Tuesday, October 22, 2024

Invasive flathead catfish impacting Susquehanna’s food chain, researchers find

Study’s findings may help inform Pennsylvania river management as the large, hungry predators continue spreading throughout the basin

Peer-Reviewed Publication

Penn State

UNIVERSITY PARK, Pa. — Flathead catfish — native to the Mississippi River basin — were first detected in the Susquehanna River in Pennsylvania in 2002, according to the U.S. Geological Survey. In the two decades since then, the invasive species has spread throughout the river basin. The impact of the large predator on the waterway’s food webs and ecology was unknown, but now a research team is beginning to understand what Susquehanna flatheads are eating and how their presence is affecting native aquatic species in the river.

The findings, which the team said state fisheries managers can use to better manage the waterway, were recently published in Transactions of the American Fisheries Society. The researchers from Penn State, the Pennsylvania Fish and Boat Commission, the U.S. Fish and Wildlife Service, and the U.S. Geological Survey, reported that flatheads are opportunistic feeders preying on dozens of aquatic species. The invaders are voracious and have become the apex predators in the river — some specimens are known to grow more than 4 feet long and nearly 70 pounds in Pennsylvania waters. They have great potential to affect the abundance of riverine fish species, according to the researchers.

“We conducted the first flathead catfish population diet study in a mid-Atlantic region waterway because it was unknown how this invader is impacting food webs and which species may be at greatest predation risk,” said study coauthor, Megan Schall, associate professor of biology at Penn State Hazleton. “Flathead catfish in waters where they are not native pose a threat to aquatic communities.”

To determine what the flathead catfish were eating, researchers collected 576 of them over two years using electrofishing and hoop net capture methods, as well as collection from the Conowingo Dam fish lift, with 241 individuals having recoverable stomach contents. The researchers extracted DNA from those contents and identified prey tissues using a molecular genetics technique known as DNA bar coding. Researchers conducted genetic sequencing of selected stomach contents at the Genomics Core Facility at Penn State’s Huck Institutes of the Life Sciences.

In all, researchers identified 47 different prey species. Thirty-four of the species detected were at a low frequency, occurring in less than 2% of fish sampled. The most common were rusty crayfish, margined madtoms — a variety of catfish typically 2 to 3 inches long, considered to be a species of conservation concern — and shiners, which are silvery minnows. While frequency of occurrence of prey species differed depending on the length of flathead catfish, rusty crayfish were found in the stomachs of almost half the fish sampled in the study.

Among other prey species identified were blueback herring, gizzard shad, northern hog sucker, shorthead redhorse, goldfish, river chub, bluntnose minnow, longnose dace, white catfish, brown bullhead, channel catfish, flathead catfish, banded killifish, rock bass, green sunfish, bluegill, smallmouth bass, white crappie, black crappie, white perch, greenside darter, yellow shield darter and walleye.

Not surprisingly, the researchers said, with increasing flathead catfish size comes a proclivity to feed on larger prey. In general, flatheads over 24 inches long primarily consumed fish species, and fish below 24 inches generally fed on a mix of invertebrates and fish species.

Learning that flathead catfish in the Susquehanna River basin are consuming a diverse set of prey species, including species of recreational importance — smallmouth bass, rock bass, channel catfish and walleye — and species of conservation importance — blueback herring and margined madtom — will help fisheries managers who oversee the river, according to Schall.

“Identifying prey species consumed by this invasive predator is one of the first steps in elucidating potential community-level impacts from this actively expanding aquatic invasive species,” she said. “That knowledge is vital for determining potential management solutions to a novel invader.”

The discovery that flathead catfish in the Susquehanna River are consuming so many rusty crayfish — themselves an invasive species that are largely supplanting native crayfish species in the U.S. Northeast — was especially interesting, said research team leader Julian Avery, assistant research professor of wildlife ecology and conservation in the College of Agricultural Sciences.

“These invasive species likely ended up in the Susquehanna River because of human tampering — anglers moving them around — and the scale of what can go wrong with ecosystems as a result is eye-opening,” he said. “We are only now coming to grips with the effect these aquatic invaders are having on river ecosystems.”

Also contributing to the research were Geoffrey Smith, Pennsylvania Fish and Boat Commission, Division of Fisheries Management; Aaron Maloy and Jason Coombs, U.S. Fish and Wildlife Service, Northeast Fishery Center, Lamar, Pennsylvania; and Tyler Wagner, U.S. Geological Survey, Pennsylvania Cooperative Fish and Wildlife Research Unit at Penn State.

The Pennsylvania Sea Grant, Penn State Commonwealth Research and Development Program and Mid-Atlantic Panel on Aquatic Invasive Species provided funding for this research.

catfish study area in the Susquehanna River basin

The study area in the Susquehanna River basin, Pennsylvania, where flathead catfish were collected for dietary analysis. Shapes denote collection methods: diamonds represent high-frequency electrofishing, triangles represent hoop nets, circles represent low-frequency eiectrofishing and the square represents the fish lift at the Conowingo Dam.
Credit
Penn State

Journal

Transactions of the American Fisheries Society

DOI

10.1002/tafs.10480

Method of Research

Observational study

Subject of Research

Animals

Article Title

Feeding habits and ecological implications of the invasive Flathead Catfish in the Susquehanna River basin, Pennsylvania

Harnessing science to tackle global crises

The Club of Rome

In a paper published in PLOS Sustainability and Transformation, an international team of researchers looked at how science could play a more active role in managing crises. The paper builds on the outcomes of the international conference “What Role for Science in Crisis Times? Outlook in the Health, Environment, and Agriculture Interconnected Areas”, held in Montpellier in 2022.

To enhance science’s contribution to crisis management, the paper emphasises the need for interdisciplinarity, where science is integrated across disciplines, and transdisciplinarity, which incorporates various societal actors and stakeholders. By co-designing and co-producing solutions with scientists, policymakers and affected populations, transdisciplinary science can contribute to integrated and cooperative decision-making.

“We are now living in a polycrisis world, where science should be playing a more engaged and active role,” says Paul Shrivastava, Co-President of The Club of Rome, Professor of Management & Organizations, The Pennsylvania State University and the lead author of the paper. “It should be more fluid, timely, and integrated with social and political decision-making.”

The paper summarises the key actions to harness science to tackle crises, which include implementing interventions on both global and local scales, engaging the public, democratising science, adopting new governance frameworks, and integrating community engagement. It also highlights the importance of aligning science-based interventions with cultural norms and increasing the engagement with countries suffering from unequal access to scicence.

The authors stress that the effort needs to come from both directions—political leaders need to proactively engage with scientists and rely on evidence-based solutions, while scientists need to seek access points to connect with crisis responders and affected populations. The latter could be encouraged by rewarding scientists for their real-world contributions within the academic system and increasing funding for research with a direct crisis impact.

"Science has identified the existential threats we face, but this knowledge is often ignored, contested, or slowly acted upon. It’s time to flip the science model and mobilise significant resources for the benefit of people and the planet," says Carlos Alvarez Pereira secretary general of The Club of Rome and co-author of the study. “That is why The Club of Rome and partners established the Earth-Humanity Coalition — a global network that encourages transformative research and action at all levels.”

This paper underscores the vital role of science in navigating crisis-ridden times and urges

decision-makers to view scientific input as crucial for fostering sustainability and transformation. By harnessing the transformative power of science, transcending traditional boundaries, and cultivating collaborative solutions, we can chart a course towards a sustainable future in an equitable and healthy world for all.

Journal

PLOS Sustainability and Transformation

DOI

10.1371/journal.pstr.0000132

Method of Research

Commentary/editorial

Subject of Research

Not applicable

Article Title

Science in crisis times: The crucial role of science in sustainability and transformation

Article Publication Date

22-Oct-2024

Air pollution linked to having a peanut allergy during childhood

Murdoch Childrens Research Institute

Exposure to higher levels of air pollution as a baby is linked to having a peanut allergy throughout childhood, according to a new study. And policies aimed at tackling poor air quality could potentially reduce the prevalence and persistence of peanut allergies, it stated.

The research, led by Murdoch Children’s Research Institute (MCRI) and the University of Melbourne, found being exposed to higher levels of air pollution from infancy was associated with increased odds of developing a peanut allergy and having the allergy persist across the first 10 years of life. However, the same association was not seen for egg allergy or eczema.

Published in the Journal of Allergy and Clinical Immunology, the study is the first to explore the link between air pollution and challenge-proven food allergy over the first decade of life.

The research involved 5,276 children in Melbourne from the HealthNuts study, recruited at age one and followed-up at four, six and 10 years. The research team used estimates of the annual average concentration of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) at each participant’s residential address at the time of each follow up.

MCRI Associate Professor Rachel Peters said the study found that higher levels of air pollution was a risk factor for the development and persistence of peanut allergies. And this was despite Melbourne having generally good air quality compared to our international counterparts, she said.

“The rise in allergy prevalence has occurred at a similar time to increased urbanisation, leading to the belief that environmental factors may be contributing to high allergy rates,” Associate Professor Peters said.

“Eczema and food allergy most often develop in infancy. Both immune conditions can naturally resolve over time, but for some they can persist throughout adolescence and into adulthood.”

“This is the first study to use an oral food challenge, the gold-standard of food allergy diagnosis, to investigate the relationship between food allergy and air pollution.”

University of Melbourne’s Dr Diego Lopez said the co-exposure of peanut allergens in the environment and air pollutants could be increasing the allergy risk.

“Air pollutants have an irritant and inflammatory effect that may boost the immune systems pro-allergic response, potentially triggering the development of food allergies,” he said.

“However, the underlying mechanisms of how air pollution increases the risk of a peanut allergy, and why eczema and egg allergy aren’t impacted in the same way, need to be explored further.”

Allergic disease is one of Australia's greatest public health challenges, with one in 10 developing a food allergy in their first year of life.

Associate Professor Peters said policies aimed at tackling air pollution could potentially reduce the development and persistence of peanut allergy.

“The research highlights the importance of early-life interventions aimed at reducing exposure to air pollution, which could potentially prevent peanut allergies and other poor child health outcomes,” she said.

“Improving city design to support greater air quality regulation, better promoting public transport and switching to non-combustion fuels may help turn the tide on peanut allergy.”

Mae, 8, was diagnosed with peanut, diary and egg allergies at 8 months old after an allergic reaction saw her breakout in hives across her entire body. She has since gone onto have several anaphylaxis reactions.

Her mum, Eleanor Jenkin, said the most severe episode occurred five years ago during a food challenge at The Royal Children’s Hospital to check Mae’s tolerance for adding egg back into her diet.

“She was eating cupcakes as part of the challenge until she started to refuse to eat anymore,” she said. We thought she was just being fussy, but she began vomiting and lost consciousness. It was her first anaphylaxis and while it was scary, she returned to her normal self a few minutes after being given an adrenaline shot.”

Since then, Mae has carried an EpiPen with her at all times.

“We were hopeful she would grow out of the food allergies but now we have come to accept that Mae will be living with serious and ongoing allergies,” Eleanor said.

“Her allergies are always going to be in the back of her mind, influencing the decisions that she makes every time she eats at a restaurant, orders takeaway or goes to a birthday party. As a family we are learning to manage this new normal as best we can.”

Living in Melbourne’s west, Eleanor said the new MCRI research showed why it was important to tackle air pollution.

“There is a whole suite of reasons why we should be addressing air pollution and its link with peanut allergy just adds to that,” she said.

“Multiple factors are behind the allergy epidemic and if higher levels of air pollution are impacting the prevalence and persistence then that’s an important discovery for families.

“We want to see the quality of life improve for children living with allergies as well as fewer children having to go through what Mae has experienced. The more we know about how to prevent allergies the better.”

The GenV study, tracking the health and wellbeing of Victorians from birth to old age, is also starting to look at the impact of air pollution and climate change on children’s health. GenV has gathered data from more than 120,000 participants, including 48,000 babies.

MCRI researchers are linking information on heat vulnerability with perinatal and child health data from the GenV cohort and are seeking to include temperature extremes and climate related disaster evidence in the future.

Associate Professor Suzanne Mavoa said this would improve our understanding of how climate change impacts the health of children and families, identify those most at risk and test policies and interventions to better protect against severe weather events.

Associate Professor Peters is the National Allergy Centre of Excellence (NACE) Epidemiology Lead and a Centre for Food Allergy Research (CFAR) Associate Investigator. Eleanor is also a member of the NACE Consumer Advisory Group. Both national research bodies are hosted at MCRI to help accelerate allergic disease research across Australia.

Researchers from Monash University, The University of Sydney, Sydney Local Health District, The Royal Children's Hospital, University of Queensland, Deakin University and the Environment Protection Authority Victoria also contributed to the findings.

Publication: Diego J. Lopez, Caroline J. Lodge, Dinh S. Bui, Nilakshi T.Waidyatillake, John C.Su, Luke D. Knibbs, Rushani Wijesuriya, Kirsten P Perrett, Jennifer J Koplin, Victoria X Soriano, Kate Lycett, Yichao Wang, Suzanne Mavoa, Shyamali C. Dharmage, Adrian J. Lowe and Rachel L. Peters. ‘Early life air pollution is associated with persistent peanut, but not egg allergy, across the first ten years,’ Journal of Allergy and Clinical Immunology: In Practice. DOI: 10.1016/j.jaci.2024.08.018

*The content of this communication is the sole responsibility of MCRI and does not reflect the views of the NHMRC.

Available for interview:

Associate Professor Rachel Peters, MCRI Team Leader, Population Allergy

Dr Diego Lopez, University of Melbourne’s Allergy and Lung Health Unit

Eleanor Jenkin, whose daughter Mae, 8, has multiple food allergies

Journal

Journal of Allergy and Clinical Immunology: In Practice

DOI

10.1016/j.jaci.2024.08.018

Method of Research

Observational study

Subject of Research

People

Article Title

Early life air pollution is associated with persistent peanut, but not egg allergy, across the first ten years

Article Publication Date

22-Oct-2024

Floor swabbing could help prevent COVID-19 outbreaks in hospitals

In two Ontario hospitals, high levels of SARS-CoV-2 on floors correlated with COVID-19 cases among healthcare workers and patients, suggesting floor swabbing as a potential method to prevent outbreaks

Lunenfeld-Tanenbaum Research Institute

COVID-19 is here to stay. As restrictions and human testing have waned, new research is tackling the challenge of how we can monitor, predict, and prevent cases and outbreaks of COVID-19, especially among vulnerable groups like hospitalized patients.

One approach is environmental surveillance. The most well-known incarnation is wastewater surveillance, which rose in prominence following the advent of the COVID-19 pandemic. But the Coronavirus in the Urban Built Environment research team, also known as CUBE, is exploring an alternative—swabbing the floors.

In a recent study at two hospitals in Ontario, CUBE researchers swabbed the floors of healthcare worker areas, such as change rooms, meeting rooms and staff washrooms, and observed a strong association between the amount of SARS-CoV-2 viral matter found on the floor and the number of cases and outbreaks of COVID-19 in the hospital.

“The association between floor swabs and human cases and outbreaks was something we had previously observed in long-term care homes, and we wanted to test the hypothesis in the hospital setting,” says Dr. Caroline Nott, Infectious Disease Physician at The Ottawa Hospital, Assistant Professor at the University of Ottawa Department of Medicine, and one of the principal investigators of CUBE.

For every 10-fold increase in the amount of virus detected on the floor, the researchers observed a corresponding 15-fold increase in patient cases and a 22-fold higher odds of a COVID-19 outbreak. These results add to the mounting evidence that floor swabbing may provide an additional layer of monitoring to help inform infection prevention and control measures in hospitals and other settings.

“To be clear, COVID-19 is not spreading via the floor,” reassures Nott. “It is extremely rare to catch COVID-19 from any surface. Rather, what we are seeing in our floor swabs is a reflection of the burden of infection in the humans occupying the environment where we are swabbing. So if we start seeing an increase in the amount of virus we are finding on the floor, it could be a signal that additional cases and potentially outbreaks are on the way. This kind of early warning may help the hospital prepare and take preventative measures.”

But why would the amount of virus on the floor in healthcare worker areas reflect the burden of COVID-19 in the hospital’s patient population?

“Great question,” says Dr. Michael Fralick, Clinician Scientist at Sinai Health, Associate Professor at the University of Toronto, and CUBE principal investigator. “COVID-19 is a respiratory illness. It spreads via droplets and aerosols, which can travel a relatively long distance before falling to the floor.”

Fralick continues, “We focused on healthcare worker areas mainly for pragmatic reasons: those areas are more straightforward to access and do not disrupt direct patient care, which are important considerations if an approach like this were to be implemented.”

The study was conducted over 39 weeks between July 2022 and March 2023, with a total of 760 floor swabs collected. Swabs were processed for SARS-CoV-2 using quantitative reverse-transcriptase polymerase chain reaction. Grouped fivefold cross-validation was used to evaluate model outbreak discrimination. The paper was published last month in Cambridge University Press’s Infection Control and Hospital Epidemiology.

While COVID-19 has fallen out of the public consciousness, building the capacity in our healthcare systems to prevent illness and death in the event of seasonal resurgence and future variants is paramount, says Nott. “We weren’t prepared for COVID-19, and as a result many people died or have suffered long-term effects, especially vulnerable people like those being treated in hospitals or living in long-term care. We are driven to develop methods to prevent similar suffering in future, whether it is a new COVID-19 variant or a different pathogen altogether.”

Journal

Infection Control and Hospital Epidemiology

Subject of Research

Not applicable

Article Title

SARS-CoV-2 burden on the floor was associated with COVID-19 cases and outbreaks in two acute care hospitals: a prospective cohort study

Expanding access to weight-loss drugs could save thousands of lives a year

Yale University

New Haven, Conn. — Expanding access to new, highly effective weight-loss medications could prevent more than 40,000 deaths a year in the United States, according to a new study led by researchers at Yale School of Public Health and the University of Florida.

The findings highlight the critical need to remove existing barriers that are hindering people’s access to effective weight loss treatments and impeding public health efforts to address the national obesity crisis, the researchers said. According to the U.S. Centers for Disease Control and Prevention, about 74% of Americans are considered overweight, with about 43% of those individuals considered obese.

Obesity's widespread impact on health is well-documented. It exacerbates conditions such as type 2 diabetes, cardiovascular disease, and certain cancers. Yet, despite its severe consequences, the development and deployment of highly effective treatments for obesity have been lacking. Recent advancements in pharmaceutical interventions however, particularly the introduction of glucagon-like peptide-1 (GLP-1) receptor agonists, such as Ozempic and Wegovy, and dual gastric inhibitory polypeptide and GLP-1 (GIP/GLP-1) receptor agonists, such as tirzepatide, have demonstrated substantial efficacy in weight loss. These medications have shown promise in clinical trials and are increasingly being used for weight management.

In conducting their study, the researchers aimed to quantify the potential mortality impact of increased access to these weight-loss drugs. They integrated data on mortality risk associated with different body mass index (BMI) categories, obesity prevalence, and the current limitations on drug access due to high costs and insurance restrictions.

According to the findings, if access to these new medications were expanded to include all eligible individuals, the U.S. could see up to 42,027 fewer deaths annually. This estimate includes approximately 11,769 deaths among individuals with type 2 diabetes — a group particularly vulnerable to the complications of obesity. Even under current conditions of limited access, the researchers project that around 8,592 lives are saved each year, primarily among those with private insurance.

The study highlights a critical disparity in drug access. Currently, the high cost of these medications, which can exceed $1,000 per month without insurance, limits their availability. For example, Medicare — one of the largest insurance programs for older adults — does not cover these drugs for weight loss, impacting many who could benefit from them. Medicaid coverage varies widely by state, and private insurance often imposes high deductibles and copays, further restricting access, the researchers said.

"Expanding access to these medications is not just a matter of improving treatment options but also a crucial public health intervention," said Alison P. Galvani, one of the study's corresponding authors and the Burnett and Stender Families Professor of Epidemiology (Microbial Diseases) at the Yale School of Public Health. "Our findings underscore the potential to reduce mortality significantly by addressing financial and coverage barriers."

The study also explored how expanded access could affect different regions and socioeconomic groups. States with high obesity and diabetes rates, such as West Virginia, Mississippi, and Oklahoma, stand to benefit the most from increased medication availability. In these areas, expanding access could lead to the largest per capita reductions in mortality.

However, the study's authors caution that while the potential benefits are substantial, several challenges remain. The high price of these medications is a significant barrier, and there are concerns about the pharmaceutical industry's profit margins. Furthermore, supply constraints and production limitations continue to hamper widespread availability.

"Addressing these challenges requires a multifaceted approach," said Dr. Burton H. Singer, PhD, another corresponding author of the study and adjunct professor of mathematics at the Emerging Pathogens Institute at the University of Florida. "We need to ensure that drug prices are more aligned with manufacturing costs and increase production capacity to meet demand. At the same time, we must tackle the insurance and accessibility issues that prevent many people from getting the treatment they need."

The researchers also considered the impact of socioeconomic factors on the effectiveness of expanded drug access. They adjusted their estimates to account for income disparities, finding that even with these adjustments, the potential for lives saved remains significant. The results suggest that improving access to these medications could reduce health care costs associated with obesity-related conditions and improve overall quality of life for many Americans.

The study appears in the peer-reviewed journal Proceedings of the National Academy of Science.

Abhishek Pandey, a research scientist at the Yale School of Public Health, is lead author of the study. Yale postdoctoral research associates Yang Ye and Chad R. Wells are coauthors.

###

Journal

Proceedings of the National Academy of Sciences

Medicare has a revolving door, study suggests

Understanding why people cycle between Medicare Advantage plans and traditional Medicare – and back again – is important for families and policymakers alike

Michigan Medicine - University of Michigan

Right now across the country, tens of millions of older adults and people with serious disabilities have a choice to make: whether to stick with their current Medicare option, or change during Open Enrollment.

One of the biggest decisions they face is whether to go with a Medicare Advantage plan offered by an insurance company, or traditional Medicare coverage offered directly by the federal government.

If they change from one to the other, a new University of Michigan study finds, they may be entering a revolving door and find themselves changing again in the future.

On average, the study shows, 3% of people with traditional Medicare switch over to an MA plan each year. But when the researchers looked closely at these “switchers”, they found that switching to MA was more than twice as common – 6.5% -- among those who had switched from MA to traditional Medicare only one to three years before.

In fact, 9% of those who had jumped from MA to traditional Medicare the year before then switched back to Medicare Advantage, staying just one year in the traditional program. For those who had left MA for traditional Medicare two or three years earlier, the percentage switching back to MA was still much higher than average.

“Medicare Advantage plans now cover more than half of all Americans with Medicare, so really understanding patterns like these is important from a policy perspective,” said Geoffrey Hoffman, Ph.D., the lead author of the new study and an associate professor in the U-M School of Nursing. “What we found here is that it’s just not an open-and-shut case that everyone who leaves Medicare Advantage is permanently dissatisfied and will never go back. But what we need to understand more is what is driving this revolving door.”

Previous research has suggested that people might switch from MA to traditional Medicare when they develop a serious health condition that might lead them to want the less-restrictive choice in doctors and hospitals that traditional Medicare offers.

But the researchers found that there was no major difference in MA switching patterns among people who had been diagnosed with Alzheimer’s disease or another form of dementia, or had a chronic disease.

“Older adults have an enormous number of Medicare Advantage choices,” said Donovan Maust, M.D., M.Sc., the study’s senior author and a geriatric psychiatrist at the U-M Medical School. “Understanding how they make their choices to either enroll or disenroll is important for their own health and finances, but understanding and supporting these plan changes has big implications for U.S. policy and the federal budget.”

The researchers examined data from nearly 4 million people who were enrolled in traditional fee-for-service Medicare in 2017 through 2019.

One factor they could not look at directly, but tried to examine, was whether people switched back to Medicare Advantage after being in traditional Medicare because their health status made them unable to get a Medigap plan to cover some of the out-of-pocket costs they might incur in traditional Medicare.

Most states do not require insurers to ensure that people have the right to purchase Medigap plans regardless of their health status, except for an initial period after they enroll in Medicare for the first time.

However, when the researchers looked at people with Alzheimer’s disease living in states with no guaranteed-issue clause for Medigap plans, they did not find a significant difference in switching behavior.

Hoffman is now looking further at Medicare Advantage experiences among people with Alzheimer’s or other forms of dementia, through funding from the National Institute on Aging.

He notes that the multiple-switching behavior seen in the new study may be an indication of people acting as savvy consumers on the Medicare Advantage marketplace. That’s because those who came back to Medicare Advantage after being in traditional Medicare for a year or more were much more likely to choose an MA plan with a higher star rating for quality, or a plan with a broader network.

“They may be shopping in a logical manner,” he said. Or it may be that MA plans were able to target them for marketing materials based on the information the plans had on file from their prior enrollments.

No matter what, he said, the costs of the administrative tasks needed to transition someone from one form of Medicare coverage to another do add up – both for staff time on the federal government and insurance company side, and time spent by participants and their caregivers.

For individuals and their caregivers during this Open Enrollment season, Hoffman advises being very careful to look at total costs and access to providers and hospitals, not just monthly premiums, when deciding whether to stay in, switch to, or jump out of Medicare Advantage.

This is important, but potentially overwhelming, given the large number of choices available to many beneficiaries. While the Medicare PlanFinder has information about costs, individuals will need to go to the websites of plans, providers and hospitals to determine which ones are in-network.

It’s also important to understand a state’s policy about a Medigap coverage guarantee, when deciding whether to switch to traditional Medicare after a time in Medicare Advantage. Only a handful of states have protections in place to guarantee purchase of those plans.

“The bottom line is, plan carefully, and be a savvy consumer,” Hoffman said. “There are so many choices, and you can get free assistance with choosing the one for you.”

Medicare enrollment assistance is available for free in every state via the SHIP program. Find the one for your state via https://www.shiphelp.org/

Both Hoffman and Maust, and co-authors Hyungjin (Myra) Kim, Sc.D., M.A. and Lillian Min, M.D., MSHS, are members of the U-M Institute for Healthcare Policy and Innovation. Other co-authors are Zhaohui Fan, M.D., M.P.H. and Yang Amy Jiao M.P.P.

The study was funded by the NIA, which is part of the National Institutes of Health, through grant R01AG074944. This content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging.

Citation: Should I stay or should I go again: Multiple switching between fee‐for‐service Medicare and Medicare advantage among older beneficiaries, Health Services Research , DOI:10.1111/1475-6773.14398, https://onlinelibrary.wiley.com/doi/10.1111/1475-6773.14398

Journal

Health Services Research

DOI

10.1111/1475-6773.14398

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Should I stay or should I go again: Multiple switching between fee‐for‐service Medicare and Medicare advantage among older beneficiaries

Article Publication Date

17-Oct-2024

Scurvy may be re-emerging amid cost of living crisis and rise of weight loss surgery

Condition caused by vitamin C deficiency first linked to sailors during Renaissance era

Peer-Reviewed Publication

BMJ Group

The scourge of scurvy, which is caused by vitamin C deficiency, may be re-emerging amid the cost of living crisis and the rise in weight loss (bariatric) surgery, suggest doctors in the journal BMJ Case Reports after treating a middle-aged man with the condition.

Scurvy is eminently treatable, but because it’s a disease of the past, first associated with sailors during the Renaissance era, it may be mistaken for other conditions, especially inflamed blood vessels (vasculitis), potentially risking fatal bleeding if left untreated, highlight the authors.

Signs can appear as early as a month after a daily intake of less than 10 mg of vitamin C.

The authors treated a middle aged man whose legs were covered with tiny painful red-brown pinpoints, resembling a rash. Blood was also present in his urine and he was anaemic.

He tested negative for inflammatory, autoimmune, and blood disorders, and scans revealed no evidence of internal bleeding. Similarly, a skin biopsy returned no diagnostic clues.

His rash continued to spread while he was in hospital. And further questioning revealed that he was short of cash and neglected his diet, eating little in the way of fruit and vegetables. He said that he sometimes skipped meals altogether.

He had also stopped taking the nutritional supplements prescribed for him after previous weight loss surgery, because he said he couldn’t afford them.

Blood tests to assess his general nutritional status indicated no detectable levels of vitamin C and very low levels of other key nutrients. He was diagnosed with scurvy and treated with daily vitamin C (1000 mg), vitamin D3, folic acid and multivitamin supplements, after which his painful rash and other symptoms cleared up.

This is just one case report, and while it’s not clear what the current prevalence of scurvy is, it’s still relatively rare.

But the authors point out: “Scurvy is still seen as a disease of the past, especially in developed countries.” The rising cost of living also makes it harder for families to afford good quality nutritious foods, while there have been numerous reports of scurvy arising from complications following bariatric surgery, they add.

Other risk factors for scurvy include alcoholism, smoking, eating disorders, low household income, obesity, kidney dialysis and drugs that interfere with vitamin C absorption, such as steroids and those that curb stomach acid production (proton pump inhibitors), they highlight.

“Our patient had multiple risk factors, namely, poor dietary habits, obesity, previous bariatric surgery, use of proton pump inhibitors and low-income status. His history of iron, vitamin D and folate deficiencies were also clues to his underlying nutritional deficiency,” they conclude.

Journal

BMJ Case Reports

DOI

10.1136/bcr-2024-261082

Method of Research

Case study

Subject of Research

People

Article Title

Scurvy—a re-emerging disease with the rising cost of living and number of bariatric surgical procedures

Article Publication Date

22-Oct-2024

New study reveals larger insects' critical role in decomposition in arid ecosystems

The Hebrew University of Jerusalem

A Macrodecomposer Foraging in Dryland — image:
An isopod, well-adapted to the harsh conditions of arid-lands, crawls on the desert floor in search of plant litter.
view more
Credit: Viraj R Torsekar

New study reveals that in arid ecosystems, larger arthropods such as termites and beetles play a crucial role in decomposition, challenging the traditional view that microbial activity dominates this process in dry environments. By demonstrating that macro-decomposition can peak during the summer in arid sites and that overall decomposition rates in these regions can be similar to or even exceed those in wetter climates, the research provides new insights into how decomposition functions in drylands and its implications for global carbon cycling and ecosystem management.

Link to pictures: https://drive.google.com/drive/folders/19a7FbAw4DvYeg5_GdvFJzc6p-0gMuBqp?usp=sharing

Researchers from The Hebrew University of Jerusalem have discovered a potential solution to the long-standing "desert decomposition conundrum" in a new study in eLife. Led by Dr. Viraj Torsekar, Dr. Nevo Sagi and Professor Dror Hawlena from Hebrew University, the study challenges conventional beliefs about decomposition processes across different climate gradients. Traditionally, it was thought that decomposition rates were primarily driven by microorganisms and would decrease in drier environments. However, this new research uncovers that larger arthropods play a crucial and previously underappreciated role in arid ecosystems.

Key Findings:

Decomposers of different sizes respond distinctively to precipitation levels.
Microbial decomposition increases with precipitation during winter months.
Macro-decomposition, driven by larger arthropods such as termites and beetles, peaks in arid sites during the summer.
These contrasting responses result in similar overall decomposition rates across most of the precipitation gradient.

The researchers conducted their study across seven sites in Israel, ranging from hyper-arid to Mediterranean climates. They utilized innovative litter baskets with varying mesh sizes to isolate the effects of different-sized decomposers.

"Our findings show that the contrasting climate dependencies of micro- and macro-fauna decomposers lead to unexpectedly high decomposition rates in arid environments," says Dr. Torsekar. "This provides a plausible explanation for why plant litter decomposition in drylands occurs faster than previously thought—a puzzle that has challenged scientists for decades."

"This research highlights the overlooked role of larger arthropods in dry ecosystems," adds Dr. Sagi. "By revealing that arid regions can support decomposition rates similar to or higher than wetter areas, we hope to inspire new strategies for conserving these vulnerable ecosystems."

Professor Hawlena concludes, "Understanding the dynamics of decomposition in drylands is essential for conserving and restoring critical ecosystem processes, particularly as these regions expand globally. Our findings also have significant implications for global carbon cycling and climate change models."

The study's implications reach beyond ecology, potentially influencing climate change models and conservation strategies for arid ecosystems worldwide.