication, 32 of which (71%) were able to provide complete and comparable data for the past five years. 

In total, the 32 police forces recorded 1068 incidents of violence at health centres and GP surgeries in 2021-22, compared to 791 in 2020-21 and 586 in 2017-18. These figures include all incidents defined in the category of “violence against the person”, which include all forms of assault and harassment.

Within this number there were 182 assaults resulting in injury last year, the highest for five years and almost double the 98 recorded in 2017-18. 

And also within this number, recorded incidents of stalking and harassment at GP surgeries have almost tripled over the past five years, with 223 instances last year compared to 85 in 2017-18. This is to a large extent driven by a surge in malicious communications - which can include sending letters or emails - which increased from 25 in 2017-18 to 92 last year. 

As well as a rise in incidents of violence, public order offences such as threatening behaviour rose by 24% last year from 438 to 541 and are up 40% on five years ago (387).

Richard Van Mellaerts, a GP in Kingston Upon Thames and an executive officer for the BMA’s GP Committee, said the figures obtained by The BMJ matched the experiences of doctors on the frontline, including his own. “I regularly hear abuse directed at reception staff in my practice, we've had to call the police several times over the last year,” he said. 

Meanwhile, Richard Vautrey, a GP in Leeds and former chair of the BMA’s GP committee, said the police crime figures are only “the tip of a much, much bigger iceberg” of the incidents occurring in general practice, citing “often daily abuse that staff are having to deal with.”

Van Mellaerts noted that as well as the police and courts taking action against perpetrators of violent crimes, it was crucial to understand why the increase in abuse and violence was happening to try to tackle the problem. 

He points to possible drivers for some of the aggression, including a dramatic increase in remote consultations, and fewer GPs doing more and more, but says the rise in violent incidents and abuse aimed at GPs and staff will only exacerbate the staff shortages which are contributing to difficulties in accessing care. 

“We appreciate patients’ frustrations and upset with delays in their care, but those frustrations need to be channelled into holding governments to account in order that they invest appropriately in general practice and solve these systemic issues, not taken out on their GPs and practice staff.”

In response to The BMJ’s findings, a Department of Health and Care spokesperson said, “Deliberate violence or abuse directed at NHS staff, who continue to work tirelessly to provide care, is unacceptable – all staff, including GPs and their teams, deserve to work in a safe and secure environment.
 
“The NHS violence reduction programme aims to protect the workforce and ensure offenders are punished quickly and effectively, and the government has taken action to support this – including by passing legislation to double the maximum sentence for assaults on emergency workers, including those in the NHS.
 
“Security measures including CCTV, panic buttons and screens at reception have also been rolled out across GP surgeries.”

NHS England also recently updated its Primary Medical Care Policy and Guidance Manual for service commissioners to add a new chapter on managing inappropriate and unacceptable patient behaviours.

An NHS spokesperson said: “The NHS will not tolerate abuse or violence towards its staff and, despite the despicable actions of a minority, is grateful for the overwhelming sense of national support NHS workers have received from the wider public over the last two years as it stepped up to fight covid.

---

JOURNAL

The BMJ

DOI

10.1136/bmj.o1333 

Citizen power mobilized to fight against mosquito borne diseases

Citizen scientists use phone apps to work in collaboration with researchers to collect huge amounts of data on disease carrying mosquitoes as part of a WHO-supported series on vector-borne diseases

Peer-Reviewed Publication

GIGASCIENCE

 

IMAGE: YELLOW FEVER MOSQUITO HAVING A BLOOD-MEAL. view more 

CREDIT: AUTHOR: JAMES GATHANY SOURCE CDC - PHIL

The latest from Mosquito Alert, a citizen science system for investigating and managing disease-carrying mosquitoes, has collected and released 13,700 new database records on the presence, location, and spread of these mosquitos. These data, hosted in the Global Biodiversity Information Facility (GBIF), are part of an ongoing world-wide collaboration between citizen volunteers, who use a specifically designed app to photograph mosquitos and report bites and locations of potential breeding sites, and entomological experts, who validate the findings to determine if the collected information provides evidence of the presence of any of the mosquito species of top concern. This study is part of a WHO-sponsored series on vector borne human diseases, which collects and presents biodiversity data for a range of different disease vectors and promotes data sharing to increase the speed at which researchers can assess and address human health threats. In this particular study, an entire community of citizen scientists have been actively engaged in furthering the acquisition of information in a cost-effective, as well as publicly educational, manner. In addition to providing a large, widespread, valuable resource for studying and containing infectious diseases, this work serves as an excellent model for bringing together the mobilizing power of citizens and scientists to address important health issues. This study has been published in the open-access, open-data journal GigaByte.

Vector-borne diseases account for more than 17% of all human infectious diseases, with mosquito-borne diseases causing the greatest health burden on society based on case numbers, deaths, and resultant disabilities. While there has been significant progress in the fight against malaria, this progress is currently slowing. Whereas, progress on combating other mosquito-driven diseases, such as dengue, chikungunya, yellow fever, and Zika, are expanding, due to the increasing number of cases and fatalities for these diseases. To best combat these health risks, researchers must fill the large gaps in knowledge related to the presence, spread, and activity of mosquitos that spread these diseases, Data mobilization campaigns serve as one of the best means to improve geographical data coverage. Harnessing the collective power of citizen scientists across the globe has served the scientific community well with regard to being able to collect massive amounts of information across the globe, especially in the areas of biology, conservation, and ecology. It is currently a major weapon in the fight against mosquito-borne diseases.

The work presented in the article was carried out by Mosquito Alert, which provided the first detection of the Asian bush mosquito Aedes japonicus in Spain in 2018. This finding was a striking observation as it was an isolated population of mosquitos that were located 1,300 km from its previously nearest known location in Europe. Since this species was not expected to appear in this region, it had not been targeted by any local surveillance program. This served as clear indication of the danger of monitoring specific species in areas that were primarily in and close to regions they were known to exist. However, budget and manpower limitations, make it nearly impossible to collect data across expansive ranges.  Mosquito Alert, by harnessing a largely free resource of manpower, were able to extend their work to identify and track other invasive mosquitoes across a much larger geographical range. They armed a cadre of citizen scientists with a phone app aimed at collecting usable types of data and developing a harmonized methodology for collecting and validating these data by experts. The information collected in the apps are updated on a daily basis, and thus, provide near real-time information on the status of deadly disease-carrying mosquitos.

This form of combined data collection strategies provides an incredible addition to governmental vector screening programs, which require huge resources to fill all geographical corners of their countries. Since citizens with mobile devices are everywhere, the potential to use this approach as an early warning system of invasive species of all types can move from city-scale to continental scale, and, with continued growth, global scale.

Of this huge potential, first author Dr Živko Južnič-Zonta says: “Because of its daily update, this dataset could help to optimize vector control, as citizen scientists provide information about nuisance and presence of mosquitoes at almost real time.”

The availability of such a large public collection of validated mosquito images not only allows researchers themselves to work directly with these data, this enormous dataset can also be used to train machine-learning models for vector detection and classification, further increasing the power of these data to serve as part of an arsenal to improve global human health.

The value of such data collected by an army of citizen scientists in concert with experts also shows the need for developing a new publication credit system to evaluate contributions from multiple and diverse collaborators, which, for this study, included university researchers, entomologists, and other non-academics such as independent researchers and citizen scientists. For this article, the authors carefully considered and designed such a credit system. As research that makes use of citizens as a major, and free, component of research programs continues to grow, the credit system used in this article sets forth a process to allow such large consortium to provide clear credit to the entire cadre of individuals involved in any study, which is long past due.

This work is part of a series of articles that assess the range and diversity of a wide variety of vector-borne diseases. GigaScience Press has partnered with GBIF, which has been supported by TDR, the Special Programme for Research and Training in Tropical Diseases, hosted at the World Health Organization. Through this, GBIF are releasing the first 11 Data Release papers on vectors of human disease in a thematic series in the journal GigaByte. To better incentivize the sharing of these extremely important datasets, the article processing charges to authors have been waived for these easy-to-write descriptions that are associated with public domain datasets in the GBIF database to assist with the global call for novel data. This effort has led to the release of newly digitized location data for over 600,000 vector specimens observed across the Americas and Europe.

 

GigaByte’s novel, end-to-end XML publishing platform, means publication can be done in a quicker and more interactive manner than traditional scientific publications. Papers in this biodiversity series include interactive maps, embedded protocols, and multilingual options for several of these articles, allowing Portuguese and Spanish speakers to better comprehend the implications of important work relating to the public health of their communities.

 

Further Reading

Južnič-Zonta Ž, et al. Mosquito alert: leveraging citizen science to create a GBIF mosquito occurrence dataset. GigaByte 2022. doi: 10.46471/gigabyte.54

Mosquito Alert website: http://www.mosquitoalert.com/en/project/what-is-mosquito-alert

Mosquito Alert App: http://www.mosquitoalert.com/en/project/envia-datos

 

Mosquito Alert website: http://www.mosquitoalert.com/en/project/what-is-mosquito-alert

Mosquito Alert App: http://www.mosquitoalert.com/en/project/envia-datos

Read more, see the GigaScience Blog at: http://gigasciencejournal.com/blog/publishing-mosquito-alert-data

To see all of the articles in this WHO-sponsored vector-borne disease series go to: https://doi.org/10.46471/GIGABYTE_SERIES_0002

 

Media contacts:

GigaScience Editor-in-Chief:

Scott Edmunds, Scott@gigasciencejournal.com, Office: +852 3610 3531 Cell: +852 92490853

Sharing on social media?

Find GigaScience online on twitter @GigaScience; Facebook https://www.facebook.com/GigaScience/, and keep up-to-date with our blog http://gigasciencejournal.com/blog/

About GigaScience Press

GigaScience Press is BGI's Open Access Publishing division, which publishes scientific journals and data. Its publishing projects are carried out with international publishing partners and infrastructure providers, including Oxford University Press and River Valley Technologies. It currently publishes two data-centric journals: its premier journal GigaScience (launched 2012) and its new journal GigaByte (launched 2020). It also publishes data, software, and other research objects via its GigaDB.org database. To encourage transparent reporting of scientific research as well as enable future access and analyses, it is a requirement of manuscript submission to all GigaScience Press journals that all supporting data and source code be made available in GigaDB or in a community approved, publicly available repository. See GigaSciencePress.com

---

JOURNAL

Gigabyte

DOI

10.46471/gigabyte.54 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Mosqu

Tired mosquitoes would rather catch up on sleep than bite you

By understanding the mosquitoes’ circadian rhythms, researchers hope to find better ways to prevent infection.

Peer-Reviewed Publication

UNIVERSITY OF CINCINNATI

 

IMAGE: UC BIOLOGISTS DISCOVERED THAT OVERTIRED MOSQUITOES CHOOSE TO CATCH UP ON SLEEP RATHER THAN SEEK A BLOOD MEAL. view more 

CREDIT: ANDREW HIGLEY/UC CREATIVE

Turns out you’re not the only one who needs a good night's rest to function well the next day.

Researchers with the University of Cincinnati found that mosquitoes whose slumber is disrupted are more interested in catching up on their sleep than looking for food the next day. The research demonstrates how vital this biological function is even among insects.

“It was a bit surprising. Sleep deprived or not, a blood meal should appeal to them,” UC doctoral student and study lead author Oluwaseun Ajayi said.

The study was published online on May 3 and in print on June 1 in the Journal of Experimental Biology.

The phenomenon of catching up on missed sleep, called sleep rebound, has been observed in other animals such as honeybees, fruit flies and people.

Biologists in UC’s College of Arts and Sciences and Virginia Tech’s Department of Biochemistry spent more than a year developing protocols to study mosquito sleep. While observations can affect the outcome of virtually any experiment — a phenomenon called the observer effect — UC biologist Joshua Benoit said this was especially true when studying mosquito sleep.

Mosquitoes are able to sense people through their body heat, odors, movement, vibrations and the carbon dioxide they exhale from their lungs and emit from their skin.

“It’s really hard to quantify sleep in mosquitoes when, as soon as you walk in the room, you’re considered their Thanksgiving dinner,” Benoit said.

So researchers set up the experiment in a quiet part of Crosley Tower on UC’s Uptown campus, where the mosquitoes were separated from passersby by multiple rooms within rooms. Researchers set up cameras and infrared sensors that could record when the mosquitoes were moving without disturbing them.

Mosquitoes in the lab sleep a lot — between 16 and 19 hours a day depending on the species and the stimulation around them.

Recognizing a sleeping mosquito takes some skill. When they’re not looking for food, mosquitoes perch for long periods of time to conserve energy. But researchers discovered a subtle telltale sign the mosquitoes were asleep.

“When mosquitoes enter a sleep-like state, their hind legs droop and their body comes closer to the surface,” Ajayi said.

Virginia Tech researcher and study co-author Clément Vinauger used video observations to document this behavior in several mosquito species.

The experiment examined three species of mosquitoes, each responsible for transmitting disease to people: Aedes aegypti, a “day biter,” Culex pipiens, which seeks a meal at dusk; and Anopheles stephensi, which is most active at night.

Researchers studied the mosquitoes’ sleep and feeding behavior for about a week after they were acclimatized to their new experimental habitat. In a second experiment, researchers subjected them to sleep deprivation during their normal bedtime by vibrating their enclosures at regular intervals during the day or night.

While more than 75% of mosquitoes that were not subjected to sleep deprivation sought a blood meal, less than one-quarter of them had any interest in food after a sleepless night. This represented a 54% decrease in the propensity to feed among sleep-deprived mosquitoes.

“What’s surprising to me is that as much as mosquitoes need blood to produce eggs, they will give it up to recover the sleep they lost,” Benoit said. “They might not be aroused as much because of the need to catch up on sleep.”

The overtired mosquitoes also were less likely to land on a host in both laboratory and field settings, suggesting that the same behaviors would occur in natural settings like your back yard.

Lucas Gleitz participated in the research project as a UC undergraduate biology student. After graduation this year, he plans to attend medical school.

The study’s findings were relatable given the sleepless nights most college students endure.

“As a college student, we joke that we eat sleep for dinner,” Gleitz said.

Sleep is tied to immune and restorative functions such as tissue repair and protein synthesis, Gleitz said. Research has also demonstrated how important sleep is to memory and brain function.

“We learned that sleep is a very crucial aspect of living organisms. Those internal clocks keep running, even for mosquitoes,” he said.

Mosquitoes cause more human suffering than any other animal, according to the World Health Organization. Malaria alone kills more than 400,000 people annually. And mosquitoes carry pathogens for other deadly diseases such as dengue and yellow fever.

By understanding the mosquitoes’ circadian rhythms, researchers hope to find better ways to prevent infection.

“It’s important to understand their sleep dynamics — when they feed and when they sleep,” Benoit said.

---

JOURNAL

Journal of Experimental Biology

DOI

10.1242/jeb.244032 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Behavioral and postural analyses establish sleep-like states for mosquitoes that can impact host landing and blood feedingito alert: leveraging citizen science to create a GBIF mosquito occurrence dataset