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)
Sunday, May 09, 2021
Why is COVID-19 so hard to treat? Growing evidence points to unique infectious profile
A comprehensive review into what we know about COVID-19 and the way it functions suggests the virus has a unique infectious profile, which explains why it can be so hard to treat and why some people experience so-called "long-COVID", struggling with significant health issues months after infection.
There is growing evidence that the virus infects both the upper and lower respiratory tracts - unlike "low pathogenic" human coronavirus sub-species, which typically settle in the upper respiratory tract and cause cold-like symptoms, or "high pathogenic" viruses such as those that cause SARS and ARDS, which typically settle in the lower respiratory tract.
Additionally, more frequent multi-organ impacts, and blood clots, and an unusual immune-inflammatory response not commonly associated with other, similar viruses, mean that COVID-19 has evolved a uniquely challenging set of characteristics.
While animal and experimental models imply an overly aggressive immune-inflammation response is a key driver, it seems things work differently in humans: although inflammation is a factor it is a unique dysregulation of the immune response that causes our bodies to mismanage the way they fight the virus.
This may explain why some people experience "long-COVID" and suffer severe lung damage after infection.
Ignacio Martin-Loeches, Clinical Professor in Trinity College Dublin's School of Medicine, and Consultant in Intensive Care Medicine at St James's Hospital, is a co-author of the review just published in leading medical journal, The Lancet. He said:
"The emergence of severe acute respiratory syndrome coronavirus two (SARS-CoV-2), which causes COVID-19, has resulted in a health crisis not witnessed since the 1918 Spanish flu pandemic. Tragically, millions around the world have died already.
"Despite international focus on the virus, we are only just beginning to understand its intricacies. Based on growing evidence we propose that COVID-19 should be perceived as a new entity with a previously unknown infectious profile. It has its own characteristics and distinct pathophysiology and we need to be aware of this when treating people.
"That doesn't mean we should abandon existing best-practice treatments that are based on our knowledge of other human coronaviruses, but an unbiased, gradual assembly of the key COVID-19 puzzle pieces for different patient cohorts - based on sex, age, ethnicity, pre-existing comorbidities - is what is need to modify the existing treatment guidelines, subsequently providing the most adequate care to COVID-19 patients."
The review article was produced by the European Group on Immunology of Sepsis (EGIS) in which Professor Martin-Loeches is one of the funding members. EGIS is a multidisciplinary group of scientists and doctors with special interest in severe infection in patients admitted to ICU.
Training the artificial intelligence models that underpin web search engines, power smart assistants and enable driverless cars, consumes megawatts of energy and generates worrying carbon dioxide emissions. But new ways of training these models are proven to be greener.
Artificial intelligence models are used increasingly widely in today's world. Many carry out natural language processing tasks - such as language translation, predictive text and email spam filters. They are also used to empower smart assistants such as Siri and Alexa to 'talk' to us, and to operate driverless cars.
But to function well these models have to be trained on large sets of data, a process that includes carrying out many mathematical operations for every piece of data they are fed. And the data sets they are being trained on are getting ever larger: one recent natural language processing model was trained on a data set of 40 billion words.
As a result, the energy consumed by the training process is soaring. Most AI models are trained on specialised hardware in large data centres. According to a recent paper in the journal Science, the total amount of energy consumed by data centres made up about 1% of global energy use over the past decade - equalling roughly 18 million US homes. And in 2019, a group of researchers at the University of Massachusetts estimated that training one large AI model used in natural language processing could generate around the same amount of CO2 emissions as five cars would generate over their total lifetime.
Concerned by this, researchers at the University of Cambridge set out to investigate more energy-efficient approaches to training AI models. Working with collaborators at the University of Oxford, University College London, and Avignon Université, they explored the environmental impact of a different form of training - called federated learning - and discovered that it had a significantly greener impact. Instead of training the models in data centres, federated learning involves training models across a large number of individual machines. The researchers found that this can lead to lower carbon emissions than traditional learning.
Senior Lecturer Dr Nic Lane explains how it works when the training is performed not inside large data centres but over thousands of mobile devices - such as smartphones - where the data is usually collected by the phone users themselves.
"An example of an application currently using federated learning is the next-word prediction in mobile phones," he says. "Each smartphone trains a local model to predict which word the user will type next, based on their previous text messages. Once trained, these local models are then sent to a server. There, they are aggregated into a final model that will then be sent back to all users."
And this method has important privacy benefits as well as environmental benefits, points out Dr Pedro Porto Buarque De Gusmao, a postdoctoral researcher working with Dr Lane.
"Users might not want to share the content of their texts with a third party," he explains. "In federated learning, we can keep data local and use the collective power of millions of mobile devices together to train AI models without users' raw data ever leaving the phone."
"And besides these privacy-related gains," says Dr Lane, "in our recent research, we have shown that federated learning can also have a positive impact in reducing carbon emissions.
"Although smartphones have much less processing power than the hardware accelerators used in data centres, they don't require as much cooling power as the accelerators do. That's the benefit of distributing the training of models across a wide pool of devices."
The researchers recently co-authored a paper on this called 'Can Federated Learning save the planet?' and will be discussing their findings at an international research conference, the Flower Summit 2021, on 11 May.
In their paper, they offer the first-ever systematic study of the carbon footprint of federated learning. They measured the carbon footprint of a federated learning setup by training two models -- one in image classification, the other in speech recognition - using a server and two chipsets popular in the simple devices targeted by federated methods. They recorded the energy consumption during training, and how it might vary depending on where in the world the chipsets and server were located.
They found that while there was a difference between CO2 emission factors among countries, federated learning under many common application settings was reliably 'cleaner' than centralised training.
Training a model to classify images in a large image dataset, they found any federated learning setup in France emitted less CO2 than any centralised setup in both China and the US. And in training the speech recognition model, federated learning was more efficient than centralised training in any country.
Such results are further supported by an expanded set of experiments in a follow-up study ('A first look into the carbon footprint of federated learning') by the same lab that explores an even wider variety of data sets and AI models. And this research also provides the beginnings of necessary formalism and algorithmic foundation of even lower carbon emissions for federated learning in the future.
Based on their research, the researchers have made available a first-of-its-kind 'Federated Learning Carbon Calculator' so that the public and other researchers can estimate how much CO2 is produced by any given pool of devices. It allows users to detail the number and type of devices they are using, which country they are in, which datasets and upload/download speeds they are using and the number of times each device will train on its own data before sending its model for aggregation.
They also offer a similar calculator for estimating the carbon emissions of centralised machine learning.
"The development and usage of AI is playing an increasing role in the tragedy that is climate change," says Dr Lane, "and this problem will only worsen as this technology continues to proliferate through society. We urgently need to address this which is why we are keen to share our findings showing that federated learning methods can produce less CO2 than data centres under important application scenarios.
"But even more importantly, our research also shines a light as to how federated learning should evolve towards being even more broadly environmentally friendly. Decentralized methods like this will be key in the invention of future sustainable forms of AI in the years ahead."
IMAGE: CLOCKS PERVADE EVERY ASPECT OF LIFE, FROM THE ATOMIC CLOCKS THAT UNDERLIE SATELLITE NAVIGATION TO THE CELLULAR CLOCKS INSIDE OUR BODIES. view more
CREDIT: LANCASTER UNIVERSITY
A new experiment shows that the more energy consumed by a clock, the more accurate its timekeeping.
Clocks pervade every aspect of life, from the atomic clocks that underlie satellite navigation to the cellular clocks inside our bodies. All of them consume energy and release heat. A kitchen clock, for example, does this by using up its battery. Generally the most accurate clocks require the most energy, which hints at a fundamental connection between energy consumption and accuracy. This is what an international team of scientists from Lancaster, Oxford, and Vienna set out to test.
To do this, they built a particularly simple clock, consisting of a vibrating ultra-thin membrane, tens of nanometers thick and 1.5 millimeters long, incorporated into an electronic circuit. Each oscillation of the membrane generated one electrical tick. The ingenious aspect of this design is that it is powered simply by heating the membrane, while the complete flow of energy through the clock can be measured electrically.
The scientists found that the more heat they supplied, the more accurately the clock ran. In fact, the accuracy was directly proportional to the heat released. To make the clock twice as accurate, they needed to supply twice as much heat.
The experimental team consisted of Dr Edward Laird at Lancaster University, Professor Marcus Huber at Atominstitut, TUWien, Dr Paul Erker and Dr Yelena Guryanova at the Institute for Quantum Optics and Quantum Information (IQOQI), and Dr Natalia Ares, Dr Anna Pearson and Professor Andrew Briggs from Oxford.
Their study, published in Physical Review X, is the first time that a measurement has been made of the entropy - or heat loss - generated by a minimal clock.
Understanding the thermodynamic cost involved in timekeeping is a central step along the way in the development of future technologies, and understanding and testing thermodynamics as systems approach the quantum realm.
It also shows a similarity between the operation of a clock and a steam engine. With a steam engine there is fundamental constraint on how much heat we must supply to do a desired amount of work. This constraint is the famous Second Law of Thermodynamics which is central to modern engineering. What this experiment suggests is that clocks, like engines, are constrained by the Second Law, with their output being accurate ticks instead of mechanical work.
Dr Edward Laird of Lancaster University said: "The subject of thermodynamics, which incorporates the most fundamental principles of nature, tells us that there are two types of machine that we cannot operate without releasing heat. One is the mechanical engine, which releases heat to do work, and the other is the computer memory, which releases heat when it rewrites itself. This experiment - in conjunction with other work - suggests that clocks are also limited by thermodynamics. It also poses an intriguing question: are all possible clocks limited in this way, or is it just a property of the ones we have studied?"
Interestingly, many everyday clocks have an efficiency that is close to what the scientists' analysis predicts. For example, their formula predicts that a wristwatch whose accuracy per tick is one part in ten million must consume at least a microwatt of power. In fact, a basic wristwatch usually consumes only a few times this amount. The laws of thermodynamics, discovered in the nineteenth century, are still finding new applications today.
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Losing an only child is more devastating than losing a spouse, according to study of Chinese parents
With millions of one-child families in China, study highlights distress experienced after loss
Which wound cuts deeper: the loss of an only child or loss of a spouse? A new study led by researchers at NYU Rory Meyers College of Nursing and Fudan University suggests that Chinese parents find the loss of an only child to be approximately 1.3 times as psychologically distressing than the loss of a spouse. The findings are published in the journal Aging & Mental Health.
Older adults in China rely heavily on family support, particularly from their adult children. Filial piety--the Confucian idea describing a respect for one's parents and responsibility for adult children to care for their parents as they age--is a central value in traditional Chinese culture.
In the 1970s, China introduced a one-child policy to slow the population growth, resulting in hundreds of millions of families with only children. While the policy ended in 2016, its consequences will be felt for decades, particularly for families who experience the loss of a child.
"The death of a child has been recognized as one of the most challenging and traumatic events for a parent," said Bei Wu, PhD, Dean's Professor in Global Health at NYU Rory Meyers College of Nursing and co-director of the NYU Aging Incubator, as well as the study's senior author. "Within the cultural context of China, the death of an only child is devastating not only due to the emotional loss, but also the loss of financial and instrumental support that is critical to older adults."
The death of a spouse is also recognized as a distressing life event, forcing older adults to navigate both the emotional loss and the shattering of a married couple's social and economic circumstances. In this study, Wu and her colleagues wanted to examine whether the loss of a spouse had a similar impact on psychological well-being as the loss of an only child, and whether the presence of one mitigated the absence of the other.
The researchers analyzed data from a 2013 survey conducted in Shanghai involving more than 1,100 adults, including 128 parents who lost their only child. The survey evaluated the impact of the loss of a spouse or child on participants' psychological well-being, including depression, loneliness, and life satisfaction.
They found that adults who lost their only child but have a living spouse had more psychological distress than those who lost their spouse but have a living child. This effect appeared to be stronger in women than in men.
Losing an only child resulted in 1.37 times the level of loneliness and 1.51 times the level depression as losing a spouse, and life satisfaction was 1.14 times worse for those who lost an only child vs. their spouse. Adults whose children and spouse were both alive had better psychological well-being than those who experienced loss.
"Our findings demonstrate that the loss of an only child carries more psychological weight than the loss of a spouse in Chinese culture," said Wu.
Wu and her colleagues recommend increasing access to professional mental health services for adults who experience loss, as well as developing culturally relevant interventions to address social isolation and loneliness among older Chinese adults.
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Wu collaborated on this study with Yan Liang and Hong Liang of Fudan University, Hanzhang Xu of Duke University, and Feinian Chen of the University of Maryland.
About NYU Rory Meyers College of Nursing (@NYUNursing)
NYU Rory Meyers College of Nursing is a global leader in nursing and health. Founded in 1932, the College offers B.S., M.S., DNP and Ph.D. degree programs providing the educational foundation to prepare the next generation of nursing leaders and researchers. NYU Meyers has several programs that are highly ranked by U.S. News & World Report and is among the top 10 nursing schools receiving NIH funding, thanks to its research mission and commitment to innovative approaches to health care worldwide.
New research sets stage for development of salmonella vaccine
With the COVID-19 vaccines on many people's minds, some may be surprised to learn that we do not yet have vaccines for many common infectious diseases.
Take salmonella, for example, which can infect people through contaminated food, water and animals. According to the World Health Organization, non-typhoidal salmonella infection affects more than 95 million people globally each year, leading to an estimated 2 million deaths annually. There is no approved vaccine for salmonella in humans, and some strains are antibiotic-resistant.
But just as scientists spent decades doing the basic research that made the eventual development of the COVID-19 vaccines possible, University of Florida researchers led by Mariola Edelmann in the department of microbiology and cell science, UF/IFAS College of Agricultural and Life Sciences, are laying the groundwork for an effective vaccine for salmonella and other hard-to-treat bacterial infections. In their study supported by the National Institutes of Health and published in PLOS Pathogens, the UF/IFAS scientists demonstrate a novel approach to triggering immunity against salmonella.
This approach takes advantage of how cells communicate with each other, said Winnie Hui, first author of the study, which was conducted while she was a doctoral candidate in microbiology and cell science.
"Cells communicate with each other through particles called extracellular vesicles or EVs. Think of these like molecular telephones that let cells talk to each other. We wanted to know if some of those messages included information related to immune response," said Hui, who graduated from the UF/IFAS College of Agricultural and Life Sciences in 2019 and is now a postdoctoral researcher in the UF College of Medicine, division of rheumatology and clinical immunology.
"Host EVs have not been previously studied in the context of fighting enteric bacterial infections, so that is part of what makes our approach new and adds to the field," said Edelmann, senior author on the study, Hui's dissertation director and an assistant professor of microbiology and cell science.
Edelmann hypothesized that a specific type of EVs called exosomes were part of the immune response against salmonella and may one day hold the key to developing a vaccine.
To test their idea, the research team took exosomes from white blood cells infected with salmonella. Inside those exosomes, which measure just a few dozen nanometers across, they found salmonella antigens, which are bits of salmonella protein known to trigger an immune response.
Next, the researchers wanted to know if these exosomes might function as a vaccine, helping the body build up its defenses against salmonella, said Lisa Emerson, one of the study's co-authors and a doctoral student in Edelmann's laboratory.
"We put the exosomes in 'nanobubbles' that the mice inhaled. Later, we ran tests to see how their immune systems responded," said Emerson, who is in the UF/IFAS College of Agricultural and Life Sciences.
The researchers found that after they introduced the exosomes containing salmonella antigens, the exosomes localized to tissues that produce mucous, activating specific cells at these sites. Weeks later, mice developed antibodies against salmonella and specific cellular immune responses, which typically target this bacterium for elimination. For the researchers, this is a promising result.
"There are two types of immune responses generated when our bodies encounter a pathogen. The first one is called innate immunity, which is an immediate response to an infection, but it is also less specific. The other response is called adaptive immunity, and this protective response is specifically tailored to a given pathogen, but it also takes longer to develop. Exosomes generated by infected white blood cells stimulated both of these responses in animals," said Hui.
While these results show promise, more research will be needed before we have a salmonella vaccine that works in humans, Hui said.
"Our study has identified a novel role of exosomes in the protective responses against salmonella, but we also think that exosomes can find broader applications for other intestinal infections and beyond," Edelmann said.
"Exosomes have this unique capability to encapsulate precious cargo while enabling its targeted delivery to tissue of interest. For many conditions and infections, this precise delivery of therapeutic payload is what makes a difference, and we are currently also evaluating exosomes in delivering cargo to other tissues of choice," said Edelmannn whose work is supported by several federal funds focused on the roles of extracellular vesicles in bacterial infections and disease and host-directed therapies against intestinal infections.
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Archaeologists pinpoint population for the Greater Angkor region
Study designed at the University of Oregon provided a foundation that drew new information from lidar imagery, machine learning, archaeological and historical data
IMAGE: A PAIR OF CONTEMPORARY CAMBODIAN HOUSES: THE HOUSE IN THE BACKGROUND IS MADE FROM WOOD AND MODERN MATERIALS. THE HOUSE IN THE FOREGROUND WAS BUILT TRADITIONALLY FROM ORGANIC MATERIALS SUCH... view more
CREDIT: PHOTO BY ALISON CARTER
EUGENE, Ore. -- May 7, 2021 -- Long-running archaeological research, boosted by airborne lidar sensing and machine-learning algorithms, finds that Cambodia's Greater Angkor region was home to 700,000-900,000 people.
The sprawling city, which thrived from the 9th to 15th centuries, has slowly revealed its forest-hidden past to archaeologists, but its total population has been a mystery.
The new estimate, made possible by a study designed at the University of Oregon, is the first for the entire 3,000-square-kilometer mix of urban and rural landscape. The findings published May 7 in the journal Science Advances.
The finding is vital for potentially helping cities under pressure of climate change, said co-author Roland Fletcher of the University of Sydney and director of the Angkor Research Program, a collaboration with Cambodia's Authority for the Protection of the Site and Management of the Region of Angkor.
"We predominantly are living in giant low-density cities around the world that are similar to Angkor, which displayed serious vulnerability to severe climate change," Fletcher said. "We really need to know the mechanics of how Angkor worked and what people were doing to get some idea of how referable those experiences are to the risks that we face in our future."
With the combined data, including that from several decades of research by international and Cambodian researchers, the new study revealed population details of Angkor's ceremonial city center, the metropolis extending outward like modern suburbia and embankments incorporating agricultural areas. Angkor was a low-density city, with its population spread out across a wide area.
An initial population estimate was for 750,000 residents in an area of 1,000-square kilometers around central Angkor, Fletcher said. In this area are stone religious temples, including Angkor Wat that attract tourists.
Beyond the stone temples of central Angkor were homes and locations of supporting structures, all made of organic materials reclaimed by the jungle, said UO archaeologist Alison K. Carter, an expert in fine-grain archaeological research who has conducted fieldwork in Cambodia since 2005.
Carter was co-lead author with Sarah Klassen, formerly a postdoctoral researcher at the University of British Columbia. The two planned and designed the study while Klassen was a visiting scholar at the UO with support from the Office of International Affairs' Global Oregon Faculty Collaboration Fund. In all, 14 long-active Angkor researchers collaborated.
Klassen brought machine-learning to the project, deploying a multilayered statistical analysis that merged data from historical archives and maps with details obtained of lidar scans of the region in a project led by co-author Damian Evans of the French Institute of Asian Studies, in 2012 and 2015.
Lidar, which is short for light detection and ranging, is done by sending laser pulses groundward from aircraft. It captures details of ground by ignoring ground clutter such as forests. The new data, Klassen said, "really transformed our understanding of the landscape."
Lidar documented and mapped 20,000 features not seen before, adding to a previous database of 5,000 locations, said Klassen, now a postdoctoral researcher at the University of Leiden.
"When you are on the ground in the main parts of the city center it is quite forested," Carter said. "As you walk around you can tell there is something in the landscape around you, but you cannot see anything clearly. Lidar gave us a beautiful grid of mounds and depressions, which we think were little ponds."
As initial lidar images were being transmitted, researchers at the Angkor field station stayed up into the early morning hours to watch, Fletcher said.
"It was absolutely fabulous," he said. "We had earlier radar data, but the amount of new information was staggering, especially because the lidar images captured the entire region in great detail."
The new data have been organized into different periods of Angkor's growth, particularly in the lifetimes of kings who were most influential to infrastructure changes, said Carter, who heads the UO's Southeast Asian Archeology Lab.
Lidar showed where houses, which had been built on mounds and elevated on posts, had stood. Researchers estimated that five people lived in each household and extrapolated that data to assess the region's total population.
"We looked at the growth of the city of Angkor over time," Carter said. "We found that different parts of the city grew in different ways. The way we think about population growth in cities and suburbs today is probably the same for Angkor."
The study's findings enhance the "comparative understanding of premodern urbanism," said co-author Miriam T. Stark, director of the Center for Southeast Asian Studies at the University of Hawaii at Manoa.
"Studying Angkor's population is important for envisioning the future's urbanism with respect to global climate change," Stark said. "Angkor was a tropical city that persisted through centuries of political and climatic volatility. Tracking its history and tipping point could help urban planners understand some kinds of constraints that face increasing numbers of the world's cities."
Klassen's machine learning contributions initially were published in a 2018 study in PLOS ONE.
"In this new paper," she said, "we introduced statistical learning paradigms and our archaeological case study and dataset. We then explored four classical mathematical approaches to find statistically significant predictors to date temples built in different locations in the region."
That led to a historical model for temples built between the modern-era years of 821-1149 within an absolute average error of 49-66 years.
"This was critical for our study, because it allowed us to see how the metropolitan area developed in comparison to the civic-ceremonial centers," Klassen said. "It also allowed us to estimate populations connected to the temples and see how those population changed over time."
Population information paves the way for better understanding Angkor's economics and resilience, said co-author Christophe Pottier of the French Institute of Asian Studies, who has researched the site for 30 years.
Periods of growth covered in the new study occurred between 770 and 1300.
Future research, Fletcher said, will more deeply examine the expansion of population clusters.
"What was the population of Angkor prior to this sample period? We have to get below all of the current structures with archaeology to predict and model earlier periods," he said.
Klassen and Carter's contributions are crucial to future research, Fletcher said.
Several of the new study's co-authors, including Carter, Evans and Stark, and other collaborators have questioned the conception that Angkor depopulated quickly due to climate pressures in the 15th century.
"We can tell from our archaeological data that that were still people on the landscape, and there is evidence of modifications being made to temples into the 16th century," Carter said. "Our work isn't really designed to answer the timing question for the shift of population away from this area, but it probably happened much slower than long thought."
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Several organizations funded the research, including the Rust Family Foundation, Social Sciences and Humanities Research Council of Canada, a National Science Foundation Doctoral Dissertation Research Improvement Award, the American Council of Learned Societies-Robert H. N. Ho Family Foundation Program in Buddhist Studies, Australian Research Council and European Research Council.
For some people, social gatherings can be a time to imbibe. And for some, that can turn into a time to overindulge. But how do your neighborhood and your social network affect binge drinking?
Along with colleagues at the RAND corporation in Santa Monica, Indiana University researcher Hank Green examined how neighborhood and social network characteristics were related to adult binge drinking. He and his co-authors found that both factors play a role in how much someone drinks, information that can help us better understand binge drinking among adults.
The study was published in the journal Health and Place, indexed in Science Direct and PubMed.
"Adults living in cohesive neighborhoods where people get along, help and look out for one another had a lower likelihood of any binge drinking at all compared to those living in less cohesive neighborhoods," the co-authors point out.
"Living in a highly cohesive neighborhood may impact social norms and constrain behavior in such a way that binge drinking is very unlikely, even if the opportunity to drink arises," Green said.
The researchers also found that, for those who live in neighborhoods they consider safe and orderly, and who have a more interconnected social network, the likelihood of social drinking increases, and drinking heavily might occur in those social drinking situations, regardless of how cohesive they find their neighborhood to be. However, the study also found that those neighborhood and network factors also restrict how often someone binge-drinks, probably through social control processes such as friends and neighbors looking out for each other or commenting on someone's drinking, etc.
"We also found that binge drinking was more likely among adults who lived in orderly neighborhoods and who had denser social networks, but reported lower neighborhood cohesion," said Green, associate professor at the IU School of Public Health-Bloomington.
In neighborhoods ranked by study participants as disordered, unsafe, and lacking cohesion, neighborhood factors lose their overall impact. Social networks tend to take over the role of social control, according to the study. In these types of neighborhoods, it's people with more interconnected social networks who binge less often.
Researchers utilized online surveys from adults ages 30-80 drawn randomly from the RAND American Life Panel. The main predictor variables were neighborhood cohesion (do neighbors help neighbors, do neighbors get along); neighborhood order (my neighborhood is clean, safe); and social network density. Associations of these measures with past month binge drinking (any, number of days) were examined, controlling for demographic characteristics.
Green said the study could help inform intervention practices such as cognitive behavioral therapy because those approaches already focus on identifying people and places that trigger binge drinking and addressing those triggers with behavioral changes. Indirectly, Green said, the study suggests that those interventions could also focus on people and places that discourage binge drinking or facilitate less frequent binge drinking and better drinking choices. Those interventions could also consider a broader definition of "place" that moves beyond a specific location to consider how larger areas like neighborhoods might impact drinking.
"Because neighborhood and social network factors work in tandem to affect the likelihood of binge drinking and the frequency of binge drinking, interventions for problem drinking should incorporate both of these aspects to make them more effective," Green said.
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The study was funded by ongoing National Institutes of Health grants to explore how social networks impact adult health.
IU Research
IU's world-class researchers have driven innovation and creative initiatives that matter for 200 years. From curing testicular cancer to collaborating with NASA to search for life on Mars, IU has earned its reputation as a world-class research institution. Supported by $854 million last year from federal, foundation, and other external support, IU researchers are building collaborations and uncovering new solutions that improve lives in Indiana and around the globe.
Sleep disorders tally $94.9 billion in health care costs each year
Patients with conditions like sleep apnea utilize approximately double the amount of doctors' visits and prescriptions and account for 60% more in overall health care costs
Boston, Mass. – Sleep disorders are associated with significantly higher rates of health care utilization, conservatively placing an additional $94.9 billion in costs each year to the United States health care system, according to a new study from researchers at Mass Eye and Ear, a member hospital of Mass General Brigham.
In their new analysis, published in the Journal of Clinical Sleep Medicine, the researchers found the number of medical visits and prescriptions filled were nearly doubled in people with sleep disorders such as sleep apnea and insomnia, compared to similar people without. Affected patients were also more likely to visit the emergency department and have more comorbid medical conditions.
Costly medical care for sleep disorder patients
The researchers sought out to determine the true diagnostic prevalence of sleep disorders and how expensive these conditions were to the health care system. They examined differences in health expenditures in similar patients with and without a sleep disorder diagnosis, as determined by their ICD-10 diagnosis code. The study included data from a nationally-representative survey of more than 22,000 Americans called the 2018 Medical Expenditure Panel Survey, which is administered by the Department of Health and Human Services’ Agency for Healthcare Research and Quality.
They found 5.6 percent of respondents had at least one sleep disorder, which translated to an estimated 13.6 million U.S. adults. This likely represents a significant underestimate, according to the authors, as insomnia alone is felt to conservatively affect 10 to 20 percent of the population. These individuals accumulated approximately $7,000 more in overall health care expenses per year compared to those without a sleep disorder – about 60 percent more in annual costs. This equates to a conservative estimate of $94.9 billion in health care costs per year attributable to sleep disorders.
The analysis revealed that patients with sleep disorders attended more than 16 office visits and nearly 40 medication prescriptions per year, compared to nearly 9 visits and 22 prescriptions for those without a sleep disorder. The study did not quantify non-health care related costs, but the authors noted it can be assumed that more doctors’ appointments means more time off from work, school or other social obligations, not to mention decreased productivity associated with symptoms, only exacerbating costs to society.
Sleep disorders raise risk for other conditions
Sleep disorders can take a toll on health and quality of life in numerous ways. Individuals with certain sleep disorders experience decrease daytime functionality related to sleepiness, mental fog and an increased risk of motor vehicle accidents, for instance. Obstructive sleep apnea is one of the most common sleep disorders and if untreated, can increase risk for neurocognitive issues, such as difficulty concentrating and mood disorders, as well as cardiovascular conditions including heart attacks, strokes, high blood pressure and irregular heart rhythms.
Getting a proper diagnosis at the sign of asleep problem can lead to an effective treatment for a sleep disorder.
“Fortunately, studies have demonstrated that treating certain sleep disorders effectively reduces health care utilization and costs. Therefore, sleep issues should not be ignored. Greater recognition of sleep disorders and an early referral to a sleep specialist are essential,” said Dr. Huyett. “Your sleep is important, and if there’s an issue with your sleep, seek help for it.”
About Mass Eye and Ear
Massachusetts Eye and Ear, founded in 1824, is an international center for treatment and research and a teaching hospital of Harvard Medical School. A member of Mass General Brigham, Mass Eye and Ear specializes in ophthalmology (eye care) and otolaryngology–head and neck surgery (ear, nose and throat care). Mass Eye and Ear clinicians provide care ranging from the routine to the very complex. Also home to the world's largest community of hearing and vision researchers, Mass Eye and Ear scientists are driven by a mission to discover the basic biology underlying conditions affecting the eyes, ears, nose, throat, head and neck and to develop new treatments and cures. In the 2020–2021 “Best Hospitals Survey,” U.S. News & World Report ranked Mass Eye and Ear #4 in the nation for eye care and #6 for ear, nose and throat care. For more information about life-changing care and research at Mass Eye and Ear, visit our blog, Focus, and follow us on Instagram, Twitter and Facebook.
The legume family tree
Massive molecular study uncovers clues to the evolution and diversification of essential plant family
IMAGE: ILLUSTRATION OF A TREE REPRESENTING THE LEGUME FAMILY TREE WITH BRANCHES REPRESENTING THE SIX SUBFAMILIES. ON EACH BRANCH ARE FLOWERS OR PODS OF SPECIES BELONGING TO THE SUBFAMILIES. THE LINES... view more
CREDIT: YIYONG ZHAO, CHIEN-HSUN HUANG, AND HONG MA
The most comprehensive study of the family tree for legumes, the plant family that includes beans, soybeans, peanuts, and many other economically important crop plants, reveals a history of whole-genome duplications. The study also helps to uncover the evolution of genes involved in nitrogen fixation--a key trait likely important in the evolutionary spread and diversification of legumes and vital for their use as "green manure" in agriculture. To reconstruct the family tree, researchers compared the DNA sequence of more than 1500 genes from 463 different legume species, including 391 newly sequenced species, that span the diversity of this large plant family.
A paper describing the study, led by Penn State Professor of Biology Hong Ma, appears in the May 2021 issue of the journal Molecular Plant.
"Legumes make up the third largest family of flowering plants and are incredibly diverse--ranging from tiny herbs to giant trees," said Ma, who is the Huck Distinguished Research Professor of Plant Molecular Biology at Penn State. "They are essential food crops for both humans and livestock, can be used as lumber, and have many other uses. Maybe most importantly, they can 'fix' nitrogen--extracting the vital nutrient from the atmosphere and storing it in nodules on their roots in a symbiotic relationship with soil bacteria--making them important as green manure to improve soil health."
There are over 19,000 species in the legume family divided into six subfamilies and then further divided into narrower and narrower groupings based on their evolutionary relationships. There are 765 genera--the grouping one level above species--of which the team sampled members of 333. To build the family tree, the team analyzed gene sequences from the transcriptomes--the portion of the genome that is expressed as genes--of most of the 463 species and a small number of shallowly sequenced whole genomes from across legume diversity.
"This is the largest study of this kind for a single plant family," said Ma. "We went to great lengths to sample as many species as we could to get a broad representation of the legume family, but it is often difficult to get well-preserved specimens that we can extract DNA or RNA from, especially for species found in remote locations. Having this broad representation of species allowed us to build the most detailed nuclear-gene family tree for legumes to date."
In addition to helping researchers understand the evolution and diversification of legumes, the new legume family tree helps to clarify the relationship between crop plants and their wild relatives. Although the close relatives of important agricultural crops are often known, studying more distant wild cousins could reveal traits that could be exploited to help plants thrive in changing environments and resist diseases or insect pests.
Across the legume family tree, the research team identified strong evidence for 28 separate whole-genome duplication events. Whole-genome duplications, evolutionary events that result in complete duplication of the entire genome, are fairly common among flowering plants and are thought to allow for functional innovation and evolutionary diversification. One of the duplication events that the team identified appears to have occurred in the ancestor of all members of the legume family.
"Because for most of the species in our study we used transcriptomes and do not have entire genome sequences, we consider these as 'proposed' genome duplication events," said Ma. "These kinds of studies are kind of like solving a mystery. If you only have one or a few witnesses it might be difficult to convince a jury of your evidence, but if you have a hundred witnesses who have different perspectives and they all point to the same thing it becomes difficult to dismiss that evidence. In our case, the different species are like our witnesses. The size of our study allowed us to identify events that we might otherwise have dismissed."
The two largest subfamilies account for over 17,000 legume species and include all of the species with the ability to fix nitrogen. Nitrogen is an important plant nutrient--most commercial fertilizers contain a mix of nitrogen, phosphorus and potassium--so the symbiotic relationship between some legumes and the microorganisms that allow them to assimilate nitrogen from the atmosphere using root nodules has spurred their success by allowing them to colonize areas with less fertile soil. The research team also identified clues to the evolution of the genes responsible for this important trait.
"Our data support the idea that nodulation and nitrogen fixation originated a single time early in the history of legumes and other related nitrogen-fixing plants and the whole-genome duplication event at the origin of legumes might have been crucial for the evolution of this process," said Ma. "In addition to this duplication event, we are also able to see gene loss in plants that do not have the ability to nodulate, and evolutionary changes in genes that contributed to their role in nodulation."
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In addition to Ma, the research team includes Yiyong Zhao, Rong Zhang, Kaiwen Jiang, Ji Qi, Yi Hu, Jing Guo, Renbin Zhu, Taikui Zhang, Ashley N. Egan, Ting-Shuang Yi, and Chien-Hsun Huang. This research was funded by the National Natural Science Foundation of China, the Strategic Priority Research Program of Chinese Academy of the Sciences, the State Key Laboratory of Genetic Engineering, the Ministry of Education Key Laboratory of Biodiversity Science and Ecological Engineering at Fudan University, and Penn State.
Vegetarians have healthier levels of disease markers than meat-eaters
Vegetarians appear to have a healthier biomarker profile than meat-eaters, and this applies to adults of any age and weight, and is also unaffected by smoking and alcohol consumption, according to a new study in over 166,000 UK adults, being presented at this week's European Congress on Obesity (ECO), held online this year.
Biomarkers can have bad and good health effects, promoting or preventing cancer, cardiovascular and age-related diseases, and other chronic conditions, and have been widely used to assess the effect of diets on health. However, evidence of the metabolic benefits associated with being vegetarian is unclear.
To understand whether dietary choice can make a difference to the levels of disease markers in blood and urine, researchers from the University of Glasgow did a cross-sectional study analysing data from 177,723 healthy participants (aged 37-73 years) in the UK Biobank study, who reported no major changes in diet over the last five years.
Participants were categorised as either vegetarian (do not eat red meat, poultry or fish; 4,111 participants) or meat-eaters (166,516 participants) according to their self-reported diet. The researchers examined the association with 19 blood and urine biomarkers related to diabetes, cardiovascular diseases, cancer, liver, bone and joint health, and kidney function.
Even after accounting for potentially influential factors including age, sex, education, ethnicity, obesity, smoking, and alcohol intake, the analysis found that compared to meat-eaters, vegetarians had significantly lower levels of 13 biomarkers, including: total cholesterol; low-density lipoprotein (LDL) cholesterol--the so-called 'bad cholesterol; apolipoprotein A (linked to cardiovascular disease), apolipoprotein B (linked to cardiovascular disease); gamma-glutamyl transferase (GGT) and alanine aminotransferase (AST)--liver function markers indicating inflammation or damage to cells; insulin-like growth factor (IGF-1; a hormone that encourages the growth and proliferation of cancer cells); urate; total protein; and creatinine (marker of worsening kidney function).
However, vegetarians also had lower levels of beneficial biomarkers including high-density lipoprotein 'good' (HDL) cholesterol, and vitamin D and calcium (linked to bone and joint health). In addition, they had significantly higher level of fats (triglycerides) in the blood and cystatin-C (suggesting a poorer kidney condition).
No link was found for blood sugar levels (HbA1c), systolic blood pressure, aspartate aminotransferase (AST; a marker of damage to liver cells) or C-reactive protein (CRP; inflammatory marker).
"Our findings offer real food for thought", says Dr Carlos Celis-Morales from the University of Glasgow, UK, who led the research. "As well as not eating red and processed meat which have been linked to heart diseases and some cancers, people who follow a vegetarian diet tend to consume more vegetables, fruits, and nuts which contain more nutrients, fibre, and other potentially beneficial compounds. These nutritional differences may help explain why vegetarians appear to have lower levels of disease biomarkers that can lead to cell damage and chronic disease."
The authors point out that although their study was large, it was observational, so no conclusions can be drawn about direct cause and effect. They also note several limitations including that they only tested biomarker samples once for each participant, and it is possible that biomarkers might fluctuate depending on factors unrelated to diet, such as existing diseases and unmeasured lifestyle factors. They also note that were reliant on participants to report their dietary intake using food frequency questionnaires, which is not always reliable.
