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)
Saturday, October 03, 2020
Face masks unlikely to cause over-exposure to CO2, even in patients with lung disease
IMAGE: FACE MASKS DO NOT CONTRIBUTE TO CARBON DIOXIDE POISONING. FACE MASKS IS KEY TO PREVENTING COVID-19 INFECTION. view more
CREDIT: ATS
New research findings contradict statements linking wearing face masks to carbon dioxide poisoning by trapping CO2. During the COVID-19 pandemic the wearing of face masks has become a highly political issue with some individuals falsely claiming that wearing face masks may be putting people's health at risk. The study published in the Annals of the American Thoracic Society shows otherwise.
In "Effect of Face Masks on Gas Exchange in Healthy Persons and Patients with COPD," Michael Campos, MD and co-authors assessed problems with gas exchange, that is, changes in oxygen level or carbon dioxide levels in healthy individuals as well as veterans with chronic obstructive pulmonary disease or COPD before and while using surgical masks. People with COPD, according to the ATS Patient Education Fact Sheet on the disease, "must work harder to breathe, which can lead to shortness of breath and/or feeling tired."
"We show that the effects are minimal at most even in people with very severe lung impairment," said Dr. Campos of the Miami Veterans Administration Medical Center and the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at the University of Miami.
As for the feeling of breathlessness that some healthy people may experience, Dr. Campos explained: "Dyspnea, the feeling of shortness of breath, felt with masks by some is not synonymous of alterations in gas exchange. It likely occurs from restriction of air flow with the mask in particular when higher ventilation is needed (on exertion)."
If you're walking briskly up an incline, for example, you may experience feelings of breathlessness. An overly tight mask may also increase the feeling of breathlessness. The solution is simply to slow down or remove the mask if you are at a safe distance from other people.
Dr. Campos stressed the importance of wearing a face mask to prevent COVID-19 infection. If a surgical mask is not available, a cloth mask with at least two layers is recommended by the CDC. Patients with lung disease, in particular, should avoid getting infected and should wear a face mask, which, along with handwashing and social distancing, is proven to reduce the risk of COVID-19 infection.
The impetus for the study came after reports of a public hearing in Florida where individuals made inflammatory comments, namely that wearing masks were putting lives at risk and finding out that no data on the effects of surgical masks on gas exchange was available.
"We acknowledge that our observations may be limited by sample size, however our population offers a clear signal on the nil effect of surgical masks on relevant physiological changes in gas exchange under routine circumstances (prolonged rest, brief walking)," wrote the authors. "It is important to inform the public that the discomfort associated with mask use should not lead to unsubstantiated safety concerns as this may attenuate the application of a practice proven to improve public health."
"The public should not believe that masks kill," added Dr. Campos.
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About the Annals of the American Thoracic Society
The AnnalsATS is a peer-reviewed journal published by the American Thoracic Society. The Journal delivers up-to-date and authoritative coverage of adult and pediatric pulmonary and respiratory sleep medicine and adult critical care. The scope of the Journal encompasses content that is applicable to clinical practice, the formative and continuing education of clinical specialists and the advancement of public health. The journal's impact factor is 4.836.
Editor: Colin Cooke, MD, MS, associate professor in the department of internal medicine at the University of Michigan.
About the American Thoracic Society
Founded in 1905, the American Thoracic Society is the world's leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society's more than 16,000 members prevent and fight respiratory disease around the globe through research, education, patient care and advocacy. The ATS publishes four journals, the American Journal of Respiratory and Critical Care Medicine, the American Journal of Respiratory Cell and Molecular Biology, the Annals of the American Thoracic Society and ATS Scholar.
Bright light bars big-eyed birds from human-altered landscapes
IMAGE: IN A STUDY OF 240 BIRD SPECIES, FLORIDA MUSEUM OF NATURAL HISTORY RESEARCHERS FOUND STRONG LINKS BETWEEN EYE SIZE, LIGHT AND HABITAT USE. THE FINDINGS SUGGEST EYE SIZE COULD BE... view more
CREDIT: IAN AUSPREY/FLORIDA MUSEUM
GAINESVILLE, Fla. --- New research shows the glaring light in human-altered landscapes, such as livestock pastures and crop fields, can act as a barrier to big-eyed birds, potentially contributing to their decline.
Florida Museum of Natural History researchers found strong links between bird eye size, habitat and foraging technique. Birds that kept to the shade of the forest had larger eyes than those that inhabited the canopy, and birds with relatively small eyes were more numerous in agricultural settings.
The findings suggest eye size is an overlooked, but important trait in determining birds' vulnerability to changes in their habitat and could help inform future research on their sensitivity to other bright environments, such as cities.
"Many bird species literally disappear from highly disturbed, anthropogenic habitats such as agricultural landscapes," said lead author Ian Ausprey, a Ph.D. student in the Florida Museum's Ordway Lab of Ecosystem Conservation and a National Geographic Explorer. "That's probably due to many reasons, but this paper suggests light could be part of that."
Despite numerous studies on how light influences the makeup of plant communities, little research has focused on how it drives the ecology of vertebrates. Ausprey said while some of the study's results may seem like "a no-brainer," it is the first to document the relationships between light, eye size and how birds navigate their world.
Light is especially key for birds, which use their vision to detect food. Big eyes house more photoreceptors and are a common feature in birds of prey such as owls and raptors, enabling them to resolve images at longer distances and in darker settings.
But large eyes can also be susceptible to overexposure and glare in bright environments. Previous research has shown too much light can overwhelm birds, causing them to alter their feeding behavior and diminish their alertness to threats.
For four years, Ausprey and fellow University of Florida Ph.D. student Felicity Newell, a study co-author, surveyed birds in the cloud forests of northern Peru, part of the tropical Andes, a global biodiversity hotspot. In these forests, light is structured on a vertical gradient, powerful at the canopy and increasingly weaker as it filters down to the darkest parts of the understory. Gaps in the canopy open up patches of startling brightness, changing light intensity "over infinitesimally small scales," Ausprey said. "You can go from being very dark to very bright within inches."
The swift, dramatic changes in the landscape are mirrored in its variety of birds: A difference of 1,000 feet in elevation can uncover a completely distinct avian community.
The region is also home to small-scale farms with livestock pastures and vegetable fields, often interspersed with islands of remaining forest. The broad range of ambient light, from the deep, dark forest interior to wide open country, made an ideal model system for measuring birds' use of light, Newell said.
Ausprey and Newell measured eye size relative to body size in 240 species that make up the cloud forest bird community of Amazonas, their study region.
They found the largest-eyed insect-eating birds were "far-sighted" species, those that nab prey on the wing, such as flycatchers. Eye size in "near-sighted" species that hunt in the dimly lit understory increased the closer to the ground they lived. One such big-eyed species is the rufous-vented tapaculo, Scytalopus femoralis, a bird only found in Peru. Ausprey said the species behaves much like a mouse, scuttling across the forest floor in search of insects in mossy logs and under tree roots.
For bird groups that eat fruit, seeds and nectar - food items that don't require capture - eye size did not vary based on which part of the forest they inhabited.
The researchers also attached tiny light-sensing backpacks to 71 birds representing 15 focal species. The sensors tracked the intensity of light the birds encountered over a period of days, providing a first look at their light "micro-environments."
Of these 15 species, the bird that inhabited the darkest environment was the rusty-tinged antpitta, Grallaria przewalskii, another species exclusive to Peru, which spends much of its life walking along the forest floor. The blue-capped tanager, Thraupis cyanocephala, lived in the brightest environments.
The researchers also found that eye size was correlated with the abundance of a species in agricultural settings, with smaller-eyed birds being more common, suggesting that birds better adapted to the dark forest understory would struggle to adjust to the flood of light in a field, Ausprey said.
Preliminary results from subsequent research suggest these patterns hold at a global scale. The trend might also carry over into urban areas, which "are basically extreme forms of agricultural landscapes in some ways," he said.
In fact, the rufous-collared sparrow, Zonotrichia capensis, the bird most commonly found in agricultural fields, is also the most abundant species in Latin American cities, Newell said.
The study is the first to emerge from Ausprey and Newell's project, which examined how climate and land use influence cloud forest birds.
"This study makes excellent use of emerging technologies to answer one of the major questions in ecology - how do light levels affect the niches of birds and their vulnerability to habitat modification," said Scott Robinson, Ordway Eminent Scholar at the Florida Museum.
But the technology required a bit of MacGyvering: The light sensors don't directly transmit data, meaning Ausprey had to figure out a way to get them back. The solution was to superglue a radio tag to the delicate sensor and use a surgical adhesive to attach the packet to a bird's back, sticking long enough to get meaningful information, but detaching after a few days. Ausprey would then clamber over steep ridges and through thick shrubs and bamboo, antenna in hand, to retrieve it.
They also had to select the bird species that would cooperate: Large tanagers, toucans and woodcreepers were excluded due to their strong bills and proclivity for aggressive behavior. Even so, three of the expensive, imported sensors wound up chewed and destroyed.
"When you work with technology in the field, you have to have a strong stomach for tragedy," Ausprey said.
Ausprey and Newell expressed thanks to the large team - about 100 people - of field assistants, hosts, nature reserve staff and community members that contributed to the project.
Ausprey is also a fellow with the UF Biodiversity Institute.
Researchers hear more crickets and katydids 'singing in the suburbs'
IMAGE: COLLECTION METHODS USED TO MONITOR POPULATIONS OF KATYDIDS, SUCH AS THIS RATTLER ROUND-WINGED KATYDID, CAN BE CHALLENGING BECAUSE MANY KATYDID SPECIES LIVE HIGH IN TREES, ACCORDING TO D.J. MCNEIL, THE... view more
CREDIT: D.J. MCNEIL, PENN STATE
UNIVERSITY PARK, Pa. -- The songs that crickets and katydids sing at night to attract mates can help in monitoring and mapping their populations, according to Penn State researchers, whose study of Orthoptera species in central Pennsylvania also shed light on these insects' habitat preferences.
"We were surprised to find more species in suburban areas than in either urban or rural areas," said the study's lead researcher, D.J. McNeil, postdoctoral fellow in Penn State's Insect Biodiversity Center and the Department of Entomology.
The study was the first to show that the use of aural point count surveys -- a method commonly used by wildlife biologists to study birds and other vertebrates by listening to their songs -- can be effective in exploring the population dynamics of night-singing insect species, the researchers said.
"Insect populations are showing declines globally, and several studies have indicated that Orthopterans, such as grasshoppers, crickets and katydids, are among the most threatened insect groups," said study co-author Christina Grozinger, Publius Vergilius Maro Professor of Entomology, Penn State College of Agricultural Sciences. "Having a nondestructive way to monitor and map these species is vital for understanding how to conserve and expand their populations."
McNeil explained that Orthoptera species -- such as those in suborder Ensifera, which consists of crickets and katydids -- are known to be highly sensitive to variation in habitat conditions. Since they feed on plants, these species also can be affected negatively when insecticides and herbicides are applied to vegetation.
McNeil noted that few efficient, standardized monitoring protocols exist for Ensifera, and many involve lethal trapping or time-intensive collection efforts such as mark-recapture. In addition, other collection methods such as sweep-netting are challenging in densely vegetated habitats, especially for katydid species, many of which live high in trees. The researchers pointed out that the conspicuous stridulations, or mating calls, produced by singing Ensifera make them excellent candidates for aural population surveys.
"Although researchers have used acoustic sampling methods for crickets and katydids in the past, these methods often require specialized audio gear and complex machine-learning algorithms to disentangle the insects' calls from the background noise," McNeil said. "This is very expensive, and it requires a very high-tech skill set. Developing a simple and efficient monitoring protocol can greatly improve our ability to study and understand Ensifera population ecology."
To address this need, McNeil drew on his background in ornithology -- his doctoral research focused on birds -- to develop a protocol that required only a human being to conduct aural point count surveys.
"You can identify birds by their calls really easily, and I came to realize that this was true for crickets and katydids," he said. "For example, one cricket species makes a particular type of chirp, and another one has a different pattern. So, over the course of a few years, I've taught myself the different breeding calls of the crickets and katydids, and I've reached the point where I can confidently identify a large portion of the species that we have in this region."
The researchers defined the study area by selecting a central point in downtown State College, Pennsylvania, and plotting four transects extending 10 kilometers east, west, north and south. Along each transect, they selected 10 points, about 1 km apart, as survey locations. The resulting 41 roadside sampling points encompassed deciduous forest, row-crop agricultural fields, pastures, and varying degrees of urban and suburban cover types.
"That allowed us not only to get different habitat types, but to capture a smooth gradient across the entire spectrum of what a cricket might experience," McNeil said.
McNeil conducted all of the surveys by standing stationary for three minutes at each location and using a checklist to record the number of Ensifera species detected. Because the study focused on crickets and katydids that sing mostly after dark, sampling was performed between sunset and midnight, and each location was sampled five times from July to November in 2019, a time of year that includes the seasonal singing periods for most local Ensifera. He then used occupancy modeling approaches to map the species distributions across the urban-to-rural gradient.
The findings, reported Sept. 29 in the Journal of Insect Conservation, provided the first quantitative glimpse into the habitat needs for a variety of night-singing Orthoptera in eastern North America, the researchers said. For example, some species preferred agriculturally dominated landscapes, some preferred urban habitats, and others were found across all areas surveyed.
"We found that intermediate levels of urbanization, such as what you'd find in suburban areas, hosted the highest number of species, perhaps because areas with intermediate levels of disturbance host the greatest number of habitat niches and can support more species than heavily disturbed or totally undisturbed ecosystems," McNeil said.
"We hope that this study inspires people to listen carefully to the diverse insect songs in their backyards at night and think about ways to improve the habitat for these important species," Grozinger said.
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Tips on how to support insect biodiversity can be found on the Insect Biodiversity Center website.
Penn State funding for the Insect Biodiversity Center supported this work.
Ice discharge in the North Pacific set off series of climate events during last ice age
IMAGE: THE JOIDES RESOLUTION, A RESEARCH VESSEL THAT DRILLS INTO THE OCEAN FLOOR TO COLLECT AND STUDY CORE SAMPLES IS SEEN AT THE PORT OF VALDEZ. THE JR IS A PART... view more
CREDIT: BILL MILLS, IODP/TAMU [PHOTO ID: EXP346_003]
CORVALLIS, Ore. - Repeated catastrophic ice discharges from western North America into the North Pacific contributed to, and perhaps triggered, hemispheric-scale changes in the Earth's climate during the last ice age, new research published online today in Science reveals.
The discovery provides new insight into the impact rapidly melting ice flowing into the North Pacific may have on the climate across the planet, said Maureen Walczak, a paleoclimatologist in Oregon State University's College of Earth, Ocean, and Atmospheric Sciences and the study's lead author.
"Understanding how the ocean has interacted with glacial ice in the past helps us predict what could happen next," Walczak said.
The Cordilleran ice sheet once covered large portions of western North America from Alaska to Washington state and western Montana. Radiocarbon dating and analyses of the marine sediment record revealed that recurrent episodes of discharge from this ice sheet over the past 42,000 years were early events in a chain reaction of disturbances to the global climate. These disturbances triggered changes in deep ocean circulation and retreat of ice sheets in the North Atlantic.
The findings challenge theories that those massive, globally-reaching disturbances originated in the North Atlantic as rapid ice loss from the Laurentide ice sheet, another massive ice sheet that covered much of Canada and the northern United States, including the upper Midwest and Northeast. The Laurentide ice loss events are known as Heinrich Events.
"The outcome of this research was unexpected. The data irrevocably says that the Pacific ice goes first, with Heinrich Events and other changes following in a rhythm. The Pacific Ocean sets the drum beat," Walczak said. "This is a paradigm shift in our thinking about how these events are connected."
To gain insight into the climate history of the North Pacific, an international team of researchers collected and analyzed sediment cores from the northern Gulf of Alaska that were recovered by drilling as part of the International Ocean Discovery Program.
"Getting these new insights took years of work. We first mapped the seafloor and recovered short sediment cores in 2004, drilled longer cores in 2013 and had 16 years of painstaking laboratory work involving several Ph.D. students," said Alan Mix, the project's principal investigator and co-author of the paper.
"This was a virtually unknown area when we started, and now it offers among the most detailed and best-dated long records of ocean change on the planet during the ice age," said Mix, a distinguished professor in OSU's College of Earth, Ocean, and Atmospheric Sciences.
Researchers measured radioactive isotopes of carbon using two particle accelerators to establish the chronology of events and also added meticulous counts of small rocks dropped by icebergs known as ice-rafted debris.
The research team traced the source of the ice-rafted debris back to purges of massive ice streams emanating from the Cordilleran ice sheet, which covered northern Washington, most of British Columbia and southern Alaska from about 70,000 to 17,000 years ago.
Dirty icebergs broke off from surging ice streams and drifted northward in ocean currents, carrying and eventually dropping their load of sand, pebbles and gravel, leaving a record of rapid ice retreat buried in the deep sea like sunken treasure.
The authors of the study named these Alaskan iceberg dumps "Siku Events" after the Inuit word for ice. The big surprise, discovered by combining the record of glacial debris with the radiocarbon chronology, was that Siku Events immediately preceded Heinrich events, which are a similar type of ice purge in the North Atlantic.
Scientists have been aware of Heinrich Events, from similar evidence of ice-rafted debris in the North Atlantic, for more than 30 years but the trigger for those events has never been convincingly explained, the researchers said.
It makes sense for the Pacific Ocean to be involved in major planetary changes, Mix said. The Pacific Ocean is connected to the rest of the world by large-scale atmospheric circulation and physically around Antarctica, and during times of high sea level, through the Bering Strait and the Arctic Ocean to the North Atlantic.
"The Pacific Ocean is the largest exchangeable reservoir of heat and water and carbon dioxide on Earth, simply because of its massive size," he said. "It really is the 800-pound gorilla in the zoo of climate beasts."
Today the ice that remains along the coast of Alaska is mostly retreating and may be gone within this century as the climate warms. The melting ice will drain to the Pacific and the Arctic, contributing to sea level rise and impacting the balance of buoyant fresh and dense salty water in the ocean, much as it did in the past.
If the current ice melt follows patterns of the past, and happens quickly, it could contribute to the retreat of distant glacial systems in the North Atlantic and the Arctic.
"This is yet another reason that it is prudent to slow down warming by reducing our fossil-fuel use," Mix said.
"The new findings are likely to fuel increased interest in the North Pacific, an area that has not been as well-studied as other parts of the planet," Walczak said.
One thing that remains unclear is why the discharges from the Cordilleran ice sheet occurred. Researchers also would like to better understand the relationship between the discharges of the Cordilleran and the other climate events.
"Why did the other ice sheets respond to the retreat of the Cordilleran? How fast do the dominoes fall in this sequence of events?" Walczak asked. Those are among the questions the research team is continuing to investigate.
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Additional coauthors of the study include Andreas Schmittner, Joseph Stoner, Brian Haley; and June Padman, all of OSU's College of Earth, Ocean, and Atmospheric Sciences; Jianghui Du, who recently earned his doctorate at Oregon State; Jay Alder of OSU and the U.S. Geological Survey; Summer Praetorius, previously of OSU and now at the U.S. Geological Survey; Ellen Cowan of Appalachian State University; Stewart Fallon and L. Keith Fifield of Australian National University; and Sarah Zellers of University of Central Missouri.
The research was supported by the National Science Foundation, the Australian Research Council, the Australian-New Zealand IODP Commission and the American Australian Association.
Black lives also matter in cancer care
It is not biology, but access to health care that is causing Black Non-Hispanic patients with squamous cell cancer of the head and neck to have lower survival rates
IMAGE: JESSICA MCDERMOTT, MD, AND SANA KARAM, MD, PHD view more
CREDIT: CU CANCER CENTER
Studies have long reported that Black cancer patients have poorer outcomes than their white counterparts. But two University of Colorado Cancer Center researchers decided to investigate the data further and figure out why. What they found was that the outcome disparity was caused not by biology, but simply by differences in access to health care.
The researchers, Jessica McDermott, MD, an assistant professor in the Department of Medical Oncology, and Sana Karam, MD, PhD, an associate professor in the Department of Radiation Oncology, examined Medicare data for individuals suffering squamous cell cancer of the head and neck. All 13,117 patients in this study were diagnosed with their first and only malignant tumor at age 66 or older sometime between 2006 and 2015.
The data confirmed what has been widely reported for years ¬- that the Black head and neck cancer patients had worse outcomes than the white cancer patients.
"But then when we controlled for access to care, those differences suddenly disappeared," says McDermott. "When you closely examine the data, it becomes clear what is going on."
Their findings were published this week in the Journal of the National Comprehensive Cancer Network. The physicians hope their research will catch the attention of those who can help narrow those disparate outcomes.
McDermott and Karam identified two major differences for Black patients: first, they presented at later stages of cancer, and second, they were less likely to receive treatment.
"This is an interesting finding," says McDermott. "A lot of the reasons driving the disparate outcomes came down to socially related things - they were less likely to be married, lived in poor areas, had comorbidities [presence of two or more chronic diseases], were less likely to see a primary care provider in the year leading up to the diagnosis, and were more likely to present in the emergency room."
For most cancers, where and when a patient first presents can make a large difference both in the care received and in the outcome.
"Just a reminder that we are talking about a curable disease, a disease that, if treated properly, can be eradicated with a high degree of certainty," says Karam. "I hope that more targeted interventions can be developed as a result of our findings. The problem lies not so much in biological differences, but access. If Black patients get the treatment, they do just as well."
A teaching and research hospital like the University of Colorado can lead the way in improving the care of underserved communities.
"Like many other tertiary care centers, we have a great number of clinical trials, but not everyone who could benefit from them enjoys access," says Karam. "We need to enhance our ability to deliver more broadly the best and newest trials that can extend life and decrease symptom burden."
Black lives matter
The disparities that Black community members face are gaining national attention after the deaths of George Floyd and other Black men and women. But one area of inequity that has not received as much attention is access to medical care. Last month, dozens of providers gathered at the Anschutz Medical Campus to support a national movement by kneeling with fellow White Coats for Black Lives members.
"Speaking up is an important first step towards change," says Karam. "But it must be accompanied by policy change aimed at expanding access to care. We invest billions in new therapies that might or might not work but devote far less attention to helping our socially challenged patients get through the door, which our study shows does work."
The doctors say that more work is needed to overcome hurdles to health care access.
"We also need to educate the next generation of doctors on showing compassion and sensitivity to issues of race, income, social challenges, addiction, and other access barriers," says Karam.
Prior to this study's publication, Dr. McDermott was awarded a grant from the CU Cancer Center Office of Community Outreach and Engagement to increase the representation of the Hispanic populations in head and neck cancer clinical trials. Colorado has a large population of Hispanics, which makes that population an easier place to begin making changes.
"Our goal is to use that project to branch out to Hispanics, Blacks, and anyone else with socioeconomic issues that currently compromise their access to care," says McDermott.
The CU Cancer Center will continue studying the health disparities for different types of cancer and investigating strategies for eliminating the barriers faced by those needing care.
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Not all patients are offered the same effective breast cancer treatment
Socioeconomic status and race could play a role in treatment decisions, according to new research.
Breast cancer is one of the most common cancers among women in the U.S. It's also the most costly cancer to treat. Now, Jefferson researchers have shown that although the use of an effective and less expensive treatment is on the rise, some patients, specifically Black women and those without private insurance are offered the beneficial therapy less often. The findings pave the way for reducing healthcare costs and increasing patient satisfaction.
"We have identified patient populations at risk of not receiving a beneficial and more cost-effective therapy," says Dr. Alliric Willis, a surgical oncologist and associate professor of surgery at Sidney Kimmel Medical College (SKMC) - Jefferson Health, who led the study along with his research team from SKMC and the College of Population Health at Thomas Jefferson University.
"This research really illustrates that not all patients are being treated equally," says Dr. Willis, who published the results online September 12, 2020 in the International Journal of Radiation Oncology Biology Physics, also known as the Red Journal.
Standard breast-conserving cancer treatment involves surgery followed by radiation therapy, which helps to lower the risk of cancer recurring in the treated breast. Traditionally, patients receive 25 to 30 daily radiation treatments over five to six weeks. In recent years, however, doctors have begun using an alternative radiation treatment plan known as hypofractionated whole breast radiation (HR).
HR uses a higher radiation dose per treatment than the traditional regimen. The higher dose means patients require about half as many treatment sessions -15 to 16 treatments over three to four weeks - to achieve the same total dose. Compared with traditional radiation therapy, the approach is just as effective at reducing the risk of the cancer returning, more cost-effective and offers patients fewer side effects and better breast restoration outcomes following treatment.
"Despite the fact that both patients and practitioners say they prefer hypofractionated radiation because of its efficacy and better cosmetic outcomes, HR use in the U.S., while increasing, has lagged for particular groups," Dr. Willis says.
To better understand who is at risk of missing out on the valuable therapy, Dr. Willis and colleagues turned to the National Cancer Database. The researchers examined data from nearly 260,000 early-stage breast cancer patients over 40 years old who were diagnosed between 2012 and 2016. All patients studied had received radiation treatment following breast conserving surgery. The researchers looked at demographics, tumor attributes and treatment facility characteristics between patients who received either HR or traditional radiation.
The investigation revealed that HR use increased over the four-year study period, from about a quarter of eligible patients in 2012 to more than two-thirds in 2016. Despite the upward trend, the analysis uncovered marked disparities among those who received HR therapy. Patients who identified as white were most likely to receive HR, whereas HR use was lowest for African Americans, for example.
"When we took all other factors into account, African American women were 15% less likely to be treated with HR than white women," Dr. Willis says. "This demonstrates that even though treatment guidelines do not take race into account, race is a factor in breast cancer treatment."
Socioeconomic status also affected those who received HR therapy. Patients with private insurance were more likely to receive HR than uninsured patients or those on Medicaid, according to the study. In addition, patients who lived in zip codes with the highest income levels were 25% more likely to undergo HR than patients from zip codes in the lowest income category.
Where patients sought care made a difference in their treatment, too. Treatment facilities associated with academic medical centers were twice as likely to use HR as community cancer or integrated network cancer facilities.
"This tells us that there is a need to actively communicate information to healthcare providers about the spectrum of treatment options across all treatment facility types," Dr. Willis says.
Dr. Willis hopes that this research will shine light on treatment inconsistencies and motivate physicians to expand their treatment repertoire.
"Patients should have access to all treatment options no matter their race, socioeconomic background or where they seek care," he says. "Hopefully, our research will help to address gaps in provider education and extend this favorable treatment to all patients."
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Article reference: Steven G. Woodward, MD, Karan Varshney, Pramilla R. Anne, MD, Brandon J. George, PhD, MS, Alliric I. Willis, MD, FACS, "Trends in Utilization of Hypofractionated Whole Breast Radiation in Breast Cancer: An Analysis of the National Cancer Database," The International Journal of Radiation Oncology Biology PhysicsDOI: 10.1016/j.ijrobp.2020.09.004, 2020.
New research explores how multinational firms can manage corruption
Findings from Lehigh University College of Business professor provides unique insights on ways multinational firms can manage corruption
IMAGE: CHARLES E. STEVENS IS AN ASSOCIATE PROFESSOR OF MANAGEMENT IN LEHIGH UNIVERSITY'S COLLEGE OF BUSINESS view more
CREDIT: CHARLES STEVENS/LEHIGH UNIVERSITY
For many developing countries, it is difficult to break the cycle of corruption on their own. Historically, multinational firms have assumed that they have two options available when dealing with corruption in developing countries: "play the game," meaning pay bribes or engage in corrupt activities, or "leave the table" by avoiding investing in countries where corruption is widespread. New research from Charles E. Stevens, associate professor of management in Lehigh's College of Business, shows firms taking a third approach-managing corruption by promoting positive engagement with the host country.
The study, "Avoid, acquiesce ... or engage? New insights from sub-Saharan Africa on MNE strategies for managing corruption," funded by a Social Sciences and Humanities Research Council of Canada grant, is published in the latest issue of Strategic Management Journal.
Using an inductive, qualitative research design, Stevens, in collaboration with Aloysius Newenham-Kahindi, associate professor at the University of Victoria, was able to better understand how and why issues relating to corruption arose and how firms dealt with them. According to Stevens, firms may typically "tread lightly," but his research shows firms having success by making deeper, long-term commitments.
"Within the last decade, a number of developing country firms, many of them from China, were taking a different approach that we termed an engagement strategy that, in many ways, was unexpected and counter-intuitive because it tended to involve greater commitment and greater investment to countries where there was more corruption," said Stevens.
Stevens and Newenham-Kahindi were curious to see if these firms were less concerned with corruption, but research found that was not the case.
"Many of these firms were following rather interesting and complex strategies, many that involved multiple actors that were designed at minimizing the ability of host-country actors to request bribes by maximizing their bargaining power or by minimizing the motivation of host-country actors to request bribes by increasing their legitimacy," explained Stevens.
Facing challenges related to studying corruption due to the illegal activity often being hidden, Stevens and Newenham-Kahindi surveyed those who experience dealing with corruption directly. Among those interviewed for the study were 445 individuals representing industries such as construction, mining, manufacturing, energy, and telecommunications in both developed and developing country firms; 126 host country government officials and employees; 34 local private sector employees; 44 local institutional researchers; and 142 members of the general public.
According to Stevens, this paper fills an important gap in corruption literature by increasing the understanding of the options and strategies that firms have at their disposal when they invest in countries where corruption is a greater problem.
With this study, the researchers are hoping to change policies and practices by both firms and governments.
"We hope that this research allows firms, governments, and the general public to achieve economic prosperity, reduce corruption, and create mutually-beneficial solutions through investment and growth," said Stevens. "Firms shouldn't automatically be afraid to invest in countries where risks like corruption are present. Such countries present many challenges, but for firms that go in with a comprehensive plan, are prepared to make a long-term commitment, and find ways to leverage partnerships with governments and other firms, the rewards can be worth the risks."
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Invasion by non-native insects expected to increase 36 percent worldwide by 2050
Europe in line for greatest biological invasion, followed by Asia and the Americas
IMAGE: NEW RESEARCH BY AN INTERNATIONAL TEAM OF SCIENTISTS SUGGESTS THAT WORLDWIDE, INVASION BY NON-NATIVE INSECTS WILL INCREASE 36 PERCENT BY 2050. PHOTOGRAPH SHOWS AN EMERALD ASH BORER, A NON-NATIVE INSECT... view more
CREDIT: LEAH BAUER, USDA FOREST SERVICE
Research by an international team of scientists found that the steady, centuries-long increase in insect invasions globally is likely to continue. Using a new modelling approach to simulate non-native insect species numbers on continents for different taxonomic groups based on observed long-term historic trends, scientists established that biological invasions will increase by 36 percent between 2005 and 2050.
Modeling suggests that Europe is likely to experience the strongest biological invasions, followed by Asia, North America and South America.
The study delivers a first baseline for the assessment of future developments of biological invasions, information that will support decision-making related to containing the spread of alien species. Andrew Liebhold, a USDA Forest Service research entomologist based in West Virginia and the study's only North American co-author, describes the research as an important tool in allowing a shift from a reactionary stance to a proactive stance in defending against biological invasion.
"For centuries, the element of surprise has worked in favor of invasive pests," Liebhold said. "Because we were not anticipating these insects, and not monitoring for them, many have been well established and causing damage by the time we did find them. This research gives nations the opportunity to play offense instead of defense by identifying where invasions are likely and what species are most likely to invade."
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The study, "Projecting the continental accumulation of alien species through to 2050," was published this week in the journal Global Change Biology. In addition to Liebhold, the research team included lead author Hanno Seebens of Senckenberg of the Biodiversity and Climate Research Centre in Germany and scientists from Germany, Switzerland, the United Kingdom, Portugal, South Africa, Austria, Italy, New Zealand, China, and the Czech Republic. The study is available through the Northern Research Station at: https://www.nrs.fs.fed.us/pubs/61296
Would menthol cigarettes be banned if the typical consumer was young, white and upper-middle class?
A new paper highlights menthol cigarettes as a social justice issue
COLUMBIA UNIVERSITY'S MAILMAN SCHOOL OF PUBLIC HEALTH
October 1, 2020 -- Menthol could be exacerbating deep social inequities according to a paper just published in Nicotine & Tobacco Research. Researchers at Columbia University Mailman School of Public Health and colleagues at CUNY and Rutgers School of Public Health suggest that a ban on menthol cigarettes could have monumental implications for both the short- and long-term physical and mental health of communities of color.
"Assessing menthol smoking status should be a priority in all substance use research and smoking cessation interventions," observed Renee Goodwin, PhD, an epidemiologist at Columbia Mailman School, and senior author. "A decade after Congress exempted menthol from the flavored cigarette ban, preference for menthol remains more popular among young smokers and extremely high among Black smokers."
Overall estimates indicate that over 630,000 deaths would be averted and that one of three of these would be a Black life if menthol was included in the flavored cigarette ban.
Using data from the most recent National Survey on Drug Use and Health (NSDUH), the analysis showed that 10 years after the exemption of menthol from the ban, its preference among cigarette smokers remains inversely correlated with age and race. Among black smokers, 85 percent had a preference for menthol cigarettes while only 29 percent of Non-Hispanic Whites expressed the same penchant.
According to Goodwin, in the context of inaction on menthol, young people and Black smokers are not the only vulnerable populations that warrant attention with respect to menthol smoking. Preference for menthol among cigarette smokers was also disproportionately high among lesbian and gay smokers (51 percent), bisexual smokers (46 percent), and smokers with mental health problems (45 percent). The analyses also highlighted disproportionately high percentages among socioeconomically disadvantaged populations and pregnant women.
"The menthol loophole and subsequent inaction on menthol comes down to policy makers, political influence, and power," noted Cristine Delnevo of Rutgers and the first author. "For decades, tobacco companies have been targeting marginalized populations with advertising for menthol cigarettes. It's clear that a ban on menthol is not only necessary for the protection of public health, but also to achieve health equity in the U.S."
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The work was supported by the National Heart, Lung, and Blood Institute (R21 HL149773-01) and the Tobacco Centers of Regulatory Science, National Cancer Institute, and the U.S. Food and Drug Administration (U54CA229973).
A co-author is Ollie Ganz, Rutgers School of Public Health.
About Columbia University Mailman School of Public Health
Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the seventh largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master's and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu.
A social-belonging intervention improves STEM outcomes for ESL students
IMAGE: A SOCIAL-BELONGING INTERVENTION IMPROVES STEM OUTCOMES FOR STUDENTS WHO SPEAK ENGLISH AS A SECOND LANGUAGE. view more
CREDIT: PROVIDED BY INDIANA UNIVERSITY
A study conducted at 19 universities by IU researchers and their colleagues in the U.S. and Canada, found that a brief social belonging exercise, administered online before students arrive on campus, boosts the performance and persistence of students in STEM disciplines - science, technology, engineering and math - who speak English as a second language.
Published this week in the journal Science Advances, the study demonstrates that the exercise increases ESL students' perception that a sense of belonging on campus will grow over time. It also increases the number of STEM credits ESL students successfully completed, as well as their STEM GPAs.
As Jennifer LaCosse, an IU post-doctoral researcher and lead author on the study, explained, ESL students are greatly underrepresented in U.S. colleges, particularly within STEM fields, and their absence is a disadvantage both to the students themselves and the economy more broadly. Having a college degree, particularly in STEM fields, gives ESL students the opportunity to have higher paying jobs and more successful careers overall. It also creates a diverse and multilingual workforce that is needed to meet the needs of an increasingly globalized economy.
Results of the study suggest that one way to increase the representation and academic success of ESL students in STEM is to target their sense of belonging. "Students often ask themselves, 'Do I belong here?' and we know that this concern can undermine academic performance and persistence," said LaCosse.
Students who speak English as a second language often report concerns about not fitting in with native English-speaking students and a lack of social connections. In addition, many are required to pass language proficiency tests or enroll in special ESL courses during their first few years of college.
"These policies can metaphorically and literally separate ESL students from non-ESL students during the pivotal transition to college when feelings of belonging are critical," said LaCosse. "Finding ways of buttressing ESL students' feelings of belonging may be essential to their academic success--which is what we wanted to examine in our research."
The study utilized data collected at 19 universities from more than 12,000 STEM students by the College Transition Collaborative, a partnership co-founded by IU social psychologist and study co-author Mary Murphy. Students in the study who were randomly assigned to receive the social belonging treatment, read short stories attributed to juniors and seniors describing the challenges they faced in their transition to college. The students in the stories initially questioned the degree to which they belonged in college; and yet, with time they ultimately developed a greater sense of belonging. Study participants followed the readings with a writing exercise about their own experiences.
Results of the study revealed that both ESL and non-ESL students who received the social belonging exercise anticipated greater growth in their sense of belonging than students who received the control treatment. However, these psychological gains in belonging only bolstered the academic persistence and performance of ESL students. Specifically, STEM-interested ESL students who received the social-belonging exercise (vs. the control group, which did not) completed more of the STEM courses that they began in their first term in college--and this effect persisted through the first year. ESL students who completed the social belonging exercise also earned higher STEM GPAs in Term 1 than did their ESL peers who did not.
"People do not often think about ESL students as a disadvantaged group in the same way they do about other disadvantaged students, such as Black or women students," observed LaCosse. "The results of this study, however, provide rigorous empirical evidence that ESL students have similar psychological experiences to these other disadvantaged students."
As co-author Mary Murphy, IU professor of psychological and brain sciences noted, "Because of the large sample size across so many universities this is one of the first studies to quantitatively examine and mitigate this important psychological barrier for ESL students in STEM fields as they begin college."
"The findings are really exciting," said LaCosse, "because ESL students' psychological experiences in higher education have received far less attention than they deserve. Our research suggests that we need to rethink the policies and practices that are in place that create and maintain the underrepresentation of ESL students in higher education."
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In addition to LaCosse and Murphy, other researchers on the team were Elizabeth Canning, assistant professor of psychology at Washington State University and former IU postdoctoral researcher in Murphy's lab; Nicholas Bowman, professor of education at the University of Iowa; and Christine Logel, associate professor of social development studies at Waterloo University.
Funding for the study was provided by the Raikes Foundation, the National Science Foundation, the Higher Education Quality Council of Ontario, and partner schools.
