Thursday, January 12, 2023

Consumption of fast food linked to liver disease

Risk of liver damage is highest for those with obesity or diabetes

Peer-Reviewed Publication

UNIVERSITY OF SOUTHERN CALIFORNIA - HEALTH SCIENCES

Ani Kardashian, MD, a hepatologist with Keck Medicine of USC, is the lead author of a new study showing that fast-food consumption is linked to liver disease. 

IMAGE: ANI KARDASHIAN, MD, A HEPATOLOGIST WITH KECK MEDICINE OF USC, IS THE LEAD AUTHOR OF A NEW STUDY SHOWING THAT FAST-FOOD CONSUMPTION IS LINKED TO LIVER DISEASE. view more 

CREDIT: RICARDO CARRASCO III

LOS ANGELES — The new year has begun, and with it, resolutions for change.

study from Keck Medicine of USC published today in Clinical Gastroenterology and Hepatology gives people extra motivation to reduce fast-food consumption.

The study found that eating fast food is associated with nonalcoholic fatty liver disease, a potentially life-threatening condition in which fat builds up in the liver.

Researchers discovered that people with obesity or diabetes who consume 20% or more of their daily calories from fast food have severely elevated levels of fat in their liver compared to those who consume less or no fast food. And the general population has moderate increases of liver fat when one-fifth or more of their diet is fast food.

“Healthy livers contain a small amount of fat, usually less than 5%, and even a moderate increase in fat can lead to nonalcoholic fatty liver disease,” said Ani Kardashian, MD, a hepatologist with Keck Medicine and lead author of the study. “The severe rise in liver fat in those with obesity or diabetes is especially striking, and probably due to the fact that these conditions cause a greater susceptibility for fat to build up in the liver.”

While previous research has shown a link between fast food and obesity and diabetes, this is one of the first studies to demonstrate the negative impact of fast food on liver health, according to Kardashian.

The findings also reveal that a relatively modest amount of fast food, which is high in carbohydrates and fat, can hurt the liver. “If people eat one meal a day at a fast-food restaurant, they may think they aren’t doing harm,” said Kardashian. “However, if that one meal equals at least one-fifth of their daily calories, they are putting their livers at risk.”

Nonalcoholic fatty liver disease, also known as liver steatosis, can lead to cirrhosis, or scarring of the liver, which can cause liver cancer or failure. Liver steatosis affects over 30% of the U.S. population.

Kardashian and colleagues analyzed the most recent data from the nation’s largest annual nutritional survey, the 2017-2018 National Health and Nutrition Examination Survey, to determine the impact of fast-food consumption on liver steatosis.

The study characterized fast food as meals, including pizza, from either a drive-through restaurant or one without wait staff.

The researchers evaluated the fatty liver measurement of approximately 4,000 adults whose fatty liver measurements were included in the survey and compared these measurements to their fast-food consumption.

Of those surveyed, 52% consumed some fast food. Of these, 29% consumed one-fifth or more daily calories from fast food. Only this 29% of survey subjects experienced a rise in liver fat levels.

The association between liver steatosis and a 20% diet of fast food held steady for both the general population and those with obesity or diabetes even after data was adjusted for multiple other factors such as age, sex, race, ethnicity, alcohol use and physical activity.

“Our findings are particularly alarming as fast-food consumption has gone up in the last 50 years, regardless of socioeconomic status,” said Kardashian. “We’ve also seen a substantial surge in fast-food dining during the COVID-19 pandemic, which is probably related to the decline in full-service restaurant dining and rising rates of food insecurity. We worry that the number of those with fatty livers has gone up even more since the time of the survey.”

She hopes the study will encourage health care providers to offer patients more nutrition education, especially to those with obesity or diabetes who are at higher risk of developing a fatty liver from fast food. Currently, the only way to treat liver steatosis is through an improved diet.

Jennifer Dodge, MPH, assistant professor of research medicine and population and public health sciences at the Keck School of Medicine of USC and Norah Terrault, MD, MPH, a Keck Medicine gastroenterologist and division chief of gastroenterology and liver diseases at the Keck School, were also authors on the study.

###

For more information about Keck Medicine of USC, please visit news.KeckMedicine.org.

It would take 23 million years for evolution to replace Madagascar’s endangered mammals

“Now or never” for preventing extinction

Peer-Reviewed Publication

FIELD MUSEUM

Mouse lemur 

IMAGE: BROWN MOUSE LEMUR, ONE OF THE 104 SPECIES OF LEMURS THAT ARE CURRENTLY THREATENED WITH EXTINCTION. A TOTAL OF 17 SPECIES OF LEMURS HAVE GONE EXTINCT SINCE HUMANS ARRIVED ON MADAGASCAR. view more 

CREDIT: © CHIEN C. LEE

In many ways, Madagascar is a biologist’s dream, a real-life experiment in how isolation on an island can spark evolution. About 90% of the plants and animals there are found nowhere else on Earth. But these plants and animals are in major trouble, thanks to habitat loss, over-hunting, and climate change. Of the 219 known mammal species on the island, including 109 species of lemurs, more than 120 are endangered. A new study in Nature Communications examined how long it took Madagascar’s unique modern mammal species to emerge and estimated how long it would take for a similarly complex set of new mammal species to evolve in their place if the endangered ones went extinct: 23 million years, far longer than scientists have found for any other island.

That is, simply put, really bad news. “It's abundantly clear that there are whole lineages of unique mammals that only occur on Madagascar that have either gone extinct or are on the verge of extinction, and if immediate action isn't taken, Madagascar is going to lose 23 million years of evolutionary history of mammals, which means whole lineages unique to the face of the Earth will never exist again,” says Steve Goodman, MacArthur Field Biologist at Chicago’s Field Museum and Scientific Officer at Association Vahatra in Antananarivo, Madagascar, and one of the paper’s authors.

Madagascar is the world’s fifth-largest island, about the size of France, but “in terms of all the different ecosystems present on Madagascar, it’s less like an island and more like a mini-continent,” says Goodman. In the 150 million years since Madagascar split from the African mainland and the 80 million since it parted ways with India, the plants and animals there have gone down their own evolutionary paths, cut off from the rest of the world. This smaller gene pool, coupled with Madagascar’s wealth of different habitat types, from mountainous rainforests to lowland deserts, allowed mammals there to split into different species far more quickly than their continental relatives.

But this incredible biodiversity comes at a cost: evolution happens faster on islands, but so does extinction. Smaller populations that are specially adapted to smaller, unique patches of habitat are more vulnerable to being wiped out, and once they're gone, they're gone. More than half of the mammals on Madagascar are included on the International Union for Conservation of Nature Red List of Threatened Species, aka the IUCN Red List. These animals are endangered primarily because of human actions over the past two hundred years, especially habitat destruction and over-hunting.

An international team of Malagasy, European, and American scientists, including Goodman, collaborated to study the looming extinction of Madagascar’s endangered mammals. They built a dataset of every known mammal species to coexist with humans on Madagascar for the last 2,500 years. (Humans have lived on the island, perhaps intermittently, for the past 10,000 years, but have remained constant there for the last 2,500.) The scientists came up with the 219 known mammal species alive today, plus 30 more that have gone extinct over the past two millennia, including a gorilla-sized lemur that went extinct between 500 and 2,000 years ago.

Armed with this dataset of all the known Malagasy mammals that interacted with humans, the researchers built genetic family trees to establish how all these species are related to each other and how long it took them to evolve from their various common ancestors. Then, the scientists were able to extrapolate how long it took this amount of biodiversity to evolve, and thus, estimate how long it would take for evolution to “replace” all of the endangered mammals if they go extinct.

To rebuild the diversity of land-dwelling mammals that have already gone extinct over the past 2,500 years, it would take around 3 million years. But more alarmingly, the models suggested that if all the mammals that are currently endangered were to go extinct, it would take 23 million years to rebuild that level of diversity. That doesn’t mean that if we let all of the lemurs and tenrecs and fossas and other unique Malagasy mammals go extinct, that evolution will recreate them if we just wait around 23 million more years. “It would be simply impossible to recover them,” says Goodman. Instead, the model means that to achieve a similar level of evolutionary complexity, whatever those new species might look like, would take 23 million years.

Luis Valente, the study’s corresponding author, says he was surprised by this finding. “It is much longer than what previous studies have found on other islands, such as New Zealand or the Caribbean,” says Valente, a biologist at the Naturalis Biodiversity Center and the University of Groningen in the Netherlands. “It was already known that Madagascar was a hotspot of biodiversity, but this new research puts into context just how valuable this diversity is. These findings underline the potential gains of the conservation of nature on Madagascar from a novel evolutionary perspective.”

According to Goodman, Madagascar is at a tipping point for protecting its biodiversity. “There is still a chance to fix things, but basically, we have about five years to really advance the conservation of Madagascar’s forests and the organisms that those forests hold,” he says.

This urgent conservation work is made difficult by inequality and political corruption that keeps land-use decisions out of the hands of most Malagasy people, says Goodman: “Madagascar’s biological crisis has nothing to do with biology. It has to do with socio-economics.” But while the situation is dire, he says, “we can't throw in the towel. We’re obliged to advance this cause as much as we can and try to make the world understand that it’s now or never.”

The critically endangered Verreaux’s Sifaka is one of the 109 species of lemurs that currently are extant on Madagascar. A total of 17 species of lemurs have already gone extinct.

CREDIT

© Chien C. Lee

COVID-19 vaccine acceptance increased globally in 2022

Findings from new 23-country survey can help policymakers address vaccine hesitancy

Peer-Reviewed Publication

CUNY GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY

New York, NY, January 9 – Global willingness to accept a COVID-19 vaccine increased from 75.2% in 2021 to 79.1% in 2022, according to a new survey of 23 countries that represent more than 60% of the world’s population, published today in Nature Medicine. Vaccine acceptance decreased in eight countries however, and nearly one in eight vaccinated respondents were hesitant about receiving a booster dose.

This third annual study, led by a team of researchers from the CUNY Graduate School of Public Health and Health Policy (CUNY SPH) and the Barcelona Institute for Global Health (ISGlobal), reveals a wide variability between countries and suggests a need to tailor communication strategies to effectively address vaccine hesitancy.

“The pandemic is not over, and authorities must urgently address vaccine hesitancy and resistance as part of their COVID-19 prevention and mitigation strategy,” says CUNY SPH Senior Scholar Jeffrey V. Lazarus. “But to do so effectively, policymakers need solid data on vaccine hesitancy trends and drivers.”

To provide these data, an international collaboration led by Lazarus and CUNY SPH Dean Ayman El-Mohandes performed a series of surveys starting in 2020 in 23 highly populated countries which were impacted significantly by the pandemic (Brazil, Canada, China, Ecuador, France, Germany, Ghana, India, Italy, Kenya, Mexico, Nigeria, Peru, Poland, Russia, Singapore, South Africa, South Korea, Spain, Sweden, Turkey, the United Kingdom and the United States).

Of the 23,000 respondents (1000 per country surveyed), 79.1% were willing to accept vaccination, up 5.2% from June 2021. The willingness of parents to vaccinate their children also increased slightly, from 67.6% in 2021 to 69.5% in 2022. However, eight countries saw an increase in hesitancy (from 1.0% in the U.K. to 21.1% in South Africa). Worryingly, almost one in eight (12.1%) vaccinated respondents were hesitant about booster doses, and booster hesitancy was higher among the younger age groups (18-29).

“We must remain vigilant in tracking this data, containing COVID-19 variants and addressing hesitancy, which may challenge future routine COVID-19 immunization programs,” says Dean El-Mohandes, the study’s senior author.

The survey also provides new information on COVID-19 treatments received. Globally, ivermectin was used as frequently as other approved medications, despite the fact that it is not recommended by the WHO or other agencies to prevent or treat COVID-19.  

Also of note, almost 40% of respondents reported paying less attention to new COVID-19 information than before, and there was less support for vaccine mandates. 

In some countries, vaccine hesitancy was associated with being female (for example in China, Poland, Russia), having no university degree (in France, Poland, South Africa, Sweden, or the U.S.), or lower income (in Canada, Germany, Turkey or the U.K.). Also, the profile of people paying less attention to the pandemic varied between countries.

“Our results show that public health strategies to enhance booster coverage will need to be more sophisticated and adaptable for each setting and target population,” says Lazarus, also head of the Health Systems Research Group at ISGlobal. “Strategies to enhance vaccine acceptance should include messages that emphasize compassion over fear and use trusted messengers, particularly healthcare workers.”

The data provided by these surveys may offer insight to policymakers and public health officials in addressing COVID-19 vaccine hesitancy. The study follows on the heels of a global consensus statement on ending COVID-19 as a public health threat that Lazarus, El-Mohandes and 364 co-authors from 112 countries published in Nature in November.

Lazarus JV, Wyka K, White TM, Picchio C, et al. A survey of COVID-19 vaccine acceptance across 23 countries in 2022. Nature Medicine. 2023. https://doi.org/10.1038/s41591-022-02185-4  

Also see:

Lazarus JV, Wyka K, White TM, Picchio CA, et al. Revisiting COVID-19 vaccine hesitancy around the world using data from 23 countries in 2021. Nature Comms. 2022. https://doi.org/10.1038/s41467-022-31441-x

For media inquiries, contact:

Ariana Costakes

Communications Editorial Manager

ariana.costakes@sph.cuny.edu  

About CUNY SPH

The CUNY Graduate School of Public Health and Health Policy (CUNY SPH) is committed to promoting and sustaining healthier populations in New York City and around the world through excellence in education, research and service in public health and by advocating for sound policy and practice to advance social justice and improve health outcomes for all. sph.cuny.edu

Studies identify new strategies for insect control

UC Riverside research shows how ammonia and amine odorants could be used to combat insect-driven diseases

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - RIVERSIDE

RIVERSIDE, Calif. -- Mosquitoes spread several diseases, such as malaria and dengue. In 2020 about 241 million cases of malaria occurred worldwide, with a few more million cases occurring in 2021. Nearly half the world’s population lives in regions where contracting dengue virus is a risk. Insects also destroy a third of agriculture. 

New research by scientists at the University of California, Riverside, has potential in insect control through volatile repellents that could be applied on surfaces such as windowsills, eaves of huts, house entryways, backyards, outside produce storage areas, entryways of livestock shelters, and next to crops in a field.

The researchers focused on ammonia, a basic volatile compound found in insect environments. At low concentrations, such as in human sweat, ammonia is an attractant for mosquitoes and other insects. At high concentrations, however, for example the concentrations found in household cleaners, ammonia is no longer attractive to insects. The researchers inquired into what happens to the olfactory (smell) system and gustatory (taste) system of fruit flies and mosquitoes in the presence of ammonia.

“We found the olfactory neurons seem to have a burst of activity and then they become silent for a while,” said Anandasankar Ray, a professor of molecular, cell and systems biology, who led the study that appears in iScience, a journal. “During the silent period, the neurons are not able to detect any odorants, which means insects cannot effectively find human skin odor.” 

When Ray’s team tested the taste system of fruit flies and mosquitoes (Aedes aegypti), they found a similar response. 

“Where taste is concerned, we found ammonia and ‘amines’ — derivatives of ammonia that make up many synthetic odorants — don’t produce the flash type of activity we see in the olfactory system,” Ray said. “But they do show the inhibition we found in the olfactory system. We were able to show that ammonia silences the sugar and salt response in insects.”

After most insects find a location to land on via their smell system, their taste system is executed. Mosquitoes use the labella — sensory probes that aid in searching for a good place to bite — on their legs to taste food. Fine hairs, called sensilla, on the labella of fruit flies enable the flies to taste potential foods without eating them.

According to Ray, the discovery could be used to make effective insect repellents in the future. 

“While compounds like ammonia, which have a high pH and are basic, cannot be used on skin due to their corrosive properties, they can be used in other ways,” he said. “Many biting insects fly into homes from outside. In most parts of the world, insects bite humans and pets indoors and often at night. For example, if walls, where insects land and wait, had a high pH material in them, mosquitoes would be affected. Similarly, if a high pH compound, such as an amine, were dispensed around entryways of homes and animal sheds, it could keep mosquitoes away.”

The study was supported by grants from the National Institute on Deafness and Other Communication Disorders, a member of the National Institutes of Health.

Ray was joined in the study by Jonathan Trevorrow Clark, Anindya Ganguly, Jadrian Ejercito, Matthew Luy, and Anupama Dahanukar. 

The research paper is titled “Chemosensory detection of aversive concentrations of ammonia and basic volatile amines in insects.”

It’s the humidity

In a separate paper, published in the journal Scientific Reports, Ray’s lab studied behavior modification to humidity in the Asian citrus psyllid, or ACP, which transmits citrus greening disease, and mosquitoes. Although insects can sense humidity, little research has been done on disrupting their humidity-sensing neurons.

“We found amine odorants inhibit the humidity response,” Ray said. “We identified neurons in the ACP that detect humidity and found that certain amines could inhibit their humidity sensing. We then showed this was conserved in fruit flies. This is probably the first time that researchers have shown that humidity sensing can be inhibited by odorants.”

The researchers then tested humidity sensing in gravid mosquitoes (Aedes aegypti and Anopheles coluzzi) that are attracted to water bodies to lay eggs. In the lab, blood-fed mosquitoes that were ready to lay eggs were presented with two cups of water. One cup contained a small vial of odor that inhibits humidity sensing. The researchers found the mosquitoes avoided laying eggs there and preferred instead the untreated cup.  

“This suggests it is possible to block the humidity sensing neurons in insects by using a volatile chemical and lower the level of egg laying,” Ray said. 

He also explained that ACPs appear to avoid high humidity. To test their humidity sensing, his lab used a Y shaped tube with high humidity in both arms. The ACPs preferred neither arm at first. But when the researchers introduced a humidity inhibiting odorant in one arm, the ACPs began to prefer it because they could not sense the humidity anymore.

“This means that by blocking the insects’ ability to sense water using a volatile odorant, we can manipulate their humidity sensing pathway and alter their behavior in a predictable manner,” Ray said. “In the future it may be possible to engineer amines to prevent insect egg laying in certain areas.”

The research has implications for regions where mosquitoes spread diseases. After they take a blood meal, mosquitoes look for water in which to lay down their eggs. A single female mosquito can lay up to 300 eggs in a single night. 

“Because of this extremely high reproductive potential, from spring to summer we see an explosion of mosquitoes,” Ray said. “Where you have water with mosquito larvae, it is extremely difficult to control the mosquito population. This is why in tropical countries it is impossible to kill off all the mosquitoes. Even if a few mosquitoes are left over, they reproduce very fast.”

The study was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health.

Ray, the founder of two startups, Sensorygen Inc. and Remote Epigenetics Inc., was joined in the study by Coutinho‐Abreu and Trevorrow Clark of UCR.

The title of the research paper is “Pentylamine inhibits humidity detection in insect vectors of human and plant borne pathogens.” 

The University of California, Riverside is a doctoral research university, a living laboratory for groundbreaking exploration of issues critical to Inland Southern California, the state and communities around the world. Reflecting California's diverse culture, UCR's enrollment is more than 26,000 students. The campus opened a medical school in 2013 and has reached the heart of the Coachella Valley by way of the UCR Palm Desert Center. The campus has an annual impact of more than $2.7 billion on the U.S. economy. To learn more, visit www.ucr.edu.

Climate ‘presses’ and ‘pulses’ impact Magellanic penguins — a marine predator — with guidance for conservationists

Peer-Reviewed Publication

UNIVERSITY OF WASHINGTON

Punta Tombo in summer 

IMAGE: A SUMMER SCENE AT THE MAGELLANIC PENGUIN COLONY AT PUNTA TOMBO IN ARGENTINA. view more 

CREDIT: DEE BOERSMA/UW CENTER FOR ECOSYSTEM SENTINELS

Climate change will reshape ecosystems worldwide through two types of climate events: short-term, extreme events — like a heat wave — and long-term changes, like a shift in ocean currents. Ecologists call the short-term events “pulses,” and the long-term changes “presses.”

Presses and pulses will likely have different effects on animal species. But how? And how will animals respond? Answering these questions is no easy feat because individual events can have dramatically divergent impacts on an animal species. Yet understanding the effects of presses and pulses is essential as conservationists and policymakers try to preserve ecosystems and safeguard biodiversity.

Researchers at the University of Washington have discovered how different presses and pulses impacted Magellanic penguins — a migratory marine predator — over nearly four decades at their historically largest breeding site in Punta Tombo, Argentina. In a paper published the week of Jan. 9 in the Proceedings of the National Academy of Sciences, the team from the UW’s Center for Ecosystem Sentinels reports that, though individual presses and pulses impacted penguins in a variety of ways, both were equally important for the future survival of the penguin population. They also found that these types of climate changes, taken together, are leading to an overall population decline at this particular site.

“We found that penguin survival doesn’t rest solely — or even largely — on one or a few climate effects,” said lead author T.J. Clark-Wolf, a UW postdoctoral researcher in biology and center scientist. “Instead, many different presses and pulses impact penguin reproduction and survival over time.”

The study analyzed data collected at Punta Tombo from 1982 to 2019 by co-author Dee Boersma, founder of the Center for Ecosystem Sentinels and a UW professor of biology, and collaborators. The data include:

  • survival and reproductive success for nearly 54,000 penguins at the site, which historically is where hundreds of thousands of Magellanic penguins have come to breed each summer
  • climate conditions during each breeding season
  • ocean conditions off the coast of Punta Tombo, where adults feed during the breeding season and bring food back to the nest to feed their chicks
  • offshore ocean conditions along the coast of South America, where adults and juveniles feed when migrating outside of the breeding season

Clark-Wolf and senior author Briana Abrahms, a UW assistant professor of biology, folded these data into an integrated population model that parsed out the effects of separate presses and pulses on penguin survival over time. They found that different climate effects had distinct impacts on the Punta Tombo population. For example, heat waves — a climate pulse — have a detrimental effect on the population by killing both adults and chicks, as illustrated by a 2019 single-day heat wave at Punta Tombo that killed more than 350 penguins. A climate press, increased rainfall at the site, also negatively impacted the population, because storms during the breeding season kill chicks due to exposure.

The gradual weakening of the plume of silt expelled into the ocean by the Río de la Plata, the second largest river basin in South America, is one press that positively affected penguin survival. This press impacts the penguins' winter feeding waters off the coast of northern Argentina, Uruguay and Brazil. Past research by Ginger Rebstock, a co-author on the new study and a UW research scientist, has indicated that a weaker plume may make it easier for penguins, particularly females, to catch enough food each winter and return to the breeding site in prime condition.

But the positive effects of a weakening plume could not overcome the negative effects of other climate events at Punta Tombo, which over nearly four decades has become warmer and wetter. The number of breeding pairs at the site has declined from a high of approximately 400,000 in the early 1980s to about 150,000 in 2019.

“This colony will be 100 years old in 2024, but we finished another on-the-ground survey in late October at Punta Tombo and its numbers continue to decline,” said Boersma. “The penguins are instead moving north to be closer to their food.”

Surveys have reported that Magellanic penguins are establishing other breeding sites farther north on the South American coast in search of better foraging opportunities.

Understanding how these presses and pulses shape this population is crucial for informing conservation efforts, the researchers said.

“For conservation to be most effective, we need to know where, when and how to apply our limited resources,” said Abrahms. “Information generated by this study tells us which climate effects we need to worry about and which ones we don’t — and therefore can help us focus on measures that we know will have a positive impact.”

The decades of data faithfully collected at Punta Tombo made it possible for the team to consider the effects of long-term climate changes and extreme events in combination, and as a result, to better predict how climate will impact this population in the future. It is this same approach, they believe, that can help conservationists and scientists understand how climate shifts will shape other long-lived animal species across our warming globe.

Fieldwork over the years at Punta Tombo has been funded by the Wildlife Conservation Society; the ExxonMobil Foundation; the Pew Fellows Program in Marine Conservation; the Disney Worldwide Conservation Fund; the Chase, Cunningham, CGMK, Offield, Peach, Thorne, Tortuga and Kellogg Foundations; the Wadsworth Endowed Chair in Conservation Science at the UW; the Friends of the Penguins fund; and private donations to the Center for Ecosystem Sentinels.

Rain soaks the down plumage of a Magellanic chick, left, that is still too young to have the waterproof plumage of its parent, right.

CREDIT

Dee Boersma/UW Center for Ecosystem Sentinels

2019 heat wave at Punta Tombo 

For more information, contact Clark-Wolf at tc130053@uw.edu and Abrahms at abrahms@uw.edu.

Reference: "Climate presses and pulses mediate the decline of a migratory predator," PNAS manuscript number 2022-09821RR

Copies of the study are available for registered journalists through EurekAlert or by contacting the PNAS News Office at pnasnews@nas.edu or +1 202-334-1310. The University of Washington news office is prohibited from sharing copies of the study before the PNAS embargo lifts.