Hidden microearthquakes illuminate large earthquake-hosting faults in Oklahoma and Kansas

Peer-Reviewed Publication

SEISMOLOGICAL SOCIETY OF AMERICA

Using machine learning to sift through a decade’s worth of seismic data, researchers have identified hundreds of thousands of microearthquakes along some previously unknown fault structures in Oklahoma and Kansas.

The newly identified microearthquakes allowed the seismologists to map and measure earthquake clusters in the region, which has experienced unusual levels of seismicity due to unconventional oil and gas production.

As they report in The Seismic Record, the researchers found that 80% of the magnitude 4 and larger earthquakes that occurred in the past decade could have been anticipated based on the spatial extent of seismicity clusters that included the large earthquake before it occurred.

They also found that once a cluster reached a length scale large enough to host a magnitude 4 or larger earthquake, there was nearly a 5% chance that it would do so within a year of achieving that length scale, according to Yongsoo Park, a Ph.D. student at Stanford University and colleagues.

The cluster information could be used by companies and regulators to monitor oil and gas operations in the future, Park and colleagues suggest.

With little natural seismicity and incomplete mapping of faults in Oklahoma and Kansas before unconventional hydrocarbon development, researchers have been looking for new ways to understand the region’s seismic hazard.

Park and colleagues had used a machine learning technique to find almost 90,000 unknown microearthquakes in Arkansas in a previous study. “We were impressed with the result, especially because the catalog revealed previously unknown clusters,” said Park. “We knew that most earthquakes in the Oklahoma-Kansas area occurred on hidden faults in the basement, so we wanted to apply the workflow to reveal these faults.”

The researchers reanalyzed seismic data collected from 17 publicly available seismic networks in Oklahoma and Kansas from 2010 to 2019. Using a neural network to detect earthquakes and their P and S-wave arrival times, they found over 300,000 earthquakes in the data.

When mapped, the additional microearthquakes “connected the dots” between scattered earthquakes and the small clusters formed by the 60 magnitude 4 or larger earthquakes included in the study. The newly detected microearthquakes illuminated the surprising presence of many previously unknown faults, said Park.

“However, the more surprising part was that many of the clusters that were thought to be separated in previous studies were in fact connected by microearthquakes. In other words, finding small earthquakes is probably no longer an option, but rather a requirement when we are trying to do clustering analysis on earthquake data,” he said.

Park said that regulators could adapt the usual “traffic light” protocol--which oil and gas operators use to monitor and stop or slow their activities to mitigate seismic hazard--to incorporate the length scale of an earthquake cluster.

The original traffic light protocol is guided by observed earthquake magnitudes and controlled by the largest magnitude event. Estimating earthquake magnitudes from the length scale could make this process proactive, and controlled by both large and small earthquakes, the researchers note.

“But because the magnitudes are only estimates, the required actions to be taken should probably be different,” Park explained. If a length scale of the cluster raises concern, for example, “the regulators could ask the operators to deploy more seismometers around the concerning cluster to better map the hidden fault.”

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JOURNAL

The Seismic Record

DOI

10.1785/0320220020 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Basement Fault Activation before Larger Earthquakes in Oklahoma and Kansas

ARTICLE PUBLICATION DATE

26-Aug-2022

SOCIOBIOLOGY

 When can we be bothered to help others? Scientists pinpoint brain region responsible for effortful helping behaviour

Peer-Reviewed Publication

UNIVERSITY OF BIRMINGHAM

An area of the brain specifically involved in putting in effort to help others out has been pinpointed by scientists at the University of Birmingham and University of Oxford.

The research, published in Current Biology, shows that effortful altruistic behaviour –choices people make that help others – takes place in a different part of the brain from that used to make physically demanding choices that help oneself.

Understanding more precisely what goes on in the brain when these decisions are made could help clinicians to develop approaches for treating psychopathic behaviours. It could also be useful for better understanding why people are willing to perform everyday effortful helping behaviours like voluntary work, recycling waste to slow global warming or stopping to help strangers.

The area identified, called the anterior cingulate cortex gyrus (ACCg), is located towards the front of the brain. It is known to play a role in social behaviour, but has not previously been linked to putting in effort to help others. Interestingly, the researchers found that the ACCg is not activated when individuals make effortful decisions that only benefit themselves.

“From holding open a door to volunteering for a charity, we often have to decide whether we can be bothered to put in effort to help other people out but the brain mechanisms behind these acts have remained elusive” says Dr Patricia Lockwood, first author on the paper. “By identifying the specific brain region that is activated when people need to put in effort, we have taken a step closer to understanding what drives some individuals, but not others, to perform what are often physically demanding decisions to help people – even when it doesn’t directly benefit themselves.”

In the study, the researchers worked with 38 participants aged between 18 and 35. All participants were each asked to take part in a effortful decision-making task and to complete a questionnaire to self-assess their empathy levels.

The participants made decisions while undergoing a functional MRI scan. This identifies different areas of the brain which are activated while people made decisions to either “work” or “rest” to help themselves or someone else.

If they chose the work option, they had to squeeze a device that measured their grip strength. They had to do this for long enough to reach a threshold, which they could see in real-time on the screen. For each decision they were told whether they would be working for themselves, or for another person.  If they decided to put in the effort, they had to squeeze hard enough to reach the threshold and get the reward, which was different numbers of points that were converted into money, either for themselves or for the other anonymous person they were playing for.

Using a new statistical technique to analyse the data, the researchers were able to identify patterns in the brain that showed how much effort they were willing to put in. They found that the ACCg was the only brain area that showed the effort pattern when people made these decisions to help someone else, but it did not activate at all when they made decisions to put in effort to reward themselves. Intriguingly those people who had said they were very high in empathy had the strongest effort patterns in ACCg. The researchers also found that those people who represented effort more strongly in the ACCg also went on to put in more grip strength to help out.

The next step for the research team will be to investigate what happens to effortful helping behaviour in people who have suffered lesions in that area of the brain through stroke or other brain injury. They will also be researching what happens in people who have high levels of antisocial behaviour and both willingness to put in effort into activities and helping others might be different.

The work was supported by UK Research and Innovation, the Wellcome Trust and the Royal Society, as well as support from Christ Church, Oxford, and the Jacobs Foundation.

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JOURNAL

Current Biology

DOI

10.1016/j.cub.2022.08.010 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Distinct neural representations for prosocial and self-benefitting effort

ARTICLE PUBLICATION DATE

26-Aug-2022

NIH experts review monkeypox challenges

Peer-Reviewed Publication

NIH/NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

 

IMAGE: COLORIZED TRANSMISSION ELECTRON MICROGRAPH OF MONKEYPOX VIRUS PARTICLES (RED) CULTIVATED AND PURIFIED FROM CELL CULTURE. IMAGE CAPTURED AT THE NIAID INTEGRATED RESEARCH FACILITY (IRF) IN FORT DETRICK, MARYLAND. view more 

CREDIT: NIAID

WHAT:
Lessons learned from the public health responses to the HIV and COVID-19 pandemics should help guide the response to the current outbreak of monkeypox, National Institutes of Health experts write in an editorial published today in the New England Journal of Medicine. Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), and H. Clifford Lane, M.D., NIAID deputy director for clinical research and special projects, discuss a published case series (JP Thornhill et al.) detailing the symptoms and outcomes of 528 people with monkeypox from 16 countries in five continents.   

The authors note that the epidemiologic pattern of the multi-continent outbreak of monkeypox resembles that of the early cases of AIDS in that most cases are among men who have sex with men. They caution, however, that it should not be assumed that cases of monkeypox will remain confined to this population. Monkeypox virus has been known to spread from direct lesion-to-skin contact—in prior outbreaks, such spread was often from an infected child to a caregiver. Data suggest that sexual transmission likely plays a role in the current outbreak, the authors note. They call for detailed observational studies, serosurveys and ongoing surveillance to learn more about the epidemiology of the current outbreak.

Drs. Fauci and Lane also compare monkeypox, HIV/AIDS and COVID-19 regarding the causes of each disease and the countermeasures available to fight them. Fortunately, diagnostics, vaccines and treatments for monkeypox already exist. A challenge for the public health and research communities is ensuring equitable, efficient distribution of these existing countermeasures while simultaneously conducting rigorous clinical research to gather more data on their safety and optimal use, they conclude.

ARTICLES: 
HC Lane and AS Fauci. Monkeypox – Past as Prologue. The New England Journal of Medicine DOI: 10.1056/NEJMe2210535 (2022).

JP Thornhill et al. Monkeypox Virus Infection in Humans across 16 Countries — April–June 2022. The New England Journal of Medicine DOI: 10.1056/NEJMoa2207323 (2022).

WHO: 
Dr. Fauci and Dr. Lane are available for comment.

NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.  

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit https://www.nih.gov/. 

NIH...Turning Discovery Into Health

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JOURNAL

New England Journal of Medicine

DOI

10.1056/NEJMe2210535 

UC Davis Health study reports on the safety, efficacy of tecovirimat in treating monkeypox

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - DAVIS HEALTH

A UC Davis Health study finds that the antiviral tecovirimat appears to be safe and effective for the treatment of monkeypox symptoms and skin lesions. The study is one of the earliest studies to assess and report the outcomes of treating patients with monkeypox with this antiviral.

Tecovirimat (TPOXX) is an FDA-approved antiviral drug for the treatment of smallpox. It limits viral spread in the body by inhibiting the work of the protein involved in the release of the enveloped virus. Recently, the Centers for Disease Control and Prevention (CDC) allowed physicians to prescribe tecovirimat on a compassionate use basis to treat adults and children with orthopoxvirus infections, including monkeypox.

In a research letter published in JAMA, UC Davis infectious disease experts presented insights on 25 patients with monkeypox who were given tecovirimat therapy.

“We have very limited clinical data on the use of tecovirimat for monkeypox infection. There is much to learn about the natural progression of the disease and how tecovirimat and other antivirals may affect it,” said lead author Angel Desai. She is an adult infectious disease specialist at UC Davis Health.

Treating monkeypox with tecovirimat

The recent global outbreak of monkeypox has led to more than 45,500 cases as of August 22, 2022. While symptoms usually resolve on their own in 2-4 weeks, a recent study showed that 13% of patients needed hospitalization.

The new study included patients referred to UC Davis Medical Center, primarily through the Sacramento County Department of Public Health, between June 3 and August 13, 2022.

Patients with skin lesions in multiple body parts or in sensitive areas such as the face or genital region were offered oral tecovirimat treatment. The treatment was weight-based, given every 8 or 12 hours, and was taken within 30 minutes of a high-fat meal.

The researchers collected clinical data at the first in-person evaluation for treatment and by in-person or telephone interview on day 7 and day 21 following the beginning of therapy.

In total, 25 patients with confirmed monkeypox infection completed a course of tecovirimat therapy. All were male. Their age ranged between 27 and 76 years (the median age was 40). Nine patients had HIV.

Only one patient had the smallpox vaccine (taken more than 25 years ago) and four others received a dose of JYNNEOS vaccination after symptoms started.

Symptoms in patients with monkeypox, MPX

The study found that 92% of patients had lesions in their genital or anal area. While all patients had painful lesions, around half had fewer than 10 lesions over their entire body.

On average, the patients had symptoms or lesions for 12 days before they started their antiviral treatment. Fever was the most common symptom (76% of the patients), followed by fatigue (32%), sore throat (20%) and chills (20%). Other symptoms included backache (12%), muscle pain (8%), nausea (4%) and diarrhea (4%).

All patients completed the tecovirimat therapy and tolerated their treatment well. They were treated for two weeks, except for one patient who was treated for 21 days.

On day 7 of therapy, 40% of patients had healed from their lesions. By day 21, 92% had healed and were pain-free.

The most reported adverse events on day 7 of therapy included: fatigue (28%), headache (20%), nausea (16%), itching (8%) and diarrhea (8%).

“We have to be very careful in how we interpret the data. It is hard to differentiate the side effects due to therapy from those caused by the infection,” said infectious diseases expert and co-author George Thompson. Thompson is a professor at the UC Davis School of Medicine in the Department of Internal Medicine, Division of Infectious Diseases, and the Department of Medical Microbiology and Immunology.

The study was small and did not include a control group. So, assessing antiviral efficacy in terms of symptom duration and severity was limited. Also, the time from symptom onset to starting the antiviral therapy varied among the patients.

The researchers called for large-scale studies to explore antiviral efficacy dosing and adverse events. Coauthors on this study are Sonja Neumeister, Anna Arutyunova, Katelyn Trigg and Stuart H. Cohen.

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JOURNAL

JAMA

DOI

10.1001/jama.2022.15336 

METHOD OF RESEARCH

Case study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Compassionate Use of Tecovirimat for the Treatment of Monkeypox Infectio

LEGIONAIRES DISEASE

Reclaimed water aerosol is becoming a health concern

Peer-Reviewed Publication

HIGHER EDUCATION PRESS

Reclaimed water has been widely used in urban area. However, residual pathogens in the recycled water have been frequently reported, and are identified as the main source of health risks for wastewater reuse. Thus, the paramount need is to ensure the safety of all potential end users. Common applications of reclaimed water such as road cleaning, greenfield irrigation or landscape fountain tend to produce significant amounts of aerosols, and people exposed to the aerosols containing pathogens might get illnesses. However, the relevant studies are rare and the amount of reclaimed water inhaled was often simply estimated by hypothesis.

This study entitled “Aerosol exposure assessment during reclaimed water utilization in China and risk evaluation in case of Legionella” is published online in Frontiers of Environmental Science & Engineering in 2022.

In this study, the research team estimated the health risks associated with the potential exposure of airborne Legionella emitted from the urban use of reclaimed water in China. Nationwide questionnaire was designed to investigate the exposure habits of Chinese population in different scenarios: 1) people walk on the sidewalk where road cleaning is taking place; 2) people walk along a greenfield in a park for recreational purpose where irrigation system is on operation; 3) people pass by the ornamental landscape fountain. The results indicated that annual infection probability of populations exposed to Legionella for three scenarios, 0.0764 for road cleaning, 1.0000 for greenfield irrigation, 0.9981 for landscape fountain, were markedly higher than the threshold recommended by WHO (10−4 per person per year) according to the concentration distribution of Legionella in the reclaimed water. An age-, educational background-, region- and gender-specific data in annual infection probability also showed different tendencies for some subpopulations.

The risk assessment results indicated that actions need to be taken to reduce the exposure and potential transmission of Legionella during water reuse. Reclaimed water can be disinfected in storage tank before used for road cleaning and landscape fountains. Reducing the retention time of water in tank could also effectively mitigate the growth of Legionella. A warning sign should be set up in a prominent place in the park when using reclaimed water, considering that the high risks of certain subgroups are mainly due to the coincidence of their recreational activities with the time of reclaimed water utilization.

###

About Higher Education Press

Founded in May 1954, Higher Education Press Limited Company (HEP), affiliated with the Ministry of Education, is one of the earliest institutions committed to educational publishing after the establishment of P. R. China in 1949. After striving for six decades, HEP has developed into a major comprehensive publisher, with products in various forms and at different levels. Both for import and export, HEP has been striving to fill in the gap of domestic and foreign markets and meet the demand of global customers by collaborating with more than 200 partners throughout the world and selling products and services in 32 languages globally. Now, HEP ranks among China's top publishers in terms of copyright export volume and the world's top 50 largest publishing enterprises in terms of comprehensive strength.

The Frontiers Journals series published by HEP includes 28 English academic journals, covering the largest academic fields in China at present. Among the series, 13 have been indexed by SCI, 6 by EI, 2 by MEDLINE, 1 by A&HCI. HEP's academic monographs have won about 300 different kinds of publishing funds and awards both at home and abroad.

 

About Frontiers of Environmental Science & Engineering

Frontiers of Environmental Science & Engineering (FESE) is the leading edge forum for peer-reviewed original submissions in English on all main branches of environmental disciplines. FESE welcomes original research papers, review articles, short communications, and views & comments. All the papers will be published within 6 months since they are submitted. The Editors-in-Chief are Prof. Jiuhui Qu from Tsinghua University, and Prof. John C. Crittenden from Georgia Institute of Technology, USA. The journal has been indexed by almost all the authoritative databases such as SCI, Ei, INSPEC, SCOPUS, CSCD, etc.

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JOURNAL

Frontiers of Environmental Science & Engineering

DOI

10.1007/s11783-021-1516-1 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Aerosol exposure assessment during reclaimed water utilization in China and risk evaluation in case of Legionella

Academics started working even more during the pandemic

Peer-Reviewed Publication

NATIONAL RESEARCH UNIVERSITY HIGHER SCHOOL OF ECONOMICS

Academics’ work week became even longer during the pandemic. This is true of researchers from different countries, independently of their gender and specialisation, an international research team with HSE University participation found. Their working time during the pandemic was 51 hours compared to the usual 40. The increased number of working hours per week seems to have become part of the new academic norm. The results of the study were published in the Plos One journal.

The COVID-19 pandemic added ambiguity to many academics’ working conditions. University scholars had to adapt to new forms of study, learn to work with online learning platforms, assess student performance and provide high-quality feedback.

A team of researchers from Russia, Portugal and Hong Kong carried out a study in 2020 to look at how the COVID-19 crisis impacted their peers’ workload and distribution of time for work assignments. The paper itself was a result of the pandemic: the authors met only online.

The respondents were selected randomly out of the authors of academic papers (articles, conference abstracts, books etc) added to the Scopus academic database in 2019. The participants were asked to fill out a questionnaire on their current workload, as well as on the time they thought they would spend on different research, teaching and administrative tasks, and the time they actually spent.

The respondents first filled out the questionnaire in May 2020, then again in November 2020. A total of 126,000 invitation letters were sent out, and 902 academics from all over the world took part in the first wave. The effective sample included 525 respondents. Most of the participants were from the USA (104), Brazil (49), and Italy (31). The second wave included 169 academics, and the same countries had the biggest representation again.

The scholars were asked to describe a specific academic task (such as academic supervision) and assess how much time they would expect to spend on it before the pandemic (as if the pandemic never happened) and during the pandemic.

They found that in 2020, university scholars worked on average three hours more a week than in 2019. The working time duration during the pandemic was about 51 hours compared to the usual 40.

The main reasons for the increased workload were teaching and, to a lesser extent, administrative responsibilities. The most difficult thing during the pandemic was adapting to new teaching methods. The teachers spent a significant amount of time transferring studies to the online environment and learning to use online learning platforms. The academics had to develop new methods to assess student performance and to provide feedback. The time of teacher-student communication also changed. While previously, teachers met with their students only during certain office hours, during the pandemic, they were getting requests from students at any working hours during the week. Answering these requests increased the load on teachers.

However, the time spent by scholars on research remained the same, independently of gender and the field of studies.

While most studies on the presumed effect of the COVID-19 pandemic on the academic environment have been dedicated to opportunities for changing teaching methods and the pressure experienced by scholars during the crisis, the new study looks at the pandemic as an event that has reinforced existing trends of working extra hours in academia.

‘Scholars already work more than the norm. And during the crisis, they started working even more in order to alleviate the ambiguity during the pandemic. This adaptive behaviour only reinforced the long-standing trend. Such a strategy could have been both their personal choice and the result of pressure from their university or their co-workers,’ commented Anna Panova, Senior Research Fellow at the HSE Center for Institutional Studies.

‘Working overtime makes researchers more and more susceptible to stress and burnout. During the pandemic, a new norm evolved that saw researchers working even more. The questions are how sustainable this situation is and what its long-term consequences will be. This is particularly interesting, since other industries, by contrast, are looking into decreasing the number of working days and hours in order to improve performance and quality of life,’ said Maria Yudkevich, Director of the HSE Center for Institutional Studies.

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JOURNAL

PLoS ONE

DOI

10.1371/journal.pone.0273246 

ARTICLE TITLE

The adaptation of academics to the Covid-19 crisis in terms of work time allocation

Study finds that agricultural diversity has a positive impact on food security

Peer-Reviewed Publication

THE ALLIANCE OF BIOVERSITY INTERNATIONAL AND THE INTERNATIONAL CENTER FOR TROPICAL AGRICULTURE

 

IMAGE: WOMEN SELLING DIFFERENT PRODUCE INCLUDING WATERMELONS, CUCUMBERS AND PINEAPPLES IN A LOCAL MARKET IN PAPUA NEW GUINEA. view more 

CREDIT: ALLIANCE OF BIOVERSITY AND CIAT / P. MATHUR

Agricultural diversity can be an important driver of food security, but the magnitude of the contribution depends on the broader socio-economic and biophysical characteristics of the local farming system, according to a recently published paper from researchers including those from the Alliance of Bioversity International and CIAT.

In their paper, “The benefits and trade-offs of agricultural diversity for food security in low- and middle-income countries: A review of existing knowledge and evidence” published in the journal Global Food Security in June of 2022, the researchers found that in almost two-thirds of all cases, agricultural diversity had a positive effect on food security, but in about one third of the relationships there was no effect of agricultural diversity on food security, or the results were mixed. 

According to the Food and Agriculture Organization of the United Nations (FAO), food security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life, whereas agricultural diversity includes the diversity of crop varieties, livestock breeds, fish species and non-domesticated (wild) resources, including the way in which they are processed and consumed. 

The literature review conducted by the researchers showed the work that had been done across the Global South or the Lower-Middle-Income (LMIC) countries looking at the link between agricultural diversity and food security and providing a base for other researchers in the field can now use to find collaborators or to think about further research questions.

Katharina Waha, a Senior Research Scientist in the Global Food and Nutrition Security group at CSIRO in Brisbane, Australia and the lead author of the study said that there were 40 indices measuring the different measures and individual relations.  

“We looked at all the combinations you could think of and how to quantitatively measure between the food security and diversity indicators,” Waha said, “In terms of negative health outcomes for individuals, all the literature on nutritional and health outcomes would say that not having that diversity or quality is the final outcome.”

The researchers found that although agricultural diversity can be beneficial for food security, it is not the only available strategy to promote food security. Where diversification is also the cheapest strategy in terms of monetary and labor costs, it can be an appealing and effective option to improve agricultural practices and profits. 

Elisabetta Gotor is principal scientist and agricultural economist at the Alliance of Bioversity International and CIAT. She has 20 years of experience in economic analyses and evaluation of food system solutions that are at the nexus of agriculture, environment and nutrition, with research focusing on linking biodiversity-based intervention with poverty reduction, food security and nutrition, sustainable rural livelihoods and resilience outcomes. Gotor said that it was important to study the link between the two concepts. 

Gotor said that it was important to study the link between the two concepts. 

“I have a number of studies where I find the link between agricultural diversity and food security,” Gotor said, “Not only is it the driver, but it's the foundation of everything,” 

Gotor said on-farm diversity must be preserved and the way to conserve that is through daily use. 

“If you have a diverse system, you can deal with biotic and abiotic stresses, for example, like the impacts of climate change,” Gotor said, adding that genetic diversity is needed to find new crop varieties. 

“It's important to understand how we measure diversity and how we assess the other elements of diversity,” Gotor said. 

The researchers said holistic study designs considering the natural, social and economic aspects of agricultural and food systems are best suited to represent interactions between them and understand the complex effects of diversification.

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JOURNAL

Global Food Security

DOI

10.1016/j.gfs.2022.100645 

METHOD OF RESEARCH

Systematic review

ARTICLE TITLE

The benefits and trade-offs of agricultural diversity for food security in low- and middle-income countries: A review of existing knowledge and evidence

Researchers warn of potential threat to heart health from extreme weather

Reports and Proceedings

EUROPEAN SOCIETY OF CARDIOLOGY

Barcelona, Spain – 26 Aug 2022: An analysis in nearly 2.3 million Europeans has found detrimental associations between cold weather and deaths from heart disease, particularly in poor neighbourhoods. The late-breaking research is presented at ESC Congress 2022.1 Hot weather was linked with excess deaths from heart disease and stroke in patients with heart conditions.

Study author Professor Stefan Agewall of the University of Oslo, Norway said: “Climate change is leading to a rise in the average global temperature but also extreme cold in some regions. More than 70,000 excess deaths occurred across Europe during the summer of 2003 due to intense heatwaves.2 Cold weather also accounts for excess deaths and hospital admissions.3,4 Previously studies on the cardiovascular effects of heat and cold mainly used aggregated data, such as daily deaths in a city. The EXHAUSTION project used individual data, enabling us to identify vulnerable subgroups for protective interventions, thereby increasing resilience for future weather events.”

The analysis included 2.28 million adults from five cohort studies conducted in Italy, Germany, the UK, Norway, and Sweden between 1994 and 2010. The average age ranged from 49.7 years to 71.7 years and the proportion of women ranged from 36.0% to 54.5%. Participants with and without cardiovascular disease at baseline were included. Data on mortality and new-onset disease were collected through death and disease registries and follow up surveys. Daily average air temperatures at participants’ home addresses were collected from local weather stations or estimated using modelling of temperature data from weather stations

The relationships between temperature and cardiovascular conditions and death were analysed for all participants and in subgroups with particular characteristics. A time-stratified case-crossover study design was used where for each participant, the researchers compared the temperature on the day of the week an adverse event occurred (e.g. Monday) with the temperature on the same day of the week without an adverse event (e.g. all remaining Mondays) within the same month. Using within-participant comparisons between days in the same month eliminated the potential confounding effects of participant characteristics and time trends.

The analysis found increased risks of death from cardiovascular disease overall and ischaemic heart disease in particular, as well as an elevated risk of new-onset ischaemic heart disease, associated with cold weather. With an approximately 10°C temperature drop, from 5°C to -5°C, there was a 19% greater risk of death from cardiovascular disease (relative risk [RR] 1.19; 95% confidence interval [CI] 1.04–1.36) and a 22% elevated likelihood of death from ischaemic heart disease (RR 1.22; 95% CI 1.07–1.38). There was a 4% higher risk of new-onset ischaemic heart disease associated with an approximately 11°C temperature drop, from 2°C to -9°C (RR 1.04; 95% CI: 1.01–1.08).

Professor Agewall said: “The relationships between cold temperatures and deaths were more pronounced in men and people living in neighbourhoods with a low socioeconomic status. The links between cold and new-onset ischaemic heart disease were stronger among women and people older than 65 years.”

Heat was not related to detrimental effects in the overall study population. However, temperature rises from 15°C to 24°C were associated with 25% (RR 1.25; 95% CI 1.12–1.39) and 30% (RR 1.30; 95% CI 1.10–1.53) elevated risks of death from cardiovascular disease and stroke, respectively, in people with heart disease at baseline.

Professor Agewall said: “Clinicians can use this information to provide tailored advice to those most at risk of adverse health outcomes during hot and cold days. Patients with heart conditions should stay hydrated in hot weather and adhere to advice from their cardiologist on medication use. We can all check the news for extreme heat and cold alerts and follow safety tips from local authorities.”

 

ENDS

 

Notes to editors

Authors: ESC Press Office
Mobile: +33 (0)7 85 31 20 36
Email: press@escardio.org

The hashtag for ESC Congress 2022 is #ESCCongress.

Follow us on Twitter @ESCardioNews 

This press release accompanies an presentation at ESC Congress 2022. It does not necessarily reflect the opinion of the European Society of Cardiology.

Acknowledgements: The analysis was led by Dr. Alexandra Schneider from Helmholtz Munich.

Funding: This study was conducted within the framework of the EXHAUSTION project (Exposure to heat and air pollution in Europe – cardiopulmonary impacts and benefits of mitigation and adaptation), which has received funding from the European Union’s Horizon 2020 research and innovation programme.

Disclosures: There are no disclosures to report.

References and notes

1EXHAUSTION will be presented by Dr. Siqi Zhang from Helmholtz Munich during the session Latest science in primary and secondary prevention and environmental health on Friday 26 August at 14:00 to 15:15 CEST in room Dali.

2Robine JM, Cheung SLK, Le Roy S, et al. Death toll exceeded 70,000 in Europe during the summer of 2003. C R Biol. 2008;331:171–178.

3Gasparrini A, Guo Y, Hashizume M, et al. Mortality risk attributable to high and low ambient temperature: a multicountry observational study. Lancet. 2015;386:369–375.

4Sun Z, Chen C, Xu D, Li T. Effects of ambient temperature on myocardial infarction: A systematic review and meta-analysis. Environ Pollut. 2018;241:1106–1114.

 

About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2022

It is the world’s largest gathering of cardiovascular professionals, disseminating ground-breaking science both onsite in Barcelona and online – from 26 to 29 August. Explore the scientific programme. More information is available from the ESC Press Office at press@escardio.org.

Majority of clinicians in US safety net practices report ‘moral distress’ during COVID-19 pandemic

UNC School of Medicine’s Donald Pathman, MD, MPH, found that most healthcare providers experienced either mild or intense levels of moral distress during the first year of the pandemic due to issues related to patient care and their workplaces.

Peer-Reviewed Publication

UNIVERSITY OF NORTH CAROLINA HEALTH CARE

 

IMAGE: DONALD PATHMAN, MD, MPH view more 

CREDIT: UNC SCHOOL OF MEDICINE

CHAPEL HILL, NC – The distress of doctors and nurses working in hospitals during the COVID-19 pandemic has received much attention in news media and academic research, including their moral distress witnessing so many deaths at times when they could offer so little. Much less attention has been paid to the moral distress of clinicians working in other settings during the pandemic.

Using data from a survey of more than 2,000 primary care, dental, and behavioral health clinicians who work with low income patients in safety net clinics, UNC School of Medicine’s Donald Pathman, MD, MPH, found that nearly 72 percent reported experiencing either mild or intense levels of moral distress during the first year of the pandemic due to limits on what they could do for their patients, witnessing their patients’ struggles and the challenges of their own work situations.

This analysis, published in BMJ Open, was conducted from data late in 2020 from practices in 20 states.

“Most people receive their health care in office settings, and many clinicians working there experienced moral distress from how the pandemic limited the care they could provide to patients and from witnessing the pandemic’s effects on patients and coworkers,” said lead author Donald Pathman, MD, MPH, a professor in the UNC Department of Family Medicine.

Moral distress was defined in the survey as when one witnesses or does things that contradict deeply held moral and ethical beliefs and expectations. “Moral distress is a concept developed to understand the consequences of disturbing situations nurses can experience in hospitals, but the concept of moral distress is likely just as useful in understanding a type of distress clinicians in all disciplines and work settings experience,” Pathman said.

Respondents in the survey were 2,073 clinicians who work in community health centers, mental health facilities and other types of safety net clinics that provide care to low income patients who face barriers to receiving care in the mainstream U.S. healthcare system. Many of these patients are also members of racial-ethnic minority groups.

Among respondents, 28.4% reported no moral distress related to work during the pandemic. But 44.8% reported “mild” or “uncomfortable” levels of moral distress, and 26.8 percent described their moral distress as “distressing,” “intense” or “worst possible.” The latter two groups combined are 71.6% of respondents, a substantial majority.

Many of this study’s office-based clinicians reported moral distress from not being able to provide care to all patients — think of the closed practices early in the pandemic that then reopened but limited care to only the sickest patients — and not being able to provide best care to their patients when care protocols changed to minimize infecting patients and staff within the office and virtual visits were required even when in-office, face-to-face visits were better for their patients.

Other respondents felt moral distress witnessing how the pandemic affected the health and lives of their patients, some of whom they had known for years. One study nurse practitioner in North Carolina noted moral distress watching how the pandemic “has impacted families in our clinic and feeling powerless to make meaningful change.”

Other clinicians were morally distressed when their coworkers’ health was jeopardized or they lost their jobs. Respondents sometimes regarded the hardships for coworkers as unavoidable during the pandemic but sometimes as due to their employers’ lack of concern for clinic staff’s wellbeing. One dentist reported: “All our manager and director seem to care about is making money and how many patients we see. I was having to balance being exposed to so many patients then going home to my family and potentially exposing them.”

Some respondents reported moral distress from patients, clinic staff and people in the community not wearing masks or following public health recommendations, as well as the politicization of the pandemic. As healthcare professionals, they knew these precautions worked, and when people did not follow them they knew others would be infected needlessly.

Social inequities and health disparities morally distressed some respondents, such as a respondent distressed from, “Seeing how my patient population has been disproportionately affected by illness and death because of socioeconomic issues.” Pathman noted that, “given the type of individual who chooses to provide healthcare in low income communities, it is not surprising that some would be morally distressed watching the pandemic worsen the health and lives of their patients because of their limited resources.”

The consequences of moral distress are concerning. The article notes that moral distress is known to cause burnout, compassion fatigue, disengagement from patients and job turnover for nurses in hospital settings and is likely to also do so for clinicians in safety net practices.

Co-authors of the article are Jeffrey Sonis, MD, MPH, an associate professor in the UNC Departments of Social Medicine and Family Medicine; Thomas E. Rauner at the Nebraska Division of Public Health; Kristina Alton, MD, at Vanderbilt University Medical Center; Anna S. Headlee at the University of Nebraska-Lincoln, and Jerry N. Harrison at New Mexico Health Resources.

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JOURNAL

BMJ Open

DOI

10.1136/bmjopen-2022-061369 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Moral distress among clinicians working in US safety net practices during the COVID-19 pandemic: a mixed methods study

ARTICLE PUBLICATION DATE

25-Aug-2022