Deadly flooding hit several countries at once. Scientists say this will only be more common

by ISABELLA O'MALLEY, BRITTANY PETERSON and DREW COSTLEY
A partially submerged car is visible in floodwaters after heavy rains in Zonguldak, Turkey, July 10, 2023. Scientists say increasingly frequent and intense storms could unleash more rainfall in the future as the atmosphere warms and holds more moisture. Credit: Dia Images via AP, File

Extreme rainfall accompanied by deadly flooding hit the United States and several other countries over the weekend and last week.

There were several dozen fatalities in central and southern regions of South Korea, including the Chongju region where an underpass flooded and drowned motorists who became trapped in their submerged vehicles.

In the U.S., flooding claimed five lives in Upper Makefield Township, Pennsylvania, where a search is ongoing for two missing children. Flooding also struck parts of New Hampshire, Massachusetts, Connecticut, New York and New Jersey this past weekend. A state of emergency was declared in New Jersey by Gov. Phil Murphy following significant damage from flooding and landslides.

This follows last week's relentless flooding in India, Japan, China, Turkey and the U.S.

Although the destructive floods are occurring in different parts of the world, atmospheric scientists say they have this in common: With climate change, storms are forming in a warmer atmosphere, making extreme rainfall a more frequent reality now. The additional warming that scientists predict is coming will only make it worse.

That's because a warmer atmosphere holds more moisture, which results in storms dumping more precipitation that can have deadly outcomes. Pollutants, especially carbon dioxide and methane, are heating up the atmosphere. Instead of allowing heat to radiate away from Earth into space, they hold onto it.

A car is buried in mud and rocks from recent flooding, Monday, July 17, 2023, in Belvidere, N.J. Scientists say increasingly frequent and intense storms could unleash more rainfall in the future as the atmosphere warms and holds more moisture. Credit: AP Photo/Eduardo Munoz Alvarez

While climate change is not the cause of storms unleashing the rainfall, these storms are forming in an atmosphere that is becoming warmer and wetter.

"Sixty-eight degrees Fahrenheit can hold twice as much water as 50 degrees Fahrenheit," said Rodney Wynn, a meteorologist at the National Weather Service in Tampa Bay. "Warm air expands and cool air contracts. You can think of it as a balloon—when it's heated the volume is going to get larger, so therefore it can hold more moisture."

For every 1 degree Celsius (1.8 degrees Fahrenheit) that the atmosphere warms, it holds approximately 7% more moisture. According to NASA, the average global temperature has increased by at least 1.1 degrees Celsius (1.9 degrees Fahrenheit) since 1880.



"When a thunderstorm develops, water vapor gets condensed into rain droplets and falls back down to the surface. So as these storms form in warmer environments that have more moisture in them, the rainfall increases," explained Brian Soden, professor of atmospheric sciences at the University of Miami.

A rescue worker with a dog searches for people at the site of a landslide caused by heavy rain in Yecheon, South Korea, July 16, 2023. Scientists say increasingly frequent and intense storms could unleash more rainfall in the future as the atmosphere warms and holds more moisture. Credit: Yun Kwan-shick/Yonhap via AP, File

Along Turkey's mountainous and scenic Black Sea coast, heavy rains swelled rivers and damaged cities with flooding and landslides.

At least 15 people were killed by flooding in another mountainous region, in southwestern China.

"As the climate gets warmer we expect intense rain events to become more common, it's a very robust prediction of climate models," Soden added. "It's not surprising to see these events happening, it's what models have been predicting ever since day one."

Gavin Schmidt, climatologist and director of the NASA Goddard Institute for Space Studies, said the regions being hit hardest by climate change are not the ones that emit the largest amount of planet-warming pollutants.

"The bulk of the emissions have come from the industrial Western nations and the bulk of the impacts are happening in places that don't have good infrastructure, that are less prepared for weather extremes and have no real ways to manage this," said Schmidt.

Kathy Eason, a worker at the Center for Highland Falls, stands on the storefront's stoop where she had been trapped by floodwaters the previous day, July 10, 2023, in Highland Falls, N.Y. Credit: AP Photo/John Minchillo, File

People wade through a street due to a heavy rain in Kurume, Fukuoka prefecture, southern Japan on July 10, 2023. Scientists say increasingly frequent and intense storms could unleash more rainfall in the future as the atmosphere warms and holds more moisture. Credit: Kyodo News via AP, File

People are transferred by boat as a residential area is flooded due to heavy rain in Akita, northern Japan, July 15, 2023. Scientists say increasingly frequent and intense storms could unleash more rainfall in the future as the atmosphere warms and holds more moisture. Credit: Kyodo News via AP, File

People walk through a bridge across River Beas swollen due to heavy rains in Kullu District, Himachal Pradesh, India, July 10, 2023. Scientists say increasingly frequent and intense storms could unleash more rainfall in the future as the atmosphere warms and holds more moisture. Credit: AP Photo/Aqil Khan, File

Workers cross roadway impacted by recent storms and flooding, Monday, July 17, 2023, in Belvidere, N.J. Credit: AP Photo/Eduardo Munoz Alvarez

A man looks at a swollen Beas River following heavy rains in Kullu, Himachal Pradesh, India, July 9, 2023. Scientists say increasingly frequent and intense storms could unleash more rainfall in the future as the atmosphere warms and holds more moisture. Credit: AP Photo/Aqil Khan, 

In last week's flooding, schools in New Delhi were forced to close on July 10 after heavy monsoon rains battered the Indian capital, with landslides and flash floods killing at least 15 people. Farther north, the overflowing Beas River swept vehicles downstream as it flooded neighborhoods.

In Japan, torrential rain pounded the southwest, causing floods and mudslides that left two people dead and at least six others missing. Local TV showed damaged houses in Fukuoka prefecture and muddy water from the swollen Yamakuni River appearing to threaten a bridge in the town of Yabakei.

In Ulster County, in New York's Hudson Valley and in Vermont, some said the flooding is the worst they've seen since Hurricane Irene's devastation in 2011.

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Explore further  Deadly flooding hits several countries, scientists said this will be increasingly common

WHEN THE CHURCH BANNED ABORTION

New findings suggest historical infanticide in Europe likely more widespread than estimated

New study examines selective infanticide within European communities as a means of controlling resources and social status in Italy, France and England

Book Announcement

TAYLOR & FRANCIS GROUP

‘Routine’ infanticide of newborns by married parents in early modern Europe was a much more widespread practice than previously thought, a new book posits.

This fresh insight sits at the heart of a new book, Death Control in the West 1500–1800: Sex Ratios at Baptism in Italy, France and England, by Gregory Hanlon and contributors.

The French-trained behavioural historian explains: “In most cases, infanticide was a crime leaving no aggrieved party seeking revenge if it was committed right away. It could be overlooked and forgotten with the passage of time.”

Widespread infanticide

Hanlon, who is Distinguished Research Professor at Dalhousie University in Canada, calls attention to the limited scope of existing scholarship, which has never focused on sex ratios of infants brought for baptism within hours or days after their birth.

These records reveal startling spikes in the number of male baptisms in the aftermath of famines or diseases.

He notes: “Historians in the West have relied almost exclusively on records of criminal trials in which unwed mothers or married women carrying progeny not sired by their husbands hid their pregnancies and killed their newborns alone or with female accomplices. Married infanticidal mothers may have been a hundred times more numerous.”

Hanlon’s research suggests that in rural Tuscany at the height of infanticide the victims might have constituted up to a third of the total number of live births.

Beyond the lone woman perpetrator

Using baptismal registers and ecclesiastical censuses drawn from scores of parishes in Italy, France and England, Hanlon shows similar infanticide patterns across city and country, for Catholics, Calvinists and Anglicans alike.

In Italy’s rural 17th century Tuscany, Hanlon suggests that parents seemed willing to sacrifice a child if they were a twin, opting to keep just one of the newborns. In the north Italian city of Parma, Laura Hynes Jenkins found that working-class parents preferred girls over boys.

Contributor Dominic J. Rossi finds a clear pattern of a preference for girls in the French town of Villeneuve-sur-Lot after 1650.

Rossi – one of the five former students who contributes to the book – posits the idea that ‘the lower-status families would want to marry their daughters up at the same time as economic conditions allowed them to make long-term plans for social movement’.

Meanwhile Evan Johnson, another contributor, finds evidence to demonstrate that upper-class parents in rural Mézin showed a clear preference for keeping newborn males.

Infanticide within the contemporary

Death Control in the West 1500-1800 shines a light on the many infants whose existence went unrecorded and whose deaths remained unpunished.

Hanlon calls attention to lax punitive measures taken for crimes of infanticide, and notes: “Tribunals operated against single mothers almost exclusively, but only if they killed the newborn deliberately. Simple abandonment was not a comparable offense.”

The roles of the state and criminal justice system are rigorously examined in the study, alongside realities of poverty and social class structures. The book draws parallels between histories of infanticide and present discussions of reproductive rights.

“Infanticide is murder, of course, but people did not consider this murder to be a crime,” explains Hanlon, who says ‘most people could live with it as an unpleasant fact of life’.

Together, Hanlon and his contributors invite readers to reckon with infanticide beyond a moralistic approach, in order to understand the social practice’s ramifications for our present times.

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DOI

10.4324/9781003289784 

Climate change fostered rise and fall of the Tibetan Empire during 600-800 AD

Peer-Reviewed Publication

SCIENCE CHINA PRESS

 

IMAGE: THE VARVES OF JIANGCO ARE ANNUAL VARVES, EACH LAYER DIVIDED INTO COARSE-GRAINED AND FINE-GRAINED SUB-LAYERS view more 

CREDIT: ©SCIENCE CHINA PRESS

This study is led by Dr. Juzhi Hou, Dr. Fahu Chen, and Dr. Kejia Ji (Group of Alpine Paleoecology and Human Adaptation (ALPHA), State Key Laboratory of Tibetan Plateau Earth System, Resources and Environment (TPESRE), Institute of Tibetan Plateau Research, Chinese Academy of Sciences). The research team obtained a high-resolution climate record of the past 2000 years using the varved sediments of Lake JiangCo on the central Tibetan Plateau. The warm and humid climate during the 7th-9th centuries AD and the subsequent cold and aridification are consistent with the rise and fall of the Tibetan Empire. Climate change is one of the possible reasons for the rise and fall of the Tibetan Empire.

During the preliminary field investigation, the researchers found that the varved sediment in JiangCo, a lake on the central Tibetan Plateau, was well-preserved. Through earlier varve counting and other radiometric dating methods, the time range of a gravity core of up to 1 meter covering the past 2000 years was determined. Subsequently, high-resolution XRF elements scanning and carbonate carbon/oxygen isotope analysis were performed on the sediment, and the temperature and precipitation records for the past 2000 years were reconstructed using biomarkers such as alkenones. The results showed that the 7th-9th centuries AD was an unusually warm and humid period. The researchers compared this period with historical literatures and found that it coincided with the only unified local regime, the Tibetan Empire, which existed on the Tibetan Plateau at that time. The changes in warm and humid climate and cold and dry climate were highly correlated with the foreign policy changes of the Tibetan Empire. Combined with the ecological niche model, the researchers simulated the area of highland barley cultivation during the warm and humid period of the 7th-9th centuries AD and the subsequent cold and dry period, which differed by about 10.88 million hectares.

The element titanium is an allothigenic element that reflects changes in precipitation. The dry and wet periods reflected by titanium are highly consistent with the timing of historical events such as the treaties and wars of the Tibetan Empire.

CREDIT

©Science China Press

On the ecologically fragile environment of the Tibetan Plateau, climate change is one of the factors that constrains human activities. This latest research results show that warm and humid climates promote the development of agriculture and animal husbandry on the plateau, while cold and arid conditions have negative effects on agriculture and animal husbandry. Climate change played a important role in the rise and fall of the Tibetan Empire. Today, with the warming and humidification of the Tibetan Plateau, studying the human-environment interactions in the past has important implications for modern responses to climate change.

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JOURNAL

Science Bulletin

DOI

10.1016/j.scib.2023.04.040 

Heading frequency and risk of cognitive impairment in retired male professional soccer players

JAMA Network Open

Peer-Reviewed Publication

JAMA NETWORK

About The Study: The findings of this study suggest that repetitive heading during a professional soccer career is associated with an increased risk of cognitive impairment in later life. Further study is needed to establish the upper threshold for heading frequency to mitigate this risk. 

Authors: Weiya Zhang, Ph.D., of the University of Nottingham in Nottingham, United Kingdom, is the corresponding author. 

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/ 

(doi:10.1001/jamanetworkopen.2023.23822)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

 http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2023.23822?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=071723

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

Addressing the future challenges of global surface water quality

Sub-Saharan Africa as the key future hotspot

Peer-Reviewed Publication

UNIVERSITEIT UTRECHT FACULTEIT GEOWETENSCHAPPEN

As the world's population continues to grow, ensuring access to clean and safe water has become an increasingly important concern, yet little is known about how surface water quality will change in the future. Recent scientific research has shed light on the potential challenges that surface water quality may face in the coming years, particularly in Sub-Saharan Africa. “While surface water quality is projected to improve in most developed countries, there is an important caveat: the outlook for the poorest nations is bleak”. 

A recent study, published in Nature Water, has projected an increase in surface water pollution in Sub-Saharan Africa. These findings highlight the need for proactive measures to protect surface water resources and safeguard the well-being of communities. The study, led by Utrecht University researcher Edward Jones, emphasizes the importance of equitable and sustainable development, particularly in regions expected to experience the greatest challenges. Using a new global model, he assessed how climate change and societal developments could impact surface water quality until the end of the century.

Key hotspot

“Irrespective of climate change and socio-economic scenario, there will be a strong increase in the number of people living in Sub-Saharan Africa who are exposed to poor surface water quality”, warns Jones. “This pattern is not systematically replicated in any other world region.” Even under the most optimistic future scenario the number of people exposed to pollutant concentrations exceedances in Sub-Saharan Africa will more than double. Alternatively, under pessimistic assumptions, the number of people exposed to poor surface water quality can increase 5-fold. “With the combination of strong water quality degradation and the drastic increases in the number of people exposed to poor surface water quality, our paper concludes that Sub-Saharan Africa will become the key hotspot of surface water pollution in the future.”

Challenges

The challenges are multifold, according to Jones. Waterborne diseases caused by pathogen-contaminated water can pose a significant risk to human populations. With a growing global population, the availability of good quality water for irrigation is of utmost importance. Additionally, energy production, which is key for global development, can be hampered by a combination of both low water levels and high water temperatures. Thus, the study highlights the importance of limiting both climate change and anthropogenic water pollution to safeguard both human livelihoods and ecosystem health in the future.

Article

Edward R. Jones, Marc F.P. Bierkens, Peter J.T.M. van Puijenbroek (...), Michelle T.H. van Vliet, ‘Sub-Saharan Africa will increasingly become the dominant hotspot of surface water pollution’, Nature Water, https://doi.org/10.1038/s44221-023-00105-5 (after lift of embargo)

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JOURNAL

Nature Water

DOI

10.1038/s44221-023-00105-5 

METHOD OF RESEARCH

Computational simulation/modeling

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Sub-Saharan Africa will increasingly become the dominant hotspot of surface water pollution

ARTICLE PUBLICATION DATE

17-Jul-2023

All about the Benjamins: Researchers decipher the secrets of Benjamin Franklin’s paper money

A rare window into the early American monetary history — thanks to techniques from physics

Peer-Reviewed Publication

UNIVERSITY OF NOTRE DAME

 

IMAGE: KHACHATUR MANUKYAN AND HIS TEAM EMPLOYED CUTTING-EDGE SPECTROSCOPIC AND IMAGING INSTRUMENTS TO GET A CLOSER LOOK THAN EVER AT THE INKS, PAPER AND FIBERS THAT MADE BENJAMIN FRANKLIN’S BILLS DISTINCTIVE AND HARD TO REPLICATE. view more 

CREDIT: UNIVERSITY OF NOTRE DAME

Benjamin Franklin may be best known as the creator of bifocals and the lightning rod, but a group of University of Notre Dame researchers suggest he should also be known for his innovative ways of making (literal) money.

During his career, Franklin printed nearly 2,500,000 money notes for the American Colonies using what the researchers have identified as highly original techniques, as reported in a study published this week in the Proceedings of the National Academy of Sciences.

The research team, led by Khachatur Manukyan, an associate research professor in the Department of Physics and Astronomy, has spent the past seven years analyzing a trove of nearly 600 notes from the Colonial period, which is part of an extensive collection developed by the Hesburgh Libraries’ Rare Books and Special Collections. The Colonial notes span an 80-year period and include notes printed by Franklin’s network of printing shops and other printers, as well as a series of counterfeit notes.

Manukyan explained that the effort to print money for the fledgling Colonial monetary system was important to Franklin not just as a printer but as a statesman as well.

“Benjamin Franklin saw that the Colonies’ financial independence was necessary for their political independence. Most of the silver and gold coins brought to the British American colonies were rapidly drained away to pay for manufactured goods imported from abroad, leaving the Colonies without sufficient monetary supply to expand their economy,” Manukyan said.

However, one major problem stood in the way of efforts to print paper money: counterfeiting. When Franklin opened his printing house in 1728, paper money was a relatively new concept. Unlike gold and silver, paper money’s lack of intrinsic value meant it was constantly at risk of depreciating. There were no standardized bills in the Colonial period, leaving an opportunity for counterfeiters to pass off fake bills as real ones. In response, Franklin worked to embed a suite of security features that made his bills distinctive.

“To maintain the notes’ dependability, Franklin had to stay a step ahead of counterfeiters,” said Manukyan. “But the ledger where we know he recorded these printing decisions and methods has been lost to history. Using the techniques of physics, we have been able to restore, in part, some of what that record would have shown.”

Manukyan and his team employed cutting-edge spectroscopic and imaging instruments housed in the Nuclear Science Laboratory and four Notre Dame research core facilities: the Center for Environmental Science and Technology, the Integrated Imaging Facility, the Materials Characterization Facility and the Molecular Structure Facility. The tools enabled them to get a closer look than ever at the inks, paper and fibers that made Franklin’s bills distinctive and hard to replicate.

One of the most distinctive features they found was in Franklin’s pigments. Manukyan and his team determined the chemical elements used for each item in Notre Dame’s collection of Colonial notes. The counterfeits, they found, have distinctive high quantities of calcium and phosphorus, but these elements are found only in traces in the genuine bills.

Their analyses revealed that although Franklin used (and sold) “lamp black,” a pigment created by burning vegetable oils, for most printing, Franklin’s printed currency used a special black dye made from graphite found in rock. This pigment is also different from the “bone black” made from burned bone, which was favored both by counterfeiters and by those outside Franklin’s network of printing houses.

Another of Franklin’s innovations was in the paper itself. The invention of including tiny fibers in paper pulp — visible as pigmented squiggles within paper money — has often been credited to paper manufacturer Zenas Marshall Crane, who introduced this practice in 1844. But Manukyan and his team found evidence that Franklin was including colored silks in his paper much earlier.

The team also discovered that notes printed by Franklin’s network have a distinctive look due to the addition of a translucent material they identified as muscovite. The team determined that Franklin began adding muscovite to his papers and the size of this muscovite crystals in his paper increased over time. The team speculates that Franklin initially began adding muscovite to make the printed notes more durable but continued to add it when it proved to be a helpful deterrent to counterfeiters.

Manukyan said that it is unusual for a physics lab to work with rare and archival materials, and this posed special challenges.

“Few scientists are interested in working with materials like these. In some cases, these bills are one-of-a-kind. They must be handled with extreme care, and they cannot be damaged. Those are constraints that would turn many physicists off to a project like this,” he said.

But for him, the project is a testament to the value of interdisciplinary work.

“We were fortunate to have student researchers on this project with interests both in physics as well as in history and art conservation. And the core research facilities as well as the Rare Books and Special Collections team were incredible research partners. Without an uncommon level of collaboration across disciplines, our discoveries would not have been possible.”

In addition to lead investigator Manukyan, the research team for this project included Armenuhi Yeghishyan, a laboratory technician in the Department of Physics and Astronomy; Ani Aprahamian, the Frank M. Freimann Professor of Physics and concurrent professor in the Department of Chemistry and Biochemistry; Louis Jordan, an associate University librarian emeritus for academic services and collections; Michael Kurkowski, a former undergraduate researcher studying physics and mathematics; Mark Raddell, a former undergraduate researcher studying finance and physics who is now a consultant at Deloitte; Laura Richter Le, a former undergraduate researcher who is now a graduate student at the Conservation Center at New York University’s Institute of Fine Arts; Zachary D. Schultz, a former associate professor at Notre Dame who is now a faculty member at the Ohio State University; Liam Spillane, who works at Gatan Inc.; and Michael Wiescher, the Frank M. Freimann Professor of Physics.

This research project was funded by an internal grant from Notre Dame Research. For more information on the Nuclear Science Laboratory’s work investigating historical materials, visit sites.nd.edu/kmanukyan/research/.

Khachatur Manukyan and his team employed cutting-edge spectroscopic and imaging instruments to get a closer look than ever at the inks, paper and fibers that made Benjamin Franklin’s bills distinctive and hard to replicate.

CREDIT

University of Notre Dame

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JOURNAL

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2301856120 

ARTICLE TITLE

Multiscale analysis of Benjamin Franklin’s innovations in American paper money

ARTICLE PUBLICATION DATE

17-Jul-2023

https://www.gutenberg.org/ebooks/26295

COVID-19 vaccines saved dementia patients' lives in nursing homes

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - SAN FRANCISCO

Deaths among older adults with dementia fell starkly in nursing homes and long-term care centers after COVID-19 vaccinations became available, yet remained high for those living at home, according to a new study led by UC San Francisco.  
 
The nationwide study published July 17, 2023 in JAMA Neurology, is the first to use data from 2019 to 2022 to quantify “excess” deaths – or those above what would have been anticipated had there been no pandemic – taking into account age, sex, racial and ethnic groups, as well as the settings where people died. 

In the first year, there were 509,179 dementia-related deaths in the U.S. among people 65 and older, which the researchers estimated was 94,688 more than would be expected in that population if the pandemic had not occurred. In the second year, the number of excess deaths dropped by 77% to 21,586.  

The decline in mortality shows people with dementia generally benefited from the COVID-19 vaccines that became available in December of 2020, as well as from new treatments. 
 
Dementia deaths declined in every age, sex, racial and ethnic group evaluated among those in long-term care and nursing homes. But deaths did not decline nearly as much for those who remained at home. Among the home-based population, there were 34,487 excess deaths in the first year of the pandemic. That decreased by just 16% to 28,804 in the second year.  

“Older adults with Alzheimer’s Disease and related dementias are very vulnerable to the COVID pandemic,” said Ruijia Chen, ScD, MS, a postdoctoral fellow in epidemiology and biostatistics at UC San Francisco and first author of the paper. “What we were trying to understand with this paper is whether the excess deaths actually declined after the vaccines became available.”  
 
Nursing homes were an early epicenter of the COVID-19 pandemic. Older people with dementia were especially susceptible to contracting the virus and dying from it due to comorbidities, difficulties adhering to infection control protocols, disruptions in care and isolation from family members and caregivers.  
 
The pandemic also saw significant disparities in excess deaths among ethnic groups, with higher rates of infection, hospitalization and death among Black, Latino and Asian patients, compared to non-Hispanic white people.  
 
Researchers analyzed data from the National Center for Health Statistics (NCHS) to compare deaths from the first year of the pandemic (March 2020 to February 2021) to the second (March 2021 to February 2022).  

Many of the oldest, frailest nursing home residents were lost in the first year of the pandemic, although that doesn’t fully explain the trend.
 
The researchers said other factors could have played a role. Nursing home residents were among the first to receive the vaccines, while their delivery was not as well coordinated for those at home. Loneliness and social isolation also likely played a role for those remaining in the community, along with deferred medical care and the shift to virtual care, which is difficult for this population to access.  
 
“The declining mortality in long-term care settings when vaccines became available show how lives can be saved when systems are in place to achieve comprehensive access to vaccinations,” said Maria Glymour, ScD, MS, senior author of the paper. Now chair of the Department of Epidemiology at Boston University, Glymour conducted the research when she was at UCSF. “Our findings suggest critical resources to make COVID-19 a survivable infection – most importantly vaccinations for themselves and those around them – are not reaching older adults living at home.”
   
Authors:  In addition to Glymour and Chen, UCSF authors include Kirsten Bibbons-Domingo, MD, PhD, Jingxuan Wang, MS, Erika Meza, MPH, Hélène E. Aschmann, PhD, Michelle A. DeVost, MPH, and Yea-Hung Chen, PhD. For other authors, please see the study. 

Funding: This work was supported by the National Institute on Aging (K00AG068431 and F31AG079651), the SNSF Postdoc Fellowship, the National Institute on Drug Abuse (K99DA051534) and the Robert Wood Johnson Foundation.  

 

About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF's primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. UCSF School of Medicine also has a regional campus in Fresno. Learn more at https://ucsf.edu, or see our Fact Sheet.

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JOURNAL

JAMA Neurology

World-first clinical trial to help millions with penicillin allergies

Peer-Reviewed Publication

VANDERBILT UNIVERSITY MEDICAL CENTER

 

IMAGE: VANDERBILT UNIVERSITY MEDICAL CENTER PRINCIPAL INVESTIGATOR ELIZABETH PHILLIPS, MD, THE JOHN OATES PROFESSOR OF CLINICAL RESEARCH. view more 

CREDIT: VANDERBILT UNIVERSITY MEDICAL CENTER

Penicillin allergy affects more than 25 million people in the United States (up to 1 in 10 Americans) and has been shown to lead to particularly poor health outcomes in pregnant women and surgical patients. It is also a public health threat, leading to antibiotic resistance and infections in hospitalized patients that can be life threatening.

Seventy-five% or more penicillin allergy labels come on by age 3 due to, for example, confusion with a viral rash. The majority of these rashes were never allergic, but the labels ‘stick’ into adulthood and carry many adverse consequences.”

 

Many low-risk patients with a penicillin allergy were able to have their penicillin allergy label removed through a simple procedure known as “direct oral challenge” as part of a world-first multicenter randomized control trial known as the Penicillin Allergy Clinical Decision Rule (PALACE) study.

 

In the PALACE study, investigators randomized low-risk penicillin allergic patients to two different approaches to remove their allergy label. They either underwent the current standard of care to have skin testing followed if negative by oral challenge with a penicillin or they went straight to oral challenge (“direct oral challenge”) without preceding skin testing.   

 

“The majority of patients labeled as penicillin allergic, more than 90%, have low-risk histories, meaning they did not have a history to suggest a severe or more recent reaction to a penicillin,” said PALACE study protocol member and Vanderbilt University Medical Center principal investigator Elizabeth Phillips, MD, the John Oates Professor of Clinical Research. “We would expect more than 95% of these patients to have negative testing and be able to take penicillin in the future.”

 

The study, undertaken by a team of researchers from specialized centers in North America and Australia, enrolled 382 adults who were assessed using a specialized risk assessment tool called PEN-FAST. Participants were randomly assigned to receive either a direct oral penicillin challenge or the standard approach (penicillin skin testing followed by an oral challenge). The primary goal was to determine if the direct oral penicillin challenge was no worse than the standard method of skin testing followed by oral challenge which needs to be performed in an allergist’s office.

 

Only one patient (0.5%) in each group experienced a positive reaction to the penicillin challenge, demonstrating that the direct oral penicillin challenge performs just as well as the standard method. Importantly, there were no significant differences in adverse events between the two groups, and no serious adverse events were reported.

 

The findings have wide-ranging implications for patients. By accurately identifying low-risk penicillin allergy patients, health care providers can ensure appropriate antibiotic prescriptions. Patients with a documented penicillin allergy are more likely to be prescribed alternative antibiotics, known as second-line antibiotics, which are often not as effective against certain infections and may have more side effects.

 

“Patients with penicillin allergy are more likely to get second-line or broader spectrum antibiotics that lead to risk of antibiotic resistance and serious infections such as antibiotic-associated diarrhea due to Clostridioides difficile, which can spread through hospitals and become a major public health problem.” Phillips said. “In the U.S. increasingly we also have a major problem with other antibiotic-resistant ‘superbugs’ such as multi-resistant gram-negative infections, Candida auris and even a resurgence of syphilis for which penicillin is the best treatment and the only treatment that should be used in pregnancy to prevent transmission to an unborn child.

 

“The evidence provided by the PALACE study will change clinical practice.  Many patients in the United States do not have direct access to an allergist to provide specialized testing such as skin testing.  Therefore, the ability to go to direct oral challenge with a penicillin in low-risk patients which can be carried out in any observed setting will make it easier for patients in the United States to access health care to safely and effectively remove the label of penicillin allergy,” she said.

 

The PALACE study was led by Ana-Maria Copaescu, MD, PhD, McGill University Health Centre, Montréal, and senior author Jason Trubiano. PhD, Center for Antibiotic Allergy and Research, Department of Infectious Diseases at Austin Health. Cosby Stone, MD, assistant professor of Medicine in the Division of Allergy, Pulmonology, and Critical Care Medicine, was a co-investigator for VUMC.

 

 

 

 

 

 

 

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JOURNAL

JAMA Internal Medicine

DOI

10.1001/jamainternmed.2023.2986 

ARTICLE TITLE

Efficacy of a Clinical Decisiion Rule to Enable Direct Oral Challenge in Patients ith Low-Risk Penicillin Allergy

ARTICLE PUBLICATION DATE

17-Jul-2023