A biological fireworks show 300 million years in the making

DOE/ARGONNE NATIONAL LABORATORY

Research News

IMAGE: FROG EGGS LIKE THOSE PICTURED HERE RELEASE ZINC WHEN FERTILIZED, MUCH LIKE MAMMALIAN EGGS DO. view more 

CREDIT: (IMAGE BY TERO LAAKSO/LICENSED UNDER CC BY-SA 2.0.)

Five years ago, researchers at Northwestern University made international headlines when they discovered that human eggs, when fertilized by sperm, release billions of zinc ions, dubbed "zinc sparks."

Now, Northwestern has teamed up with the U.S. Department of Energy's (DOE) Argonne National Laboratory and Michigan State University (MSU) to reveal that these same sparks fly from highly specialized metal-loaded compartments at the egg surface when frog eggs are fertilized. This means that the early chemistry of conception has evolutionary roots going back at least 300 million years, to the last common ancestor between frogs and people.

"This work may help inform our understanding of the interplay of dietary zinc status and human fertility." -- Thomas O'Halloran, professor, Michigan State University

And the research has implications beyond this shared biology and deep-rooted history. It could also help shape future findings about how metals impact the earliest moments in human development.

"This work may help inform our understanding of the interplay of dietary zinc status and human fertility," said Thomas O'Halloran, the senior author of the research paper published June 21 in the journal Nature Chemistry.

O'Halloran was part of the original zinc spark discovery at Northwestern and, earlier this year, he joined Michigan State as a foundation professor of microbiology and molecular genetics and chemistry. O'Halloran was the founder of Northwestern's Chemistry of Life Processes Institute, or CLP, and remains a member.

The team also discovered that fertilized frog eggs eject another metal, manganese, in addition to zinc. It appears these ejected manganese ions collide with sperm surrounding the fertilized egg and prevent them from entering.

"These breakthroughs support an emerging picture that transition metals are used by cells to regulate some of the earliest decisions in the life of an organism," O'Halloran said.

To make these discoveries, the team needed access to some of the most powerful microscopes in the world as well as expertise that spanned chemistry, biology and X-ray physics. That unique combination included collaborators at the Center for Quantitative Element Mapping for the Life Sciences, or QE-Map, an interdisciplinary National Institutes of Health-funded research hub at MSU and Northwestern's CLP. The research relied heavily on the tools and expertise available at Argonne.

The research team brought sections of frog eggs and embryos to Argonne for analysis. Using both X-ray and electron microscopy, the researchers determined the identity, concentrations and intracellular distributions of metals both before and after fertilization.

X-ray fluorescence microscopy was conducted at beamline 2-ID-D of the Advanced Photon Source (APS), a DOE Office of Science User Facility at Argonne. Barry Lai, group leader at Argonne and an author on the paper, said that the X-ray analysis quantified the amount of zinc, manganese and other metals concentrated in small pockets around the outer layer of the eggs. They found these pockets contained more than 30 times the manganese as the rest of the eggs, and 10 times the zinc.

"We are able to do this analysis because of the elemental sensitivity of the beamline," Lai said. "In fact, it is so sensitive that substantially lower concentrations can be measured."

Complementary scans were conducted using transmission electron microscopy at the Center for Nanoscale Materials (CNM), a DOE Office of Science User Facility at Argonne. Further analysis was performed on a separate prototype scanning transmission electron microscope that includes technology developed by Argonne Senior Scientist Nestor Zaluzec, an author on the paper. These scans were performed at smaller scales -- down to a few nanometers, about 100,000 times smaller than the width of a human hair -- but found the same results: high concentrations of metals in pockets around the outer layer.

Both X-ray and electron microscopy showed that the metals in these pockets were almost completely released after fertilization.

"Argonne has the tools necessary to examine these biological samples at these scales without destroying them with X-rays or electrons," Zaluzec said. "It's a combination of the right resources and the right expertise."

The APS is in the process of undergoing a massive upgrade, one that will increase the brightness of its X-ray beams by up to 500 times. Lai said that an upgraded APS could complete these scans much more quickly or with higher spatial resolution. What took more than an hour for this research could be done in less than one minute after the upgrade, Lai said.

"We often think of genes as key regulating factors, but our work has shown that atoms like zinc and manganese are critical to the first steps in development after fertilization," said MSU Provost Teresa K. Woodruff, Ph.D., another senior author on the paper.

Woodruff, an MSU foundation professor and former member of CLP, was also a leader of the Northwestern team that discovered zinc sparks five years ago. With the discovery of manganese sparks in African clawed frogs, or Xenopus laevis, the team is excited to explore whether the element is released by human eggs when fertilized.

"These discoveries could only be made by interdisciplinary groups, fearlessly looking into fundamental steps," she said. "Working across disciplines at the literal edge of technology is one of the most profound ways new discoveries take place."

"Xenopus is a perfect system for such studies because their eggs are an order of magnitude larger than human or mouse eggs, and are accessible in large numbers " said Carole LaBonne, another senior author on the study, CLP member, and chair of the Department of Molecular Biosciences at Northwestern. "The discovery of zinc and manganese sparks is exciting, and suggests there may be other fundamental signaling roles for these transition metals."

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About Argonne's Center for Nanoscale Materials The Center for Nanoscale Materials is one of the five DOE Nanoscale Science Research Centers, premier national user facilities for interdisciplinary research at the nanoscale supported by the DOE Office of Science. Together the NSRCs comprise a suite of complementary facilities that provide researchers with state-of-the-art capabilities to fabricate, process, characterize and model nanoscale materials, and constitute the largest infrastructure investment of the National Nanotechnology Initiative. The NSRCs are located at DOE's Argonne, Brookhaven, Lawrence Berkeley, Oak Ridge, Sandia and Los Alamos National Laboratories. For more information about the DOE NSRCs, please visit https://science.osti.gov/User-Facilities/User-Facilities-at-a-Glance.

About the Advanced Photon Source

The U. S. Department of Energy Office of Science's Advanced Photon Source (APS) at Argonne National Laboratory is one of the world's most productive X-ray light source facilities. The APS provides high-brightness X-ray beams to a diverse community of researchers in materials science, chemistry, condensed matter physics, the life and environmental sciences, and applied research. These X-rays are ideally suited for explorations of materials and biological structures; elemental distribution; chemical, magnetic, electronic states; and a wide range of technologically important engineering systems from batteries to fuel injector sprays, all of which are the foundations of our nation's economic, technological, and physical well-being. Each year, more than 5,000 researchers use the APS to produce over 2,000 publications detailing impactful discoveries, and solve more vital biological protein structures than users of any other X-ray light source research facility. APS scientists and engineers innovate technology that is at the heart of advancing accelerator and light-source operations. This includes the insertion devices that produce extreme-brightness X-rays prized by researchers, lenses that focus the X-rays down to a few nanometers, instrumentation that maximizes the way the X-rays interact with samples being studied, and software that gathers and manages the massive quantity of data resulting from discovery research at the APS.

This research used resources of the Advanced Photon Source, a U.S. DOE Office of Science User Facility operated for the DOE Office of Science by Argonne National Laboratory under Contract No. DE-AC02-06CH11357.

Argonne National Laboratory seeks solutions to pressing national problems in science and technology. The nation's first national laboratory, Argonne conducts leading-edge basic and applied scientific research in virtually every scientific discipline. Argonne researchers work closely with researchers from hundreds of companies, universities, and federal, state and municipal agencies to help them solve their specific problems, advance America's scientific leadership and prepare the nation for a better future. With employees from more than 60 nations, Argonne is managed by UChicago Argonne, LLC for the U.S. Department of Energy's Office of Science.

The U.S. Department of Energy's Office of Science is the single largest supporter of basic research in the physical sciences in the United States and is working to address some of the most pressing challenges of our time. For more information, visit https://energy.gov/science.

 

What kind of sea ice is that? Ask Knut!

A new app under development is using deep learning and artificial intelligence to classify different kinds of sea ice

NORWEGIAN UNIVERSITY OF SCIENCE AND TECHNOLOGY

Research News

 

IMAGE: THE ASK KNUT APP HAS BEEN DEVELOPED USING THOUSANDS OF DIFFERENT KINDS OF ICE PHOTOGRAPHS. THE IMAGE SHOWS WHAT THE APP SEES COMPARED TO WHAT HUMANS SEE. view more 

CREDIT: SVEINUNG LØSET/NTNU

If you've watched Netflix, shopped online, or run your robot vacuum cleaner, you've interacted with artificial intelligence, AI. AI is what allows computers to comb through an enormous amount of data to detect patterns or solve problems. The European Union says AI is set to be a "defining future technology."

And yet, as much as AI is already interwoven into our everyday lives, there's one area of the globe where AI and its applications are in their infancy, says Ekaterina Kim, an associate professor at the Norwegian University of Science and Technology's (NTNU) Department of Marine Technology. That area is the Arctic, an area where she has specialized in studying sea ice, among other topics.

"It's used a lot in marketing, in medicine, but not so much in Arctic (research) communities," she said. "Although they have a lot of data, there is not enough AI attention in the field. There's a lot of data out there, waiting for people to do something with them."

So Kim and her colleagues Ole-Magnus Pedersen, a PhD candidate from the Department of Marine Technology and Nabil Panchi, from the Indian Institute of Technology Kharagpur, decided to see if they could develop an app that used artificial intelligence to identify sea ice in the Arctic.

You may think there's not much difference between one chunk of sea ice and another, but that's just not so.

In addition to icebergs, there's deformed ice, level ice, broken ice, ice floes, floe bergs, floe bits, pancake ice and brash ice.

The researchers wanted the app to be able to distinguish between the different kinds of ice and other white and blue objects out there, like sky, open water and underwater ice.

Different kinds of ice really matter to ship captains, for example, who might be navigating in icy waters.  Actual icebergs are nothing like brash ice, the floating bits of ice that are 2 metres in diameter or less. Think of it --the Titanic wouldn't have sunk if it had just blundered into a patch of brash ice instead of a big iceberg.

Another factor that adds urgency to the situation is climate change, which is dramatically altering sea ice as oceans warm. Even with the help of satellite images and onboard ship technologies, knowing what's in icy waters ahead can be a difficult challenge, especially in fogs or storms.

"Ice can be very difficult for navigation," Kim said. "From the water (at the ship level) It can be hard to detect where there is strong ice, multiyear ice, and different ice.  Some ice is much more dangerous than other types.

The team began teaching their app's AI system using a comprehensive collection of photographs taken by another NTNU ice researcher, Sveinung Løset.

But an AI system is like a growing child -- if it is to learn, it needs to be exposed to lots of information. That's where turning the AI into an app made sense. Although the COVID-19 pandemic has shut down most cruise operations, as the pandemic wains, people will begin to take cruises again -- including to the Arctic and Antarctic.

Kim envisions tourists using the app to take pictures of different kinds of ice to see who finds the most different kinds of ice. And every one of those pictures helps the app learn.

"If the app is used for 'infotainment,'  accuracy isn't that important," Kim said.  "It can even be fun when the model makes mistakes."

As the AI learns, Kim says, the increasingly complex dataset could be taken into the classroom, where navigators could learn about ice in a much more sophisticated way.

Currently, students just look at pictures or listen to a PowerPoint presentation, where lecturers describe the different kinds of ice.

"So this could revolutionize how you learn about ice," she said. "You could have it in 3-D, you could emerge yourself and explore this digital image all around you, with links to different kinds of ice types."

The researchers are planning an AI in the Arctic workshop in September to explore AI applications in these remote areas.

"There are extreme challenges unique to the Arctic, from human activities and impacts in remote Arctic locations to Arctic data acquisition, sharing, and quality," Kim said. "We need to direct AI applications towards solving Arctic challenges that are important for the world as well as to highlight the 'black holes' or knowledge gaps and raise awareness on what does not work, needs improvements."

CAPTION

As global warming thaws Arctic sea ice, more and more ships will travel these waters. Knowing what kinds of ice they might meet can help make the journey safer. The photo shows the Swedish icebreaker Oden in broken and brash ice.

CREDIT

Sveinung Løset/NTNU

For more information about the workshop, see https://www.ntnu.edu/imt/aidingarctic

Reference: N. Panchi, E. Kim and A. Bhattacharyya, "Supplementing remote sensing of ice: Deep learning-based image segmentation system for automatic detection and localization of sea ice formations from close-range optical images," in IEEE Sensors Journal, doi: 10.1109/JSEN.2021.3084556.

 

Reading the rocks: Geologist finds clues to ancient climate patterns in chert

BINGHAMTON UNIVERSITY

Research News

BINGHAMTON, N.Y. -- A million years ago, dry seasons became more frequent and forests retreated before the encroaching savanna. Meanwhile, clustered around a nearby lake, our ancient ancestors fashioned stone tools.

During the long press of years, mud and sediment in that East African lake turned to stone, trapping pollen and microscopic organisms in its lattice. Today, researchers like Kennie Leet analyze samples of these ancient sediments, known as sediment cores, to create a picture of the environment early humans called home.

A doctoral student in geological sciences, Leet is the first author on "Labyrinth patterns in Magadi (Kenya) cherts: Evidence for early formation from siliceous gels," published in a recent issue of Geology, the leading journal in the field. Co-authors include Distinguished Professor of Geological Sciences and Environmental Studies Tim Lowenstein, her advisor, as well as Robin Renaut of Canada's University of Saskatchewan, R. Bernhart Owen of Hong Kong Baptist University and Andrew Cohen of the University of Arizona.

Leet's research is part of the National Science Foundation-funded Hominin Sites and Paleolakes Drilling Project (HSPDP), which looks at how the climate may have impacted hominin evolution in the East African rift. Overall, the project looks at the last 5 million years; Leet's portion of the project considers the last million.

She particularly focuses on the origin of the chert found in Kenya's Lake Magadi. A fine-grained rock that forms from siliceous material, chert is "cryptocrystalline," composed of crystals so small that they can't even be seen by high-powered microscopes, much less the naked eye.

Scientists believe that chert forms on the earth's surface and thus contains information about the environment at the time of its formation, she explained. Because of this quality, they can use chert to calculate the time period for particular climactic events, such as droughts -- not unusual in East Africa, where the climate oscillates between wet and dry periods.

Opening a window into the distant past, the chert points to an even larger trend.

"One of the surprising things we found was that there has been a progressive drying trend for the last million years in East Africa. It's just been progressively getting drier and drier," she said. "But in that, we still have the oscillation between wet and dry."

In the Geology article, she explores a labyrinth pattern she found in the rocks of this period. Patterns are common in nature, and this specific one is formed by drying, she explained.

"It tells us that all of the chert formation and solidification occurred near the surface, where there was exposure to air," she said. "Because this happened before the sediments were buried and compacted, there is other supporting evidence, such as really beautifully preserved plant fragments and single-celled organisms called diatoms."

The time period coincides with the region's transition from trees and forests to grasslands, which biologists and microbiologists on the team are able to track through pollen preserved in the sediment core. During that period, the early humans of Lake Magadi were also creating stone tools in new ways. Researchers wonder: Were these ancient communities moving about and trading more, prompted by drought?

Interestingly, the trend has reversed over the last decade, with the region becoming wetter. In fact, one of the places she stayed during a visit to Kenya in 2019 is now underwater, she said.

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Climate changed the size of our bodies and, to some extent, our brains

UNIVERSITY OF CAMBRIDGE

Research News

IMAGE: SKULLS: - LEFT: AMUD 1, NEANDERTHAL, 55.000 YEARS AGO, ~1750 CM³ - MIDDLE: CRO MAGNON, HOMO SAPIENS, 32.000 YEARS AGO, ~1570 CM³ - RIGHT: ATAPUERCA 5, MIDDLE PLEISTOCENE HOMO, 430.000 YEARS AGO,... view more 

CREDIT: MANUEL WILL

• The average body size of humans has fluctuated significantly over the last million years and is strongly linked to temperature.
• Colder, harsher climates drove the evolution of larger body sizes, while warmer climates led to smaller bodies.

  Brain size also changed dramatically but did not evolve in tandem with body size.

An interdisciplinary team of researchers, led by the Universities of Cambridge and Tübingen, has gathered measurements of body and brain size for over 300 fossils from the genus Homo found across the globe. By combining this data with a reconstruction of the world's regional climates over the last million years, they have pinpointed the specific climate experienced by each fossil when it was a living human.

The study reveals that the average body size of humans has fluctuated significantly over the last million years, with larger bodies evolving in colder regions. Larger size is thought to act as a buffer against colder temperatures: less heat is lost from a body when its mass is large relative to its surface area. The results are published today in the journal Nature Communications.

Our species, Homo sapiens, emerged around 300,000 years ago in Africa. The genus Homo has existed for much longer, and includes the Neanderthals and other extinct, related species such as Homo habilis and Homo erectus.

A defining trait of the evolution of our genus is a trend of increasing body and brain size; compared to earlier species such as Homo habilis, we are 50% heavier and our brains are three times larger. But the drivers behind such changes remain highly debated.

"Our study indicates that climate - particularly temperature - has been the main driver of changes in body size for the past million years," said Professor Andrea Manica, a researcher in the University of Cambridge's Department of Zoology who led the study.

He added: "We can see from people living today that those in warmer climates tend to be smaller, and those living in colder climates tend to be bigger. We now know that the same climatic influences have been at work for the last million years."

The researchers also looked at the effect of environmental factors on brain size in the genus Homo, but correlations were generally weak. Brain size tended to be larger when Homo was living in habitats with less vegetation, like open steppes and grasslands, but also in ecologically more stable areas. In combination with archaeological data, the results suggest that people living in these habitats hunted large animals as food - a complex task that might have driven the evolution of larger brains.

"We found that different factors determine brain size and body size - they're not under the same evolutionary pressures. The environment has a much greater influence on our body size than our brain size," said Dr Manuel Will at the University of Tubingen, Germany, first author of the study.

He added: "There is an indirect environmental influence on brain size in more stable and open areas: the amount of nutrients gained from the environment had to be sufficient to allow for the maintenance and growth of our large and particularly energy-demanding brains."

This research also suggests that non-environmental factors were more important for driving larger brains than climate, prime candidates being the added cognitive challenges of increasingly complex social lives, more diverse diets, and more sophisticated technology.

The researchers say there is good evidence that human body and brain size continue to evolve. The human physique is still adapting to different temperatures, with on average larger-bodied people living in colder climates today. Brain size in our species appears to have been shrinking since the beginning of the Holocene (around 11,650 years ago). The increasing dependence on technology, such as an outsourcing of complex tasks to computers, may cause brains to shrink even more over the next few thousand years.

"It's fun to speculate about what will happen to body and brain sizes in the future, but we should be careful not to extrapolate too much based on the last million years because so many factors can change," said Manica.

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EHR alerts go unread, do not lead to deprescribing of medicines linked to dementia

REGENSTRIEF INSTITUTE

Research News

 

IMAGE: THE VAST MAJORITY OF ELECTRONIC HEALTH RECORD (EHR) ALERTS ATTEMPTING TO REDUCE THE PRESCRIBING OF HIGH-RISK MEDICATIONS LINKED TO DEMENTIA IN OLDER ADULTS WENT UNREAD IN A STUDY LED BY... view more 

CREDIT: REGENSTRIEF INSTITUTE

INDIANAPOLIS -- The vast majority of electronic health record (EHR) alerts attempting to reduce the prescribing of high-risk medications linked to dementia in older adults went unread in a study led by research scientists from Regenstrief Institute, Purdue University and Indiana University School of Medicine. The goal of the intervention was to facilitate the deprescribing of anticholinergics through both provider and patient-based alerts, however, engagement with the alerts was so low, the study team was unable to conclude if this approach could be an effective method.

Anticholinergics are drugs which affect the brain by blocking acetylcholine, a nervous system neurotransmitter that influences memory, alertness and planning skills. They are linked to dementia and prescribed for many conditions common in older adults including depression, urinary incontinence, irritable bowel syndrome and Parkinson's disease. These medications are used by approximately one in four older adults each year, and nearly half of older adults have used this type of medication at least once in a five-year period.

Many medical groups have come out in support of deprescribing anticholinergics, but it is challenging to execute in an already busy primary care environment.

"Deprescribing is very complex and rarely prioritized over common medical problems during visits with primary care providers," said study lead author Noll Campbell, PharmD, M.S., research scientist at the IU Center for Aging Research at Regenstrief and assistant professor of pharmacy at Purdue University College of Pharmacy. "In this study, we used principles of behavioral economics in the design of EHR nudges directed at both providers and patients to promote the deprescribing of high-risk anticholinergic medications. However, very few of the alerts were viewed by either recipient, so we are now evaluating how we can change or improve this approach."

In this study, an alert let the provider know that the patient had high-risk anticholinergic medications prescribed in the medical record and offered alternatives to those medications. Alerts also prompted staff to play a video providing education about the medicines and modeling a discussion that led to a change in prescription for patients who were prescribed one of the target medications.

The research team conducted the cluster randomized trial in Eskenazi Health clinics and compared the medication records to the previous year to see if there were any changes. They found there were no significant differences in deprescribing between the control group and the intervention group.

During the course of the study, 85 percent of alerts to providers and 95 percent of alerts to medical assistants went unread, so study authors cannot conclude that priming patients and providers for the discussion is not a feasible strategy, only that the methods used in this study were not successful in reaching the target recipients.

"One option going forward is to experiment with different design approaches in EMR-based nudges," said Dr. Campbell. "Alternatively, a shift towards human-based interventions that can manage the complexity of deprescribing activities may be more effective at deprescribing high-risk anticholinergic medications. While we pursue the goal of understanding clinical implications, we are also cognizant of the scalability of interventions if there is clinical benefit realized by reducing these high-risk medications."

Dr. Campbell and his colleagues at Regenstrief are currently conducting a clinical trial designed to determine if stopping anticholinergic medications results in sustained improvements in cognition. This trial involves clinical pharmacists working with physicians and patients to switch to safer medicines.

Another study at the IU Center for Aging Research at Regenstrief is testing an app called BrainSafe, which provides information on anticholinergics to patients with the goal of leading them to initiate a deprescribing conversation.

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"Multicomponent behavioral intervention to reduce exposure to anticholinergics in primary care older adults" is published in the June print issue of the Journal of the American Geriatrics Society. This study was supported by a grant from the Agency for Healthcare Research and Quality (AHRQ) (P30HS24384).

In addition to Dr. Campbell, authors on the paper are Richard Holden, PhD of Regenstrief, the Sandra Eskenazi Center for Brain Care Innovation, IU School of Medicine and the Center for Health Innovation and Implementation Science; Qing Tang, M.S. of IU School of Medicine; Malaz Boustani, M.D., MPH of Regenstrief, the Sandra Eskenazi Center for Brain Care Innovation, IU School of Medicine and the Center for Health Innovation and Implementation Science; Evgenia Teal, M.A. of Regenstrief; Jennifer Hillstrom, B.S. of the Sandra Eskenazi Center for Brain Care Innovation; Wanzhu Tu, PhD of Regenstrief Institute and IU School of Medicine; Daniel O. Clark, PhD of Regenstrief, the Sandra Eskenazi Center for Brain Care Innovation and IU School of Medicine and Christopher M. Callahan, M.D. of Regenstrief, the Sandra Eskenazi Center for Brain Care Innovation and IU School of Medicine.

About Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute's research mission.

About Purdue University College of Pharmacy

The mission of the Purdue University College of Pharmacy is to advance scientific discovery and development, maximize global health outcomes through patient care and public service, and educate and train students to become leading pharmacists and scientists. The goal is to transform the practice and science of pharmacy to lead advances in human health.

About IU School of Medicine

IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.

About Noll Campbell, PharmD, M.S.

In addition to his role as a research scientist at Regenstrief Institute, Noll Campbell, PharmD, M.S., is an assistant professor of pharmacy practice at the Purdue University College of Pharmacy.

SCIENCE SEZ

Discrimination, stress linked to poorer heart health in transgender, gender diverse adults

American Heart Association Scientific Statement

AMERICAN HEART ASSOCIATION

Research News

DALLAS, July 8, 2021 -- The stress of experiencing discrimination in multiple ways, including transphobia, interpersonal discrimination, violence and public policies specifically targeting transgender and gender diverse (TGD) people, is linked to higher rates of heart disease among the TGD population, according to a new scientific statement from the American Heart Association, published today in Circulation, the Association's flagship journal. A scientific statement is an expert analysis of current research and may inform future guidelines.

The statement, Assessing and Addressing Cardiovascular Health in People Who Are Transgender and Gender Diverse, examines existing research about TGD-specific cardiovascular health disparities, identifies research gaps and provides suggestions for systematically improving overall heart health and care of TGD people. The statement writing group suggests improving overall heart health within the TGD community will require a multi-pronged approach that includes health care professionals, educators, researchers and policymakers.

In terms of health, transgender, gender diverse and gender non-conforming people are considered "gender minorities." Expanding on the minority stress theory, statement writing group members documented how chronically high levels of stress faced by members of stigmatized, underrepresented populations associate with poor health outcomes and health disparities. They concluded that higher rates of cardiovascular prevalence and deaths among TGD people, while related to traditional cardiovascular risk factors, are also significantly driven by psychosocial stressors across the lifespan at multiple levels, including structural violence, discrimination, lack of affordable housing and access to health care.

"Heart health of transgender and gender diverse people is an important and understudied topic, and it's critical we highlight what we know and what we need to know about heart health among these populations," said Carl G. Streed, Jr., M.D., M.P.H., chair of the writing group for the statement, an assistant professor of internal medicine at Boston University School of Medicine and the research lead at the Center for Transgender Medicine and Surgery at Boston Medical Center. "Addressing these issues will require a focus on 'traditional' risk factors for heart attack and stroke, and a commitment to fight transphobia in order to decrease the additional stress experienced by this population."

This statement, specific to TGD persons, builds upon the Association's 2020 scientific statement, Assessing and Addressing Cardiovascular Health in Lesbian, Gay, Bisexual, Transgender and Queer (or Questioning) Adults, which noted that more than half (56%) of LGBTQ adults and 70% of those who are transgender or gender non-conforming reported experiencing some form of discrimination from a health care professional.

The new statement notes a growing body of research indicates TGD populations may be at a significantly greater risk for cardiovascular disease compared to their cisgender peers. Transgender men are twice as likely to have a heart attack than cisgender men and four times as likely than cisgender women. TGD people are also more likely to experience blood clots when undergoing estrogen hormone therapy. The writing group points out more investigation is urgently needed to explain these disparities.

TGD populations also face unique psychological stressors, including gender non-affirmation (e.g., being called by the incorrect pronoun), discrimination, rejection or concealment of gender identity and violence based on gender identity. These factors contribute to higher overall levels of stress, which, in turn, negatively affect heart health. Additionally, TGD people who are also part of historically excluded racial or ethnic groups experience multiple layers of stress, such as lower income levels or limited access to health care. Research on how these complex and intertwined factors affect heart health within TGD populations is limited.

Most gender identification options in a clinical or research setting include only "male" and "female," so while population-based studies can help in understanding some cardiovascular health risk factors, data on TGD people is scarce. The statement suggests studies should standardize measures of gender identity and expression to collect larger samples of underrepresented groups among TGD populations.

Data collected through electronic health records (EHRs) does present an advancement in terms of data access, however, EHRs often lack the ability to capture sociocultural factors relevant to heart health among TGD persons. It's important to note that TGD individuals who do not regularly access health care services are less likely to be included in EHR data, and TGD people who are uncomfortable disclosing gender identity to health care professionals will be unlikely to be identified as TGD in EHR systems.

While the ability to document sexual orientation and gender identity has been required for electronic health records since 2018, additional steps are needed to ensure culturally responsive and supportive care. The statement details the critical need for researchers and clinicians to use gender-affirming pronouns and obtain an anatomy inventory where appropriate, noting that assumptions about a TGD person's identity or anatomy may negatively impact clinical decisions.

The writing group suggests increased training across health professions would enhance clinical practices and foster more compassionate care for TGD persons. While many institutions acknowledge the need for TGD educational content, efforts to include these topics into clinical curricula have not progressed. The statement suggests a collaborative effort with organizational-level mandates across governing bodies is needed to create a curriculum that encompasses gender affirming hormone therapy, surgical procedures, anatomy-based preventive health, social determinants of health and the proper assessment of sex and gender in health care settings.

While the statement emphasizes existing data is limited, it reviews research on disparities among TGD people as it relates to the American Heart Association's Life's Simple 7 to measure ideal heart health and how hormone therapy may affect heart health for TGD people. Current research on blood pressure, lipid profiles or blood sugar levels for TGD persons is too sparse and inconclusive, although the writing group does suggest several areas of Life's Simple 7 that are directly linked to heart attacks and strokes. The evaluation of existing research found:

TGD people are more likely (24%) to report tobacco use than the remainder of the U.S. population (18%).

Transgender men are less likely to exercise, especially in older age.

TGD persons undergoing gender-affirming hormone therapy are more physically active, which may be because they report being more satisfied with their bodies.

TGD youth report eating more fast food and using unsafe ways of trying to manage their weight (e.g., diet pills, fasting or laxative abuse).

TGD people report overall higher body mass index (BMI), yet they may experience additional stress about their weight since many surgeons have strict BMI cut-offs above which they will not perform gender-affirming surgeries.

"Discrimination also contributes to disparities in social determinants of health among TGD populations, and many TGD persons are at even greater risk of heart disease and stroke due to transphobia and experiences of discrimination based on gender non-conformity," said Lauren B. Beach, Ph.D., J.D., vice-chair of the statement writing group and research assistant professor in the department of medical social sciences at Northwestern University's Feinberg School of Medicine in Chicago. "Systematic transphobic discrimination results in a higher burden of workplace discrimination, job loss and unemployment among TGD populations. Combined with experiences of discrimination in health care settings, lack of access to a stable income further limits health care access among TGD people. These structural factors combine to result simultaneously in higher levels of chronic stress and in lower levels of resources to prevent or manage a broad variety of health conditions including cardiovascular disease."

The writing group also cited studies showing that TGD persons experience disproportionate burdens of additional cardiovascular risk factors, including living with HIV, vascular dysfunction, trouble sleeping and alcohol abuse.

The writing group acknowledges limited data and encourages further research to understand the numerous and complex issues faced by TGD individuals and as a community. The statement emphasizes available information does illustrate that TGD people often experience challenges due to unique stressors, including internalizing gender identity, sexual victimization and concerns about hormone therapies and gender-affirming surgeries.

"Data specific to transgender and gender diverse persons lag behind what is needed to understand and improve individual and community heart health. The information available is rapidly improving, though," Streed said. "This statement summarizes the available evidence showing that addressing traditional cardiovascular risk factors and decreasing stigma-linked stress, together, would improve the heart health of TGD people. By focusing on the unique issues affecting the well-being of transgender and gender diverse persons, we have the potential to do better for everyone."

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This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association's Council on Peripheral Vascular Disease; the Council on Arteriosclerosis, Thrombosis and Vascular Biology; the Council on Cardiovascular and Stroke Nursing; the Council on Cardiovascular Radiology and Intervention, the Council on Hypertension; and the Stroke Council. The statement is endorsed by the American Academy of Physician Assistants. The American Medical Association affirms the educational benefit of this scientific statement.

Co-authors and members of the volunteer writing group are Billy A. Caceres, Ph.D., R.N., FAHA; Nadia L. Dowshen, M.D., M.S.H.P.; Kerrie L. Moreau, Ph.D.; Monica Mukherjee, M.D., M.P.H.; Tonia Poteat, Ph.D., P.A.-C., M.P.H.; Asa Radix, M.D. Ph.D., M.P.H.; Sari L. Reisner, Sc.D.; and Vineeta Singh, M.D., FAHA. Author disclosures are in the manuscript.

Additional Resources:

Multimedia is available on the right column of the release link: https://newsroom.heart.org/news/discrimination-stress-linked-to-poorer-heart-health-in-transgender-gender-diverse-adults?preview=129cf7aad1a1ed3c6844e742bbfbba87

The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association's overall financial information are available here.

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public's health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org , Facebook , Twitter or by calling 1-800-AHA-USA1.

 

Yoga helps reduce work-related stress

WILEY

Research News

 

Physical relaxation through yoga or other practices can help reduce work-related stress, according to an analysis of studies conducted in healthcare staff.

The analysis, which is published in the Journal of Occupational Health, included 15 randomized clinical trials with a total of 688 healthcare workers. The studies examined the effects of yoga, massage therapy, progressive muscle relaxation, and stretching on alleviating stress and improving physical and mental health.

Overall, the physical relaxation methods reduced measures of occupational stress compared with no intervention. More detailed analyses indicated that only yoga and massage therapy were more effective than no intervention, with yoga being the best method.

"Work-related stress has been linked with cardiovascular disease, diabetes, depression, and other serious causes of morbidity. Our results suggest that physical relaxation methods are helpful in reducing occupational stress," said lead author Michael Zhang, MD, of the Southern Nevada Health District. "Yoga is particularly effective and can be delivered virtually, making it convenient for employers to offer distance options to promote worker health."

 

How can counselors address social justice amid climate change?

WILEY

Research News

 

We're currently living in what many scientists are calling the Anthropocene, the period during which human activity has been the dominant influence on climate and the environment. An article published in the Journal of Multicultural Counseling and Development discusses how counselors can promote environmental justice during this time.

The Environmental Protection Agency defines environmental justice as "the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies."

The article accomplishes three goals:

• It builds awareness about climate change and the Anthropocene among counselors.
• It expands knowledge regarding how climate change may exacerbate issues of social inequality.
• And it demonstrates how counselors can address environmental justice issues affecting clients and their communities.

The article's author, Alexander J. Hilert, PhD, LPC, CCTP, of William & Mary, provides examples of how counselors can make a difference, noting that they can use their skills, such as group facilitation, to help educate communities on the climate crisis or to help environment activists process their grief to help prevent burnout. Also, counselor educators can help lead the way by focusing research on the implications of the climate crisis on marginalized communities.

"As counselors, it is our ethical duty to respond to issues of systemic injustice that affect the lives of our clients," said Hilert. "Using the framework of environmental justice, counselors can better understand the disproportionate impacts of climate change on communities experiencing marginalization and oppression, and how we can respond through advocacy and outreach."

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Improving transparency of integrated assessment models related to climate change

WILEY

Research News

Integrated Assessment Models (IAMs) connect trends in future socio-economic and technological development with impacts on the environment, such as global climate change. Critics have taken issue with the transparency of IAM methods and assumptions as well as the transparency of assessments of IAMs by the Intergovernmental Panel on Climate Change (IPCC), the United Nations body for assessing the science related to climate change.

An article published in WIREs Climate Change that's co-authored by officials at the IPCC documents various activities underway to enhance the transparency of IAMs and their assessments.

"The purpose of this paper is to document how both the IAM community and IPCC are working to enhance transparency and to suggest some criteria for judging the success of these efforts," the authors wrote. "Transparency does not in itself guarantee scientific closure, but it facilitates debate and provides a clearer evidence base for policymakers."

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Wage inequality negatively impacts customer satisfaction and does not improve long-term firm performance

News from the Journal of Marketing

AMERICAN MARKETING ASSOCIATION

Research News

 

Researchers from University of Mannheim published a new paper in the Journal of Marketing that examines the effect of wage inequality on customer satisfaction and firm performance.

The study, forthcoming in the Journal of Marketing, is titled "Wage Inequality: Its Impact on Customer Satisfaction and Firm Performance" and is authored by Boas Bamberger, Christian Homburg, and Dominik M. Wielgos.

Irrespective of wage cuts and employee layoffs, the wages of top managers rose to record levels during the pandemic and wage inequality continues to grow worldwide. However, according to a 2015 OECD report, "wage inequality is harmful to long-term economic growth and undermines societal cohesion." This situation raises the question: Do firms have an incentive to raise wage inequality?

This new study addresses this question by examining the impact of wage inequality on customer satisfaction and firm performance. The researchers surveyed more than 100 top sales and marketing managers in public firms selling to businesses in three countries. They analyzed the responses and company financial data to understand how wage inequality impacts customer satisfaction and firm performance.

Results show that unequal wages between top managers and employees can boost the short-term profitability of a firm. As Bamberger explains, "In the long run, however, this benefit fades. What persists is that wage inequality motivates employees to opportunistically exploit customers and weakens a firm's customer-oriented culture, thereby harming customer satisfaction.

How does this happen? Suppose a firm has high wage inequality. Thus, the ultimate prize in a tournament setting, to gradually rise to top management, is a strong incentive for employees at all levels. But in the process, they may engage in opportunistic behaviors and also collaborate less with coworkers.

For example, to enhance her chances for promotion, an employee might show more effort by interacting with customers more frequently to better understand and fulfill their needs to boost sales. By contrast, she could also distort facts about products to close deals more quickly.

Non-customer-facing employees could also be affected. Take, for instance, an R&D employee. He could interact with customers more often to learn and adapt innovations to their needs to increase sales. Conversely, he could also design products to fail to force customers to buy a product over and over again.

"Through customer-directed effort or opportunism, employees may improve their chances of getting promoted to the next higher level. Our results show that wage inequality does raise customer-directed effort and opportunism," says Homburg.

At the same time, wage inequality might also weaken collaboration among coworkers. An employee who worries about advancing to the next higher level is less concerned about their coworkers. But less collaboration impairs the flows of information and knowledge about customers throughout the firm. This, in turn, can lead to worse coordination between departments. Ultimately, the firm becomes less responsive to the changing needs of customers. Thus, wage inequality weakens the customer-oriented culture of a firm.

The adverse impact wage inequality has on opportunism and customer-oriented culture extends to customer satisfaction and reduces the short-term profitability of a firm. At the same time, wage inequality also raises a firm's short-run profits through a direct path. Despite the harm through the customer path, the total impact of wage inequality on short-term profitability is slightly positive.

This slightly positive effect on short-term profitability holds in a different sample with more than 500 observations of U.S. firms selling to consumers. Wielgos explains that "When we analyzed how wage inequality plays out in the long run, the situation reverses. The harm that wage inequality causes to customer satisfaction leads to long-term performance decline. In sum, a firm sees no profitability lift from wage inequality in the long run."

Do firms have an incentive to raise wage inequality? In terms of bottom-line impact, the answer is: "Yes" in the short run and "No" in the long run. However, when looking at the customer impact, the answer is "No" because of the negative impact of wage inequality on customer satisfaction, which weakens firm profits.

What can managers learn? If the goal is short-term profitability, go with higher wage inequality, but keep an eye on customer satisfaction. If managers are interested in the long-term success of the firm, consider reducing wage inequality to help employees orient toward customers.

What can shareholders learn? Suppose that you care about the long-term profitability of your investment. In that case, make sure to reward top managers for achieving sustainable profitability and good customer relationships.

What can policymakers learn? Wage inequality is not in a firm's long-term interest. This argument can help to create a consensus with managers to restrain wage inequality. However, short-term-oriented managers might care little about the damage wage inequality does to society. It thus might be necessary to disincentivize them from raising wage inequality.

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Full article and author contact information available at: https://doi.org/10.1177/00222429211026655