RACIST MEDICINE

Most patients unaware of how race is used to make risk assessments, guide clinical care

New study provides an important contribution to the ongoing discussions about racism in medicine

Peer-Reviewed Publication

BOSTON UNIVERSITY SCHOOL OF MEDICINE

(Boston)— Algorithms that incorporate race as a modifying factor to guide clinical decision-making have recently been criticized for propagating racial bias in medicine. The calculation of lung or kidney function are examples of equations that have different diagnostic parameters depending on an individual’s race. While these clinical measures have multiple implications for care, patients’ awareness of and their perspectives on the application of such algorithms is unknown.

To examine patients’ perspectives on race and the use of race-based algorithms in clinical decision-making, researchers from Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center (BMC) undertook a study to investigate patients’ perspectives on race, racism and the use of race-based algorithms in clinical decision-making. 

“We learned that patients were generally unaware of the widespread use, and misuse of race in medicine and also elicited differing perspectives on race and racial discrimination in healthcare settings,” explained corresponding author Insa Marie Schmidt, MD, MPH, assistant professor of medicine. “For example, the use of race to calculate pulmonary function can reduce the likelihood that Black patients receive disability support for lung diseases.”

To examine patients’ perspectives, the researchers conducted semi-structured, qualitative interviews. Most study participants were not cognizant of how race has been used to make risk assessments and guide clinical care. Experiences described by non-white participants ranged from micro-aggressions to overt acts of racism, including perceived racist encounters with healthcare providers. In addition, patients spoke of a deep mistrust in the healthcare system as a major barrier to equitable care. 

According to the researchers these findings highlight the deleterious effects of racism on health and suggest that focusing research on patients and their lived experiences is crucial to inform the development of anti-racist policies and regulatory agendas.

“We hope this study will ultimately highlight the need to center the voices of historically marginalized and minoritized patients when designing research aimed at addressing racism in medicine,” adds Schmidt.

These findings appear online in the Journal of General Internal Medicine. 

I.M.S. is supported by the American Philosophical Society Daland Fellowship in Clinical Investigation. I.M.S. and Merav S. are supported by the Social Science Research Council grant SSRC-4393. S.S.W. is supported by NIH grants UH3DK114915, U01DK085660, U01DK104308, R01DK103784, and R21DK119751.

Note to Editor:

S.S.W. reports personal fees from Public Health Advocacy Institute, CVS, Roth Capital Partners, Kantum Pharma, Mallinckrodt, Wolters Kluewer, GE Health Care, GSK, Allena Pharmaceuticals, Mass Medical International, Barron and Budd (vs. Fresenius), JNJ, Venbio, Strataca, Takeda, Cerus, Pfizer, Bunch and James, Harvard Clinical Research Institute (aka Baim), Oxidien, Sironax, Metro Biotechnology, Biomarin, and Bain. N.D.E is a full-time employee of Fresenius Medical Care. E.C.M. is also employed by the American Medical Association in the Center for Health Equity. All other authors have nothing to disclose.

JOURNAL

Journal of General Internal Medicine

DOI

10.1007/s11606-023-08035-4 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Patients’ Perspectives on Race and the Use of Race-Based Algorithms in Clinical Decision-Making: a Qualitative Study

ARTICLE PUBLICATION DATE

22-Feb-2023

COI STATEMENT

S.S.W. reports personal fees from Public Health Advocacy Institute, CVS, Roth Capital Partners, Kantum Pharma, Mallinckrodt, Wolters Kluewer, GE Health Care, GSK, Allena Pharmaceuticals, Mass Medical International, Barron and Budd (vs. Fresenius), JNJ, Venbio, Strataca, Takeda, Cerus, Pfizer, Bunch and James, Harvard Clinical Research Institute (aka Baim), Oxidien, Sironax, Metro Biotechnology, Biomarin, and Bain. N.D.E is a full-time employee of Fresenius Medical Care. E.C.M. is also employed by the American Medical Association in the Center for Health Equity. All other authors have nothing to disclose.

Black people less likely to receive dementia-related medications

Meeting Announcement

AMERICAN ACADEMY OF NEUROLOGY

MINNEAPOLIS – Black people are receiving medications for dementia less often than white people, according to a preliminary study released today, February 26, 2023, that will be presented at the American Academy of Neurology’s 75th Annual Meeting being held in person in Boston and live online from April 22-27, 2023.

“Previous research has shown that due to racial disparities, people with dementia do not always receive the same access to medications that may be beneficial in nursing homes and hospitals,” said Alice Hawkins, MD, of Mount Sinai in New York, New York, and a member of the American Academy of Neurology. “However, there is limited data for the use of dementia medications that people take at home. Our study found disparities in this area as well. We hope our findings lead to a better understanding of these disparities so that steps can be taken to eliminate this health inequity.”

The study involved 25,930 people. Of this group, 3,655 were Black and 12,885 were white. Researchers collected information on the participants including asking them about race and outpatient medications.

Researchers looked at how often participants received one or more of five medication classes typically prescribed for dementia. Cholinesterase inhibitors prevent the breakdown of a chemical messenger in the brain called acetylcholine, which is important for memory and thought. People with dementia may also use N-methyl-D-aspartate (NMDA) antagonists, which can help cognitive function. Both drug classes help facilitate communication between nerve cells. Selective serotonin reuptake inhibitors (SSRIs) are common antidepressants, antipsychotics treat psychosis and benzodiazepines can be used to treat anxiety and agitation.

Researchers found that Black people with dementia received all five medication types less often than white people.

For cholinesterase inhibitors, 20% of Black people received a prescription compared to 30% of white people. For NMDA antagonists, the numbers were 10% for Black people and 17% for white people. For SSRIs, the numbers were 24% and 40%. For antipsychotics, the numbers were 18% and 22%. For benzodiazepines, the numbers were 18% and 37%.

The differences remained after researchers controlled for factors such as age, sex, and insurance type.

“Black people who saw a neurologist were receiving cholinesterase inhibitors and NMDA antagonists at rates more comparable to white people,” said Hawkins. “Therefore, referrals to specialists such as neurologists may decrease the disparities for these prescriptions.”

A limitation of the study was that the data relied on what was present in participants’ medical records. Another limitation is that data on the actual prescription behavior of physicians could not be reliably collected. Therefore, Hawkins said it remains unclear how much of the observed disparity is due to physicians prescribing fewer medications to Black people versus other patient-related factors, such as inability to afford medications.

Hawkins noted, “More research is needed to understand the root cause of such disparities and design programs to eliminate them.”

The study was supported by the American Academy of Neurology Resident Research Scholarship, which was awarded to Hawkins.

Learn more about dementia at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.

When posting to social media channels about this research, we encourage you to use the American Academy of Neurology’s Annual Meeting hashtag #AANAM.

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 38,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.

How income, race, and rural residence among risk factors for low telemedicine literacy

Social factors are largest barriers to wider adoption of telehealth, reports Plastic and Reconstructive Surgery®

Peer-Reviewed Publication

WOLTERS KLUWER HEALTH

 

IMAGE: THE NEW STUDY IN PLASTIC AND RECONSTRUCTIVE SURGERY FINDS WIDELY VARYING LEVELS OF TELEMEDICINE LITERACY BY COUNTY ACROSS THE UNITED STATES. view more 

CREDIT: PLASTIC AND RECONSTRUCTIVE SURGERY

February 24, 2023 – Demographic factors including low income and living in a rural area are linked to low telemedicine literacy – which may limit access to plastic surgeons and other healthcare providers at a time of expanding use of telehealth and video visits, according to a report in the March issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.

"Our study finds that patients who fall into specific socioeconomically disadvantaged groups are at the highest risk of being underserved by telehealth services," comments senior author Kavitha Ranganathan, MD, of Brigham and Women's Hospital and Harvard Medical School. "The findings may help in targeting at-risk communities for interventions to increase telemedicine literacy and access."

Does your county have a low 'Technology Literacy Index'?

Use of telemedicine in the US healthcare system has increased dramatically since the start of the COVID-19 pandemic, facilitated by the 2020 CARES Act. "Due to its convenience, telemedicine will undoubtedly play an important role in plastic surgery practices moving forward," says Dr. Ranganathan. "However, barriers to successful telemedicine visits may exacerbate existing health disparities among disadvantaged groups."

The researchers identified sociodemographic and geographic factors associated with barriers to successful telemedicine visits, based on a 2019 Pew Research Institute survey on internet and technology use. Using the survey data, the researchers developed a new Technology Literacy Index (TLI), consisting of three factors: access to the internet, access to a smartphone, and comfort with technology.

The TLI and factors associated with barriers to telemedicine were then extrapolated to the population using 2018 US Census data. This allowed the researchers to classify telemedicine literacy as high, medium, or low for more than 3,000 counties, parishes, and boroughs nationwide.

A wide range of factors were associated with a low TLI, indicating low telemedicine literacy. Independent risk factors (in descending order of importance) included widowed marital status, less than high-school education, age over 65, disabled employment status, some college but no degree, and Black people or African American race. Higher income and higher education were associated with a higher TLI.

Extrapolated to the county level, the data showed varying levels of telemedicine literacy across the United States. Counties with low TLI had a lower median annual income, $44,000 versus $60,000; and a lower percentage of the population with a college degree, 17% versus 26%.

Policy implications for improving telemedicine literacy

Rural areas were three times more likely to be classified with low TLI. Areas with the highest proportions of Black people or African American residents were also more likely to have low telemedicine literacy: 78%, compared to 49% of areas with the lowest proportions of Black residents.

"[T]he largest barriers to wider adoption are social, with one of them being inadequate digital literacy," the researchers write. Previous studies have linked many of the same factors to lower digital literacy, and to decreased physician visits since the start of the COVID-19 pandemic.

"Within the field of plastic surgery, these disparities highlight specific at-risk populations," Dr. Ranganathan and coauthors add. For example, some subgroups of reconstructive surgery patients may have sociodemographic risk factors for telemedicine-related health disparities.

"[I]nsurers, policymakers, healthcare providers, and patient champions may be able to target specific communities for interventions to increase telemedicine literacy and access," Dr. Ranganathan and coauthors conclude. "As plastic surgery and healthcare more broadly is becoming increasingly dependent on the ability to utilize technology, appropriate efforts to mitigate and prevent adding to pre-existing healthcare disparities are critical."

Read [Disparities in Telemedicine Literacy and Access in the United States]

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

###

About Plastic and Reconstructive Surgery

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

About ASPS

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

About Wolters Kluwer

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

 Wolters Kluwer reported 2021 annual revenues of €4.8 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 20,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

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

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

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JOURNAL

Plastic & Reconstructive Surgery

Cleft lip and palate surgery procedures are undervalued, study suggests

Peer-Reviewed Publication

WOLTERS KLUWER HEALTH

February 24, 2023 – Plastic surgery procedures performed to correct cleft lip and palate deformities in infants and children are economically undervalued, relative to pediatric craniofacial procedures, concludes an analysis in the March issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.

The study finds unbalanced allocation of relative value units (RVUs) used in billing and compensation for cleft surgery in children, compared to craniofacial procedures, report Roberto L. Flores, MD, of Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, and colleagues. "The current RVU allocation to cleft and craniofacial procedures creates arbitrary disparities in physician efficiency, with cleft procedures disproportionately negatively affected," the researchers write.

Procedures with the lowest RVUs are mainly for cleft surgery

The RVU system is a standardized coding method to account for a wide range of factors affecting the value of physicians' work, such as the time, effort, and risks of specific procedures and services. Each surgical procedure (or component of a complex procedure) has a specified RVU. The values assigned to RVUs have important implications for surgeons' reimbursement and productivity.

Using a national database, the researchers identified 50,450 pediatric cleft or craniofacial surgery cases performed by plastic surgeons between 2012 and 2019. For each of 69 different procedures, efficiency was assessed by dividing the total RVUs by the total operative time, to arrive at RVUs per hour. The analysis accounted for a range of variables affecting patient complexity and surgeon effort.

Four of the five most frequently performed procedures involved primary or secondary repair of cleft palate. Yet most procedures in the top quartile (one-fourth) of efficiency were craniofacial procedures: average efficiency 15.65 RVUs per hour.

In contrast, most procedures in the bottom quartile of efficiency were cleft procedures, with an average efficiency of 7.39 RVUs per hour. Average operating time was 167 minutes for craniofacial procedures versus 108 minutes for cleft procedures.

Thus even though they accounted for some of the most frequently performed plastic surgery procedures in children, cleft procedures were rated as having an average efficiency roughly half that of the most-efficient procedures. The researchers note that a relatively simple procedure such as performing a local skin flap would be rated more efficient than a more complex procedure such as palatal lengthening for cleft palate correction.

'Arbitrary disparities' may create disincentives to perform cleft surgery

RVUs were correlated with operative time, as well as with serious adverse events, other patient health conditions (comorbidity), patient age, and hospital readmission risk. However, these factors accounted for just 38% of the variance in RVUs – "suggesting that other factors are at play in explaining RVU allocation," the researchers write.

The study builds on a previous analysis of adult plastic surgery procedures, which concluded that "RVU allocation did not confer a consistent accurate representation of physician efficiency." The new analysis extends the analysis to pediatric plastic surgery cases – most of which consist of cleft surgery or craniofacial surgery to correct congenital malformations such as craniosynostosis.

"[T]he current RVU allocation system undervalues cleft surgical services relative to craniofacial procedures," Dr. Flores and colleagues conclude. "In order to avoid disincentivizing surgeons from performing cleft procedures and thus constructing artificial barriers to quality care for children with cleft lip and palate, the current RVU allocation should be re-evaluated."

"Cleft lip and palate disproportionately affects vulnerable patient populations," Dr. Flores comments. "Therefore, addressing RVU inequities is all the more important in with regards to the service of the underserved."

Read [National Undervaluation of Cleft Surgical Services: Evidence from a Comparative Analysis of 50,450 Cases]

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

###

About Plastic and Reconstructive Surgery

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

About ASPS

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

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the healthcare; tax and accounting; governance, risk and compliance; and legal and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

Wolters Kluwer reported 2021 annual revenues of €4.8 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 20,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

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

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JOURNAL

Plastic & Reconstructive Surgery

Comparing transmission of COVID-19 in nightlife, household, health care settings

JAMA Network Open

Peer-Reviewed Publication

JAMA NETWORK

About The Study: In this case series study that analyzed 44,000 confirmed COVID-19 cases in Tokyo, cases identified in nightlife settings were associated with a higher likelihood of spreading COVID-19 than household and health care cases. Surveillance and interventions targeting nightlife settings should be prioritized to disrupt COVID-19 transmission, especially in the early stage of an epidemic. 

Authors: Michihiko Yoshida, Ph.D., of the Minato Public Health Center in Tokyo, is the corresponding author. 

 http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2023.0589?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=022423

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

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JOURNAL

JAMA Network Open

Developing countries pay the highest price for living with large carnivores

Peer-Reviewed Publication

NORTHERN ARIZONA UNIVERSITY

 

IMAGE: OUR MODEL ASSUMES THAT A SINGLE CATTLE KEEPER IS EXPOSED TO A SINGLE CALF (250 KG) PREDATION EVENT ANYWHERE ACROSS A GIVEN CARNIVORE’S RANGE. THE ORANGE SILHOUETTES REPRESENT THOSE SPECIES THAT HAVE >25% OF THEIR RANGE LOCATED IN AREAS WHERE COMMUNITIES WOULD EXPERIENCE >50% ECONOMIC INCOME LOSS THROUGH PREDATION. BAR CHARTS ARE PROVIDED FOR THE TEN SPECIES OF LARGE CARNIVORE IDENTIFIED IN OUR ANALYSIS THAT HAVE MORE THAN A THIRD OF THEIR RANGE IN AREAS WHERE A CONFLICT EVENT WOULD REPRESENT A HIGH ECONOMIC BURDEN (I.E., ≥25% OF PER CAPITA INCOME VULNERABLE FROM A SINGLE PREDATION EVENT). view more 

CREDIT: SILHOUETTES OBTAINED FROM WWW.PHYLOPIC.ORG AND ARE USED UNDER THE CREATIVE COMMONS ATTRIBUTION-NON COMMERCIAL 3.0 UNPORTED LICENSE. SILHOUETTE CREDITS ARE AS FOLLOWS: PUMA CONCOLOR= CRISTIAN OSORIO & PAULA CARRERA, URSUS AMERICANUS, URSUS THIBETANUS AND URSUS ARCTOS = TRACY HEATH, CANIS LUPUS, PANTHERA PARDUS, ACINONYX JUBATUS, HYAENA HYAENA, PARAHYAENA BRUNNEA, AND PANTHERA LEO = MARGOT MICHAUD, PANTHERA ONCA, PANTHERA UNCIA AND LYCAONPICTUS= GABRIELA PAMONO-MUNOZ, CANIS LUPUS DINGO =SAM FRASER-SMITH, PANTHERA TIGRIS = STEVEN TRAVER, CUON ALPINUS= MICHAEL KEESEY, CANIS RUFUS= DAVID ORR, CROCUTA CROCUTA= OSCAR SANISIDRO.

A team of researchers has highlighted human-wildlife conflict as one of the globe’s most pressing human development and conservation dilemmas.

New research published in Communications Biology looked at 133 countries where 18 large carnivores ranged, and found that a person farming with cattle in developing countries such as Kenya, Uganda or India were up to eight times more economically vulnerable than those living in developed economies such as Sweden, Norway or the U.S.

Duan Biggs from Northern Arizona University’s School of Earth and Sustainability is the senior author of the study. He partnered with organizations throughout the world to conduct the research, hoping to find how the lives of those living alongside these large animals are impacted.

“For most farmers, livestock represents a key—if not their only—income source. When that livestock is threatened by large predators, it can be financially devastating for them,” Biggs said.

Alex Braczkowski, a research fellow at Griffith University in Australia and lead author of the study, confirmed that such farmers bear the biggest economic and household brunt.

"Our results mirror a lot of the conversations currently taking place in the climate change space; namely that developing economies from the Global South pay the biggest price for conservation, but in this case rather than protecting forests and providing an offset environment for big polluters, they are often the ones paying the price for living alongside species like African lions or tigers—species most of the world loves and wants to see being conserved.”

The study also found that the issue was exacerbated further in developing economies because cattle keepers in these areas produced 31 percent less cattle meat per animal on average than in developed economies.

In the lowest-income areas, results suggested that the loss of a single cow or bull equated to nearly 18 months of lost calories consumed by a child.

“Our research demonstrates the urgency of developing mechanisms like payments from wealthy urban areas in rich countries where people want predators like lions conserved, to the rural communities in the Global South that bear the costs and risks of living with these fierce and dangerous animals,” Biggs said.

The results also revealed that 82 percent of carnivore range fell outside of protected areas, and five threatened carnivores have more than one-third of their range located in the most economically sensitive conflict areas.

The research team believes the findings highlight an unequal burden of human-carnivore conflict while grappling with multiple and conflicting sustainable development goals: protecting life on land and eliminating poverty and hunger.

“Our work helps show that to become truly nature positive, we need to consider both the benefits and the costs of wildlife to people, and ensure that those bearing the costs of living with wildlife are better supported, financially and otherwise,” said co-author Sophie Gilbert, senior lead for Natural Capital Development and co-author of the study. “Only when living with wildlife is stable and viable for local people will the conservation of creatures like large carnivores succeed.”

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JOURNAL

Communications Biology

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

The unequal burden of human-wildlife conflict

ARTICLE PUBLICATION DATE

24-Feb-2023

Head injuries could be a risk factor for developing brain cancer

Researchers from the UCL Cancer Institute have provided important molecular understanding of how injury may contribute to the development of a relatively rare but often aggressive form of brain tumour called a glioma.

Peer-Reviewed Publication

UNIVERSITY COLLEGE LONDON

Researchers from the UCL Cancer Institute have provided important molecular understanding of how injury may contribute to the development of a relatively rare but often aggressive form of brain tumour called a glioma.

Previous studies have suggested a possible link between head injury and increased rates of brain tumours, but the evidence is inconclusive. The UCL team have now identified a possible mechanism to explain this link, implicating genetic mutations acting in concert with brain tissue inflammation to change the behaviour of cells, making them more likely to become cancerous. Although this study was largely carried out in mice, it suggests that it would be important to explore the relevance of these findings to human gliomas.

The study was led by Professor Simona Parrinello (UCL Cancer Institute), Head of the Samantha Dickson Brain Cancer Unit and co-lead of the Cancer Research UK Brain Tumour Centre of Excellence. She said: “Our research suggests that a brain trauma may contribute to an increased risk of developing brain cancer in later life."

Gliomas are brain tumours that often arise in neural stem cells. More mature types of brain cells, such as astrocytes, have been considered less likely to give rise to tumours. However, recent findings have demonstrated that after injury astrocytes can exhibit stem cell behaviour again.

Professor Parrinello and her team therefore set out to investigate whether this property may make astrocytes able to form a tumour following brain trauma using a pre-clinical mouse model.

Young adult mice with brain injury were injected with a substance which permanently labelled astrocytes in red and knocked out the function of a gene called p53 – known to have a vital role in suppressing many different cancers. A control group was treated the same way, but the p53 gene was left intact. A second group of mice was subjected to p53 inactivation in the absence of injury.

Professor Parrinello said: "Normally astrocytes are highly branched – they take their name from stars – but what we found was that without p53 and only after an injury the astrocytes had retracted their branches and become more rounded. They weren’t quite stem cell-like, but something had changed. So we let the mice age, then looked at the cells again and saw that they had completely reverted to a stem-like state with markers of early glioma cells that could divide.”.

This suggested to Professor Parrinello and team that mutations in certain genes synergised with brain inflammation, which is induced by acute injury and then increases over time during the natural process of ageing to make astrocytes more likely to initiate a cancer. Indeed, this process of change to stem-cell like behaviour accelerated when they injected mice with a solution known to cause inflammation.

The team then looked for evidence to support their hypothesis in human populations. Working with Dr Alvina Lai in UCL’s Institute of Health Informatics, they consulted electronic medical records of over 20,000 people who had been diagnosed with head injuries, comparing the rate of brain cancer with a control group, matched for age, sex and socioeconomic status. They found that patients who experienced a head injury were nearly four times more likely to develop a brain cancer later in life, than those who had no head injury. It is important to keep in mind that the risk of developing a brain cancer is overall low, estimated at less than 1% over a lifetime, so even after an injury the risk remains modest.

Professor Parrinello said: “We know that normal tissues carry many mutations which seem to just sit there and not have any major effects. Our findings suggest that if on top of those mutations, an injury occurs, it creates a synergistic effect. In a young brain, basal inflammation is low so the mutations seem to be kept in check even after a serious brain injury. However, upon ageing, our mouse work suggests that inflammation increases throughout the brain but more intensely at the site of the earlier injury. This may reach a certain threshold after which the mutation now begins to manifest itself.”

The study is published in the journal Current Biology and involved researchers from the UCL Cancer Institute, UCL Laboratory for Molecular Cell Biology and UCL Institute of Health Informatics alongside external collaborators from Imperial College London – with funding provided by Cancer Research UK, the Oli Hildson foundation through the Brain Tumour Charity and the MRC.

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JOURNAL

Current Biology

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Injury primes mutation bearing astrocytes for dedifferentiation in later life

ARTICLE PUBLICATION DATE

24-Feb-2023

New study reveals biodiversity loss drove ecological collapse after the “Great Dying”

By exploring the stability and collapse of marine ecosystems during the Permian-Triassic mass extinction, researchers gain insights into modern biodiversity crisis

Peer-Reviewed Publication

CALIFORNIA ACADEMY OF SCIENCES

 

IMAGE: A RECREATION OF THE SEAFLOOR FROM THE PERMIAN PERIOD. (© UNIVERSITY OF MICHIGAN MUSEUM OF NATURAL HISTORY) view more 

CREDIT: © UNIVERSITY OF MICHIGAN MUSEUM OF NATURAL HISTORY

SAN FRANCISCO, CA (February 24, 2023) — The history of life on Earth has been punctuated by several mass extinctions, the greatest of these being the Permian-Triassic extinction event, also known as the “Great Dying”, which occurred 252 million years ago. While scientists generally agree on its causes, exactly how this mass extinction unfolded—and the ecological collapse that followed—remains a mystery. In a study published today in Current Biology, researchers analyzed marine ecosystems before, during, and after the Great Dying to better understand the series of events that led to ecological destabilization. In doing so, the international study team—composed of researchers from the California Academy of Sciences, the China University of Geosciences (Wuhan), and the University of Bristol—revealed that biodiversity loss may be the harbinger of a more devastating ecological collapse, a concerning finding given that the rate of species loss today outpaces that during the “Great Dying.” 

“The Permian-Triassic extinction serves as a model for studying biodiversity loss on our planet today,” says Academy Curator of Geology Peter Roopnarine, PhD. “In this study, we determined that species loss and ecological collapse occurred in two distinct phases, with the latter taking place about 60,000 years after the initial biodiversity crash.”

The event itself wiped out 95% of life on Earth, or about 19 out of every 20 species. Likely triggered by increased volcanic activity and a subsequent spike in atmospheric carbon dioxide, it caused climatic conditions similar to the human-driven environmental challenges seen today, namely global warming, ocean acidification, and marine deoxygenation. 

To conduct the study, researchers examined fossils from South China—a shallow sea during the Permian-Triassic transition—to recreate the ancient marine environment. By sorting species into guilds, or groups of species that exploit resources in similar ways, the team was able to analyze prey-predator relationships and determine the functions ancient species performed. These simulated food webs provided plausible representations of the ecosystem before, during, and after the extinction event. 

“The fossil sites in China are perfect for this kind of study because we need abundant fossils to reconstruct food webs,” says Professor Michael Benton from the University of Bristol. “The rock sequences can also be dated very precisely, so we can follow a step-by-step timeline to track the extinction process and eventual recovery.”

“Despite the loss of over half of Earth’s species in the first phase of the extinction, ecosystems remained relatively stable,” says Academy researcher Yuangeng Huang, PhD, now at the China University of Geosciences. Interactions between species decreased only slightly in the first phase of the extinction but dropped significantly in the second phase, causing ecosystems to destabilize. “Ecosystems were pushed to a tipping point from which they could not recover,” Huang continues. 

An ecosystem as a whole is more resistant to environmental change when there are multiple species that perform similar functions. If one species goes extinct, another can fill that niche and the ecosystem remains intact. This can be compared to an economy where several companies or corporations provide the same service. The demise of one corporation still leaves the service and economy intact, but the opposite will occur if the service is monopolized by a single entity.

“We found that the biodiversity loss in the first phase of the extinction was primarily a loss in this functional redundancy, leaving a sufficient number of species to perform essential functions,” Roopnarine says. “But when environmental disturbances like global warming or ocean acidification occurred later on, ecosystems were missing that reinforced resistance, which led to abrupt ecological collapse.” 

For the study team, their findings stress the importance of considering functional redundancy when assessing modern conservation strategies and remind them of the urgent need for action to address today’s human-driven biodiversity crisis. 

“We are currently losing species at a faster rate than in any of Earth’s past extinction events. It is probable that we are in the first phase of another, more severe mass extinction,” Huang says. “We cannot predict the tipping point that will send ecosystems into total collapse, but it is an inevitable outcome if we do not reverse biodiversity loss.”

Academy Curator of Geology Peter Roopnarine, PhD, focuses on global change biology, and how we can further develop our understanding of Earth's past ecosystems to better forecast our future. (California Academy of Sciences © Kathryn Whitney)

CREDIT

California Academy of Sciences © Kathryn Whitney

A section of rock from the Permian-Triassic boundary taken in Hubei Province in southern China. 

(© Peter Roopnarine)

JOURNAL

Current Biology

DOI

10.1016/j.cub.2023.02.007 

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

The stability and collapse of marine ecosystems during the Permian- Triassic mass extinction

ARTICLE PUBLICATION DATE

24-Feb-2023