Achieving prevention and health, rather than more healthcare

Rutgers is researching a new health care model that emphasizes primary care and prevention over emergency care in underserved communities

Peer-Reviewed Publication

RUTGERS UNIVERSITY

If more people have access to health insurance, we have to be sure the death rates of those with certain chronic conditions are decreasing.

This is one of the statements Gregory Peck, an acute care surgeon and associate professor at Rutgers Robert Wood Johnson Medical School, will be researching on behalf of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health.

Funded by NIH grants totaling more than $1 million through a recent two-year award from the New Jersey Alliance for Clinical and Translational Science (NJ ACTS), a Rutgers hub of the National Center for Advancing Translational Sciences, and now a four-year award from the NIDDK, Peck is on average one of just two critical care surgeons funded nationally annually creating new models of health for NIH consideration.

Peck recently published two studies investigating death rates for gallstone disease, a disease of the abdomen that causes right-sided belly pain after eating, which share risk factors with other deadly diseases. His study, published in Gastro Hep Advances, found that between 2009 and 2018 the number of deaths of people in New Jersey with diagnosed gallstone disease (1,580) remained steady and did not improve, and that deaths in Latinos ages 65 and older potentially increased.

His study in the Journal of Surgical Research found that after Medicaid expansion in 2014 as compared to before, the amount of emergency surgery to remove the gallbladders for gallstone disease decreased in the state overall, but increased in people with Medicaid. While fatality from gallbladder removal surgery decreased for those 65 or older, there was increased death from surgery in the younger population and a trend of more death in the population with Medicaid. Further, the relatively decreased amount of gallbladder removal surgery occurring in ambulatory outpatient care centers did not necessarily help this.

 

Peck discusses the implications of the findings on a new shift in healthcare to prevention model.

Why did you focus on gallstone disease?

As a metabolic disease, gallstone disease is also linked to heart disease, cancer, diabetes, obesity and a sedentary lifestyle. In fact, heart disease, which is the No. 1 killer in America, and gallstone disease, which is the No. 1 digestive disease requiring surgery in America, share the risk factors of high levels of bad cholesterol type and obesity.

How do these studies inform public policy?

The amount of people dying with gallstone disease – most of whom require surgery – over the past decade has not gotten better. That’s 160 people a year who still are dying from a preventable death such as gallstone disease. Making progress is what this type of epidemiologic study focuses on, and concerningly, we might not have made good progress.

If Medicaid expansion didn’t positively affect the death rate of people with gallstone disease and we see it increase specifically in older Latino populations, we need to be asking if we are helping people of color and those who live in communities with lower socioeconomic status improve health or treating them sooner to prevent emergency surgery and especially decreasing death from emergency surgery. Insurance expansion is certainly needed, but we have to ensure the action specific pieces of policy impact the population requiring surgery in a patient-centered way.

The real goal is preventing the disease from even occurring. When we pass public health policy, we need to advocate for preventive care that reaches people through their community. Right now, the findings show that we might just be providing people with insurance cards who find themselves still needing to use the emergency department. Instead, that insurance should help them visit their primary care doctor, who can help them make changes like decreasing their bad cholesterol levels, which contribute to gallstone disease, and help them access care in ambulatory surgery centers sooner.

We need to cultivate preventive healthcare rather than ballooning the investment in emergency healthcare, which does not solve current inequities.

What other steps to improve access to care should be taken?

We propose a novel population health approach that shifts from the reactive treatments of emergency disease to proactive prevention. One place to start is increasing access to appropriate outpatient elective healthcare for underrepresented groups with barriers to preventive care, such as by increasing health insurance that incentivizes the behaviors toward improved health. A first step for my research group is to focus on diseases that currently require as much emergency as elective care, such as gallstone disease, and understand this by understanding who presents to the hospital, as to dial this back into the community level, to decrease hospital care.

In addition, in primary care, laboratory, radiology or ambulatory care settings we need to improve communication with people with low English proficiency – especially how well prevention is explained in a patient’s primary language. Language barriers might also prevent them from understanding the importance of cholesterol or blood pressure control over the one, two and three decades of life, or how they find access to diagnostic tests or treatment needed earlier.

How is Rutgers working to increase primary care knowledge in underserved communities?

Shawna Hudson, the co-director of community engagement for NJ ACTS, and my research mentor, is researching how representatives rooted in the community can help healthcare providers and researchers better understand how we can use community engagement to involve people in a communities’ preventive care as to decrease risk factors for chronic disease before they need hospital-based care and, more importantly, emergency surgery.

One initiative is the Community Engagement Virtual Salons, which help researchers and health care providers at NJ ACTS engage with patients and community members about how biomedical and clinical research leads to action through understanding disease and then enacting policy. In these sessions, the public serves as experts to provide feedback from a community perspective. This allows the medical profession to build relationships with community partners and increase the culturally sensitive participation of hard-to-reach populations.

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JOURNAL

Journal of Surgical Research

DOI

10.1016/j.jss.2023.03.006 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Decreased Emergency Cholecystectomy and Case Fatality Rate, Not Explained by Expansion of Medicaid

ARTICLE PUBLICATION DATE

14-Apr-2023

COI STATEMENT

Gregory L. Peck, DO, MPH, FACS was first author in the intellectual content and writing of the manuscript to take public responsibility for it. He has reviewed the final manuscript, believe it represents valid work, and approves it for submission. He is currently supported by the NIH National Center for Advancing Translational Sciences’ (NCATS) Rutgers Clinical Translational Science KL2 Career Development Award (CTSA 5 KL2 TR003018-4). He reports no proprietary or commercial interest in any product mentioned or concept discussed in this article and has no potential conflicts of interest. Yen-Hong Kuo, PhD participated sufficiently in the intellectual content and writing of the manuscript to take public responsibility for it. He has reviewed the final manuscript, believes it represents valid work, and approves it for submission. He reports no proprietary or commercial interest in any product mentioned or concept discussed in this article and has no potential conflicts of interest. Shawna V. Hudson, PhD participated sufficiently in the intellectual content and writing of the manuscript to take public responsibility for it. She has reviewed the final manuscript, believes it represents valid work, and approves it for submission. She reports no proprietary or commercial interest in any product mentioned or concept discussed in this article and has no potential conflicts of interest. Vicente H. Gracias, MD, FACS participated sufficiently in the intellectual content and writing of the manuscript to take public responsibility for it. He has reviewed the final manuscript, believes it represents valid work, and approves it for submission. He reports no proprietary or commercial interest in any product mentioned or concept discussed in this article and has no potential conflicts of interest. Jason A. Roy, PhD participated sufficiently in the intellectual content and writing of the manuscript to take public responsibility for it. He has reviewed the final manuscript, believes it represents valid work, and approves it for submission. He reports no proprietary or commercial interest in any product mentioned or concept discussed in this article and has no potential conflicts of interest. Brian L. Strom, MD, MPH participated sufficiently in the intellectual content and writing of the manuscript to take public responsibility for it. He has reviewed the final manuscript, believes it represents valid work, and approves it for submission. He reports no proprietary or commercial interest in any product mentioned or concept discussed in this article and has no potential conflicts of interest.

Growing number of states provide coverage for outpatient hemodialysis for undocumented immigrants

AMERICAN COLLEGE OF PHYSICIANS   

NEWS RELEASE 24-APR-2023

Annals of Internal Medicine Tip Sheet @Annalsofim Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent. ---------------------------- 1. Growing number of states provide coverage for outpatient hemodialysis for undocumented immigrants Abstract: https://www.acpjournals.org/doi/10.7326/M23-0202 Editorial: https://www.acpjournals.org/doi/10.7326/M23-0838 URL goes live when the embargo lifts A brief research report has found that, due to increased advocacy and awareness of outcomes, a growing number of states have implemented policies that provide statewide coverage for undocumented persons with kidney failure to receive outpatient hemodialysis. The report is published in Annals of Internal Medicine. Currently, undocumented immigrants cannot receive federal health insurance and most state Medicaid programs. In many states, undocumented immigrants with kidney failure rely on emergency hemodialysis (dialysis only after presenting critically ill to an emergency department) as mandated by the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA), which requires hospitals to provide emergency care regardless of ability to pay. Emergency hemodialysis is associated with a 14-fold higher mortality rate at 5 years and increased psychosocial burden for patients, caregivers, and clinicians. In 2019, only 12 states and the District of Columbia provided statewide coverage of outpatient hemodialysis by including kidney failure as a qualifying condition under Emergency Medicaid. Researchers from the University of Colorado and University of California San Francisco assessed policy between March and October 2022 by 1) review of state Medicaid and Emergency Medicaid policy manuals for covered diagnosis codes “kidney failure,” “dialysis,” and “transplantation” and inclusion of undocumented immigrants and 2) brief interviews with clinicians with experience working with undocumented immigrants in every state. The authors found that as of 2022, twenty states and Washington, DC provide statewide coverage for standard outpatient hemodialysis for undocumented immigrants. Seventeen of those states provide outpatient hemodialysis through Emergency Medicaid, the remainder through Medicaid or state insurance pools. Five states also provide coverage for kidney transplantation. According to the authors, the expansion of dialysis coverage may be due to increasing awareness of poor outcomes with emergency hemodialysis and heightened advocacy efforts. An accompanying editorial by authors from Harvard Medical School highlights the significant burden of lack of access to kidney replacement therapy care faced by undocumented residents experiencing kidney failure. The authors call for a humane national solution to abandon emergency dialysis as the only option for undocumented immigrants and instead pursue a move toward covering outpatient dialysis in all 50 states. They also call on legislators and policymakers to support a pathway for non-U.S. citizens living in the United States, including undocumented immigrants, to be able to purchase affordable insurance. Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Katherine Rizzolo, MD, please email Katherine.rizzolo@cuanschutz.edu. ---------------------------- 2. A cash transfer temporarily alleviates functional impairments for older adults Abstract: https://www.acpjournals.org/doi/10.7326/M22-2496 URL goes live when the embargo lifts A randomized controlled trial of more than 1,100 people aged 55 years and older found that among older people living alone, a small cash transfer was effective in alleviating short-term functional impairment, but the effects were not sustained after 3 months. The findings are published in Annals of Internal Medicine. As many as 16 percent of older adults worldwide live alone, and the proportion is expected to grow over time. The resulting isolation is of significant policy concern, as loneliness is associated with depression, cognitive decline, and reduced well-being. Given the low number of trained therapists in developing countries and the financial constraints their governments face, delivery of cognitive behavioral therapy (CBT) over the phone could be a promising intervention to improve the well-being of older persons living alone. Similarly, cash transfers could have a direct impact on food security and could also affect mental health or day-to-day functioning. Researchers from Dartmouth College, MIT, Sangath, and IIT Madras studied 1,120 adults living alone in Tamil Nadu, India aged 55 and older to determine whether phone-based CBT or a cash transfer reduce functional impairment, depression, or food insecurity in this population. Participants received phone-based CBT, a one-time cash transfer of 1,000 rupees ($12 USD), or both. The outcomes were measured at baseline and at 2 rounds of follow-up phone surveys, 3 weeks and 3 months after the end of CBT. Overall, the small cash transfer reduced short-term (3 weeks) functional impairment and resulted in a small but not clinically or statistically significant reduction in depression in the short term. Cash had no effect on short-term food security. There were no short-term effects from CBT or the 2 interventions together. None of the interventions showed any effect at 3 months. Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Esther Duflo, please email eduflo@mit.edu. -------------------------------- 3. Hypotensive-avoidance strategies not associated with decrease in postoperative hypotension or adverse outcomes Abstract: https://www.acpjournals.org/doi/10.7326/M22-3157 Editorial: https://www.acpjournals.org/doi/10.7326/M23-0745 URL goes live when the embargo lifts A randomized trial of more than 7,000 people found that hypotension-avoidance strategies were not associated with a decrease in postoperative hypotension or adverse outcomes compared with hypertension-avoidance strategies. The findings are published in Annals of Internal Medicine. Hypotension is common during and after noncardiac surgery. It is also associated with an increased risk for death and cardiovascular complications at 30 days after noncardiac surgery. Similarly, postoperative hypertension is associated with vascular complications after noncardiac surgery. Half of adults having major noncardiac surgery have a history of hypertension, and most use antihypertension medication. Uncertainty remains about what intraoperative blood pressure to target and how to manage long-term antihypertensive medications perioperatively. Researchers from Population Health Research Institute conducted a partial factorial randomized trial of 7,490 people using two perioperative blood pressure management strategies. Patients using the hypotension-avoidance strategy did not take angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) from the night before surgery through postoperative day 2, resuming them 3 days after surgery. Patients using the hypertension-avoidance strategy received all their usual antihypertensives preoperatively, including on the morning of surgery, and postoperatively. The authors found that fewer patients using the hypotensive-avoidance strategy experienced clinically significant hypotension compared with patients using the hypertensive-avoidance strategy. However, there was no difference between strategies related to vascular death and nonfatal myocardial injury, stroke, or cardiac arrest. According to the authors, further research is needed to identify and evaluate perioperative interventions that can modify hemodynamics to an extent and in the direction that will lead to a favorable effect on major clinical outcomes. An accompanying editorial from authors at the University of Nebraska Medical Center and Cleveland Clinic Lerner College of Medicine highlights that the decision about whether to hold selected antihypertensive medications for surgery remains a nuanced, individualized decision. They emphasize that the degree and possibly the duration of hypotension experienced by patients in this study may have been inadequate to affect the outcomes that were studied. The authors also call for future studies to examine both intraoperative and postoperative management strategies, identify other patient risk factors for poor outcomes, and ensure the clarity of surrogate versus patient-relevant clinical outcomes. Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author P.J. Devereaux, MD, PhD, please email PJ.Devereaux@phri.ca. -------------------------------- Also published in this issue: Infectious Diseases: What You May Have Missed in 2022 Rand Al Ohaly, MBBS*; Marie-Eve Benoit, MD*; and Mindy Schuster, MD, MSCE Special Article Abstract: https://www.acpjournals.org/doi/10.7326/M23-0757

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JOURNAL

Annals of Internal Medicine

DOI

10.7326/M23-0202 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Access to Kidney Care for Undocumented Immigrants Across the United States

ARTICLE PUBLICATION DATE

25-Apr-2023

New tool for genetics and cultivating high-quality rice

Peer-Reviewed Publication

KEAI COMMUNICATIONS CO., LTD.

 

IMAGE: SCIENTISTS FROM CHINA HAVE DESINGED A NEW SINGLE-NUCLEOTIDE POLYMORPHISM CHIP THAT CAN HELP US IDENTIFY GENETIC MARKERS OF DESIRABLE TRAITS IN RICE, OPENING DOORS TO SUPERIOR RICE VARIETIES THAT CAN ENSURE FOOD SECURITY AND FLAVOR DIVERSIFICATION. view more 

CREDIT: TOSHIYUKI IMAI FROM FLICKR

Genetic markers such as fragment length polymorphisms (RFLP), simple sequence repeat (SSR), and single-nucleotide polymorphisms (SNPs) provide unique identifiers for individual organisms. This aids the identification of significant genetic variations in plants, allowing modern plant breeding to select superior crop varieties. Next-generation sequencing (NGS) has enhanced marker-assisted selection or backcross breeding of crops, which is the transfer a desired trait such into the favored genetic background of another.

However, due to its expensive nature and extensive data processing requirements, NGS is not practical for screening large populations of crop plants, especially among small and medium breeders. A more cost-effective and efficient solution to assess desirable genetic traits in these populations is SNP arrays. These chips have embedded DNA probes that interact with a genetic sample, enabling the detection of hundreds of thousands of variations amongst two or more plant samples.

Tapping the potential of this approach, Associate Professor Wensheng Wang from the Chinese Academy of Agricultural Sciences and his research team have created a SNP array containing over 56,606 genetic markers for rice.

“Globally, more than 2.6 billion people rely on rice as a staple in their diet. The gene chip developed in our study can be an effective tool for breeders in selecting superior, new, high-quality rice varieties that are more flavorful, better tasting, salt tolerant, and resistant to diseases and insects,” shared Wang. “Moreover, the gene chip can be used for various genetic studies.”

The researchers developed the custom SNP array by collecting and sequencing genetic samples belonging to 3,024 rice samples from around the world. From over 18.9 million high-quality SNPs from this sample, approximately 2.5 million polymorphic SNPs were identified and retained in the array design. These SNPs were then printed on a genotyping chip platform (Affymetrix) with four designs.

The effectiveness of the array was tested by using a representative set of 192 rice varieties, and the results were impressive. On average, it correctly identified 99.6 % of the relevant genome, while also demonstrating high density and uniform coverage with an average distance of 6.7-kb between two adjacent SNPs. Furthermore, the data obtained from this platform offered more genetic variability information than other previously developed arrays.

The team reported their findings in KeAi’s The Crop Journal.

“Rice3K56 can help small and medium-sized companies select for superior rice varieties in a manner that is less subjective and low-effort,” said Wang. “Our work makes genotyping more mechanized and streamlined, resulting in higher efficiency and accuracy. In the long run, this can ensure not only food security but also a diversification of rice flavors.”

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Contact the corresponding author: Wensheng Wang

The publisher KeAi was established by Elsevier and China Science Publishing & Media Ltd to unfold quality research globally. In 2013, our focus shifted to open access publishing. We now proudly publish more than 100 world-class, open access, English language journals, spanning all scientific disciplines. Many of these are titles we publish in partnership with prestigious societies and academic institutions, such as the National Natural Science Foundation of China (NSFC).

 

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JOURNAL

The Crop Journal

DOI

10.1016/j.cj.2023.02.006 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Rice3K56 is a high-quality SNP array for genome-based genetic studies and breeding in rice (Oryza sativa L.)

Understanding the long-term impact of climate change on Indian crops

Peer-Reviewed Publication

CARL R. WOESE INSTITUTE FOR GENOMIC BIOLOGY, UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN

 

IMAGE: RICE FIELDS IN UTTAR PRADESH, A STATE IN NORTHERN INDIA. view more 

CREDIT: FLICKR (KEES VD)

Over the past few decades, it has become obvious that climate change, and consequent extreme weather events, can wreak havoc on crop yields. Concerningly, there is a large disparity in agricultural vulnerability between developed and developing countries. In a new study, researchers have looked at major food grains in India to understand the long- and short-term effects of climate change on crop yields.

“Most studies that measure the effects of climate change are looking at year-to-year changes, which are representative of variations in weather and not climate,” said Madhu Khanna (CABBI), a professor of agriculture and consumer economics. “We used data across 60 years to examine how deviations in weather from long-term averages affect the yields of three major cereal crops: rice, maize, and wheat.”

Changes in weather are short term, like a hot day with a sudden thunderstorm. However, such variations may be distinct from long-term differences, which are the hallmark of climate change. “We were looking to see if the effect of short-term deviations in extreme temperature and precipitation are significant when compared to their long-term averages and if their effects are absent in the long term as farmers adapt to climate change,” Khanna said.

The researchers used quantile regression models to determine if farmers were adapting to the long-term changes in climate. To do so, they used 60-year data sets on temperature, precipitation, the length of the growing season, and crop yield to create different models for short-term and long-term responses of crops.

According to their analysis, if differences in temperature, for example, have no impact in either model, there have been no adaptations. On the other hand, if the short-term impact is worse, it means that the farmers have been able to adapt and smooth out the effects.

“We found that the farmers were able to adapt to changes in temperature for rice and maize but not wheat. Increased precipitation enhanced rice yield, but adversely affected wheat and maize yields,” Khanna said. “We also found that farmers are customizing their strategies across different regions and crops. For example, heat-prone districts fared better to higher temperatures compared to districts in colder regions.”

“The impacts are higher at the lower tail of the distribution, but are lower at the upper tail of the distribution,” said Surender Kumar, a professor of economics at the University of Delhi, India. Farmers who worked in areas that were less productive, and therefore at the lower tail of distribution, differed in their response to those who worked in areas where the yields were higher—the former took more adaptation measures due to higher impacts.

“Higher productive regions have better irrigation facilities and are less dependent on the monsoon, and so the difference between long-term and short-term impacts is negligible,” Kumar said.

There are two ways by which the crops can adapt: the farmers can change their management practices or the varieties themselves are hardier. Although this study cannot distinguish between these possibilities, it suggests that action can be taken to improve seed varieties and educate farmers on how they can adapt to changing climate.

“This study is a part of our overall effort to build understanding across different countries. In the past we did a similar study in the US and now we're doing it for India. It's interesting that the results of this study are telling us that in both countries, although there is a negative impact of climate, the crops are adapting,” Khanna said. “However, these effects differ across crops and across the type of effects they are adapting to. We need to take a holistic view of all the various ways in which changing climate effects yield, which is obviously a very challenging and complex problem, and understand that focusing on particular dimensions of climate change and adapting crops may not be sufficient.”

The study “Distributional heterogeneity in climate change impacts and adaptation: Evidence from Indian agriculture” was published in Agricultural Economics and can be found at https://doi.org/10.1111/agec.12765.

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JOURNAL

Agricultural Economics

DOI

10.1111/agec.12765 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Distributional heterogeneity in climate change impacts and adaptation: Evidence from Indian agriculture

Signs you could be suffering from racial trauma – and tools for healing, according to therapists

Research has shown that repeated exposure to racism, directly or indirectly, impacts long-term mental health. Now, a licensed professional counselor and psychologist have released a toolkit to not only identify racial trauma but also to heal from it.

Book Announcement

TAYLOR & FRANCIS GROUP

In the United States, depression and anxiety are on the rise in African Americans and the evidence suggests that racism is a contributing factor, creating a ripple effect on mental health.

Janeé M. Steele Ph.D. and Charmeka S. Newton, Ph.D. are licensed mental health professionals and scholars who specialize in culturally responsive therapy. They say: “In the Black community there can be a real resistance to our own trauma – for example, if I wasn’t exposed to physical abuse, is it really that bad?

“But this kind of systemic, permeating racism that exists all around us has a real and physical impact on our minds and bodies. This is trauma.”

Drs. Steele and Newton have joined forces to research and collate tools to tackle racial trauma. Their book, Black Lives Are Beautiful: 50 Tools to Heal from Trauma and Promote Positive Racial Identity, has been released today.

Cultural stereotypes

As well as overt exposure to direct racism, Drs. Steele and Newton argue racial trauma can be caused in a number of ways – including transgenerational trauma due to historical oppression.

The experts explain that trauma causes chronic stress which lives in the body and can be felt like a rush of energy to the chest or stomach. These physical symptoms can be prompted by a range of external triggers – such as race-based violence reported in news or social media.

Repeated exposure to these stressors can impact the brain – creating more of the ‘stress’ chemicals that affect memory and fight/flight responses. This means the brain remains hypervigilant and unable to relax.

“This could present itself as hypervigilance around threats to safety, anxiety about the way one is perceived – choosing certain clothes and avoiding certain places,” the authors explain. “Because racialized trauma is a result of accumulated effects over time, you may not even be aware that your reactions are in response to your encounters with race.”

Internalized racism

The experts also explain the impact of internalized racism for Black people, which often leads to self-hatred and a low sense of self-worth.

“In Western culture, White cultural standards are still upheld as the gold standard – and the beauty and cultural norms of other racial groups are portrayed as inferior,” Drs. Steele and Newton.

The experts explain that messages of inferiority include television shows that depict Black people as unintelligent, criminal, prone to violence, and sexually promiscuous; the underrepresentation of Black people in positions of leadership and power; and the lack of justice received by Black people in our judicial systems.

“Internalized racism sounds like it might be easy to identify in yourself, but it could look like simply choosing a different pair of shoes to fit in with others – it is about altering your appearance or behavior to fit into white cultural norms,” Drs. Steele and Newton explain.

Tools for healing

As well as helping Black people to identify racial trauma, Black Lives Are Beautiful also offer tools for healing.

The experts have collated a trauma checklist to help identify racial trauma, including feeling guarded around white people, having witnessed Black people being mistreated, and feelings of helplessness when hearing about racism in the news.

As well as helping to acknowledge the trauma, the experts provide a list of tools for coping, including mindfulness, physical relaxation techniques, and mental exercises including compassion meditations, positive affirmations, a self-esteem plan, and visualization tools.

Recognizing how social media can be triggering, they also offer tips to navigate the online world with wellbeing in mind – such as following uplifting content creators and taking regular breaks.

Drs. Steele and Newton say: “Because of racism, many people of color lead lives full of worry, with a constant sense of being on guard. We might suppress or deny feelings about racism, or feel conflicted about talking about it. Dealing with these thoughts and feelings repeatedly and over a prolonged period of time can eventually result in damage to mental and physical health.

“We want to give people the tools to identify their trauma, and move forward with their healing.”

Poor air quality linked to cognitive problems in babies

Peer-Reviewed Publication

UNIVERSITY OF EAST ANGLIA

 

IMAGE: THE TEAM USED AIR QUALITY MONITORS IN THE CHILDREN’S HOMES TO MEASURE EMISSION LEVELS AND AIR QUALITY. view more 

CREDIT: UNIVERSITY OF EAST ANGLIA

Poor air quality linked to cognitive problems in babies

Poor air quality could be causing cognitive deficits in babies and toddlers, according to new research from the University of East Anglia.

A new study published today reveals an association between poor air quality in India and impaired cognition in infants under two.

Without action, the negative impact on children’s long-term brain development could have consequences for life.

Lead researcher Prof John Spencer, from UEA’s School of Psychology, said: “Prior work has shown that poor air quality is linked to cognitive deficits in children, as well as to emotional and behavioural problems, which can have a severe impact on families.

“Very small particulate fragments in the air are a major concern as they can move from the respiratory tract into the brain.

“Until now, studies had failed to show a link between poor air quality and cognitive problems in babies, when brain growth is at its peak and the brain may be particularly sensitive to toxins. Our study is the first to show this association.

“We worked with families in rural India to see how in-home air quality affects infants’ cognition.”

The team collaborated with the Community Empowerment Lab in Lucknow, India – a global health research and innovation organization that works with rural communities to engage in science collaboratively.

They worked with families from a range of socio-economic backgrounds in Shivgarh, a rural community in Uttar Pradesh – one of the states in India that has been most strongly impacted by poor air quality.

They assessed the visual working memory and visual processing speed of 215 infants using a specially-designed cognition task from October 2017 to June 2019.

On one display, the tots were shown flashing coloured squares that were always the same after each ‘blink’. On a second display, one coloured square changed after each blink.

Prof Spencer said: “This task capitalises on infant’s tendency to look away from something that’s visually familiar and towards something new. We were interested in whether infants could detect the changing side and how well they did as we made the task harder by including more squares on each display.”

The team used air quality monitors in the children’s homes to measure emission levels and air quality. They also took into account and controlled for family socio-economic status.

“This research shows for the first time that there is an association between poor air quality and impaired visual cognition in the first two years of life, when brain growth is at its peak,” said Prof Spencer.

“Such impacts could carry forward across years, negatively impacting long-term development.

“Reversely, our research indicates that global efforts to improve air quality could have benefits to infants’ emerging cognitive abilities.

“This, in turn, could have a cascade of positive impacts because improved cognition can lead to improved economic productivity in the long term and reduce the burden on healthcare and mental health systems.

One key factor the team measured was the cooking fuel commonly used at home.

“We found that air quality was poorer in homes that used solid cooking materials like cow dung cake,” he added. “Therefore, efforts to reduce cooking emissions in homes should be a key target for intervention.”

Consistent with this aim and with the goal of improving maternal and child health, the Government of India has launched a national-level flagship program called the “Ujjwala Yojana” – a scheme that brings LPG fuel to women below the poverty line across the entire country.

This research was led by the University of East Anglia in collaboration with Durham University, the Community Empowerment Lab in Lucknow (India) and Brown University (US).

‘Poor air quality is associated with impaired visual cognition in the first two years of life: a longitudinal investigation’ is published in the journal eLife.

This publication is based on research funded in part by the Bill & Melinda Gates Foundation. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation.

The team used air quality monitors in the children’s homes to measure emission levels and air quality.

The team used air quality monitors in the children’s homes to measure emission levels and air quality.

The research team assessed the visual working memory and visual processing speed of 215 infants using a specially-designed cognition task.

The research team worked with families from a range of socio-economic backgrounds in Shivgarh, a rural community in Uttar Pradesh – one of the states in India that has been most strongly impacted by poor air quality.

CREDIT

University of East Anglia

JOURNAL

eLife

DOI

10.7554/eLife.83876 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Poor air quality is associated with impaired visual cognition in the first two years of life: a longitudinal investigation

ARTICLE PUBLICATION DATE

25-Apr-2023

For eco-friendly ammonia, just add water

Peer-Reviewed Publication

STANFORD UNIVERSITY

Stanford researchers have discovered a simple and environmentally sound way to make ammonia with tiny droplets of water and nitrogen from the air.

Ammonia (NH3) is the starting point for producing chemical fertilizers for farm crops. For over a century, the world has relied on the Haber-Bosch process to yield ammonia in bulk, a breakthrough that helped revolutionize agriculture and feed a booming human population. But the industrial procedure is energy intensive. To break nitrogen’s strong bonds, the Haber-Bosch process requires roughly 80-300 atmospheres of pressure and temperatures around 572-1000 F (300-500 C). The steam-treating of natural gas involved in the process also releases ample amounts of climate-changing carbon dioxide.

All told, to satisfy the current annual worldwide demand for 150 million metric tons of ammonia, the Haber-Bosch process gobbles up more than 2% of global energy and accounts for about 1% of the carbon dioxide emitted into the atmosphere.

In contrast, the innovative method debuted by the Stanford researchers requires less specialized circumstances.

“We were shocked to see that we could generate ammonia in benign, everyday temperature-and-pressure environments with just air and water and using something as basic as a sprayer,” said study senior author Richard Zare, the Marguerite Blake Wilbur Professor in Natural Science and a professor of chemistry in the Stanford School of Humanities and Sciences. “If this process can be scaled up, it would represent an eco-friendly new way of making ammonia, which is one of the most important chemical processes that takes place in the world.”

The new method also uses little energy and at low cost, thus pointing a way forward to potentially producing the valuable chemical in a sustainable manner. Xiaowei Song, a postdoctoral scholar in chemistry at Stanford, is the lead author of the study, published April 10 in the Proceedings of the National Academy of Sciences.

New chemistry from blue-sky study

The new chemistry discovered follows in the footsteps of pioneering work by Zare’s lab in recent years examining the long-overlooked and surprisingly high reactivity of water microdroplets. In a 2019 study, Zare and colleagues novelly demonstrated that caustic hydrogen peroxide spontaneously forms in microdroplets in contact with surfaces. Experiments since have borne out a mechanism of electric charge jumping between the liquid and solid materials and generating molecular fragments, known as reactive oxygen species.

Taking those findings further, Song and Zare began a collaboration with study co-author Basheer Chanbasha, a professor of chemistry at King Fahd University of Petroleum and Minerals in Saudi Arabia. Chanbasha specializes in nanomaterials for energy, petrochemical and environment applications and came to Stanford as a visiting scholar last summer.

The research team zeroed in on a catalyst – the term for any substance that boosts the rate of a chemical reaction but is not itself degraded or changed by the reaction – that they suspected could help blaze a chemical pathway toward ammonia. The catalyst consists of an iron oxide, called magnetite, and a synthetic membrane invented in the 1960s that is composed of repeating chains of two large molecules.

The researchers applied the catalyst to a Graphite mesh that Song incorporated into a gas-powered sprayer. The sprayer blasted out microdroplets in which pumped water (H2O) and compressed molecular nitrogen (N2) reacted together in the presence of the catalyst. Using a device called a mass spectrometer, Song analyzed the microdroplets’ characteristics and saw the signature of ammonia in the collected data.

Low-tech, low-energy ammonia synthesis

Zare and colleagues were very pleased with this result, especially in light of the relatively low-tech approach. “Our method does not require the application of any electrical voltage or form of radiation,” said Zare.

From a broader chemistry perspective, the method is remarkable in that it uses three phases of matter: nitrogen as gas, water as liquid, and catalyst as solid. “To our knowledge, the idea of using gas, liquid, and solid all at the same time to cause a chemical transformation is a first of its kind and has a huge potential for advancing other chemical transformations,” said Zare.

While promising, the ammonia production method revealed by Zare, Song, and Chanbasha for now is only at the demonstration stage. The researchers plan to explore how to concentrate the produced ammonia as well as gauge how the process could potentially be scaled up to commercially viable levels. While Haber-Bosch is only efficient when pursued at huge facilities, the new ammonia-making method could be portable and done on-site or even on-demand at farms. That, in turn, would slash the greenhouse gas emissions related to the transportation of ammonia from far-off factories.

“With further development, we’re hoping our ammonia generation method could help address the two major looming problems of continuing to feed Earth’s growing population of billions of people, while still mitigating climate change,” said Zare. “We are hopeful and excited to continue this line of research.”

Zare is also a member of Stanford Bio-X, the Cardiovascular Institute, the Stanford Cancer Institute, Stanford ChEM-H, the Stanford Woods Institute for the Environment, and the Wu Tsai Neurosciences Institute.

The research was funded in part by the U.S. Air Force Office of Scientific Research through the Multidisciplinary University Research Initiative.

To read all stories about Stanford science, subscribe to the biweekly Stanford Science Digest.

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JOURNAL

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2301206120 

ARTICLE TITLE

Making ammonia from nitrogen and water microdroplets

Debunking false beliefs requires tackling belief systems

Study finds biased prior beliefs affected how people from across both political parties updated their fraud beliefs regarding the 2020 U.S. presidential election

Peer-Reviewed Publication

DARTMOUTH COLLEGE

Understanding how beliefs are formed and why they can be resistant to counter evidence is important in today’s polarized world, as views sharply diverge on issues ranging from vaccines to climate change.

To debunk a false belief, it may be better to target a person’s system of beliefs rather than trying to change the false belief itself, according to a new Dartmouth-led study published in Nature Human Behaviour analyzing how people update their beliefs about fraud following the 2020 U.S. presidential election.

“People don’t just have one single belief but a system of interrelated beliefs that depend on each other,” says lead author Rotem Botvinik-Nezer, a postdoctoral researcher in the Cognitive and Affective Neuroscience Lab at Dartmouth.

“This helps explain why it’s really hard to change people’s beliefs about election fraud, just by showing them evidence against fraud, as you may need to convince them that the majority did not prefer their candidate and address the other beliefs anchoring their system,” says Botvinik-Nezer.

For a long time, members of the research team had been studying placebo effects—treatments that can lead to healing outcomes due to the power of the mind even though they have no therapeutic benefits—and they became interested in the broader view of how beliefs are formed and updated in high-stakes situations.

The researchers decided to analyze fraud beliefs during the 2020 U.S. presidential election. They surveyed more than 1,600 Americans on November 4, 2020, while the votes were still being counted for six key states.

Respondents reported their partisan preferences and were tested on fraud beliefs based on hypothetical outcomes of the election. They were asked to indicate: which presidential candidate, Joe Biden v. Donald Trump, they wanted to win and how much they preferred their candidate; how likely their candidate would win the true vote in the absence of fraud; and how likely they thought fraud would affect the actual outcome.

The respondents were then randomly assigned and shown one of two U.S. maps with hypothetical winners in the remaining states depicting either a Biden or Trump win for president and were asked again about their fraud beliefs. This provided the researchers with an opportunity to examine how respondents updated their beliefs in election fraud after new information was provided.

Approximately three months after the initial survey, a subset of respondents completed a follow-up survey reporting their beliefs about the true vote winner and who had benefited from purported election fraud.

The results showed that both Democrats and Republicans increased their beliefs in election fraud when their candidate lost but decreased them when their candidate won.  In addition, the stronger the preference for a candidate, the stronger the bias or “desirability effects,” as dubbed by the researchers.

To better understand the cognitive mechanisms of such desirability effects and predict them quantitatively, the researchers developed a probability-based computational model. “We wanted to determine if this phenomenon was irrational, where people just believe what they want to believe, or if the process of updating beliefs may be rational,” says Botvinik-Nezer.

The team created a Bayesian model, which is commonly used to model how people make rational inferences. Using the survey data, they based their model on a system of three key beliefs: whether or not respondents thought there was fraud in the election before the outcome; who they thought was going to win the true vote; and who they thought benefits from fraud.

The model contained no information on people’s preferences as to whether they wanted a Biden or Trump win; however, the team found that it was able to accurately predict how people would update their beliefs given their system of prior beliefs.

The team then compared their model to other models of irrational belief updating (believing what you want to believe) and found that their rational model best explained the patterns of updating beliefs. The key was that Democrats and Republicans tended to believe that their candidate was supposed to win and that if there was any fraud, it was committed by the opposing partisan group.

The psychological idea in the model is that as people get new information, they update their beliefs based on their existing belief system, which is a rational process involving causal attribution of new evidence across competing explanations. “For respondents who strongly believed that Trump was supposed to win the 2020 election, it didn’t make sense to them that not enough people voted for him, so for some people, it might have been rational to infer that people from the other partisan group must have either cheated or committed fraud,” says Botvinik-Nezer.

The results demonstrated that about one-third of the sample attributed a hypothetical loss in the election almost entirely to fraud and not to the true vote.

“Our results show that if you have this other explanation for an election outcome, where fraud is a potential reality, then it becomes more plausible that fraud gets credit for the election,” says Tor Wager, the Diana L. Taylor Distinguished Professor in Neuroscience and director of the Dartmouth Brain Imaging Center. “When election fraud is considered plausible, this short circuits the link between the belief in the true election winner and the evidence,” says Wager. “So, to change the false belief, you have to focus on the auxiliary beliefs that are supporting that short circuit.”

The study was co-authored by Botvinik-Nezer, Wager, and Matt Jones at the University of Colorado Boulder.

Botvinik-Nezer (rotem.botvinik.nezer@dartmouth.edu) and Wager (tor.d.wager@dartmouth.edu) are available for comment.

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JOURNAL

Nature Human Behaviour

DOI

10.1038/s41562-023-01570-4 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

A belief systems analysis of fraud beliefs following the 2020 US election