THIRD WORLD USA

Even small bills for health insurance may cause healthy low-income people to drop coverage

Data from Michigan's Medicaid expansion program could inform other states and programs

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

Research News

 

Twenty dollars a month might not seem like a lot to pay for health insurance. But for people getting by on $15,000 a year, it's enough to make some drop their coverage - especially if they're healthy, a new study of Medicaid expansion participants in Michigan finds.

That could keep them from getting preventive or timely care, and could leave their insurance company with a sicker pool of patients than before, say the researchers from the University of Michigan and University of Illinois Chicago. They have published their findings as a working paper through the National Bureau of Economic Research, ahead of publication in the American Journal of Health Economics.

The study has implications for other states that require low-income people to pay for their Medicaid coverage, or may be considering such a requirement if they expand Medicaid. It also has importance for the plans sold on the national and state Marketplaces to people who buy their coverage directly.

Impact of monthly fees

The new findings come from Michigan's Medicaid expansion program, called the Healthy Michigan Plan, which was one of the first in the nation to require some low-income participants to pay monthly fees and most participants to pay co-pays for services they receive. Nearly 906,000 Michiganders get their health coverage through the program.

Fees, formerly called contributions and similar to the monthly premiums that people with other forms of insurance pay, are only charged to those have a household income above the federal poverty level. The program is open to adults making up to 138% of the federal poverty level, a cap of about $17,700 for a single-person household in 2021.

The analysis was done by a team from the U-M Institute for Healthcare Policy and Innovation, which has conducted a formal evaluation of the program for the Michigan Department of Health and Human Services. Betsy Q. Cliff, Ph.D., now at the University of Illinois Chicago, led the analysis during her doctoral training at the U-M School of Public Health.

While people leave Medicaid for a number of reasons, the study found a 2.3 percentage point jump in disenrollment at the federal poverty level, which the researchers attribute to the imposition of premiums.

Given a baseline disenrollment of about 20% over 6 months of the program, the study finds 12% more participants dropped off the Healthy Michigan Plan after they began owing monthly fees. The amount someone had to pay also mattered: Disenrollment rose by nearly 1 percentage point for every dollar charged monthly. The study used data from the inception of the program in March 2014 and followed participants through September 2016.

Michigan's cost-sharing requirements for people in the Healthy Michigan Plan kick in after a person has been in the program for six months. An individual on the program with an income just above the poverty level - around $12,900 a year in 2021 - might be charged about $20 a month, though this amount can be reduced by engaging in a discussion with their physician about healthy behaviors. The monthly amount goes up as income increases.

"Disruptions in Medicaid coverage -- also known as churn -- can lead to worse quality care, higher administrative costs and less chance for the population to receive needed but non-urgent preventive services," says Cliff, now an assistant professor at UIC's School of Public Health.

Indeed, previous work by the IHPI team to survey past participants in the Healthy Michigan Plan showed that 81% had access to no other form of insurance before they joined the program, and that 55% went uninsured for the three months after they left it.

Signs of "adverse selection"

When the researchers looked closer at who was leaving the plan, they found that it was mainly people who were relatively healthy: Those who hadn't had any care related to a chronic illness, and that had below-median health spending.

By contrast, the study did not find an increase in disenrollment among those who had gotten care for a chronic condition or had above-median health care spending during the first months after enrollment, before they received a cost-sharing invoice.

In participants who had no care related to a chronic disease in the six months before cost-sharing kicked in, or who had below-median overall spending, facing a premium increased the chance of disenrollment by about 3 percentage points. Every dollar of monthly fees cost raised disenrollment by 0.8 percentage points. But monthly fees didn't change the disenrollment chances of less-healthy enrollees who had chronic disease care or higher-than-median health spending.

When the researchers adjusted for demographic differences, they found that the people who disenrolled had medical spending in the first six months of enrollment that was 40% lower than the spending for those who stayed in.

Being billed for co-pays did not seem to alter the chance that people of any health status would leave the program. In general, co-pays for people receiving certain health care services under the Healthy Michigan Plan are $1 to $8 for a prescription up to $100 for an inpatient hospital stay, depending on income.

Enrollees are not required to leave the program for non-payment of monthly fees or co-pays; people must actively disenroll or fail to complete yearly renewal paperwork.

Implications for other states and plans

In addition to the disruption for individuals and the private plans that cover them, the authors say the findings have implications for how the state and federal governments plan for spending on Medicaid, and how they adjust payments to insurers and providers based on patients' health risk.

States that are considering implementing or continuing cost-sharing requirements under Medicaid expansion should consider this, the authors say.

Cost-sharing is seen as a way to promote personal responsibility and encourage participants to make better decisions about health care and have been used as a way to achieve bipartisan support for Medicaid expansion in Michigan and other states.

But as the study shows, this may limit access to coverage and cause Medicaid to experience adverse selection, that can disrupt the health insurance market.

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The paper's senior author is Richard Hirth, Ph.D., the S.J. Axelrod Collegiate Professor of Health Management and Policy at the U-M School of Public Health. IHPI director John Z. Ayanian, M.D., M.P.P., who leads the institute's evaluation of the Healthy Michigan Plan and is the Alice Hamilton Distinguished University Professor of Medicine and Healthcare Policy at the Medical School with joint appointments at SPH and the Ford School of Public Policy, is a co-author. In addition to Cliff, Hirth and Ayanian, the study's authors are Sarah Miller of the U-M Ross School of Business, and Jeffrey Kullgren of the U-M Medical School.

To learn more about the IHPI evaluation of the Healthy Michigan Plan, and see previous reports, announcements and papers it has generated, visit https://ihpi.umich.edu/featured-work/hmp

Fifty shades of reading: Who reads contemporary erotic novels and why?

WHEN PORN IS POPULAR ITS CALLED EROTIC

New study is the first to explore empirically the readership and the reading rewards underlying the current large-scale cultural phenomenon of erotic novels

MAX-PLANCK-GESELLSCHAFT

Research News

 

Soon after E.L. James's Fifty Shades of Grey appeared in 2015, the book market was inundated with a flood of erotic bestsellers. People from all corners began wondering what this type of novel's secret of success could be. Now, a research team at the Max Planck Institute for Empirical Aesthetics (MPIEA) in Frankfurt/Main, Germany, has taken a closer look at the readership of erotic novels and investigated the causes of this literary predilection.

In the media as well as the academy, contemporary erotica is typically dismissed as being of low literary value. Critics and scholars tend to classify its readers as having mediocre to poor taste, without, however, examining their motivations and experiences in more detail. Against this background, the MPIEA team conducted an online study to investigate who actually reads erotic novels and why. The findings have just been published as an Open Access article in the journal Humanities & Social Sciences Communications.

The study included data sets from around 420 female participants. The majority of respondents were heterosexual women in stable relationships with an above-average level of education. They described themselves as being enthusiastic frequent readers who enjoyed sharing their reading experiences with others. Most of the study participants were between 20 and 40 years old.

The majority of respondents indicated that they read erotic novels as a diversion, and feelings of ease and relaxation were frequently named as a motivating factor. The sexual explicitness of the novels and their potential to provide orientation in readers' own lives also played a role for the participants, although this role was less significant than had been assumed in previous studies. Readers' opinions about erotic novels also came as a surprise, by contrast with more general critical ideas about contemporary erotica.

"Many of the study participants saw erotic novels - at least in part - as being emancipated, feminist, and progressive. We attribute this finding primarily to the respondents' more traditional views of male and female gender roles," explains lead author Maria Kraxenberger.

This study is the first to investigate empirically the readership and motivations for reading that underlie a major contemporary cultural phenomenon. Although readers of erotica have a significant impact on the international book market, the mainstream conversation about literature and reading is still reserved for "serious" readers of "good," if less popular, kinds of books. The study's findings underscore the need for more research that explores reading experiences outside the canon of serious literature.

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Original Publication:

Kraxenberger, M., Knoop, C. A., & Menninghaus, W. (2021). Who reads contemporary erotic novels and why? Humanities and Social Sciences Communications, 8, Article 96.
Published: 28 April 2021

Friendly pelicans breed better

UNIVERSITY OF EXETER

Research News

 

IMAGE: BLACKPOOL ZOO PELICAN NESTING AREA view more 

CREDIT: DR PAUL ROSE

Captive pelicans that are free to choose their own friendships are more likely to breed successfully on repeated occasions, new research suggests.

Social network analysis on captive great white pelicans, led by the University of Exeter, found that providing social choice within the flock and allowing partnerships to form naturally led to improved breeding success.

The study revealed that the pelicans chose their specific social relationships, and that there was a social structure across the flock, in which sub-adults (the equivalent of teenagers) spent more time with each other than with adult birds.

Zoo-housed pelicans are common, but their breeding record is poor and they receive little research attention, compared to other popular birds in zoos such as penguins.

As great white pelicans are long lived and hard to breed in captivity, they need careful management.

The team - from the University of Exeter, University Centre Sparsholt and Reaseheath College - collected data at Blackpool Zoo on the behaviour, space use and association preferences around the nesting events of great white pelicans in 2016 and 2017.

"Evaluating space use and behaviour to ensure that pelicans have the choice to behave in a way that they wish is essential to good animal welfare," said lead author Dr Paul Rose, of the University of Exeter and WWT Slimbridge Wetland Centre.

"Social network analysis enables us to identify the strongest bonds and discover who is influential in the flock. Therefore we can work out which birds might initiate breeding and encourage this activity in others.

"This is important for flock management. If birds are to be moved between flocks, we should preserve these important bonds and the experience they provide.

"Alongside the good care the birds get from zoo staff, this experience of what to do and when to do it is likely why the flock we analysed nested successfully on multiple occasions."

The research team also identified specific behavioural cues that might tell pelican keepers when breeding is likely to happen.

For example, data collected before the pelicans began nesting showed that the flock was more vigilant during this time, suggesting that vigilance may be a precursor for courtship or nesting activity.

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The paper, published in the journal Zoo Biology, is entitled: 'Understanding sociality and behavior change associated with a nesting event in a captive flock of great white pelicans'.

It is time to create contracts all users can understand

New research presents a novel four-step user-centered contract design process

UNIVERSITY OF VAASA

Research News

 

IMAGE: ACCORDING TO MILVA FINNEGAN'S RESEARCH AT THE UNIVERSITY OF VAASA, USER-CENTERED DESIGN IS A KEY TO CONTRACT SIMPLIFICATION. view more 

CREDIT: KEVIN FINNEGAN

Contracts today are complex and not user-friendly. The documents are written in black and white text, using "legalese" language, and lack page layout design. The result is that contracts are often left in drawers and are not used. So how can contracts be designed so everyone can read and understand them? This is the question Milva Finnegan explores in her doctoral dissertation at the University of Vaasa, Finland.

"Contracts are first and foremost communication tools that guide various people to perform their jobs. To function as effective communication tools the contract design must consider all users", Ms. Finnegan explains.

The research presents a novel four-step user-centered contract design process that combines cognitive, textual, and visual considerations to create a holistic simplified contract. Considering contracts as user guides, she presents ideas on how to write language the audience can understand, organizing contract content in a logical flow, and leveraging visual representations when possible. The outcome is a simplified contract.

Her research identifies structure, language, and visualization, as the three areas of design to produce a contract document that is readable, understandable, and usable for everyone that relies on the information to perform their jobs.

By integrating design thinking and focusing on who the audience is, contract development shifts from the traditional copy and pasting a prior agreement approach to designing contracts.

The research takes a multi-disciplinary approach to contract design studies seeing contracts not only as legal documents to protect businesses in case of a dispute, but as managerial tools to create and maintain positive business relations and prevent problems from arising. Building on relational contract theory, proactive law approach, and information design principles, the dissertation focuses on the communication challenges contracts present.

Just as the topic is multi-disciplinary, crossing the fields of legal, managerial economics, information design, and other studies, the work employs a mixed-method approach comprised of qualitative and quantitative research that studies contract operations as part of business and society.

"I encourage businesses to implement some of the contract simplification methods I have presented in my dissertation to make contracts more user-friendly to reduce misunderstanding between contracting parties, avoid disputes, gain efficiencies in transaction execution, and ultimately better financial performance", urges Ms. Finnegan.

Public defence

The public examination of M.Sc Milva Finnegan's doctoral dissertation " User-centered design: A key to contract simplification" will be held on Tuesday 18 May at 17.00 o´clock. The public examination will be organized online:

https://uwasa.zoom.us/j/64305300295?pwd=bXRBamxGbFJrVDBsYS9xTFQwUW84dz09

Password: 940058

The field of dissertation is Business Law. Professor Soili Nysten-Haarala (University of Lapland) will act as opponent and Professor Vesa Annola as custos. The examination will be held in English.

Dissertation

Finnegan, Milva (2021) User-centered design: A key to contract simplification. Acta Wasaensia 459. Doctoral Dissertation. Vaasan yliopisto / University of Vaasa.

Publication pdf: http://urn.fi/URN:ISBN:978-952-476-952-5

How Legionella makes itself at home

Protein remodels intracellular membrane to help bacteria survive in host cells

UT SOUTHWESTERN MEDICAL CENTER

Research News

 

IMAGE: A NEW STUDY SUGGESTS THAT LEGIONELLA (RED) OSCILLATES BETWEEN THE ENDOPLASMIC RETICULUM (GREEN), AND BUBBLE- OR TUBE-SHAPED STRUCTURES (BLUE) TO HELP CREATE OR SUSTAIN A STRUCTURE THAT HOUSES THIS BACTERIUM... view more 

CREDIT: UT SOUTHWESTERN MEDICAL CENTER

DALLAS - May 10, 2021 - Scientists at UT Southwestern have discovered a key protein that helps the bacteria that causes Legionnaires' disease to set up house in the cells of humans and other hosts. The findings, published in Science, could offer insights into how other bacteria are able to survive inside cells, knowledge that could lead to new treatments for a wide variety of infections.

"Many infectious bacteria, from listeria to chlamydia to salmonella, use systems that allow them to dwell within their host's cells," says study leader Vincent Tagliabracci, Ph.D., assistant professor of molecular biology at UTSW and member of the Harold C. Simmons Comprehensive Cancer Center. "Better understanding the tools they use to make this happen is teaching us some interesting biochemistry and could eventually lead to new targets for therapy."

Tagliabracci's lab studies atypical kinases, unusual forms of enzymes that transfer chemical groups called phosphates onto proteins or lipids, changing their function. Research here and elsewhere has shown that Legionella, the genus of bacteria that cause Legionnaires' disease, is a particularly rich source of these noncanonical kinases. According to the Centers for Disease Control and Prevention, nearly 10,000 cases of Legionnaires' disease were reported in the U.S. in 2018, though the true incidence is believed to be higher.

After identifying a new Legionella atypical kinase named MavQ, Tagliabracci and his colleagues used a live-cell imaging technique combined with a relatively new molecular tagging method to see where MavQ is found in infected human cells, a clue to its function. Rather than residing in a specific location, the researchers were surprised to see that the protein oscillated back and forth between the endoplasmic reticulum - a network of membranes important for protein and lipid synthesis - and bubble- or tube-shaped structures within the cell.

Further research suggests that MavQ, along with a partner molecule called SidP, remodels the endoplasmic reticulum so that Legionella can steal parts of the membrane to help create and sustain the vacuole, a structure that houses the parasite inside cells and protects it from immune attack.

Tagliabracci, a Michael L. Rosenberg Scholar in Medical Research and a Cancer Prevention & Research Institute of Texas (CPRIT) Scholar, says that he suspects other bacterial pathogens may use similar mechanisms to co-opt existing host cell structures to create their own protective dwellings.

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UTSW scientists who contributed to this study include Ting-Sung Hsieh, Victor A. Lopez, Miles H. Black, Adam Osinski, Krzysztof Pawlowski, Diana R. Tomchick, and Jen Liou, a Sowell Family Scholar in Medical Research.

This work was funded by NIH grants DP2GM137419, R01GM113079, T32GM008203-29, F30HL143859-01, Welch Foundation grants I-1911, I-1789, CPRIT grant RP170674, and Polish National Agency for Scientific Exchange scholarship PPN/BEK/2018/1/00431.

About UT Southwestern Medical Center

UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution's faculty has received six Nobel Prizes, and includes 25 members of the National Academy of Sciences, 17 members of the National Academy of Medicine, and 13 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 2,800 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in about 80 specialties to more than 117,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 3 million outpatient visits a year.

Dartmouth-led study finds overemphasis on toy giveaways in TV ads unfairly promotes fast-food to children

THE GEISEL SCHOOL OF MEDICINE AT DARTMOUTH

RESEARCHERS AT THE KOOP INSTITUTE AND GEISEL SCHOOL OF MEDICINE AT DARTMOUTH TO ANALYZE FAST-FOOD TV-ADS DIRECTED AT CHILDREN. THE... view more 

CREDIT: C. EVERETT KOOP INSTITUTE AT DARTMOUTH

A new Dartmouth-led study, published this week in the journal Pediatrics, has found that the disproportionate use of premiums within child-targeted TV advertising for children's fast-food meals is deceptive. The researchers examined thousands of advertisements from 11 fast-food restaurants, but one company--McDonald's--accounted for nearly all the airtime and, as a result, the findings.

The researchers report that these ads often overemphasize premiums such as toy giveaways and games relative to the primary product being sold, the fast food itself. This marketing practice violates the industry's own guidelines--put in place to ensure that the use of premiums in ads is not deceptive or unfair--as young children lack the cognitive ability to understand advertising.

The practice also works against childhood obesity prevention efforts. Previous studies have shown that childhood obesity is common in the U.S. About 26 percent of children ages 2-5 are overweight or obese, putting them at risk for major health consequences as they get older. Still, fast food is heavily promoted and regularly consumed by kids--nearly one-third of U.S. children eat fast-food on any given day.

"In the past, we've looked at the prevalence of child-directed food marketing and how it negatively impacts kids' diets, behaviors, and even weight status, but this is the first time we've examined if these companies are adhering to their own guidelines, in relationship to the content they can present to children," explains first author Jennifer Emond, PhD, MS, an assistant professor of biomedical data science and of pediatrics at Dartmouth's Geisel School of Medicine.

In the study, the investigators analyzed content of all child-directed fast-food TV advertisements on four popular national networks--Disney XD, Nickelodeon, Nicktoons, and Cartoon Network--aired from February 1, 2019 through January 31, 2020.

The team quantified the percent of the audio transcript (word count) and visual airtime (seconds) that included premiums or food, as well as the onscreen size of the toys or giveaways. During the study period, which included 142 hours of total airtime, more than 20,000 child-directed ads from 11 fast-food restaurants were aired on the four TV networks.

Of the 28 unique child-directed advertisements for children's fast-food meals during the study year, 27 were for McDonald's Happy Meals, accounting for nearly all (99.8 percent) of the total airtime. On average, premiums (vs. food) accounted for 53 percent (vs. 16 percent) of words in the audio transcript and 59.2 percent (vs. 54.3 percent) of the visual airtime.

Industry guidelines, which are managed through the Children's Advertising Review Unit and are administered by the BBB National Programs (formerly the Better Business Bureau), clearly state that premiums within child-directed advertising must be secondary to the advertised product to avoid undue influence.

"I find it very interesting that these are self-regulatory guidelines or pledges that the companies have signed on to as part of an industry initiative," says Emond. "But they're not even adhering to their own pledges. We need to hold them accountable--through stronger oversight of child-directed marketing in the U.S., from an independent review body or regulatory agency."

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To see a video about this research and co-author Hannah Utter D'21, a student intern at the C. Everett Koop Institute at Dartmouth, go to: https://www.youtube.com/watch?v=w0kM-HFH1qs.

Other co-authors of the study include James Sargent, MD, the Scott M. and Lisa G. Stuart Professor in Pediatric Oncology, Vincent Chang D'21, Alec Eschholz D'19, and Mark Gottlieb, JD, from Northeastern University School of Law.

This study was supported by funding from the C. Everett Koop Institute at Dartmouth College and a mentored research scientist training award from the National Institute of Health (5K01DK117971).

Founded in 1797, the Geisel School of Medicine at Dartmouth strives to improve the lives of the communities it serves through excellence in learning, discovery, and healing. The Geisel School of Medicine is renowned for its leadership in medical education, healthcare policy and delivery science, biomedical research, global health, and in creating innovations that improve lives worldwide. As one of America's leading medical schools, Dartmouth's Geisel School of Medicine is committed to training new generations of diverse leaders who will help solve our most vexing challenges in healthcare.

Peers who boost marginalized voices help others, and themselves, study shows

UNIVERSITY OF NOTRE DAME

Research News

For organizations to reach their potential, they must leverage the expertise of their employees. However, research demonstrates that lower-status employees may not be heard because their "voices" are more likely to be ignored.

New research from the University of Notre Dame is the first to show that peers can help boost marginalized voices, and at the same time benefit their own status, all while helping their organization realize the potential of its employees' diverse perspectives.

Publicly endorsing -- or amplifying -- another person's contribution, while giving attribution to that person, enhances the status of both parties, according to "Amplifying Voice in Organizations," forthcoming in the Academy of Management Journal. Nathan Meikle, postdoctoral research associate in Notre Dame's Mendoza College of Business, and co-lead authors Kristin Bain, Tamar Kreps and Elizabeth Tenney show that ideas that were amplified were rated as higher quality than when those same ideas were not amplified.

"Employees have a finite number of opportunities to speak up in organizations," said Meikle, who specializes in social perception and its implications for organizations. "This can create a dilemma for employees who are trying to get recognized for their contributions. Should they use these limited speaking opportunities to shine a light on themselves or on others? And if they emphasize another's contributions, does it come at a cost to themselves?"

Previous research on "voice" -- speaking up to improve one's organization -- has focused on interactions between supervisors and employees and the negative aspects of voice in such scenarios. However, Meikle and colleagues found that peers can play a crucial role in facilitating the voice process. The team found that those who publicly endorse a peer's contribution, with attribution to that person, enhance both the status of those they amplified as well as their own.

In the first study, 1,188 participants read a transcript of a sales team meeting involving employees of a fictional insurance company with declining sales. Two members offered ideas followed by a third member who ignored the previous ideas. The researchers then manipulated the scenario in one of three ways: the first member amplified the idea of the second member, voiced another idea or simply stayed quiet. The researchers found that both the first member and the second member were rated significantly higher in status in the amplification condition than the other conditions.

In a similar second study, 1,501 participants listened to the transcript rather than reading it, and gender and status were introduced. The team varied whether the first and second members were a high-status male or a low-status female. Consistent with the first study, the first member amplified the second, remained quiet or voiced a new idea. The researchers also added a condition in which the first member self-promoted their prior idea.

"We found that regardless of gender composition, amplifying was more beneficial than any of the other behaviors," Meikle said. "Furthermore, amplification increased the status of both the amplifier and the person being boosted. That was great news for us, that amplification helps even people with low status, whether they are amplifying or being amplified."

In a final study, the researchers tested whether low-status employees could be trained to amplify within their teams. The researchers collected data from 77 employees of a nonprofit educational organization serving people with developmental disabilities. The school director identified 22 employees she believed did not have the degree of influence they should have. Those 22 people were trained in amplification, and after two weeks their status significantly increased. The employees not involved in amplification maintained the same status.

"We were thrilled to see that amplification could be beneficial in a real organization," Meikle said. "We'd seen consistent results in laboratory experiments, which was obviously encouraging. But we were especially excited to see that people can use amplification to make an impact in the real world."

The researchers gained interesting insights from trying out amplification in their own group process as well. In particular, Meikle believes that the benefits of amplification may accrue subconsciously. In their research meetings, the researchers frequently amplified one another, often jokingly, but then had to point out to each other that someone had just been amplified. Meikle says these subtle actions can have a profound impact without being overt or obvious.

"The very first time we examined amplification, I was observing the amplifier as they amplified other group members, and I was surprised at how much of a leadership role the amplifier took on, simply by boosting other people," Meikle said. "Amplifying others requires no new ideas nor complicated decision making, and proves to be a very low-risk, easy strategy that can be used by anyone to help themselves and others."

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Co-lead authors of the study include Kristin Bain from the Rochester Institute of Technology, Tamar A. Kreps from the University of Hawaii and Elizabeth R. Tenney from the University of Utah.

CIA's misleading inoculation drive led to vaccine decline in Pakistan

OXFORD UNIVERSITY PRESS USA

Research News

 

A new paper in the Journal of the European Economic Association, published by Oxford University Press, indicates that distrust generated by a 2011 CIA-led vaccination campaign ruse designed to catch Osama Bin Laden resulted in a significant vaccination rate decline in Pakistan.

Using a local doctor, the US Central Intelligence Organization planned an immunization plan in Pakistan to obtain DNA samples of children living in a compound in Abbottabad where American authorities suspected Bin Laden was hiding in order to obtain proof of Bin Laden's location (because the presence of close relatives would be a likely indication of Bin Laden's presence). Without consent from the Pakistani health authorities, the doctor began to administer hepatitis B vaccines to children in Abbottabad. The Guardian published an article revealing the vaccine project shortly after a United States military special operations unit killed Bin Laden on May 2, 2011.

Even prior to this campaign extremist groups in Pakistan have worked to discredit formal medicine and vaccines. By discrediting such services (which are provided by the state) extremist groups may increase the credibility of non-state actors such as the Taliban.

The Taliban increased propaganda efforts against vaccines in the aftermath of the publication of the Guardian article. In particular, the Taliban issued several religious edicts linking vaccination campaigns to CIA espionage activities and later used violent action against vaccination workers.

Using data from the Pakistan Social and Living Standards Measurement on children born between January 2010 and July 2012, researchers have investigated the effects of the disclosure of this vaccination ruse on the extent to which children in Pakistan received doses of the polio, DPT, or measles vaccine. Their estimates indicate that the vaccination rate declined between 23% and 39% in districts with higher levels of electoral support for an alliance of parties espousing political extremism relative to districts with lower levels of electoral support for such groups. The researchers' investigation also revealed that the decline in girls' vaccination rates is larger than the decline in the vaccination rate of boys.

"The empirical evidence highlights that events which cast doubt on the integrity of health workers or vaccines can have severe consequences for the acceptance of health products such as vaccines," said Andreas Stegmann, one of the paper's authors. "This seems particularly relevant today as public acceptance of the new vaccines against Covid-19 is crucial to address the pandemic."

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Direct correspondence to:

Andreas Stegmann, Assistant Professor of Economics
Department of Economics, University of Warwick
Coventry, CV4 7AL, UNITED KINGDOM
University of Warwick
Andreas.Stegmann@warwick.ac.uk

To request a copy of the study, please contact:

Daniel Luzer
daniel.luzer@oup.com

Hidden within African diamonds, a billion-plus years of deep-earth history

Scientists find a new way to tell ages of the stones, and what made them

EARTH INSTITUTE AT COLUMBIA UNIVERSITY

Research News

 

IMAGE: A DIAMOND ENCAPSULATING TINY BITS OF FLUID FROM THE DEEP EARTH, HELD HERE BY FINE TWEEZERS, WAS PART OF A STUDY DELVING INTO THE AGE AND ORIGINS OF SOUTH AFRICAN... view more 

CREDIT: YAAKOV WEISS

Diamonds are sometimes described as messengers from the deep earth; scientists study them closely for insights into the otherwise inaccessible depths from which they come. But the messages are often hard to read. Now, a team has come up with a way to solve two longstanding puzzles: the ages of individual fluid-bearing diamonds, and the chemistry of their parent material. The research has allowed them to sketch out geologic events going back more than a billion years--a potential breakthrough not only in the study of diamonds, but of planetary evolution.

Gem-quality diamonds are nearly pure lattices of carbon. This elemental purity gives them them their luster; but it also means they carry very little information about their ages and origins. However, some lower-grade specimens harbor imperfections in the form of tiny pockets of liquid--remnants of the more complex fluids from which the crystals evolved. By analyzing these fluids , the scientists in the new study worked out the times when different diamonds formed, and the shifting chemical conditions around them.

"It opens a window--well, let's say, even a door--to some of the really big questions" about the evolution of the deep earth and the continents, said lead author Yaakov Weiss, an adjunct scientist at Columbia University's Lamont-Doherty Earth Observatory, where the analyses were done, and senior lecturer at the Hebrew University of Jerusalem. "This is the first time we can get reliable ages for these fluids." The study was published this week in the journal Nature Communications.

Most diamonds are thought to form some 150 to 200 kilometers under the surface, in relatively cool masses of rock beneath the continents. The process may go back as far as 3.5 billion years, and probably continues today. Occasionally, they are carried upward by powerful, deep-seated volcanic eruptions called kimberlites. (Don't expect to see one erupt today; the youngest known kimberlite deposits are tens of millions of years old.)

Much of what we know about diamonds comes from lab experiments, and studies of other minerals and rocks that come up with the diamonds, or are sometimes even encased within them. The 10 diamonds the team studied came from mines founded by the De Beers company in and around Kimberley, South Africa. "We like the ones that no one else really wants," said Weiss--fibrous, dirty-looking specimens containing solid or liquid impurities that disqualify them as jewelry, but carry potentially valuable chemical information. Up to now, most researchers have concentrated on solid inclusions, such as tiny bits of garnet, to determine the ages of diamonds. But the ages that solid inclusions indicate can be debatable, because the inclusions may or may not have formed at the same time as the diamond itself. Encapsulated fluids, on the other hand, are the real thing, the stuff from which the diamond itself formed.

CAPTION

A diamond used in the study.

CREDIT

Yaakov Weiss

What Weiss and his colleagues did was find a way to date the fluids. They did this by measuring traces of radioactive thorium and uranium, and their ratios to helium-4, a rare isotope that results from their decay. The scientists also figured out the maximum rate at which the nimble little helium molecules can leak out of the diamond--without which data, conclusions about ages based on the abundance of the isotope could be thrown far off. (As it turns out, diamonds are very good at containing helium.)

The team identified three distinct periods of diamond formation. These all took place within separate rock masses that eventually coalesced into present-day Africa. The oldest took place between 2.6 billion and 700 million years ago. Fluid inclusions from that time show a distinct composition, extremely rich in carbonate minerals. The period also coincided with the buildup of great mountain ranges on the surface, apparently from the collisions and squishing together of the rocks. These collisions may have had something to do with production of the carbonate-rich fluids below, although exactly how is vague, the researchers say.

The next diamond-formation phase spanned a possible time frame of 550 million to 300 million years ago, as the proto-African continent continued to rearrange itself. At this time, the liquid inclusions show, the fluids were high in silica minerals, indicating a shift in subterranean conditions. The period also coincided with another major mountain-building episode.

The most recent known phase took place between 130 million years and 85 million years ago. Again, the fluid composition switched: Now, it was high in saline compounds containing sodium and potassium. This suggests that the carbon from which these diamonds formed did not come directly from the deep earth, but rather from an ocean floor that was dragged under a continental mass by subduction. This idea, that some diamonds' carbon may be recycled from the surface, was once considered improbable, but recent research by Weiss and others has increased its currency.

One intriguing find: At least one diamond encapsulated fluid from both the oldest and youngest eras. The shows that new layers can be added to old crystals, allowing individual diamonds to evolve over vast periods of time.

It was at the end of this most recent period, when Africa had largely assumed its current shape, that a great bloom of kimberlite eruptions carried all the diamonds the team studied to the surface. The solidified remains of these eruptions were discovered in the 1870s, and became the famous De Beers mines. Exactly what caused them to erupt is still part of the puzzle.

The tiny diamond-encased droplets provide a rare way to link events that took place long ago on the surface with what was going on at the same time far below, say the scientists. "What is fascinating is, you can constrain all these different episodes from the fluids," said Cornelia Class, a geochemist at Lamont-Doherty and coauthor of the paper. "Southern Africa is one of the best-studied places in the world, but we've very rarely been able to see beyond the indirect indications of what happened there in the past."

When asked whether the findings could help geologists find new diamond deposits, Weiss just laughed. "Probably not," he said. But, he said, the method could be applied to other diamond-producing areas of the world, including Australia, Brazil, and northern Canada and Russia, to disentangle the deep histories of those regions, and develop new insights into how continents evolve.

"These are really big questions, and it's going to take people a long time to get at them," he said. "I will go to pension, and still not have finished that walk. But at least this gives us some new ideas about how to find out how things work."

CAPTION

Lead author Yaakov Weiss in the lab at Columbia University's Lamont-Doherty Earth Observatory, where the analyses were done.

CREDIT

Kevin Krajick/Earth Institute

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The other authors of the study are Yael Kiro of Israel's Weizmann Institute of Science; Gisela Winckler and Steven Goldstein of Lamont-Doherty; and Jeff Harris of Scotland's University of Glasgow.

Scientist contacts:

The Earth Institute, Columbia University mobilizes the sciences, education and public policy to achieve a sustainable earth. http://www.earth.columbia.edu.

Lamont-Doherty Earth Observatory is Columbia University's home for Earth science research. Its scientists develop fundamental knowledge about the origin, evolution and future of the natural world, from the planet's deepest interior to the outer reaches of its atmosphere, on every continent and in every ocean, providing a rational basis for the difficult choices facing humanity. http://www.ldeo.columbia.edu | @LamontEarth

Muti: Pandemic year silenced culture, leaving world stunned


RAVENNA, Italy — Maestro Riccardo Muti has once again reopened the Italian musical season in his adopted hometown of Ravenna after another — and if all goes well perhaps final — round of pandemic closures.

With a purposeful nod and flick of his baton, the 79-year-old conductor on Sunday ended what has been an unexpectedly long silence in Italian theatres, enrapturing a socially distanced and masked audience with the Vienna Philharmonic Orchestra’s first live performances since the fall — back-to-back evening concerts of Mendelssohn, Schumann and Brahms.

The concerts launched a three-stop Italian tour by the Vienna Philharmonic to celebrate 50 years of ties with the conductor and served as a precursor to the summertime Ravenna Festival, this year celebrating the 700th anniversary of Dante’s death.

“The emotion is above all one of rebirth, which is a positive word, but it means that something died before. So, within the positivity, there is the regret over something lost. And we, for a year, lost the possibility of life, in the complete sense of the word,” Muti told The Associated Press before the concert.

“This fact, that in nearly the whole world, theatres have remained empty, orchestras were reduced to silence, is something that has never been seen before.”

After World War II, Muti said, U.S. soldiers made it a priority to reopen the San Carlo Theater in his native Naples, and in Milan city fathers rebuilt La Scala, destroyed bombs, reopening it on May 11, 1946 with a concert conducted by Arturo Toscanini.

DURING WWII THE LENINGRAD ORCHESTRA PLAYED EVERY DAY OF THE NAZI SEIGE

La Scala reopened to the public on Monday after a six-month COVID-19 closure, with Riccardo Chailly conducting Verdi and Wagner for the 75th anniversary of the reconstruction. The orchestra performed from risers built over the platea, while the chorus was spaced on stage.

During this year, Muti has been unable to return to the Chicago Symphony Orchestra, where he has been music director for a decade. His last European performance, the traditional Vienna New Year’s Day concert, was a triumph but was performed to an empty concert hall. In his closing remarks, he urged governments to fund culture, as a salve to mental health that suffered during the pandemic closures. “Music helps,” he said.

Nearly a year ago, Muti reopened the European musical season after Italy’s draconian spring 2020 lockdown with an outdoor concert of the Luigi Cherubini Youth Orchestra he founded. Then, the hope was that the summer music festivals would flow smoothly into the fall concert calendar, and cultural life would resume. The fall virus spike and variants doomed that trajectory. Musicians around the world have been deprived of playing for an audience, not to mention income, and audiences the comfort of a live performance.

Muti called the experience of the past year “an unnatural global experiment” that had “stunned” the world.

“If we truly took into account how we are living, we would all go crazy. We try to maintain the illusion that we are living a normal life. It is the only way to reach the end of this absurd path,’’ he said.

Muti is plunging back into concert life. He is conducting his much-curtailed 50th anniversary tour with the Vienna Philharmonic in Florence on Monday and at Milan’s La Scala on Tuesday, before returning to Ravenna to prepare for festival appearances of his Luigi Cherubini Youth Orchestra and for the debut of a piece of music written for the Dante anniversary based on the Divine Comedy's Purgatory canticle.

The world premiere of “Purgatory” by Armenian composer Tigran Mansurian will be held in the Armenian capital, Yerevan, on July 4, part of Muti’s series of Paths of Friendship concerts in their 25th year in cities recovering from war, hatred and conflicts. It will be repeated in Ravenna for the 700th anniversary celebrations of Dante’s death in September. It is one of three, along with Inferno and Paradise, commissioned for this year’s festival.

Muti plans to be back in Chicago by the fall.

The Ravenna Festival, founded 30 years ago by Muti’s wife, Cristina Mazzavillani, reopens June 2 with an ambitious program of 120 musical, dance and theatrical performances and runs through July 31, despite uncertainty in the pace of reopening and the return of tourism. Optimistically, the program calls for 9:30 p.m. curtain times, even though a 10 p.m. curfew remains in place nationwide.

“It is a return of hope,” said general manager Antonio De Rosa. “We want to restore dignity to audiences with the possibility of listening live.”

With a regime of daily virus testing, the Vienna Philharmonic played without masks, spaced at least a meter a part. The audience was spread out across the four tiers of balconies, and every other row was removed from the floor seats, with government rules limiting seating in the 800-seat theatre to 250 people.

In between the shows, orchestra members in their gray pinstriped stage garb wandered over to see Dante’s tomb across the street, or to sit at an outdoor café next to the Alighieri Theater, named for the famed poet who died in Ravenna on Sept. 13, 1321.

“Starting again to make music means starting to live again. Starting to live again means starting to be together again,’’ Muti said. “What has not been able to happen for a year, has been a real tragedy.”

Muti has appealed to Italy’s culture minister to fund more orchestras, encouraged by the commitment he saw working in cities like Turin and Palermo this pandemic year bound largely to Italy, after decades spent mostly conducting abroad if not with his youth orchestra. “Their response was excellent, and this gives me hope,” he said.

The city of Tokyo, where Muti just spent a few weeks with his Italian opera academy, has 17 orchestras, he noted. Italy, the birthplace of lyric opera, has fewer than 30.

A cultural life, he said, is essential for healing from the pandemic year, especially for young people whose social contacts have been dramatically limited at a critical age.

“What future will they have? Will they overcome this trauma? They can overcome this shock only with trust in life, which comes through socializing, living together and sharing above all culture,” Muti said. “I have said it before, and I will say it again. It still seems that culture is not at the top of the priority list, but at nearly the bottom.”

Colleen Barry, The Associated Press