Wednesday, February 15, 2023

Atom-thin walls could smash size, memory barriers in next-gen devices

Nanomaterial feature could help electronic circuits adopt benefits of human memory

Peer-Reviewed Publication

UNIVERSITY OF NEBRASKA-LINCOLN

Evgeny Tsymbal 

IMAGE: NEBRASKA’S EVGENY TSYMBAL AND AN INTERNATIONAL TEAM HAVE DEMONSTRATED HOW TO CONSTRUCT, CONTROL AND EXPLAIN NANOSCOPIC WALLS THAT COULD YIELD MULTIPLE TECHNOLOGICAL BENEFITS. THOSE BENEFITS COULD INCLUDE INCREASED STORAGE AND THE ABILITY TO RETAIN DATA STATES EVEN WHEN DEVICES TURN OFF — A PRECURSOR TO ELECTRONICS THAT POWER BACK ON WITH THE SPEED AND SIMPLICITY OF A LIGHT. view more 

CREDIT: CRAIG CHANDLER, UNIVERSITY OF NEBRASKA–LINCOLN

For all of the unparalleled, parallel-processing, still-indistinguishable-from-magic wizardry packed into the three pounds of the adult human brain, it obeys the same rule as the other living tissue it controls: Oxygen is a must.

So it was with a touch of irony that Evgeny Tsymbal offered his explanation for a technological wonder — movable, data-covered walls mere atoms wide — that may eventually help computers behave more like a brain.

“There was unambiguous evidence that oxygen vacancies are responsible for this,” said Tsymbal, George Holmes University Professor of physics and astronomy at the University of Nebraska–Lincoln.

In partnership with colleagues in China and Singapore, Tsymbal and a few Husker alumni have demonstrated how to construct, control and explain the oxygen-deprived walls of a nanoscopically thin material suited to next-gen electronics.

Unlike most digital data-writing and -reading techniques, which speak only the binary of 1s and 0s, these walls can talk in several electronic dialects that could allow the devices housing them to store even more data. Like synapses in the brain, the passage of electrical spikes sent via the walls can depend on which signals have passed through before, lending them an adaptability and energy-efficiency more akin to human memory. And much as brains maintain memories even when their users sleep, the walls can retain their data states even if their devices turn off — a precursor to electronics that power back on with the speed and simplicity of a light.

The team investigated the barrier-smashing walls in a nanomaterial, named bismuth ferrite, that can be sliced thousands of times thinner than a human hair. Bismuth ferrite also boasts a rare quality known as ferroelectricity: The polarization, or separation, of its positive and negative electric charges can be flipped by applying just a pinch of voltage, writing a 1 or 0 in the process. Contrary to conventional DRAM, a dynamic random-access memory that needs to be refreshed every few milliseconds, that 1 or 0 remains even when the voltage is removed, granting it the equivalent of long-term memory that DRAM lacks.

Usually, that polarization is read as a 1 or 0, and flipped to rewrite it as a 0 or 1, in a region of material called a domain. Two oppositely polarized domains meet to form a wall, which occupies just a fraction of the space dedicated to the domains themselves. The few-atom thickness of those walls, and the unusual properties that sometimes emerge in or around them, have cast them as prime suspects in the search for new ways to squeeze ever-more functionality and storage into shrinking devices.

Still, walls that run parallel to the surface of a ferroelectric material — and net an electric charge usable in data processing and storage — have proven difficult to find, let alone regulate or create. But about four years ago, Tsymbal began talking with Jingsheng Chen from the National University of Singapore and He Tian from China’s Zhejiang University. At the time, Tian and some colleagues were pioneering a technique that allowed them to apply voltage on an atomic scale, even as they recorded atom-by-atom displacements and dynamics in real time.

Ultimately, the team found that applying just 1.5 volts to a bismuth ferrite film yielded a domain wall parallel to the material’s surface — one with a specific resistance to electricity whose value could be read as a data state. When voltage was withdrawn, the wall, and its data state, remained.

When the team cranked up the voltage, the domain wall began migrating down the material, a behavior seen in other ferroelectrics. Whereas the walls in those other materials had then propagated perpendicular to the surface, though, this one remained parallel. And unlike any of its predecessors, the wall adopted a glacial pace, migrating just one atomic layer at a time. Its position, in turn, corresponded with changes in its electrical resistance, which dropped in three distinct steps — three more readable data states — that emerged between the application of 8 and 10 volts.

The researchers had nailed down a few W’s — the what, the where, the when — critical to eventually employing the phenomenon in electronic devices. But they were still missing one. Tsymbal, as it happened, was among the few people qualified to address it.

“There was a puzzle,” Tsymbal said. “Why does it happen? And this is where theory helped.”

Most domain walls are electrically neutral, possessing neither a positive nor a negative charge. That’s with good reason: A neutral wall requires little energy to maintain its electric state, effectively making it the default. The domain wall the team identified in the ultra-thin bismuth ferrite, by contrast, possessed a substantial charge. And that, Tsymbal knew, should have kept it from stabilizing and persisting. Yet somehow, it was managing to do just that, seeming to flout the rules of condensed-matter physics.

There had to be an explanation. In his prior research, Tsymbal and colleagues had found that the departure of negatively charged oxygen atoms, and the positively charged vacancies they left in their wake, could impede a technologically useful outcome. This time, Tsymbal’s theory-backed calculations suggested the opposite — that the positively charged vacancies were compensating for other negative charges accumulating at the wall, essentially fortifying it in the process.

Experimental measurements from the team would later show that the distribution of charges in the material lined up almost exactly with the location of the domain wall, exactly as the calculations had predicted. If oxygen vacancies turn up in other ferroelectric playgrounds, Tsymbal said, they could prove vital to better understanding and engineering devices that incorporate the prized class of materials.

“From my perspective, that was the most exciting,” said Tsymbal, who undertook the research with support from the university’s quantum-focused EQUATE project. “This links ferroelectricity with electrochemistry. We have some kind of electrochemical processes — namely, the motion of oxygen vacancies — which basically control the motion of these domain walls.

“I think that this mechanism is very important, because what most people are doing — including us, theoretically — is looking at pristine materials, where polarization switches up and down, and studying what happens with the resistance. All the experimental interpretations of this behavior were based on this simple picture of polarization. But here, it’s not only the polarization. It involves some chemical processes inside of it.”

The team detailed its findings in the journal Nature. Tsymbal, Tian and Chen authored the study with Ze Zhang, Zhongran Liu, Han Wang, Hongyang Yu, Yuxuan Wang, Siyuan Hong, Meng Zhang, Zhaohui Ren and Yanwu Xie, as well as Husker alumni Ming Li, Lingling Tao and Tula Paudel.

 Digital gift cards are easy to use, hard to lose – but givers still avoid them

Peer-Reviewed Publication

WEST VIRGINIA UNIVERSITY


Most gift givers likely won’t choose a digital gift card over a physical gift card, even though many recipients would prefer the digital version.

That’s the key finding from new research by gifting expert Julian Givi, an assistant professor of marketing at West Virginia University’s Chambers College of Business and Economics. With Farnoush Reshadi and Gopal Das, Givi conducted five studies on givers’ and recipients’ reactions to scenarios involving digital and physical gift cards, analyzing the results in a paper forthcoming in Psychology and Marketing.

Givi said, “These studies looked at the psychology involved in giving and receiving gift cards. Across the board, they showed that givers are less likely to choose digital – as opposed to physical – gift cards than recipients are to prefer to receive them. This asymmetry occurs partly because givers overestimate the extent to which recipients see digital gift cards as violating the social norms of gift-giving.

“For example, in our pilot study, we asked 96 participants whether it’s more socially normative for a giver to give a physical or digital gift card,” he explained. “The vast majority of participants – 94.8% – selected the physical gift card.

“Givers may worry that digital gift cards won’t be seen as thoughtful. Whereas physical gift cards require a giver to go to a store and purchase the gift card, digital gift cards require only a minimal amount of time and effort, as the giver can quickly obtain one online. And a digital gift card is more likely to imply that the giver waited until the last minute to purchase a gift. This is all inconsistent with what we think about when it comes to gift-giving norms.”

Givi added that “physical gift cards may also provide givers with a greater sense of psychological ownership relative to digital gift cards, since physical gift cards are possessed by the giver for a period of time before the gift exchange.”

However, while givers often feel that “physical gift cards are superior in terms of desirability,” recipients are likely to see digital gift cards as “superior in terms of feasibility,” Givi said. “They’re easier to use and harder to lose.”

Indeed, his data demonstrate that when givers consider how they themselves would feel about receiving a digital gift card as a present, they’re more likely to give a digital gift card to someone else.

One study that moved the needle on givers’ openness to considering digital gift cards involved participants imagining giving a digital gift card as a gift for a birthday that was identified as happening during “National Digital Gifting Month.” The researchers invented that event as an analogue to Cyber Monday, but he said the results showed that “givers were more likely to opt for digital gift cards when there was an occasion that altered their perceptions of gifting norms.”

That discovery offers retailers options for pushing digital gift card sales through occasion-based promotions, and Givi said he’d advise marketers “to promote their digital gift cards in ways that reduce givers’ concerns about norm violations – for example, by indicating that digital gift cards are becoming more popular and thus more in line with gifting conventions.”

Despite giver anxieties, digital gift cards are increasing in popularity – the global market grew approximately 15% from 2015 to 2020, when it reached $258 billion. With similar growth expected over the next decade, the digital gift card market is projected to reach more than a trillion dollars by 2030.

Still, Givi emphasized that “gift-giving is a continuously evolving process, and digital gift cards are still a relatively new invention. Physical gift certificates were in circulation for nearly a century before they were largely replaced by physical gift cards in the 1990s. Then digital gift cards came into play fairly recently. Consumers have been gifting physical gift cards for much longer than digital gift cards and are far more used to them.”

Givi’s gift card studies fall into the “how to give” field of gifting research, which investigates how givers wrap, message, order and time their gifts, for instance. When it comes to both how to give and what to give, he consistently finds givers are more sensitive to gift-giving norms than recipients are.

“Givers worry about violating norms by giving a late gift or giving the same gift twice, while many recipients won’t really mind getting a gift after their birthday or receiving the same basket of goodies two years in a row,” he said.

“Just as in those situations, while there may be a widely accepted social norm prescribing physical gift cards over digital ones, givers pay more attention to this norm than recipients do.”

Citation:  Gifting digital versus physical gift cards: How and why givers and recipients have different preferences for a gift card's mode of delivery

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Telemedicine reduces hospital transfers for very ill kids at rural, community emergency departments

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - DAVIS HEALTH

Telemedicine visit 

IMAGE: CHILD RECEIVES TELEMEDICINE CARE view more 

CREDIT: UC DAVIS HEALTH

Many rural and community emergency departments lack access to pediatric specialty care physicians. So, when an acutely ill child is seen in one of these facilities, they are typically transferred to regional pediatric centers for more comprehensive care.

These interfacility (or hospital-to-hospital) transfers are sometimes unnecessary. They can place a large burden on patients and their families who may be transported hours away to receive better specialized care.

New UC Davis Health research confirms that pediatric critical care telemedicine consults with clinicians in rural and community emergency departments result in significantly fewer interfacility transfers. The study was published today in the Journal of the American Medical Association (JAMA) Open Network.

“This is the first randomized clinical trial assessing the impact of telemedicine consults on transfer rates compared to what is the current standard of care: telephone consultations,” said lead author James Marcin, vice chair for pediatric clinical research, director of the UC Davis Center for Health and Technology and UC Davis critical care physician. Marcin’s previous research has shown the association between the use of telemedicine on parent and provider satisfaction, measures of quality of care and transfer decisions in the emergency department.

More than one-half of emergency departments in the United States use telemedicine so pediatric specialists can visually assess patients and make precise recommendations in pediatric cases.

Two years, 15 emergency departments, 696 kids

In the two-year trial, 15 emergency departments in rural and community hospitals in Northern California were randomized to use telemedicine or the telephone for consults with pediatric critical care physicians.

Each site was outfitted with pole-mounted, high-resolution videoconferencing telemedicine units with pan-tilt-zoom capabilities that use the Internet for high-definition video.

The study evaluated whether a patient was transferred to UC Davis Children’s Hospital following a pediatric critical care consultation. UC Davis Children’s Hospital is the only pediatric referral center in the area for children with the highest acuity conditions in the region.

The study included all children ages 14 or younger who were seen at a participating emergency department with an acute medical condition that resulted in a consult with a UC Davis pediatric critical care physician. Children with acute physical trauma were not included in the study.

Telemedicine consultations involved the referring physician, bedside nurse, respiratory therapist, patient, and the patient’s parents or guardians, when available. They involved the visual assessment and physician exam of the patient.

Fewer transfers with telemedicine

A total of 696 children participated in the study. The study found that 84% of patients assigned to telemedicine and 90.6% of those assigned to telephone consults were transferred to UC Davis Children’s Hospital.

“We found that by using a relatively low-cost telemedicine intervention, children can be successfully evaluated, treated and either discharged or admitted locally from their rural and community hospitals,” Marcin said. “Our findings are important because they demonstrate that telemedicine can support emergency department clinicians’ ability to care for pediatric patients locally.”

Nathan Kuppermann, Bo Tomas Brofeldt endowed chair of the UC Davis Department of Emergency Medicine and senior author of the study, said these findings are of vital importance to the health of children in the United States.

“There are not nearly sufficient numbers of pediatric emergency medicine physicians to staff even a fraction of the emergency departments in this country,” Kuppermann said. “Telemedicine can help provide that expertise in real time to not only assist with clinical management, but also with disposition decisions. This includes avoiding unnecessary transfers, which allow many children to stay in their home communities.”  

Other study authors were Hadley Sauers-Ford, Jamie Mouzoon, Sarah Haynes, Ilana Sigal, Daniel Tancredi and Monica Lieng of UC Davis Health, and Parul Dayal of Genentech.

This research was supported, in part, by grant G01RH27872 from the Health Resources and Services Administration.

Disclaimer: AAAS and E

Does risk for heart disease start before birth?

A new American Heart Association scientific statement summarizes the intergenerational impact of prepregnancy heart health

Peer-Reviewed Publication

AMERICAN HEART ASSOCIATION

Statement Highlights:

  • The time before pregnancy is considered a critical life period for impacting the cardiovascular health of pregnant individuals and the children born to them.
  • The biological processes leading to pregnancy complications often begin before pregnancy; therefore, interventions that begin after someone becomes pregnant may miss the opportunity to alter the trajectory of cardiovascular risk for either the pregnant individual or their child.
  • The statement suggests increasing public health and research efforts to optimize pre-pregnancy cardiovascular health, particularly among people who are part of historically underrepresented racial and ethnic groups.

Embargoed until 1 p.m. CT / 2 p.m. ET Monday, Feb. 13, 2023

DALLAS, Feb. 13, 2023 — Preventing heart disease starts much earlier than you may realize,  according to a new American Heart Association scientific statement published today in a Go Red For Women spotlight issue of the Association’s flagship, peer-reviewed journal Circulation.

The statement, “Optimizing Prepregnancy Cardiovascular Health to Improve Outcomes in Pregnant and Postpartum Individuals and Their Offspring,” summarizes the available data connecting a woman’s heart health ― including the physical, environmental and cognitive experiences in childhood and young adulthood ― to the health of the children born to her. It also highlights the need for more research and for public health interventions to support improving women’s heart health throughout life.

“The biological processes that contribute to adverse pregnancy outcomes begin before a person is pregnant,” said Sadiya S. Khan, M.D., M.Sc., FAHA, chair of the scientific statement writing group and an assistant professor of medicine (cardiology) and preventive medicine (epidemiology) at Northwestern University’s Feinberg School of Medicine in Chicago. “Therefore, it is necessary to focus on optimizing cardiovascular health before pregnancy. The data indicate cardiovascular health has an intergenerational relationship. The time prior to pregnancy is a critical life stage that affects the health of the person who becomes pregnant, and the children born to them.”

The status of prepregnancy health:

The key factors to measure cardiovascular health are based on the American Heart Association’s Life’s Essential 8, which includes a heart-healthy diet, regular physical activity, nonsmoking; healthy weight, blood pressure, blood cholesterol, and blood sugar; and healthy sleep. Using Life’s Essential 8 to assess cardiovascular health in the Unites States, researchers found that just 1 in 5 people in the U.S. ages 2 and older have optimal cardiovascular health.

Low levels of pre-pregnancy cardiovascular health are associated with several pregnancy complications, such as preterm birth, gestational diabetes, high blood pressure, preeclampsia or giving birth to an infant who is small for gestational age. These pregnancy complications are also linked to higher risk for cardiovascular disease among the offspring, according to the latest research:

  • Being born preterm is associated with a 53% higher risk for heart disease by age 43.
  • Having Type 2 diabetes before becoming pregnant is associated with a 39% higher risk of cardiovascular disease among offspring by age 40.

Critical research gap

Despite the evidence linking an individual’s pre-pregnancy health to their offspring’s health, there are no large trials with enough people and data to test whether improving overall cardiovascular health before pregnancy will reduce pregnancy complications, pregnancy-related cardiovascular death or cardiovascular risk for offspring.

“If a research trial focused on cardiovascular health before pregnancy successfully reduced pregnancy complications and improved the mother’s and child’s cardiovascular health, it could be practice-changing,” Khan said.

Future research direction

New studies to address the research gap in maternal cardiovascular health need to be carefully planned to include people from diverse racial and ethnic backgrounds who are underrepresented in clinical trials. The incidence of pregnancy complications and cardiovascular disease is disproportionately higher among people from diverse racial and ethnic groups, and this needs to be better understood.

The statement also suggests that research on preventing or treating cardiovascular disease should investigate lifestyle changes like heart-healthy diet and physical activity in pregnant individuals, as well as strategies with medications known to be safe during pregnancy.

Psychological health, stress and resilience also need to be considered in optimizing cardiovascular health. Importantly, interventions are needed for women from groups who have been historically excluded from public health and research that are sensitive to the psychosocial stress of racial discrimination. Research shows that long-term stressors like continuing episodes of discrimination are associated with unfavorable cardiovascular health and a higher risk of pregnancy complications. Culturally responsive stress reduction and mindfulness-based interventions may offer a means to buffer stress from these lived experiences.

Community and policy

Community-based interventions are crucial to improving health equity among all individuals before pregnancy, especially for people from historically marginalized races and ethnicities who often face multiple barriers to optimal health. In addition, the influence of structural and social determinants of health requires interventions that change society more broadly, such as policies affecting health systems, education, income, housing and food supply.

“There is substantial opportunity to improve health across the life course and for multiple generations by improving pre-pregnancy cardiovascular health. However, the responsibility is one that should be embraced by all of us, not placed solely on individual women,” Khan said. “The pre-pregnancy period offers a unique window of opportunity to equitably address the increased incidence of adverse pregnancy outcomes, and to interrupt and improve the intergenerational relationship of poor cardiovascular health by focusing on individual-, community- and policy-level solutions.”

This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Council on Epidemiology and Prevention; the Council on Clinical Cardiology; the Council on Cardiovascular and Stroke Nursing; the Council on Arteriosclerosis, Thrombosis and Vascular Biology; the Council on Hypertension; the Council on Lifestyle and Cardiometabolic Health; the Council on Peripheral Vascular Disease; and the Stroke Council. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.

Co-authors are Holly Gooding, M.D., M.Sc., vice chair; LaPrincess C. Brewer, M.D., M.P.H.; Mary M. Canobbio, R.N., M.N., FAHA; Marilyn J. Cipolla, Ph.D., FAHA; William A. Grobman, M.D., M.B.A.; Jennifer Lewey, M.D., M.P.H.; Erin D. Michos, M.D., M.H.S.; Eliza C. Miller, M.D.; Amanda M. Perak, M.D., M.S., FAHA; and Gina S. Wei, M.D., M.P.H., FAHA. Authors’ disclosures are listed in the manuscript.

The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers, and the Association’s overall financial information are available here.

Additional Resources:

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.orgFacebookTwitter or by calling 1-800-AHA-USA1.

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Disclaimer: 

Youth suicide rates increased during COVID-19 pandemic, especially among particular subgroups

Peer-Reviewed Publication

NATIONWIDE CHILDREN'S HOSPITAL

(COLUMBUS, Ohio) – Suicide is the second leading cause of death for individuals aged 5-24 years in the United States, and a significant public health concern. Data suggest depression, anxiety and social isolation increased during the COVID-19 pandemic, which may have contributed to suicide risk in youth. 

In a study published today in Pediatrics, researchers in the Center for Suicide Prevention and Research at Nationwide Children’s Hospital found that in the United States, youth suicides increased during COVID-19, with significantly more suicides than expected among males, non-Hispanic American Indian/Alaskan Native youth, and non-Hispanic Black youth.  

“To our knowledge, no national study examined changes in youth suicide rates that occurred during the COVID-19 pandemic,” said Jeffrey A Bridge, PhD, lead author of the study and director of the Center for Suicide Prevention and Research at Nationwide Children’s Hospital. “We wanted to a see if there were any changes in the youth suicide rate that occurred and whether these changes happened with the onset of the pandemic.” 

National trends in suicides were sourced from the Web-based Wide-Ranging Online Data for Epidemiologic Research (WONDER) database from the Centers for Disease Control and Prevention (CDC). Individuals aged 5-24 years between 2015 and 2020 with suicide listed as the cause of death were included in this analysis. The start of the COVID-19 period was defined as March 2020. 

A total of 5,568 youth living in the United States died by suicide during the COVID-19 pandemic in 2020. The majority of youth decedents were male (79.2%), non-Hispanic White (59.6%) and died by firearm (51.1%). 

Compared with prepandemic suicide deaths, more suicides during the COVID-19 pandemic occurred among males, preteens aged 5-12 years, young adults aged 18-24 years, non-Hispanic American Indian/Alaskan Native youth, and non-Hispanic Black youth. Suicides by firearm were higher than expected during the pandemic, whereas suicide deaths by hanging or suffocation and poisoning were lower than expected. 

Suicide rates during the pandemic were also higher than expected among non-Hispanic Asian/Pacific Islander females, non-Hispanic White males aged 5-12 years, non-Hispanic American Indian/Alaskan Native males and non-Hispanic Black males aged 18-24 years.  

Most notably, no subgroup had significantly fewer suicides than expected. 

“We found an overall increase in the suicide rate, but that wasn't distributed equally across all subgroups. A couple of findings really stand out, such as the higher-than-expected suicide rate among non-Hispanic Asian or Pacific Islander females, for example. This is a group of young people that typically have a very low rate of suicide relative to other young people, and to see an increase in their rate associated with the COVID-19 pandemic was a cause for concern,” said Donna Ruch, PhD, co-author of the study and principal investigator in the Center for Suicide Prevention Research at Nationwide Children’s Hospital. 

The findings of this study highlight the importance of suicide preventive interventions tailored to better address racial and ethnic disparities in youth at highest risk for suicide. An increase in suicide by firearms also draws attention to the continuing need to promote safe gun storage practices. Additionally, preteen rates of suicide are increasing, warranting further research and clinical attention for this understudied subpopulation at risk. 

Reference:
Bridge JA, Ruch DA, Sheftall AH, Hahm HC, LCSW, O’Keefe VM, Fontanella CA, Brock G, Campo JV, Horowitz LM. Youth Suicide During the First Year of the COVID-19 Pandemic. [ahead of print]. 

About The Abigail Wexner Research Institute at Nationwide Children's Hospital
Named to the Top 10 Honor Roll on U.S. News & World Report’s 2022-23 list of “Best Children’s Hospitals,” Nationwide Children’s Hospital is one of America’s largest not-for-profit free-standing pediatric health care systems providing unique expertise in pediatric population health, behavioral health, genomics and health equity as the next frontiers in  pediatric medicine, leading to best outcomes for the health of the whole child.  Integrated clinical and research programs are part of what allows Nationwide Children’s to advance its unique model of care. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Children’s faculty train the next generation of pediatricians, scientists and pediatric specialists. The Abigail Wexner Research Institute at Nationwide Children’s Hospital is one of the Top 10 National Institutes of Health-funded free-standing pediatric research facilities in the U.S., supporting basic, clinical, translational,  behavioral and population health research. The AWRI is comprised of multidisciplinary Centers of Emphasis paired with advanced infrastructure supporting capabilities such as technology commercialization for discoveries; gene- and cell-based therapies; and genome sequencing and analysis. More information is available at NationwideChildrens.org/Research.

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Breast cancer risk models may incorrectly classify many women

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - LOS ANGELES HEALTH SCIENCES


Breast cancer risk estimates for individual women vary substantially depending on which risk assessment model is used, and women are likely receiving vastly different recommendations depending on the model used and the cutoff applied to define "high risk," according to a new study from UCLA. The study appears online in Journal of General Internal Medicine.

Current incidence rates indicate that about one in eight women born in the United States today will develop breast cancer at some time during her life. The risk increases with age.

As precision medicine evolves in healthcare, breast cancer risk models are increasingly used to identify women who would benefit from medicines to reduce the risk of breast cancer as well as supplemental MRI screening. Easy-to-use risk models are readily available on-line and women are often given a risk estimate on their screening mammogram reports. An important question is how accurate are those models?

In 2019, the US Preventive Services Task Force recommended that clinicians offer risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at high risk for breast cancer in the next 5 years and at low risk for adverse medication effects.

While previously, a 5-year risk cutoff of 1.67% was established, the Task Force recommended a new, higher 5-year risk cutoff of 3%. And while current breast cancer risk assessment tools work well at a population level, little attention has been paid to how they perform at an individual level or to the variation in risk estimates for the ≥ 3.0% 5-year threshold at the level of the individual.

The current study included more than 31,115 women who were part of the Athena Breast Health Network, a statewide quality improvement initiative across the University of California medical and cancer centers. It focused on three commonly used risk assessment models: the Breast Cancer Risk Assessment Tool (BCRAT, also called the Gail model), the Breast Cancer Surveillance Consortium (BCSC), and the International Breast Intervention Study (IBIS, also called the Tyrer-Cuzick model).

Investigators found when using a threshold of ≥ 1.67%, more than 21% of women were classified as high risk for developing breast cancer in the next 5 years by one model but average risk by another model.

When using a ≥ 3.0% threshold, more than 5% of women had disagreements in risk severity between models. If all three models were used, almost half of women (46.6%) were classified as high risk by at least one model. Because most women will not be diagnosed with breast cancer within 5 years, the authors say many women would be incorrectly classified as high risk.

“This study highlights the risk of a blanket approach to using risk prediction models to inform individual-level medical screening and treatment decisions,” said Dr. Joann Elmore, the paper’s senior author and a professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. “All three of the models we looked at had similar accuracy at the population level, but in our analyses, there was marked disagreement between who was identified as ‘high risk’ by all three models.”

The authors say their findings highlight the tradeoff of sensitivity and inaccurate classification of “high risk” when using the two different thresholds currently recommended. For example, when using the ≥ 1.67% cutoff for considering chemoprevention, about half of the women diagnosed with a future breast cancer might be correctly identified as high risk, yet many more women would be falsely classified as high risk. While using the more conservative ≥ 3.0% cutoff would lead to far fewer women incorrectly classified as high risk, most of the women with a future breast cancer diagnosis would be missed.

The study has some limitations. For example, the cohort was drawn from women enrolled in a longitudinal screening study. And although the authors had extensive risk factor data on many participants, some family history was missing as was data on polygenetic risk scores.

The authors point out that newer risk models are being developed that include information on breast cancer susceptibility genes and genetic susceptibility variants, which may improve predictability. Meanwhile several recent studies suggest that quantitative imaging biomarkers and artificial intelligence algorithms might also supplement or supplant the current, subjective clinical risk assessment tools.

Additional authors were Jeremy S. Paige MD, PhD, Christoph I. Lee MD, MS, MBA, Pin-Chieh Wang PhD, William Hsu PhD, Adam R. Brentnall PhD, Anne C. Hoyt MD, and Arash Naeim MD, PhD.

The study was supported by the Program Leader Vision Award from the UCLA Jonsson Comprehensive Cancer Center, the National Cancer Institute (R37 CA240403), UCLA Jonsson Comprehensive Cancer Center study recruitment funding, University of California Office of the President Multi-campus Research Programs and Initiatives Grant, and a generous donation from the Safeway Foundation.

Article: Paige, J.S., Lee, C.I., Wang, PC. et al. Variability Among Breast Cancer Risk Classification Models When Applied at the Level of the Individual Woman. J GEN INTERN MED (2023). https://doi.org/10.1007/s11606-023-08043-

Lower fracture risk for older wheelchair users

Peer-Reviewed Publication

UNIVERSITY OF GOTHENBURG

Axelsson and Lorentzon 

IMAGE: KRISTIAN AXELSSON AND MATTIAS LORENTZON, SAHLGRENSKA ACADEMY AT THE UNIVERSITY OF GOTHENBURG. view more 

CREDIT: PHOTO BY SKARABORG HOSPITAL AND UNIVERSITY OF GOTHENBURG

eing a frail elderly person and using a wheelchair involves a substantially reduced risk of fractures, a University of Gothenburg study shows. More prescriptions for wheelchairs may result.

Wheelchair use often means spending many hours in the same, seated position with no load on the legs, which can cause functional deterioration and loss of bone mass. This in turn makes the skeleton more brittle and thus subject to higher risk of fracture. Wheelchair use has therefore been considered a risk factor for fractures.

The current study — published in the journal JAMA Network Open — shows, however, that wheelchair use should not be seen as a risk factor for fracture in the group of elderly frail people. It was in fact the study’s wheelchair users who suffered fractures least often.

Comprising 55,442 wheelchair users in Sweden with an average age of 83 years, this is the largest study in the research area to date. Six of ten participants were women. People in the matched control group were ambulatory (able to walk about), with or without technical aids. The median follow-up period was approximately two years.

Significantly lower fracture risk

The wheelchair users suffered 4,148 fractures, fewer than half of the control group’s 10,344. More precisely, the controls’ risk was equivalent to 2.3 times the wheelchair users’. This was for fractures in general.

For osteoporotic and hip fractures, the intergroup differences were even more marked: There were less than a third as many fractures in the wheelchair users, and their risk of injurious falls was less than half as high, as among the ambulatory controls.

A wheelchair is usually prescribed by a physical or occupational therapist in Sweden, while in other countries it may be prescribed by a doctor. The patient’s needs determine whether a wheelchair is recommended. Factors taken into account include immobility, weakness, poor balance, and frequent falling.

Important consideration

Mattias Lorentzon, Professor of Geriatrics at the University’s Sahlgrenska Academy and chief physician at Sahlgrenska University Hospital, is the study’s senior and corresponding author.

“What we’ve shown is the link between wheelchair use and a massively reduced risk of fractures in frail elderly people, irrespective of potential reasons for using the wheelchairs. Since fractures — especially of the hip — cause enormous suffering and call for huge health care resources, these findings are important,” he notes.

The study’s first author is Kristian Axelsson, resident physician at the Närhälsan health center in Skövde and researcher at Sahlgrenska Academy, University of Gothenburg.

“The findings are of particular interest to anyone thinking of prescribing a wheelchair for a patient and performing a risk–benefit analysis. Being sedentary in a wheelchair is negative in many ways, so it’s good to see that fall and fracture risks are reduced,” Axelsson says.

Higher ed institutions, STEMM organizations should act to change cultures to support inclusive excellence and dismantle barriers created by systemic racism and implicit bias


Reports and Proceedings

NATIONAL ACADEMIES OF SCIENCES, ENGINEERING, AND MEDICINE

Feb. 14, 2023

Higher Ed Institutions, STEMM Organizations Should Act to Change Cultures to Support Inclusive Excellence and Dismantle Barriers Created by Systemic Racism and Implicit Bias

WASHINGTON – To increase diversity, equity, and inclusion in STEMM fields, higher education institutions and STEMM organizations should go beyond a focus on simply increasing the numeric participation of minoritized racial and ethnic groups and act to change their organizational cultures and environments, says a new report from the National Academies of Sciences, Engineering, and Medicine.

Removing barriers to entry and participation, while also implementing practices that convey belonging, will allow organizations to move from broadening participation by the numbers to fostering a culture of inclusion, thriving, and success, the report says. Organizations should take active, intentional steps to dismantle policies, practices, and cultures that confer power and privilege to White people over others.

“The concepts of antiracism, diversity, equity, and inclusion are not goals for which a simple checklist will indicate success,” said Gilda Barabino, president of Olin College of Engineering and professor of biomedical and chemical engineering, and co-chair of the committee that wrote the report. “Rather, the goal is to create environments that focus on inclusive excellence, where all participants have access to educational and professional opportunities, feel included, and have the resources to actualize their full potential. STEMM organizations will require ongoing leadership, resources, and commitment to ensure that these values become part of an intentionally maintained organizational culture.”

The report recommends that organizations follow a multitiered approach – at the leadership, team, and individual levels – and identifies policies and practices that can be implemented at each level.

While people from minoritized groups comprise a growing part of the U.S. population, that growth has not been mirrored by similar increases in STEMM education and careers among these groups, the report notes. The root cause of these gaps does not reflect the abilities or interests of individuals; rather, evidence shows that minoritized individuals have faced numerous systemic barriers, including macro-level policies and practices that have negatively impacted their access, representation, and ability to thrive in STEMM careers.  Racial bias at the individual and interpersonal levels also impedes STEMM careers for people from minoritized groups.

“The history of systemic racism in the United States -- both written laws and policies and a culture of practices and beliefs -- has harmed Black people, Indigenous people, Latine, Asian American, and other people from minoritized racial and ethnic groups, ingrained patterns that continue to this day,” said committee co-chair Susan Fiske, Eugene Higgins Professor of Psychology and Public Affairs at Princeton University. “STEMM organizations operate within that broader national history, which provides critical context for understanding the unequal representation of minoritized populations in STEMM higher education and workplaces.”

“The committee has identified strong and needed actions that all STEMM organizations – including our own – could take to fight racism and embrace antiracism strategies that expand our focus beyond increasing numeric diversity to ensuring that everyone has the support and resources they need to succeed and thrive,” National Academy of Sciences President Marcia McNutt, National Academy of Engineering President John L. Anderson, and National Academy of Medicine President Victor J. Dzau said jointly. “We hope this report will spark a decisive turning point for advancing diversity, equity, inclusion, and antiracism in science, engineering, and medicine.  We look forward to joining forces with other STEMM leaders to foster effective, meaningful change across the research enterprise.”

Organizations need multitiered strategies

The report recommends that organizations implement changes to policies and practices at the individual, team, and organization levels.  

Individual level. Gatekeepers — individuals in institutions or organizations who are in a position to permit or prevent access to resources — play an important role in determining who is and who is not included in STEMM by defining the skills, identities, and values necessary for individuals to persevere in these fields. Research indicates that most often in STEMM, non-Hispanic White males occupy the gatekeeper role.

Like other people, gatekeepers often have attitudinal biases, cognitive mechanisms, and social motives that keep the White status quo intact, the report says. Racial bias is not only more automatic but also more ambivalent and ambiguous than most people think; this means that individuals, including gatekeepers, may not be able to monitor their own bias impartially, and may unwittingly perpetuate it.

The report recommends generating systems of accountability that can help identify behavioral patterns of individual gatekeepers. For example, leaders of STEMM organizations and human resources directors can create organization-level or unit-level information systems to collect data on the decisions of gatekeepers related to hiring, admissions, promotion, tenure, advancement, and awards, and other factors. Data should be examined in the aggregate to identify patterns of bias exhibited by gatekeepers based on race and ethnicity.

Team level. Most science today relies on scientists training or working together in teams of varying sizes. While a common narrative is that diverse teams perform better, simply having a numerically diverse team does not automatically result in positive performance outcomes, the report says. Numerous challenges can threaten performance, including anxiety about working with people from other racial and ethnic groups, and prevalent mistreatment targeting minoritized individuals.

Conditions that foster inclusion are essential, the report says. Gatekeepers who manage teams, such as principal investigators and heads of research groups, should be intentional about creating team norms that centralize a positive climate in which all team members, including minoritized individuals, are supported, heard, and respected. They should develop interdependent teams in which everyone is cooperating and working toward an established common goal. They should ensure that team members feel psychologically safe on the team, and work to promote equal status among team members.  

Organizational and leadership level.  Leaders, notably those at the very top of the organization such as presidents and chief executive officers, have the unique opportunity to shape organizational culture and climate by (re)shaping the norms, values, policies, and practices that comprise that culture and climate.  To make large-scale change, leaders need to set an agenda that addresses the organization at multiple levels, including gatekeepers, leaders, midlevel management, and administration, with the appropriate resources in terms of person hours and funds.

Leaders should review evaluation criteria and decision-making practices at critical points of access and advancement – such as in admissions, hiring and wages, start-up resource-setting, and promotion -- and take action to redress both individual bias and discrimination and organizational processes that reproduce harm and negative outcomes for people from minoritized racial and ethnic groups. For example:

  • Admissions offices at the undergraduate and graduate levels should assess the alignment or divergence between their current admissions policies and the criteria and values of antiracism, diversity, equity, and inclusion. They should develop holistic admissions strategies that offer a systematic, contextualized evaluation of applicants on multiple dimensions.
  • Hiring managers, directors of human resources, and supervisors should measure and review the application, offer, and acceptance rates in their organization, as well as the salaries, resource packages, and academic tracks and titles of new hires, for instances of racial and ethnic discrimination in the hiring process. These leaders should implement, as appropriate, proactive outreach and recruitment to increase applications from people from minoritized racial and ethnic groups; training and resources to eliminate bias in the hiring process for managers; and updated policies to reduce bias and discrimination in setting wages.
  • Directors of human resources and supervisors should measure, evaluate, and address the presence of bias and discrimination in rewards and promotion; the proportion of people from historically minoritized backgrounds leaving their positions and their reasons for doing so; and access to culturally relevant mentorship for students and employees.

The report urges predominantly White institutions of higher education and other STEMM organizations to look to historically Black colleges and universities (HBCUs) and tribal colleges and universities (TCUs) as guides and adopt systems to increase support for people from minoritized racial and ethnic groups; they should also seek sustainable partnerships with minority serving institutions.  Federal funding agencies, private philanthropies, and other grant-making organizations should provide increased opportunities for grants, awards, and other forms of support to increase understanding of how the policies, programs, and practices of HBCUs and TCUs support students and faculty.

The study – undertaken by the Committee on Advancing Antiracism, Diversity, Equity, and Inclusion in STEMM Organizations – was sponsored by the Alfred P. Sloan Foundation, Fred Kavli Endowment Fund, Gordon and Betty Moore Foundation, Heising-Simons Foundation, National Institutes of Health, National Science Foundation, Ralph J. Cicerone and Carol M. Cicerone Endowment for NAS Missions, Rita Allen Foundation, and the Shanahan Family Charitable Foundation.

The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.

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