It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Thursday, September 21, 2023
Clinical trial of HIV vaccine begins in United States and South Africa
Novel vaccine includes NIH-funded technology in development since 2004
NIH/NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES
IMAGE: TRANSMISSION ELECTRON MICROGRAPH OF HIV-1 VIRUS PARTICLES FROM INFECTED H9 CELLS, PRODUCED IN CELL CULTURE. THE PARTICLES EXHIBIT TWO STAGES OF REPLICATION: THE TWO “ARCS” ARE IMMATURE PARTICLES BUDDING FROM THE PLASMA MEMBRANE OF THE CELL, AND THE CENTER SPHERICAL PARTICLE IS A MATURE FORM IN EXTRACELLULAR SPACE. IMAGE CAPTURED AT THE NIAID INTEGRATED RESEARCH FACILITY (IRF) IN FORT DETRICK, MARYLAND.view more
CREDIT: NIAID
WHAT: A trial of a preventive HIV vaccine candidate has begun enrollment in the United States and South Africa. The Phase 1 trial will evaluate a novel vaccine known as VIR-1388 for its safety and ability to induce an HIV-specific immune response in people. The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, has provided scientific and financial support throughout the lifecycle of this HIV vaccine concept and is contributing funding for this study.
VIR-1388 is designed to instruct the immune system to produce T cells that can recognize HIV and signal an immune response to prevent the virus from establishing chronic infection. VIR-1388 uses a cytomegalovirus (CMV) vector, meaning a weakened version of CMV delivers the HIV vaccine material to the immune system without causing disease in the study participants. CMV has been present in much of the global population for centuries. Most people living with CMV experience no symptoms and are unaware that they are living with the virus. CMV remains detectable in the body for life, which suggests it has the potential to deliver and then safely help the body retain HIV vaccine material for a long period, potentially overcoming the waning immunity observed with more short-lived vaccine vectors.
NIAID has funded the discovery and development of the CMV vaccine vector since 2004 and is funding this trial with the Bill & Melinda Gates Foundation and Vir Biotechnology, based in San Francisco. The trial is sponsored by Vir and conducted through the NIAID-funded HIV Vaccine Trials Network (HVTN) as study HVTN 142.
HVTN 142 is taking place at six sites in the United States and four in South Africa and will enroll 95 HIV-negative participants. Participants will be randomly assigned to one of four study arms: three arms will each receive a different dose of the vaccine, and one will receive a placebo. To optimize participant safety, this study will only enroll people already living with asymptomatic CMV. Initial results are expected in late 2024, and an optional long-term sub-study will continue to follow volunteers for up to three years after their first vaccine dose.
Additional information about the trial is available on ClinicalTrials.gov under study identifier NCT05854381.
WHO: Carl Dieffenbach, Ph.D., Director of NIAID’s Division of AIDS, is available to discuss this research.
CONTACT: To schedule interviews, please contact the NIAID News & Science Writing Branch, (301) 402-1663, NIAIDNews@niaid.nih.gov.
NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov/.
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Black holes eat faster than previously expected
New finding might explain why quasars flare and fade so quickly
IMAGE: A NEW STUDY SHOWS THAT, BY DRAGGING SPACE-TIME, SUPERMASSIVE BLACK HOLES CAN RIP APART THE VIOLENT WHIRLPOOL OF DEBRIS (OR ACCRETION DISKS) THAT ENCIRCLE THEM, RESULTING IN AN INNER AND OUTER SUBDISK.view more
CREDIT: NICK KAAZ/NORTHWESTERN UNIVERSITY
A new Northwestern University-led study is changing the way astrophysicists understand the eating habits of supermassive black holes.
While previous researchers have hypothesized that black holes eat slowly, new simulations indicate that black holes scarf food much faster than conventional understanding suggests.
The study will be published on Wednesday (Sept. 20) in The Astrophysical Journal.
According to new high-resolution 3D simulations, spinning black holes twist up the surrounding space-time, ultimately ripping apart the violent whirlpool of gas (or accretion disk) that encircles and feeds them. This results in the disk tearing into inner and outer subdisks. Black holes first devour the inner ring. Then, debris from the outer subdisk spills inward to refill the gap left behind by the wholly consumed inner ring, and the eating process repeats.
One cycle of the endlessly repeating eat-refill-eat process takes mere months — a shockingly fast timescale compared to the hundreds of years that researchers previously proposed.
This new finding could help explain the dramatic behavior of some of the brightest objects in the night sky, including quasars, which abruptly flare up and then vanish without explanation.
“Classical accretion disk theory predicts that the disk evolves slowly,” said Northwestern’s Nick Kaaz, who led the study. “But some quasars — which result from black holes eating gas from their accretion disks — appear to drastically change over time scales of months to years. This variation is so drastic. It looks like the inner part of the disk — where most of the light comes from — gets destroyed and then replenished. Classical accretion disk theory cannot explain this drastic variation. But the phenomena we see in our simulations potentially could explain this. The quick brightening and dimming are consistent with the inner regions of the disk being destroyed.”
Accretion disks surrounding black holes are physically complicated objects, making them incredibly difficult to model. Conventional theory has struggled to explain why these disks shine so brightly and then abruptly dim — sometimes to the point of disappearing completely.
Previous researchers have mistakenly assumed that accretion disks are relatively orderly. In these models, gas and particles swirl around the black hole — in the same plane as the black hole and in the same direction of the black hole’s spin. Then, over a time scale of hundreds to hundreds of thousands of years, gas particles gradually spiral into the black hole to feed it.
“For decades, people made a very big assumption that accretion disks were aligned with the black hole’s rotation,” Kaaz said. “But the gas that feeds these black holes doesn’t necessarily know which way the black hole is rotating, so why would they automatically be aligned? Changing the alignment drastically changes the picture.”
The researchers’ simulation, which is one of the highest-resolution simulations of accretion disks to date, indicates that the regions surrounding the black hole are much messier and more turbulent places than previously thought.
More like a gyroscope, less like a plate
Using Summit, one of the world’s largest supercomputers located at Oak Ridge National Laboratory, the researchers carried out a 3D general relativistic magnetohydrodynamics (GRMHD) simulation of a thin, tilted accretion disk. While previous simulations were not powerful enough to include all the necessary physics needed to construct a realistic black hole, the Northwestern-led model includes gas dynamics, magnetic fields and general relativity to assemble a more complete picture.
“Black holes are extreme general relativistic objects that affect space-time around them,” Kaaz said. “So, when they rotate, they drag the space around them like a giant carousel and force it to rotate as well — a phenomenon called ‘frame-dragging.’ This creates a really strong effect close to the black hole that becomes increasingly weaker farther away.”
Frame-dragging makes the entire disk wobble in circles, similar to how a gyroscope precesses. But the inner disk wants to wobble much more rapidly than the outer parts. This mismatch of forces causes the entire disk to warp, causing gas from different parts of the disk to collide. The collisions create bright shocks that violently drive material closer and closer to the black hole.
As the warping becomes more severe, the innermost region of the accretion disk continues to wobble faster and faster until it breaks apart from the rest of the disk. Then, according to the new simulations, the subdisks start evolving independently from one another. Instead of smoothly moving together like a flat plate surrounding the black hole, the subdisks independently wobble at different speeds and angles like the wheels in a gyroscope.
“When the inner disk tears off, it will precess independently,” Kaaz said. “It precesses faster because it’s closer to the black hole and because it’s small, so it’s easier to move.”
‘Where the black hole wins’
According to the new simulation, the tearing region — where the inner and outer subdisks disconnect — is where the feeding frenzy truly begins. While friction tries to keep the disk together, the twisting of space-time by the spinning black hole wants to rip it apart.
“There is competition between the rotation of the black hole and the friction and pressure inside the disk,” Kaaz said. “The tearing region is where the black hole wins. The inner and outer disks collide into each other. The outer disk shaves off layers of the inner disk, pushing it inwards.”
Now the subdisks intersect at different angles. The outer disk pours material on top of the inner disk. This extra mass also pushes the inner disk toward the black hole, where it is devoured. Then, the black hole’s own gravity pulls gas from the outer region toward the now-empty inner region to refill it.
The quasar connection
Kaaz said these fast cycles of eat-refill-eat potentially explain so-called “changing-look” quasars. Quasars are extremely luminous objects that emit 1,000 times more energy than the entire Milky Way’s 200 billion to 400 billion stars. Changing-look quasars are even more extreme. They appear to turn on and off over the duration of months — a tiny amount of time for a typical quasar.
Although classical theory has posed assumptions for how quickly accretion disks evolve and change brightness, observations of changing-look quasars indicate that they actually evolve much, much faster.
“The inner region of an accretion disk, where most of the brightness comes from, can totally disappear — really quickly over months,” Kaaz said. “We basically see it go away entirely. The system stops being bright. Then, it brightens again and the process repeats. Conventional theory doesn’t have any way to explain why it disappears in the first place, and it doesn’t explain how it refills so quickly.”
Not only do the new simulations potentially explain quasars, they also could answer ongoing questions about the mysterious nature of black holes.
“How gas gets to a black hole to feed it is the central question in accretion-disk physics,” Kaaz said. “If you know how that happens, it will tell you how long the disk lasts, how bright it is and what the light should look like when we observe it with telescopes.”
The study, “Nozzle shocks, disk tearing and streamers drive rapid accretion in 3D GRMHD simulations of warped thin disks,” was supported by the U.S. Department of Energy and the National Science Foundation.
This still from a simulation shows how a supermassive black hole's accretion disk can rip into two subdisks, which are misaligned in this image.
CREDIT
Nick Kaaz/Northwestern University
JOURNAL
The Astrophysical Journal
METHOD OF RESEARCH
Computational simulation/modeling
SUBJECT OF RESEARCH
Not applicable
ARTICLE TITLE
Nozzle shocks, disk tearing and streamers drive rapid accretion in 3D GRMHD simulations of warped thin disks
ARTICLE PUBLICATION DATE
20-Sep-2023
Impact of Child Trust Funds in the UK ‘a missed opportunity’ – Aston University research for UK Savings Week
The research calls for the need to revisit how children can be helped to develop an effective savings habit
Researchers from Aston and Lincoln Universities have conducted a comprehensive study to evaluate the effectiveness of Child Trust Funds (CTFs) in the United Kingdom.
Connected with UK Savings Week (18 – 24 September) it highlights how developing children’s savings remains an area in need of further improvement if it is to play any part in improving the UK’s financial resilience long term – a key part of the current UK Personal Financial Wellbeing strategy.
The findings from the Centre for Personal Financial Wellbeing at Aston University provide insights into the impact of this large scale, national savings scheme seeking to develop children's savings and the potential for asset-based welfare policies.
Researchers say this was one of the biggest experiments of its type, exploring how a country could make a sea change in how the next generation can be helped to develop their saving behaviour – a critical issue of financial resilience for all nations that the Covid pandemic has exposed.
The Child Trust Funds programme was an initiative introduced in 2002 under the Labour government aimed at generating a capital sum for UK children when they turn 18 from a pot of at least £250 given to all children at birth. This sum, and any other savings that parents and others also contributed, was to be invested for them to grow into a fund they could draw on as they turned 18. The programme reached a significant milestone in late 2020 when the first cohort reached adulthood.
The research shows that by 2022, £10bn had been saved in CTFs in more than six million accounts. £2bn of this was the original funds input by the UK Government. The programme was ceased for children born after 2011 and no new Government money has been applied to these funds since this time, significantly curtailing the impact of this programme.
The research explored whether there was evidence that the programme met its two primary goals: higher levels of savings for eligible children than would otherwise have been likely to occur and helping to instil an improved savings habit in both young people as fund recipients and their parents.
Professor Andy Lymer, director of the Centre for Personal Financial Wellbeing at Aston University, said:
“While the Child Trust Fund has shown modest positive impacts on savings for eligible children, it would be challenging to claim that the initial exciting design objectives and potential have been achieved. This is arguably therefore a real missed opportunity to have material effect on savings and savings related behaviour in the next generation.
“We found a small increase in saved sums on average, potentially amounting to around £200 more than the average savings for CTF-ineligible siblings – although some got lots more than this from this programme, with average pot sizes by April 2022 being just over £2,000.
“The study however highlighted that a considerable portion of accounts remained untouched, with 27% of eligible accounts remaining unclaimed by August 2022 (latest data available), despite a targeted national advertising campaign aimed at eligible 18-year-olds to remind them they have accounts that may have been forgotten about. This means that continued effort is going to be needed annually by in the financial services sector managing these funds, and the Government more generally, to make sure these funds get connected with the owners of these funds as they turn 18 to make sure these funds can have at least some positive impact on their recipients’ lives hopefully.”
Professor Steve McKay, distinguished professor in social research in the College of Social Science at the University of Lincoln and a co-author of the report, said:
“The results indicated there was a small positive effect on savings on average, but that the benefits were primarily associated with children from more affluent families who were able to continue to add to the children’s funds creating extra compounding growth.
“Furthermore, it illustrated that while net extra savings were created for most account holders over their ineligible siblings, the study shows that parents aren't compensating for their siblings in other savings.
“There was very limited evidence of a meaningful impact on creating savings habit overall, for children or parents. In fact, many parents had forgotten or lost track of the accounts over years and so their children had little idea these even existed.
“Recognising the importance of even modest savings for many families, particularly considering that a majority of children in the UK have no savings at all, the research calls for a revisit of the principles on which this programme was founded. It suggests we urgently need to revisit how we can effectively help children develop savings, and effective savings habit, with and without government support - particularly those least likely to develop it via other means.”
Periods of collective stress, such as a pandemic or climate crisis, have a major impact on our psychological wellbeing. What role do emotions play in helping us cope during tough times? In a worldwide study by sixty-two scientists among more than 24,000 participants in fifty-one countries, a relationship was established for the first time between specific emotions and wellbeing during a period of collective stress. Calm and hope appear to be promising routes to psychological wellbeing. Anxiety, loneliness, and sadness are consistently associated with reduced wellbeing. This is an important finding for wellbeing interventions, especially in view of future societal crises.
Psychological wellbeing is promoted by positive emotions, but how we experience emotions is very specific. For example, we do not just feel good, but relieved or determined or amused. Similarly, we do not just feel bad, but angry, or sad, or lonely. Emotions with the same charge, positive or negative, can also lead to completely different behaviours. For example, we behave differently when we are proud than when we are grateful. Or when we are angry than when we are bored. Understanding how specific emotions are linked to our behaviors and wellbeing provides tools to improve our wellbeing. This has now been tested on a large scale for the first time.
Hope gives resilience
And why are these five emotions particularly important? The researchers point out that calm activates the parasympathetic nervous system which helps with stress recovery. And hope provides resilience because it helps people focus on opportunities in their environment. It therefore acts as a protective mechanism against stress. Prolonged anxiety or sadness, on the other hand, are known to increase the risk of psychological problems. Finally, loneliness is strongly related to the lack of social relationships that are important for our mental health.
Welfare interventions
The findings, the scientists say, provide a key to strengthening individual and societal interventions to improve wellbeing. 'Not only individuals, but also organizations and public institutions can help to create opportunities for experiences of calm and hope, and interventions to tackle anxiety, sadness, and loneliness,' says co-researcher Disa Sauter of the University of Amsterdam. 'This is especially important given the collective stress that we can expect in the future, for example as a result of climate change.'
Global research on emotions and psychological wellbeing
Sixty-two scientists from all over the world (including researchers from the University of Amsterdam, the University Chicago Booth School of Business, the University of Cambridge, the University of Oxford, and the University of Wisconsin Madison) tested the hypothesis that certain kinds of emotional experiences relate to psychological wellbeing during a stressful period.
They studied the relationship of twenty different emotions with wellbeing during the Covid-19 pandemic, a period of great psychological stress for people worldwide. The researchers conducted a survey among 24,221 participants in fifty-one countries during the Covid-19 outbreak, and additionally conducted a replication study in the US and UK and a longitudinal diary study.
Calm, hope, anxiety, loneliness, and sadness
The scientists found that across all countries, five emotions were consistently linked to psychological wellbeing, namely calm, hope, anxiety, loneliness, and sadness. Experiences of these five emotions predicted later changes in wellbeing. Calm and hope were linked to better psychological wellbeing, while anxiety, loneliness, and sadness with lower wellbeing.
'These results were confirmed in the replication and diary study and were very consistent across countries,' says one of the researchers Rui Sun of the University of Amsterdam/ University Chicago Booth School of Business. ‘This is remarkable since the circumstances between countries differed strongly. For example, countries varied dramatically in governmental pandemic policies and levels of prosperity.’
PASADENA, Calif. — Kaiser Permanente had better 5-year survival rates among breast, colorectal, and lung cancer patients compared to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) estimates, according to new research published September 19, 2023, in The Permanente Journal.
Researchers in all 8 Kaiser Permanente regions worked together on this study. They compared the occurrence of cancer based on age, as well as the survival rate, for patients diagnosed with cancer at Kaiser Permanente to national statistics of occurrence and survival produced by the NCI’s SEER Program. SEER is a coordinated system of cancer registries across the United States that collects data on every case of cancer reported in 19 geographic areas, covering about 35% of the U.S. population.
“Our research found that breast cancer incidence rates — meaning discovery of new cases of cancer — were consistently higher for Kaiser Permanente than for SEER, and that colorectal and lung cancer incidence rates were lower. In addition, survival rates from these 3 cancers — breast, colorectal, and lung — were consistently higher than national estimates,” said the study’s co-lead author Erin E. Hahn, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation. “We believe that Kaiser Permanente’s focus on cancer prevention and cancer screening, use of cancer treatment pathways based on national guidelines, and use of a consistent electronic health record system that enables guideline-based care, protocols, and coordination of care across the cancer care continuum may have played a role in higher survival rates.”
Kaiser Permanenteis an integrated health care organization with 12.7 million members. Researchers included all patients enrolled in all 8 Kaiser Permanente regions (Southern California, Northern California, Northwest — which includes portions of Oregon and Washington — Washington, Hawaii, Colorado, Georgia, and Mid-Atlantic States — which includes Maryland, Virginia, and Washington, D.C.). Then researchers followed the Kaiser Permanente patients diagnosed from 1999 to 2013 to determine 5-year survival rates.
Researchers compared both the rate of cancer incidence and the rate of survival.
Kaiser Permanente survival rates were consistently higher than for SEER.
Incidence rates for all-stage and localized-stage breast cancer were consistently higher for Kaiser Permanente than for SEER, while colorectal and lung cancer rates were lower. Researchers believe that higher incidence rates for localized breast cancer may be due to high screening rates.
Researchers also parsed out the race and ethnicity of cancer patients at Kaiser Permanente. That analysis did not reveal disparities in the delivery of cancer screening and treatment for breast, colorectal, and lung cancer within Kaiser Permanente.
Researchers said that fluctuations in cancer occurrence and survival may reflect patterns in behaviors associated with cancer risk, such as the decline in smoking, increases in cancer screening, and availability of new treatments. For example, a 2008 spike in colorectal cancer incidence at Kaiser Permanente corresponded to the enterprisewide distribution of at-home colorectal cancer screening tests from 2006 to 2008. That, in turn, may well have led to earlier detection and subsequent improvements in survival seen among Kaiser Permanente members in 2011.
Co-lead author Debra P. Ritzwoller, PhD, of the Kaiser Permanente Colorado Institute for Health Research, said Kaiser Permanente members’ access to preventive care such as smoking cessation programs and cancer screening programs could have affected the findings of the study.
“We believe that this study shows that Kaiser Permanente’s dedication to screening and preventive care, as well as adoption of new treatments, has benefited our members,” she said.
Hahn and Ritzwoller added, though, that the findings should be interpreted cautiously given the differences in patients between Kaiser Permanente and the NCI’s SEER database. The Kaiser Permanente population is an insured, younger, and more racially diverse population than SEER’s aggregated location-specific populations.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 12.7 million members in 8 states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health.
JOURNAL
The Permanente Journal
ARTICLE TITLE
Incidence and Survival for Breast, Colorectal and Lung Cancer Patients in an Integrated System
ARTICLE PUBLICATION DATE
19-Sep-2023
Dying with dignity in Mexico
University of Oklahoma professor is studying end-of-life care in two public palliative care wards in Mexico City
IMAGE: UNIVERSITY OF OKLAHOMA ASSISTANT PROFESSOR AND MEDICAL ANTHROPOLOGIST ELYSE ONA SINGER, HAS RECEIVED A GRANT FROM THE NATIONAL SCIENCE FOUNDATION TO BETTER UNDERSTAND THE CULTURAL AND BIOETHICAL DIMENSIONS OF DEATH AND DYING.view more
CREDIT: PHOTO PROVIDED BY ELYSE ONA SINGER, UNIVERSITY OF OKLAHOMA.
University of Oklahoma assistant professor and medical anthropologist Elyse Ona Singer, Ph.D., has received a grant from the National Science Foundation to better understand the cultural and bioethical dimensions of death and dying. The project grew out of a curiosity that is at once academic and personal.
“Someone very close to me has had chronic health issues for several years now, and the end of life, death, dying and the caregiving responsibilities that entails have been on my mind in a personal way for a long time,” Singer said.
Singer and postdoctoral researcher Alicia Ordóñez Vázquez are conducting an ethnographic study across two major public hospitals’ palliative care wards in Mexico City. The two-year project is jointly funded by a $238,583 grant from the Established Program to Stimulate Competitive Research, or EPSCoR, and Cultural Anthropology programs of the National Science Foundation.
Palliative care describes a holistic approach that aims to improve the quality of life for patients facing serious illness, with a focus on managing symptoms such as pain and the psychological and emotional stressors of being unwell.
While palliative care remains limited across Mexico, in 2008, Mexico City passed the Ley de Voluntad Anticipada, or Advance Directive Law. Today, Mexico City residents have the right to passive euthanasia – the right to refuse or withdraw life-sustaining treatment. They can also register their end-of-life wishes by filing advance directives at a hospital or public notary, and comprehensive palliative care services have been made available to the terminally ill for the first time through public health institutions.
Singer and Ordóñez Vázquez are working with the two palliative care wards to ask questions in real-time of doctors, health care professionals and patients who agree to participate.
At the first hospital site, which serves cancer patients, Singer plans to collect 40 case studies of terminally ill patients together with their primary family caretaker. The case studies include follow-up interviews with the family caretaker and palliative care physician to understand the processes of bereavement and the degree to which they feel that the dignity of the deceased was preserved.
“The objective of the study is to understand how everyday people – the terminally ill, their caretakers and the palliative care professionals – understand and strive to accomplish a dignified death,” Singer said. “Also, to better understand the legal, bureaucratic, bioethical, economic and other obstacles that get in the way of that. My job as an anthropologist is to put aside my own conceptions of what a dignified death might look like and understand what it means locally to the people I’m getting to know.”
Singer says the cultural significance of death and the illegality of assisted dying in Mexico provide a unique ethnographic context in which to explore this topic.
“We see stereotypes about how people in Mexico think about death … celebrate holidays like the Day of the Dead,” she said. “I want to understand in more detail and nuance what ordinary people make of death and dying in a context where there’s so much cultural elaboration around death. Currently, all forms of assisted dying or any active euthanasia are illegal or not yet legal. The legal context for assuring dignified death, where dying individuals have autonomy and choice about when death happens, where death happens, whether they have access to pain medications and who else is present, is arguably trickier in the Mexican context because of the fewer legal options that are available to people.”
Singer hopes the findings from this study can provide insights for the clinicians, patients and caregivers that may enhance palliative care practices.
“Whether improving communication between clinicians, patients and caregivers or helping to bring attention to things that patients and their families are telling us about how the care might be improved, ideally, these findings could translate into smoother protocols or an enhancement of care in some way,” Singer said.
Singer also plans to publish a range of articles and, ultimately, a book on the study’s findings.
Singer is an assistant professor in the Department of Anthropology, Dodge Family College of Arts and Sciences at the University of Oklahoma. Her research focuses on controversial topics. Her first book, Lawful Sins: Abortion Rights and Reproductive Governance in Mexico, explored abortion politics in Mexico; it received an honorable mention for the 2022 Eileen Basker Memorial Book Prize, sponsored by the Society for Medical Anthropology, and an honorable mention for the 2023 Michelle Z. Rosaldo Book Prize sponsored by the Association of Feminist Anthropology. More information about her research is available at https://ou.academia.edu/ElyseSinger.
Founded in 1890, the University of Oklahoma is a public research university located in Norman, Oklahoma. As the state’s flagship university, OU serves the educational, cultural, economic and health care needs of the state, region and nation. OU was named the state’s highest-ranking university in U.S. News & World Report’s most recent Best Colleges list. For more information about the university, visit www.ou.edu.
Study finds COVID cases underreported in most African countries during initial stage
Those countries with the highest rates of severe infections also had the highest rates of reported cases
IMAGE: ASSISTANT PROFESSOR JUDE KONG, YORK UNIVERSITYview more
CREDIT: YORK UNIVERSITY
TORONTO, Sept. 20, 2023 – A new analysis of COVID-19 cases in Africa shows that for most of the continent’s countries the rate of infection was likely much higher than reported in the initial stages, found York University researchers.
Case counts reported by most African countries suggest the virus spread slowly during the early part of the pandemic, but the researchers say those numbers likely didn’t capture the true extent of the spread.
To get a better handle on the real number of those infected, the researchers used an epidemiological mathematical model, along with observed data, for 54 countries in Africa to estimate the number of hidden infections. Data on cumulative number of cases and daily confirmed cases were used to build an epidemic profile for Africa of the initial stage of COVID-19.
What may be most surprising is the estimation that some 66 per cent of all infections in Africa were asymptomatic, while about five per cent were severe and about 27 per cent were mild.
“Africa is primarily comprised of a young population so it’s possible there were fewer cases, less severe symptoms or more people with asymptomatic symptoms than in a population that has a higher percentage of seniors,” says Postdoctoral Fellow Qing Han, lead researcher on the paper. “This suggests the possibility of a lower rate of detection of the virus.”
The researchers found that the basic reproduction number (R0) in each country was much higher than when only reported cases were used as the average overall case reporting rate was low – estimated at about five per cent continent-wide – in the early stages for each country. They estimate that the real mean R0 is 2.02 compared to the reported R0 of 0.17 and ranged from 1.12 in Zambia and 3.64 in Nigeria.
“Counties that showed a R0 of less than one, which basically means there was no outbreak, likely have a much higher true R0. Not investigating the underreported figures could cause an underestimation of the severity and magnitude of the epidemic locally in each country,” says Han.
Those countries with the highest number of severe infections also tended to have the highest reported cases and those with the lowest severe infections generally had the lowest report rate. The researchers say the predicted true numbers of cumulative cases are high above what was reported for all countries with Sudan and Gambia reporting collectively most at 27 per cent and 22 per cent, while most countries reported less than five per cent.
Northern and southern African countries had higher reporting rates compared to central Africa, which could be explained in part by higher health-care spending in the north and south regions. Libya topped all the African countries for having the most nurses and physicians per 1,000 people.
