HIV treatment and prevention in Zambian prisons may be model for prisons worldwide

Peer-Reviewed Publication

UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE

 

IMAGE: ZAMBIAN PRISONERS PARTICIPATING IN HIV TREATMENT AND PREVENTION. view more 

CREDIT: UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE

A recent study performed in Zambia by University of Maryland School of Medicine’s (UMSOM) Institute of Human Virology researchers found that high uptake of HIV preventative medicine, known as pre-exposure prophylaxis (PrEP), is possible in prison populations with adequate resources and support from the criminal justice health system.

In Sub-Saharan Africa, HIV infection disproportionately affects people detained within the criminal justice system. These vulnerable populations may not access regular medical care before and during incarceration.

Published in the January 2023 issue of The Lancet HIV, the research team provided evidence of a model HIV prevention with at-risk populations that could possibly be extended to other criminal justice facilities, as many of the issues faced by Zambian prisoners are universal to prisoners worldwide.

"Our results show it is feasible to deliver PrEP in diverse criminal justice settings where other HIV prevention commodities, such as condoms and lubricants, are prohibited,” said epidemiologist Brianna R. Lindsay, MPH, PhD, Director of Health Programs at the Center for International Health, Education, and Biosecurity (Ciheb) at the Institute of Human Virology at UMSOM. “The approach was well received by justice-involved individuals, demonstrating high uptake among those eligible. To our knowledge, this is the first description of PrEP service delivery for people who are incarcerated in criminal justice settings in Sub-Saharan Africa."

In the study, the largest proportion of incarcerated people reached with HIV prevention services and initiated on PrEP were men between the ages of 25 and 29 years, consistent with the known demographics of the incarcerated population in Zambia. Prior to HIV testing, individuals were screened using a high-risk screening form. People who are incarcerated may be exposed to risks such as consensual and coerced sex, sexual violence, injection drug use, and tattooing. High-risk activity paired with other barriers to HIV prevention in prisons, including high inmate turnover, lack of health education, and the absence of HIV prevention tools, contributes to at least a 14 percent higher rate of infection than seen in the adult general population.

Funded by the U.S. President's Emergency Plan for AIDS Relief (USPFAR) through the U.S. Centers for Disease Control and Prevention (CDC), the study implemented PrEP through existing and previous projects that support HIV testing, and links participants, including people who are incarcerated, to treatment and service, such as the University of Maryland Baltimore-supported Community Impact to Reach Key and Underserved Individuals for Treatment and Support (CIRKUITS) and Zambia Community HIV Epidemic Control for Key Populations (Z-CHECK) programs. With an all-hands-on-deck approach, there was support for the study from all stakeholders, from the Correctional Service and Zambian Ministry of Health to the prison health committee and peer-led adherence support groups, to provide PrEP services.

To ensure a stable and continuous supply of PrEP medication, trained personnel worked with Zambia Ministry of Health supply chain teams to assess stock levels and support the distribution of HIV prevention supplies.

“We are honored to work with the Zambia Correctional Services and Ministry of Health to accomplish this initial implementation of PrEP at these facilities,” said Cassidy W. Claassen, MD, MPH, Associate Professor of Medicine and Principal Investigator for this study, and Technical Director for the Zambia County Office at the Institute of Human Virology at UMSOM. “This represents one of the first such implementations anywhere in the world and marks an important step forward in demonstrating successful HIV prevention protocols for people who are incarcerated. “

Data was collected between October 1, 2020, to March 31, 2021, from 16 Zambian criminal justice facilities, involving a total of 12,367 people (of all sexes) in the study. Of all those who tested HIV negative and were screened for PrEP, 67 percent considered high risk were eligible to initiate. All PrEP participants participated voluntarily, and care was taken to avoid undue coercion or incentives. PrEP participation exceeded 90 percent among those eligible.

“Due to Ciheb’s collaborative efforts with our partners to control HIV infection in Zambia, we have been able to help bring the HIV prevention and treatment rates to 98% across the country, and now we are focusing on targeting this previously and traditionally ignored population of people in prisons,” said Manhattan Charurat, PhD, MHS, Professor of Medicine, Director of Ciheb, and Director of the Division of Epidemiology and Prevention at UMSOM’s Institute of Human Virology.

“In many developing countries, it is much harder to institute plans for HIV interventions in prisons. However, we believe that our model can be successfully adapted to help control the spread and improve the health and well-being of inmates across the globe.”

For future studies, the researchers plan to evaluate PrEP persistence and adherence,  as well as the perceptions of people who are incarcerated regarding their HIV risk and preferences for combined HIV prevention services. They will also aim to assess and support PrEP adherence and persistence after these people are released from prison.

"There is an urgent need for health equity for all members of society. With almost 400,000 people globally incarcerated who are living with HIV, including 18,000 in the United States alone, controlling the spread of HIV in the prison system translates to healthier communities," said Dean Mark Gladwin, MD, who is also Vice President for Medical Affairs, University of Maryland, Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor. "What the team has accomplished in this study will hopefully accelerate further changes to the prison healthcare systems in Zambia and around the globe. "

The study was funded by grant 6NU2GGH002123-02-07 by the CDC.

About the Institute of Human Virology

Formed in 1996 as a partnership between the State of Maryland, the City of Baltimore, the University System of Maryland, and the University of Maryland Medical System, the IHV is an institute of the University of Maryland School of Medicine and is home to some of the most globally recognized and world-renowned experts in all of virology. The IHV combines the disciplines of basic research, epidemiology, and clinical research in a concerted effort to speed the discovery of diagnostics and therapeutics for a wide variety of chronic and deadly viral and immune disorders, most notably HIV, the virus that causes AIDS. For more information, visit ihv.org and follow us on Twitter @IHVmaryland.

About the University of Maryland School of Medicine

Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world -- with 46 academic departments, centers, institutes, and programs, and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.3 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic and clinically based care for nearly 2 million patients each year. The School of Medicine has nearly $600 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding.  As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents, and fellows. The combined School of Medicine and Medical System (“University of Maryland Medicine”) has an annual budget of over $6 billion and an economic impact of nearly $20 billion on the state and local community. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile) is an innovator in translational medicine, with 606 active patents and 52 start-up companies.  In the latest U.S. News & World Report ranking of the Best Medical Schools, published in 2021, the UM School of Medicine is ranked #9 among the 92 public medical schools in the U.S., and in the top 15 percent (#27) of all 192 public and private U.S. medical schools.  The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu

---

JOURNAL

The Lancet HIV

DOI

10.1016/S2352-3018(22)00220-X 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Initial implementation of HIV pre-exposure prophylaxis for people who are incarcerated in Zambia: a cross-sectional observational study

Heart failure places a great strain on healthcare

Peer-Reviewed Publication

KAROLINSKA INSTITUTET

Patients with heart failure often suffer from co-morbidities, which places a great strain on the healthcare services, a multinational study published in Heart reports. The researchers, who are based at Karolinska Institutet, identify an urgent need to improve risk management of the disease.  

Up to 64 million people around the world have heart failure a figure that is expected to rise as populations age and diagnostic methods improve.

According to the new study, there are no multinational studies describing heart failure patients and the consequences of the disease.   

“Given that we know that the incidence of heart failure increases with population age, a modern, broad view of what the heart failure population looks like, involving risks and costs, is important for all forms of care planning,” says Anna Norhammar, adjunct professor at the Cardiology Unit, Department of Medicine (Solna), Karolinska Institutet.

The researchers therefore collected data from both digital medical records and national registry data on over 600,000 heart failure patients from eleven European countries, including Sweden, plus Canada and Israel, from between 2018 and 2020.  

The study concludes that between one and two per cent of the population suffer heart failure and shows that it is relatively fatal, with an average annual death rate of 13 per cent.

Heart failure patients also suffer a higher rate of co-morbidity than previous national studies have suggested.

“Half of the heart failure patients had ischemic heart disease, half had signs of kidney failure and a third had diabetes,” says Professor Norhammar. “One likely reason for the escalation in comorbidity in such patients is that we live longer nowadays with several concurrent conditions. This complicates heart failure care even more, as there are many contributory factors to take account of.”

Another of the study’s conclusions is that heart failure is costly. In Europe, one to two per cent of the total healthcare budget goes towards heart failure care, a cost that is expected to increase,” she continues. “The healthcare costs are mainly related to a deterioration in heart and kidney failure that requires hospitalisation, and to a lesser extent to traditional cardiovascular diseases such as heart attack and stroke. So our data make it clear that intervention to prevent further heart and kidney failure is needed.”

One exciting find that Professor Norhammar identifies is that more patients than previous research has shown have heart failure with preserved left ventricular function.

“This is interesting because a possible new treatment is now available for these patients,” she explains. “It’s a diabetes drug that, following extensive studies, is now used for heart failure, irrespective of whether the patients have diabetes. These new drugs were basically not used by our cohort since the evidence wasn’t in place until 2020. Now that the evidence is here, it’ll be interesting to see if the situation can be improved, as we have high hopes it will.” 

Anna Norhammar has participated in advisory board meetings with companies that develop diabetes and heart failure drugs. The study was largely financed by Astra Zeneca.  

Publication: “Prevalence, outcomes and costs of a contemporary, multinational population with heart failure”, Anna Norhammar, Johan Bodegard, Marc Vanderheyden, Navdeep Tangri, Avraham Karasik, Aldo Pietro Maggioni, Kari Anne Sveen, Tiago Taveira-Gomes, Manuel Botana, Lukas Hunziker, Marcus Thuresson, Amitava Banerjee, Johan Sundström, Andreas Bollmann, Heart, online 14 February 2023, doi: 10.1136/heartjnl-2022-321702 

---

JOURNAL

Heart

DOI

10.1136/heartjnl-2022-321702 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Prevalence, outcomes and costs of a contemporary, multinational population with heart failure

ARTICLE PUBLICATION DATE

12-Feb-2023

A tool to prevent deaths due to female underrepresentation in clinical trials

Females are often underrepresented in clinical trials, yet male data does not always reflect females’ risk of heart issues due to a drug. Researchers at the University of California, Davis, are working on a new tool to predict females’ heart response 

Reports and Proceedings

BIOPHYSICAL SOCIETY

 

IMAGE: DRUGS CAN AFFECT THE HEART RHYTHMS OF MALES AND FEMALES DIFFERENTLY. UNIVERSITY OF CALIFORNIA, DAVIS, RESEARCHERS DEVELOPED A “TRANSLATOR” THAT CAN USE MALE DATA TO PREDICT FEMALE HEART RESPONSE. view more 

CREDIT: PHOTO BY STEFANO MOROTTI

ROCKVILLE, MD – Women are often underrepresented in cardiac clinical trials—yet they are at least at equally high risk of death due to cardiovascular disease, and at higher risk of developing drug-induced heart complications compared to men. Clinical trials of medicines generally rely on electrocardiograms (EKG) to measure a patient’s heart’s response to a medicine and determine its safety, yet males and females have a number of differences in their heart physiology that are reflected in consistent variations in their EKGs. As a result, a drug that might appear to be safe in males may not be safe for females.

“People tend to think that females don't really get heart diseases, but that’s not the case—males and females are equally impacted by heart issues, though most of what we know about heart disease comes from what researchers have studied in males” explained Kim Hellgren, a pharmacology researcher in the lab of Eleonora Grandi at University of California, Davis. “The best thing would be if we did our research on half males and half females,” he said. But to help interpret studies that don’t have ideal representation, and to highlight the risk of overlooking sex differences in the heart, he’s programming a tool to help predict the female response based on input from male clinical trial participants. Hellgren will present his work work on Sunday, February 19 at the 67th Annual Biophysical Society Meeting in San Diego, California.

Compared to males, females heart cells take more time to return to their resting state after an electrical impulse, which shows up as a longer QT interval on an EKG. The sex-related differences in the excitation and contraction of heart muscle cells may also affect the way in which these cells respond to drugs. As a result, what might be a therapeutic effect in males could simultaneously be detrimental in females.

Using mathematical models of excitation and contraction patterns in male and female human heart muscle cells, the team developed a regression-based “translator” that can use male data to predict female heart response. So far they’ve used their tool in virtual data sets of simulated cardiac responses to a large group of different drugs. Using male data, the translator was able to successfully predict female data that matched the computer’s simulated female data for each drug they tried.

The next step is to package the program so that it can be easily used by people conducting clinical trials, Hellgren said. The program will make it easy to enter a pile of clinical data from male EKGs and get feedback as to whether the drug would be safe or unsafe for women. This would help prevent drugs that could be unsafe for women from going to market.

Ultimately, Hellgren hopes his translator is rarely used, and instead brings attention to the disparities in clinical trials to encourage clinical trial coordinators to recruit an equal number of men and women. But for studies already underway, and for those when it just isn’t possible to get to exactly 50/50, Hellgren believes his tool will be able to bridge the gaps.

 

###

The Biophysical Society, founded in 1958, is a professional, scientific Society established to lead development and dissemination of knowledge in biophysics. The Society promotes growth in this expanding field through its annual meeting, publications, and committee and outreach activities. Its 7,500 members are located throughout the United States and the world, where they teach and conduct research in colleges, universities, laboratories, government agencies, and industry.

GSA applauds aging-related initiatives highlighted in SOTU

Business Announcement

THE GERONTOLOGICAL SOCIETY OF AMERICA

Following President Joe Biden’s 2023 State of the Union (SOTU) Address, The Gerontological Society of America (GSA) — the nation’s largest interdisciplinary organization devoted to the field of aging — is commending his administration’s commitment to several initiatives that will contribute to meaningful lives as we age.

GSA supports continued efforts to promote access to life-saving therapies and treatments. Through the Inflation Reduction Act, Medicare beneficiaries now have access to Part D vaccines, such as shingles and pertussis, at no cost. And thanks to executive action, the Food and Drug Administration has enabled 30 million hearing impaired Americans to buy affordable hearing aids without a prescription.  

And as an organization dedicated to research and education to inform practice and policy in aging, GSA supports the establishment of the Advanced Research Projects Agency for Health (ARPA-H) to accelerate breakthroughs related to cancer, Alzheimer’s Disease, and diabetes, and other conditions.  As GSA imagines the opportunities to catalyze new approaches to solve the vexing challenges of today, it draws attention to the intersection of aging and chronic disease. ARPA-H should embrace a geroscience approach, which will further understanding of how the aging process contributes to the many chronic diseases that accompany older ages.

Furthermore, GSA supports efforts to strengthen home and community-based services for older people and people with disabilities, to support the direct care workforce and family caregivers, and to improve nursing home care. A new issue of GSA’s Public Policy & Aging Report focuses on specific recommendations from the 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report titled “The National Imperative to Improve Nursing Home Quality” — and describes how relevant stakeholders can move those recommendations into action.

Finally, GSA supports the administration’s position on avoiding cuts to Medicare and Social Security. These programs provide support for older people and people with disabilities as well as family caregivers who so often are confronted by health, social engagement, and economic challenges. GSA will continue to work with the administration and all policy makers to advance evidence-based policies and practices that advance the well-being of all Americans.

###

The Gerontological Society of America (GSA) is the nation's oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging. The principal mission of the Society — and its 5,500+ members — is to advance the study of aging and disseminate information among scientists, decision makers, and the general public. GSA’s structure also includes a policy institute, the National Academy on an Aging Society.

Nightly sleep is key to student success

A new study at Carnegie Mellon University shows the impact of nightly sleep on a student’s academic performance

Peer-Reviewed Publication

CARNEGIE MELLON UNIVERSITY

College is a time of transition for young adults. It may be the first time students have the freedom to determine how to spend their time, but this freedom comes with competing interests from academics, social events and even sleep. 

A multi-institutional team of researchers conducted the first study to evaluate how the duration of nightly sleep early in the semester affects first year college students end-of-semester grade point average (GPA). Using Fitbit sleep trackers, they found that students on average sleep 6.5 hours a night, but negative outcomes accumulate when students received less than six hours of sleep a night. The results are available in the Feb. 13 issue of the Proceedings of the National Academy of Sciences. 

Previous studies have shown that total sleep is an important predictor for a broad range of health and performance outcomes. Sleep guidelines recommend teenagers get 8 to 10 hours of sleep every night. Many college students experience irregular and insufficient sleep.

David Creswell, the William S. Dietrich II Professor in Psychology and Neuroscience at the Dietrich College of Humanities and Social Sciences, led a team of researchers to evaluate the relationship between sleep and GPA. College students often push themselves to achieve, and GPA is the important marker of academic success.

“Animal studies have shown how critical sleep is for learning and memory,” said Creswell. Here we show how this work translates to humans. The less nightly sleep a first year college student gets at the beginning of the school term predicts lower GPA at the end of the term, some five to nine weeks later. Lack of sleep may be hurting students’ ability to learn in their college classrooms.” 

Past work with animals has shown that memories that form during the day are consolidated during sleep. When normal sleep patterns are interrupted, the content learned during the day is lost. Extending this logic to students, the researchers were curious if interrupted or inadequate sleep could impair their academic learning and if this would be apparent by academic achievement. 

The study evaluated more than 600 first-year students across five studies at three universities. The students wore wrist Fitbit devices to monitor and record their sleep patterns. The researchers found that students in the study sleep on average 6.5 hours a night. 

More surprising, the researchers found that students who receive less than six hours of sleep experienced a pronounced decline in academic performance. In addition, each hour of sleep lost corresponded to a 0.07 decrease in end-of-term GPA.

“Once you start dipping below six hours, you are starting to accumulate massive sleep debt that can impair a student’s health and study habits, compromising the whole system,” said Creswell. “Most surprising to me was that no matter what we did to make the effect go away, it persisted.”

The study controlled for past academic performance, daytime napping, race, gender and first-generation status. Several of the studies also controlled for total academic course load. None of these factors affected the overall impact of nightly sleep on GPA. 

“A popular belief among college students is value studying more or partying more over nightly sleep,” said Creswell. Our work here suggests that there are potentially real costs to reducing your nightly sleep on your ability to learn and achieve in college. There’s real value in budgeting for the importance of nightly sleep.” 

This works suggests the importance of building structured programs and interventions at institutions of learning that encourage undergraduate students to focus on their sleep. 

###

Creswell was joined by Stephen Price, Sheldon Cohen, Janine M. Dutcher, Daniella Villalba, Kasey Creswell and Marsha Lovett at CMU; Michael J. Tumminia at the University of Pittsburgh; Yasaman Sefidgar, Jennifer Brown Jennifer Mankoff, Yiyi Ren, Anind K. Dey and Xuhai Xu at the University of Washington; Afsaneh Doryab at the University of Virginia and

Stephen Mattingly, Aaron Striegel, Gonzalo Martinez and David Hachen at the University of Notre Dame on the project titled, “Nightly sleep duration predicts grade point average in the first year of college.” The project received funding from the National Science Foundation and the National Institute on Disability, Independent Living and Rehabilitation Research.

---

JOURNAL

Proceedings of the National Academy of Sciences

ARTICLE TITLE

Nightly sleep duration predicts grade point average in the first year of college

ARTICLE PUBLICATION DATE

13-Feb-2023

A sense of purpose may have significant impact on teens' emotional well-being

Peer-Reviewed Publication

UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN, NEWS BUREAU

 

IMAGE: EDUCATIONAL PSYCHOLOGY PROFESSOR KAYLIN RATNER FOUND IN A STUDY OF MORE THAN 200 ADOLESCENTS THAT FEELING A SENSE OF PURPOSE HAD A SIGNIFICANT IMPACT ON THEIR EMOTIONAL WELL-BEING. THOSE WHO SCORED HIGH ON PURPOSEFULNESS WERE MORE SATISFIED WITH THEIR LIVES AND EXPERIENCED MORE POSITIVE EMOTIONS IN GENERAL. view more 

CREDIT: PHOTO BY FRED ZWICKY

CHAMPAIGN, Ill. — Adolescents who feel a greater sense of purpose may be happier and more satisfied with life than peers who feel less purposeful, suggests a recent study of more than 200 teens.

Studies with adults have suggested that a sense of purpose in life is an integral component of well-being that fuels hope and optimism and has a variety of positive effects on individuals’ physical and mental health.

However, less is known about the effects of purposefulness in adolescents, who, while characteristically hopeful, are in the throes of developing their identities, making choices that reflect who they are and aspire to be, according to the study.

Educational psychology professor Kaylin Ratner of the University of Illinois Urbana-Champaign led the current study, which examined how youths’ feelings of purposefulness related to their daily levels of life satisfaction and subjective well-being.

“Teens who scored high on purpose were more satisfied with their lives and experienced more positive emotions and fewer negative emotions,” said Ratner, who collected the data while working as a postdoctoral associate at Cornell University. “Importantly, we found that on the days when these adolescents felt more purposeful than usual, they also tended to experience greater well-being.”

Her co-authors included Anthony L. Burrow, the Ferris Family Professor of Life Course Studies and the director of the Bonfenbrenner Center for Translational Research; and Qingyi Li and Gaoxia Zhu, both then-postdoctoral research associates, all of Cornell University.

Published in the Journal of Happiness Studies, the project also examined how subclinical autistic traits that fell below the diagnostic threshold for autism – behavioral and cognitive patterns such as poor social skills and difficulty shifting one’s attention – related to these teens’ sense of purpose in life and their overall happiness.

Each day for 70 days, the participants – teens ages 14-19 – were asked to rate how purposeful they felt, how satisfied they were with their life and the levels of positive and negative emotions they were feeling.

 All of those in the study were participants in GripTape, a nationwide nonprofit in the U.S. that strives to instill a sense of agency in youths by providing them with the resources to pursue a 10-week Learning Challenge project of their choosing.

  Applicants whose Learning Challenge proposals are accepted receive up to a $500 grant and an adult mentor who supports them in pursuing a project they are passionate about, such as starting a small business or researching higher education resources for undocumented teens, according to the study.

Melody Estevez, the research manager at GripTape, also was a co-author of the study.

At the beginning of the Learning Challenge, the study participants completed a 28-item survey that assessed their levels of subclinical autistic traits. A higher aggregate score suggested the teen had greater numbers of these traits, Ratner said.

Each day, the participants completed assessments, rating on a five-point scale how purposeful they currently felt. Ratner’s team calculated the average of these daily purpose scores to determine each person’s dispositional sense of purpose – their characteristic level of this trait – across the 70 days studied.

The researchers also tracked day-to-day variations in purposefulness by subtracting the teens’ daily purpose score from their dispositional level of purpose.

On the daily assessments, those in the study rated how much they were feeling four positive emotions – content, relaxed, enthusiastic or joyful – and four negative emotions – angry, anxious, sluggish or sad.

Participants’ composite positive and negative emotional affect scores, along with their life satisfaction scores, were used to assess their psychological well-being.

Feeling more purposeful than usual on any single day was a unique predictor of participants’ emotional well-being on those days, regardless of their dispositional level of purposefulness, the team found.

“Our findings show that no matter where you are in comparison with your peers, when you feel more purposeful than usual, you have better outcomes,” Ratner said. “Purpose is accessible to everyone. What we need to do is help individuals feel more purposeful from day to day.”

Ratner and her team found that the participants with greater levels of subclinical autistic traits tended to report higher levels of negative feelings, and lower levels of life satisfaction and positive feelings from day to day. However, the strength of the association between well-being and daily purpose was not moderated by these traits.

In other words, those who had more of these traits seemed to be able to reap well-being benefits at levels equal to their peers who had fewer of these traits, Ratner said. She cautioned, however, that the findings could differ for youths with known clinical diagnoses of autism.

“Our 70-day study is one of the most consistent examinations of youths’ purposefulness to date and helps cement the beneficial influence it has on their well-being,” Ratner said. “With the groundwork laid by this study, interventions that promote purposefulness may be viable routes to enhancing the well-being of many young people, including neurodiverse youths.”

The population in the study was 70% female. Nearly 31% were Asian, 22% were African American or Black, 18% were white and 14% were Hispanic. The researchers said because the sample was not representative of the gender and racial and ethnic diversity among teens in the general U.S. population, the findings may not be generalizable.

The research was supported by a grant from the Chan Zuckerberg Initiative, an advised fund of the Silicon Valley Community Foundation.

---

JOURNAL

Journal of Happiness Studies

DOI

10.1007/s10902-023-00625-7 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Daily adolescent purposefulness, daily subjective well-being and individual differences in autistic traits

ARTICLE PUBLICATION DATE

7-Feb-2023

COI STATEMENT

KR, QL, GZ, and ALB declare they have no financial interests related to the publication of this research. ME is a paid employee, the Research Manager, of the GripTape program.

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

 

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.

---

JOURNAL

Nature

DOI

10.1038/s41586-022-05503-5 

 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

-WVU-

mm/02/13/23

 

---

JOURNAL

Psychology and Marketing

ARTICLE TITLE

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

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

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - DAVIS HEALTH

 

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.

---

JOURNAL

JAMA

DOI

10.1001/jamanetworkopen.2022.55770 

METHOD OF RESEARCH

Randomized controlled/clinical trial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Impact of Tele-Emergency Consultations on Pediatric Interfacility Transfers

ARTICLE PUBLICATION DATE

13-Feb-2023

Disclaimer: AAAS and E