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Science Policy Around the Web – December 21, 2018

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By: Mohor Sengupta, Ph.D.

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Medical Detectives: The Last Hope For Families Coping With Rare Diseases

Rare diseases affect far fewer people than other diseases, and consequently many are difficult to diagnose or may even not be identified yet. Current approaches seek to identify rare diseases by examining genetic mutations at one gene at-a-time, picking the gene by roughly informed guesses based on the symptoms. This method may soon be a thing of the past, thanks to Undiagnosed Diseases Network (UDN). UDN is a research study on a never-ending scale. It collects genomic data from persons with rare diseases and identifies the culprit mutation/s. The findings are cataloged, and doctors encountering novel symptoms in their patient can go to the UDN database and dig out the disease that matches most with the symptoms. That would give them a possible starting point. In this respect, the sole purpose of UDN is to find solutions for rare medical challenges where doctors are not able to.

UDN is made up of three components: A coordinating center based at the Department of Biomedical Informatics at Harvard Medical School, twelve clinical sites in the USA, including the NIH Undiagnosed Disease Program at Bethesda and core facilities. UDN is backed by the National Institutes of Health Common Fund that seeks to provide answers for patients and families affected by mysterious conditions.

There are more than 6000 known rare diseases, and combined these affect fewer than 200,000 Americans at a given time. Eighty percent of all known rare diseases are genetic in origin and half of all rare diseases affect children. Symptoms of a single rare disease may vary from patient to patient, and the disease itself is often masked by common symptoms. This confounds appropriate diagnosis of a rare disease greatly. For many rare diseases there is no knowledge of the underlying cause and information of disease progression is limited. Without the correct intervention, patients and their families experience a decline in the quality of life over time.

Research on rare diseases need to be collaborative across nations, and a global network of physicians and researchers is needed to facilitate knowledge sharing about these diseases. There needs to be a comprehensive approach in the understanding of rare diseases, analogous to virtual knowledge bases like the UDN database and Orphanet. Happily, progress is being made in this direction. Several countries have appropriate policies in place, and there are organizations that are the voice of patients with rare diseases, such as ERORDIS in the EU, the National Organization for Rare Disorders in USA and the Organization for Rare Diseases in India. It is imperative that these cohorts have greater interaction and knowledge sharing among one another.

Finally, public awareness is crucial. The patient community plays a crucial role in addressing awareness. They form the voice of the rare disease community and the starting point for development of policies. Rare Disease Day was created by EURORDIS in 2008, and February 28th, the rarest day, was chosen to mark our combat against rare diseases and our support for those living with it. On its tenth anniversary last year, 94 countries and regions from every corner on the globe commemorated the day, and 2018 saw the addition of five more countries into the group.

As a person afflicted with a rare disease myself, I would say, we may be only a few but with your support, we have the best shot at it!

(Original article by Lesley McClurg covers UDN, NPR)

 

Will We Survive Climate Change?

 

The holidays are upon us and many will head out to different directions outside the city. Writing the last blog for this year, I thought we could ponder over some rather worrying issues and offer solace to one another.

It’s December and today is winter solstice. The day with the longest night arrived amidst torrential rains. Each year we are seeing more storms than the last. Hurricanes like Florence and Mangkhut have rocked the world with damage and destruction. The temperature on Earth is already at 1 degree Celsius above pre-industrial levels. Record number of people have experienced extreme heat wave in 2018. Countries like Canada and Japan got much warmer summers than they are used to, and July 2018 ranked as one of the hottest months in Europe. Changing wind patterns and drier climate have ravaged the state of California with wild fires. A total of 8,434 fires burnt an area of 1,890,438 acres (765,033 ha), the largest amount of burned acreage recorded in a fire season, according to the California Department of Forestry and Fire Protection and the National Interagency Fire Center, as of December 6. From June through mid-July, severe downpour in southwestern Japan caused devastating floods and mudflows, killing nearly 300 people. A month later, the southern Indian state of Kerala was slapped by an unusual monsoon, causing the worst flood in nearly a century in the state with traditionally high rainfall. It left nearly 500 people dead.

The Paris Climate Accord has set a goal of keeping global temperatures from rising more than 2 degrees above pre-industrial levels. At 2 degrees above, things are this bleak:

Icebergs in the Arctic waters are ten times more likely to vanish in the summers.

Most of the world’s coral reefs are to disappear.

37 percent of all people on Earth are to experience extreme heat waves.

411 million people are to experience severe urban draught.

80 million people will be threatened by rising sea levels.

However, at 0.5 degrees Celsius lower, many of these situations seem slightly less devastating. Arctic ocean ice is more likely to survive the summers. Coral reefs will not be wiped out completely. 14 percent of people will be exposed to extreme heat waves and 20 million will be exposed to urban drought.

Seems slightly better? Yet, no industrialized nation is expected to meet the 2 degrees goal, let alone the 1.5 degrees mark, as per their current consumption of fossil fuels. The effects of today’s atmospheric carbon dioxide will be felt by generations to come.

Enough of grim talk. As stated in John Schwartz’s article, “there is no scientific support for inevitable doom”.

Reducing the amount of greenhouse emissions could address the most troubling issues of global warming. Many countries are making efforts to rely on renewable, cleaner energy sources like solar energy. There are increased efforts to use public transportation in some countries. Cars run by electricity are trending. The world is changing. Only not as fast as we want it to.

Let us resolve to consciously cut down on fossil fuel consumption in 2019. No one way is the perfect solution for this self-created menace and not everyone will be touched by this problem in the same manner. But collective awareness and efforts can go down a log way for everyone and for the Earth.

(John Schwartz, New York Times)

 

 

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December 21, 2018 at 11:20 am

Science Policy Around the Web – November 30, 2018

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By: Allison Cross, PhD

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Fire, drought, flood: Climate challenges laid bare in US government report

On Black Friday, and amid the news of deadly wildfires in California, the federal government released the Fourth National Climate Assessment (NCA4).  This report, detailing global warming and climate change, is mandated every four years as part of The Global Change Research Act of 1990.  The report was released by the U.S. Global Change Research Program which includes scientist and policy experts from 13 federal agencies.  It affirms that the effects of climate change are already being felt across the country, and that current global efforts to combat it, as well as regional efforts to adapt to it, do not reach the levels needed to avert substantial damage to the US economy, environment, and public health.

The NCA4 describes the latest in climate-change science and examines how global warming is likely to differentially effect regions across the country and the economy.  The report explains how higher temperatures and drier conditions will result in more large fires across the west coast.  The southwest and midwest can expect persistent droughts to continue, while the east coast will suffer from increased flood risks. These conditions will disrupt agricultural productivity.  The US National Oceanic and Atmospheric Administration estimated that the 2017 economic loss in the US from major storms, floods and droughts was $290 billion, and the NCA4 declares that storms are expected to become even more powerful as global warming continues.

The report states that if the current trends in global greenhouse-house emissions continue, some US economic sectors can expect to experience annual losses of hundreds of billions of dollars by the end of the century.

Though the report was intended to inform policy-makers, it makes no specific policy recommendations to address the issues outlined in the report.  With President Trump having removed the US from the Paris climate change agreement after he took office, and repeatedly blaming the deadly California wildfires on poor forest management, many scientists are concerned that the government will not take action to address the grave findings outlined in the report.

This report released by the  U.S. Global Change Research Program  comes after, and is in agreement with, a report released in October by the Intergovernmental Panel on Climate Change (IPCC) stating that major and costly changes would be needed to avert the disastrous effects to come from climate change.

 

(Jeff Tollefson,  Nature Briefing)

 

FDA plans overhaul of decades-old medical device system

Just 24 hours after a global investigation into medical device safety was published, the Food and Drug Administration announced they will be overhauling the medical device approval process.  The FDA says the changes were planned before the new stories broke, referring to the Medical Device Safety Action Plan: Protecting Patients, Promoting Public Health issued by the FDA back in April. The investigation into medical device safety that made the headlines was led by the International Consortium of Investigative Journalists and found that, over a 10-year period, the FDA received reports of more than 1.7 million injuries and close to 83,000 deaths suspected of being linked to medical devices.

Under current regulations, most medical devices can undergo an expedited approval process if the manufacturers can prove the devices are similar to those already on the market.  This approval process was implemented by the FDA in 1976 and is known as the 510(k)clearance process.  This process means that extensive clinical safety and efficacy testing is only required for a handful of new devices. It has been reported that under this clearance process almost 20% of products are approved based on similarity to devices that are more than 10 years old.  Critics of the expedited clearance process point out that this system has allowed defective devices to be cleared included hip replacements that failed prematurely, and surgical mesh linked to pain and bleeding.

The FDA has said that under the modernized 510(k) clearance process, medical devices that come to the market “should either account for advances in technology or demonstrate that they meet more modern safety and performance criteria.”  The proposed changes to the approval process include pushing companies to compare their devices to more up-to-date technology.  The FDA also plans to pursue actions to allow them to retire outdated base-products when safer, more effective technology emerges.

The FDA has set a deadline of early 2019 to finalize its guidance on establishing an alternative accelerated pathway for medical device approval but the reforms being proposed may take years to implement.

 

(Matthew Perrone, Associated Press, Stat News)

 

 

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November 30, 2018 at 3:46 pm

Science Policy Around the Web – October 26, 2018

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By: Mohor Sengupta, Ph.D.

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Environmental Problems

A 14-year-long oil spill in the Gulf of Mexico verges on becoming one of the worst in U.S. history

In the year 2004, hurricane Ivan leveled an oil production platform in the Gulf of Mexico, owned by Taylor Energy. Its striking magnitude destroyed the colossal platform which had drilled into several oil wells. The result was a huge mound of muck, filling the broken steel structure and leaking oil. To date, efforts to seal off the leakage have not been successful.

Taylor Energy at first denied that there was any leakage and then underreported the extent of the leakage. According to current estimates, about 700 barrels of oil are leaking per day, with each barrel holding 42 gallons of oil. The company has kept this information a secret for many years, and few people are aware of the actual level of spillage. The Taylor Energy spillage in fact pre-dates the Deepwater Horizon oil spill (also called the BP leak), so far the largest marine oil spill in history at 168 million gallons. While BP has coughed up $66 billion for fines, legal settlements and cleanup, Taylor Energy is a comparatively smaller operation and financially too cash-strapped to afford cleanup on such a large scale.

In these actions Taylor Energy flouted both the EPA’s Oil Pollution Act of 1990, which mandates that spillage must be reported to the U.S. Coast Guard National Response Center (NRC), and the Clean Water Act of 1972, which created a structure for regulating water pollutants. Taylor Energy was taken to court by environmentalists, and Taylor Energy and the NRC have been jointly found accountable in presenting false numbers and data. In an assessment submitted to Taylor Energy in 2009 by Waldemar S. Nelson and Company, a private firm, risks involved in ingesting fish from the affected area were discussed. A recent and independent analysis by the Justice Department showed that the original estimate of 1 to 55 barrels of leakage per day provided by NRC was inaccurate. After several spillage tests Oscar Garcia-Pineda, the author of the article, concluded that his results didn’t tally with those reported by NRC and the actual rate of spillage was 48 to ~1700 barrels per day.

These disturbing findings have arrived at a delicate time for environmental protection policy. Earlier this year, the Trump administration proposed a wide expansion of leases to the oil and gas industry. This would render all off-shore areas on the continental shelf, including those along the Atlantic coast, amenable to drilling. Oil and gas representatives are lobbying for this cause and have provided financial justifications including billions of dollars’ worth of annual economic growth, increased jobs and lower heating costs. However, multiple governors representing states across the four planning areas, from Maine to the Florida Keys, are opposed to this proposal.

Reports show that on average there are 20 uncontrolled releases of oil per 1000 wells under state or federal governments. In Louisiana alone, approximately 330,000 gallons of oil are spilt from off-shore and on-shore rigging platforms. With changing climate patterns, hurricanes on the Atlantic are predicted to be more intense in future, and given the government’s plans to extend rigging along the Atlantic coast, a bleak prospect looms ahead.

(Darryl Fears, Washington Post)

Health Supplements

The Problem with Probiotics

The healthy balance or maintenance of the natural flora of the gut, also called the gut microbiome,is essential for a healthy digestive system. Antibiotics have been shown to disrupt the gut-microbiome, resulting in diseases such as diarrhea and infections with Clostridium difficile. As an antidote, it has been common practice to pop in “good bacteria”, or probiotics, while on antibiotic treatment. These probiotics are essentially a mixture of supposedly healthy gut microbiota and are meant to replace those disrupted by the antibiotic.

Although people commonly take probiotics, this class of product is not regulated by the FDA and there are rising concerns about the standard of manufacture and quality of these commonly sold over-the-counter health supplements. Most recently, Dr. Pieter A. Cohen cautioned against overlooking the harmful effects of widely marketed probiotics in his recent article published in “JAMA Internal Medicine”.

There have been several studies discussing the benefits of probiotics, so much so that the journal “Nutrition” recently published a systematic review of systematic reviews. In a nutshell, all the studies ever done on efficacy of probiotics have produced very limited positive results and only pure microbial strains were used as the probiotic supplement in these studies. On the other hand, there has been no evidence to show that probiotics have been beneficial in treating conditions such as Crohn’s Disease, chronic diarrhea, ulcerative colitis or liver disease, all related in some way to the gut microbiome.

Safety assessment studies have found probiotics to be contaminated with unwanted microbial strains, and without FDA regulation of the manufacturing process production doesn’t often follow a well-defined pipeline. It is not known what kinds of health hazards might be caused by these contaminants, warns Dr. Cohen, and they can be lethal. In a notorious case, the death of an infant was attributed to a contaminated dietary supplement.

Unfortunately, none of these events have deterred Americans from using probiotics. Almost four million people, or 1.6 percent of adults in the United States used probiotics in 2012 and the global market for probiotics is steadily on the rise. In this situation, it is of great importance for dietary supplements be given the rigorous assessment and quality control checks that a prescription drug undergoes. There should be increased efforts to make consumers aware of adulterations in probiotics.

(Aaron E. Carrol, New York Times)

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October 26, 2018 at 12:36 pm

Science Policy Around the Web – October 19, 2018

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By: Ben Wolfson, Ph.D.

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Climate Change

 

Climate Change prompts a rethink of Everglades management

The Florida Everglades is a large area of tropical wetlands that has received significant attention due to the degradation of its unique ecosystem by urban development. The Everglades were designated a World Heritage Sitein 1979 and Wetland Area of Global Importancein 1987, and in 2000 Congress approved the Comprehensive Everglades Restorative Plan (CERP) to combat further decline and provide a framework for Everglades restoration.

For the past 18 years, these efforts have been directed towards curtailing damage from urbanization and pollution. However, as outlined in a congressionally mandated report released on October 16th by the National Academies of Science, Engineering, and Medicine, new strategies may be necessary. In the biennial progress report, an expert panel called for CERP managers to reassess their plans in light of new climate change models. The report focuses on the 7 centimeters of sea level rise seen since 2000, and points out that Southern Florida is especially at risk from climate change and is expected to experience a 0.8-meter rise in sea level by the year 2100.

It is clear that as more is learned about the realities of climate change, the goals and methods of conservation projects are shifting, and past strategies must be adapted to fit the realities of a warming world.

(Richard Blaustein, Science)

Animal Research

NIH announces plan for chimp retirement

 

In 2015, the NIH announced that it would no longer support biomedical research on chimpanzees, two years after pledging to significantly reduce the numbers of chimpanzees used in research. These decisions were made based on a combination of reduced demand for chimpanzees in research and the designation of captured chimpanzees as an endangered species in 2015.

On Thursday October 18th, the NIH announced the next step in the process of retiring research chimps. While research was stopped in 2015, many of the chimpanzees had nowhere to go and remained housed at laboratories. One federal chimpanzee sanctuary, Chimp Haven, exists in Keithville, Louisiana, however lack of space and the difficulty of relocating some animals has slowed their transition to better habitats.

In the Thursday announcement NIH director Francis Collins outlined the guidelines for future chimpanzee relocation. These include streamlining medical records and determining whether chimpanzees are physical healthy enough to be relocated. Many of the chimpanzees are at an advanced age, meaning they have developed chronic illnesses similar to those experienced by humans. However, Collin’s emphasized that there must be a more acute medical problem for relocation not to take place. In addition both the research facility and Chimp Haven must agree that the former research chimpanzees are capable of being relocated, and disagreements will be mediated by a panel of outside veterinarians.

Collins additionally stressed that while transfer to Chimp Haven is the ideal outcome for all retired chimps, those housed at NIH-supported facilities do not live isolated in cages or in laboratories and are housed in social groups with appropriate species-specific accommodations.

The development of these clear guidelines will expediate chimpanzee relocation while emphasizing chimpanzee health and comfort.

(Ike Swetlitz, Statnews)

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October 19, 2018 at 3:25 pm

Science Policy Around the Web – September 21, 2018

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By: Mohor Sengupta, Ph.D

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Inclusion in healthcare

India’s Anti-Gay Law Is History. Next Challenge: Treat LGBTQ Patients With Respect

On September 6 this year, in a landmark verdict, the Supreme Court of India officially decriminalized gay sex. It was a much-awaited move that toppled the archaic, colonial-era Section 377 of the Indian Penal Code, which was used to criminalize sexual activities “against the order of nature”. In 2009 Section 377 was provisionally invalidated, prompting more Indians to come out. But in 2013, the law was reinstated, as it was “a miniscule fraction” of the population that was in question. Although the country has made a decisive and progressive leap catapulting itself into the international arena of contemporary sexual norms, a big change is still needed in its healthcare sector to accommodate the repeal.

Till this date, reporting to clinics or hospitals is an ordeal for the LGBTQ community. Routine prescriptions like the preventive post-exposure prophylaxis for homosexual men is still met with confusion and dilemma at the clinic. Situations have changed from the time when HIV infection was a social stigma, but it isn’t quite at a place where a transgender or homosexual person can talk freely about their medical problems with healthcare personnel. Many doctors view different sexual orientations as something that can be “cured”. Such attitudes have caused a large section of the LGBTQ community to avoid seeing a doctor altogether. Most visit clinics recommended by others in the community.

In April 2014, the Supreme Court of India officially recognized the transgender community as a third gender and granted them the same fundamental rights that the Indian Constitution grants all citizens. Gender-reassignment surgeries were legalized. Yet, in most government hospitals, patients are segregated into a male or a female ward. Arnav Srinivasan, a transgender person and almost approaching menopause, has never visited a gynecologist even though it is necessary. Government directive to construct more gender-neutral public toilets hasn’t seen the light of the day.

Indians and people all over the world are rejoicing the recent Supreme Court repeal of IPC Section 377, and rightfully so. But now the major problem grappling the government is how to educate healthcare personnel about LGBTQ-specific health issues and disseminate appropriate instructions to law enforcement agencies, where harassment of LGBTQ people has been common. The Supreme Court did mandate sensitization programs for schools and the police and some non-profit organizations are planning to offer anti-discrimination workshops to district courts and law enforcement agencies.

In an ethnically, financially, and educationally diverse and sometimes disjointed community like India, repeal of IPC Section 377 is only the tip of the iceberg. It has heralded a new age of public health policy. Attitudes towards sexuality and sexual health needs a systematic and major re-orientation.

(Sushmita Pathak & Furkan Latif Khan, NPR)

Climate

Florence, Mangkhut bring data and destruction to coastal scientists

Two violent weather systems rocked two opposite ends of the world recently. Hurricane Florence originated from a strong tropical wave off the African west coast and it steadily intensified into a Category-4 hurricane en route to North America. Subsequently weakened, it made landfall just south of Wrightsville Beach, NC on September 14. Typhoon Mangkhut arose from a tropical depression near the International Dateline and rapidly intensified in strength as it moved westwards. It made landfall as a Category-5 equivalent super typhoon in the Cagayan province of Philippines on September 15. Both storms have caused significant damage to life and property, mostly in USA, Philippines and Hong Kong.

Meteorologists in USA have noted that recent tropical storms here have caused more floods than damaging winds. They attributed this observation to rising atmospheric temperatures, which make these storms hold on to greater amount of moisture. Overall warmer weather also diminishes the temperature differences between land and ocean, making the storm hover on the land for longer durations. Although wind speeds were as high as 215 km/hr, it was sustained winds that drove large volumes of water on land and caused widespread flooding in affected areas.

Typhoon Mangkhut, on the other hand, brought damaging winds with gusts of up to 228 km/hr in Hong Kong. Tall buildings in the city caused wind tunneling, that shattered its walls. We are all familiar with photographs of skeletonized buildings left in the wake of the storm.

In all this havoc, weather scientists have gained valuable information about overtures of a changing climate pattern. Giant waves off the coast of Wilmington, NC, dragged out a buoy equipped with sensors that measure wind speeds, wave heights and other storm conditions. All data management and web services connected to these sensors had been migrated to Amazon cloud services and provided that the buoys remained functional through the storm, data collected from the sensors could be invaluable. Earlier this week it was still transmitting data and Debra Hernandez, executive director of the buoy’s operator, the Southeast Coastal Ocean Observing Regional Association in Charleston, SC is waiting to see if that data can be tapped. Two automated submarine gliders, also known as autonomous underwater vehicles (AUVs), equipped with sensors to detect water temperature, chlorophyll a, salinity etc, have been deployed along the American continental shelf. These could throw more light on specifics. Ocean researchers at The Swire Institute of Marine Science, The University of Hong Kong (HKU) are beginning to comb through the data collected on Mangkhut. They learned that the storm had passed over relatively cooler surface waters before it made landfall, and this took away some of its power.

Climate change is very real, and its tangible effects are already showing. At most we can brace ourselves from such extreme weather, but it is of utmost importance to gather as many facts as possible and get to “know” these storms, to brace ourselves better.

(Frankie Schembri, with reporting by Dennis Normile and Paul Voosen, Science)

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September 21, 2018 at 3:48 pm

Science Policy Around the Web – February 23, 2018

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By: Janani Prabhakar, Ph.D.

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Climate Change

Permafrost experiments mimic Alaska’s climate-changed future

In Denali National Park and Preserve, you will find ecologist Ted Schuur near Eight Mile Lake on an endeavor to answer some of the toughest questions in climate change research. His “laboratory” is situated in the middle of a tundra, filled with many instruments to measure changes in carbon dioxide. A gas-sensing tower can detect carbon dioxide levels a quarter mile away. Polycarbonate chambers at the top of this tower traps CO2 as it drifts through the air and measure its amount. Using a clever manipulation, he seeks to determine how rising temperatures will impact this region’s CO2 emissions.

The key to understanding the impact of rising temperature is to understand the dynamics between carbon dioxide, plants and soil. Microbes in the soil release CO2. Plants absorb more CO2 than they release, keeping it out of the atmosphere. Critically, microbes release CO2 all year while plants absorb CO2 only during growing season. For a perfect balance, there should be enough microbes in the soil that release CO2 throughout the year and enough plants in the environment to absorb it during growing season. How do rising temperatures impact this balance? Schuur measured CO2 from two different plots of land: one that was surrounded by snow fences and the other that was unfenced. Snow fences catch the cold drift and as a result, the ground they surround is 3 to 4 degrees Fahrenheit warmer than the unfenced plot. This amount of warming is significant because Alaska is projected to see an additional 4 to 5 degrees of warming by 2100. So, Schuur has created an environment within the fenced plot that mimics the projected environment of 2100.

Schuur finds that due to the warmer temperatures, slumping permafrost causes the land to lower by several feet. This, in turn, causes the depth to which the soil thaws in the summer to be deeper, allowing the permafrost layer to add more organic matter to the soil. The result is that more organic matter produces more plant growth, which means more CO2 is absorbed in these warmed fenced plots than the cooler unfenced plots. But, this only happens during the growing season. Since the deeper soil also sees more microbial growth, more CO2 is released from the soil all year around in the fenced than unfenced plot. Schuur finds that the amount of CO2 released in these warmer plots is not offset by what is absorbed by the plants in the growing season, despite the extra plant growth.

Altogether, this news is not good. Given the current rate of temperature rise, this imbalance between CO2 absorption and release may only grow. By the end of the century, the amount of carbon transferred from the thawing permafrost to the atmosphere could reach 1 billion tons, as much as present-day emissions of Germany and Japan.

(J. Madeleine Nash, Wired)

Healthcare

Synergy Between Nurses And Automation Could Be Key To Finding Sepsis Early

Sepsis is the body’s reaction to overwhelming infection and causes about a quarter of a million deaths in American each year. If caught early, it can be treated. But, healthcare workers struggle to identify sepsis in patients in a timely manner. Blood tests cannot specifically test for it, and there is nothing to search for under a microscope. Dr. David Carlbom, a pulmonologist at Harborview Medical Center in Seattle, devised a system to help healthcare providers identify sepsis symptoms and provide timely treatment. His system uses day to day electronic health records to detect subtle clues and send warning flags for impending sepsis. It helps to capture patterns in symptoms, including high or low temperatures, low blood pressure, fast breathing, and high white blood cell count. The system is implemented at nursing stations in the hospital. After a patient is admitted, a red box appears in the patient record, prompting the nurse to answer questions about symptoms and determine whether they point to early signs of sepsis. If the nurse determines that they do, a provider is paged and responds within a half hour. Altogether, the system is intended to ensure the patient is seen within three hours.

While this is a much more precise and efficient method than prior practice, there are circumstances that lead to false alarms. For example, faster breathing may be due to multiple factors, including simply walking down the hall. Or, symptoms such as high white blood cell count may not be due to sepsis, particularly in patients being seen for other health issues like cancer. One way to reduce false alarms is built into the system: the red box appears only every 12 hours. This ensures that providers are not paged throughout the day for false alarms. Furthermore, if nurses determine that the patient is not experiencing sepsis, they must report why and provide an explanation for the symptoms the patient is experiencing. This allows for thoroughness, accountability, and precision. It also ensures that nurses keep a close eye on their patients. The effectiveness of this system has been seen in the reduction of mortality rates since it was installed in 2011.

Despite the reduction in mortality rates, entering vital signs manually could have its shortcomings. Sepsis symptoms can arise quickly and affect the body rapidly. Nurses may miss these symptoms within the 12-hour window if they are not vigilant. Recent efforts have begun to address this issue. Dr. Matthew Churpek at the University of Chicago is partnering with a company to create a device that will go under a patient’s mattress to continuously calculate heart rate and respiratory rate. This will reduce false alarms and allow researchers to use an evidence-based approach to clinical practice. They can generate algorithms based on data to predict early onset of sepsis. Critically, this approach will allow clinicians to focus on preventative efforts rather than treatment.

(Richard Harris, NPR)

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February 23, 2018 at 10:43 pm

Science Policy Around the Web – November 17, 2017

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By: Janani Prabhakar, PhD 

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Public Health

The ‘Horrifying’ Consequence of Lead Poisoning

Changes in water treatment practices in Flint, Michigan in 2014 resulted in large levels of lead in the water supply, and eventually culminated to a state of emergency in January 2016. The supply affected over 10,000 residents, forcing these individuals to refrain from using the city’s water supply until 2020. Because state officials may have been aware of lead contamination in the water supply for months before it became public, these officials are now facing criminal charges. This negligence is particularly troubling given recent evidence that shows persisting effects of lead contamination on health outcomes in Flint residents. In a working paper by Daniel Grossman at West Virginia University and David Slusky at the University of Kansas, the authors compared fertility rates in Flint before and after the change in water treatment practices that led to the crisis, and compared post-change fertility rates in Flint to those of unaffected towns in Michigan. They found that the fertility rate declined by 12 percent and fetal death rate increased by 58 percent. These reductions in rate have been witnessed in other cities after similar incidents of lead contamination in the water supply. Furthermore, given that the number of children with lead-poisoned blood supply doubled after changes to the treatment practices, the long-term effects on cognitive, behavior, and social outcomes of this contamination are only beginning to be examined and understood. The circumstances in Flint are an example of how misplaced focus of high-level policy decisions can negatively impact local communities, particularly low-income black neighborhoods. Black neighborhoods are disproportionately affected by lead contamination, but the lack of sufficient attention as well as the false suggestion that effected individuals were to blame propagated by industry leaders and policy makers have deterred progress in addressing critical issues in at-risk and underserved communities.

(Olga Khazan, The Atlantic)

Climate Change

Why China Wants to Lead on Climate, but Clings to Coal (for Now)

In a country of 1.4 billion people, China is one of the world’s largest coal producers and carbon polluters. However, it aims to spearhead the international agreement to address climate change. Despite this contradiction, China is already on track to meet its commitment to the Paris climate accord. This move towards reducing its dependence on coal comes as a necessity to China because of internal pressure to curb air pollution. But, according to NRDC climate and energy policy director Alvin Lin, given its size and population, phasing out coal dependence will not only be a long process for China, but one that has lots of ups and downs. For instance, while China has shown progress in meeting its commitments, a recent report shows higher emission projections this year may reflect an uptick in economic growth and reduction in rains needed to power hydroelectric technologies. While Lin portrays this uptick as an anomaly, competing interests in the Chinese government make the future unclear. In efforts to increase its presence abroad, China has built coal plants in other countries. But, China is also the largest producer of electric cars. President Xi Jinping has derided the United States for being isolationist and reneging on the Paris climate accord, but how his Government plans to hold its end of the deal has not been revealed. An important revelation is the fact that even if every country achieves their individual Paris pledges, the planet will still heat up by 3 degrees Celsius or more. Given that this increase is large enough to have catastrophic effects on the climate, adherence to Paris pledges serves only as a baseline for what is necessary and sufficient to combat global warming.

(Somini Sengupta, The New York Times)

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November 17, 2017 at 4:51 pm