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16

Business & Entrepreneurship / Themed days - The productivity secret of Elon Musk

« on: October 04, 2020, 10:34:22 AM »

Have you ever wondered how Elon Musk manages two billion-dollar companies at once? Well, he follows a carefully planned schedule, strictly dividing his time between them and his other activities in each working week. He works at SpaceX on Monday and Tuesday, then at Tesla on Wednesday and Thursday returning to SpaceX on Friday.

He basically applies a simplified version of the “themed days” concept to his schedule. So, what are themed days?

Themed days are strategically planned days in your calendar which are completely dedicated to one single thing. It can be working on a certain goal in your life, a personal or professional project, or in Elon’s case, working for one of the companies in your portfolio.

It’s easy to employ the themed days concept. You open your calendar, select one whole day, and schedule it for the selected “theme”. Themed days are especially useful when you want to make greater progress in a short amount of time, and can be utlilized for many different reasons, such as:

*Advancing a project
*Learning new skills
*Planning and analyzing
*Brainstorming ideas
*Reading and researching
*Fixing your relationship(s)
*Building a personal brand
*Writing
*Coding etc.

Themed days are also beneficial when you have a side project or hustle outside of your primary occupation.

Let’s say you want to learn to code; It’s better to dedicate one full day to learning how to do so than to struggle with learning for an hour after every working day, when you’re already completely exhausted and frustrated.

Themed days with no interruptions will skyrocket your productivity

Probably the most useful and powerful piece of productivity advice is to keep certain hours in your schedule with zero interruptions. It can even be a whole day.

“No-interruptions” days are simply days in your working week with no meetings, no email, no socializing or other distractions of any kind. It’s only you, working on the most important task in a flow with laser focus.

When you have a no-interruptions day, you set an auto responder on your email, turn off your phones, put a “Do not disturb” sign on your office door and use every other possible preventive measure available to make sure you aren’t distracted in any way, so as to be able to create value in a godlike state and get the really important tasks done.

Combining themed days with no-interruption days can do magic for your productivity and progress your goals.

The combination of the two means that you can regularly dedicate a day in the week to an important goal in your life.

Why are themed days so effective?

Let’s do very simple math, just to show the power of themed days. For example, let’s say you want to learn Photoshop. Every day after work, when you’re already exhausted, you take one hour to learn the skill.

In one month, you will have dedicated approximately 20 hours to learning and will most likely struggle with discipline and concentration.

But what if you schedule two themed days in a row, let’s say Friday and Saturday, and you devote 10 focused hours to learning Photoshop on both days? You would achieve in two days what you would otherwise achieve in one month.

And there’s another benefit: I bet if you decide to learn for an hour a day after work, there are days when you’re too tired, when something else comes up, and so on. One month quickly becomes two months, and soon the goal has fallen by the wayside.

Maintaining self-discipline is so much easier with themed days. Why torture yourself at the end of an already full day, when you can achieve something smoothly and easily with only a slightly different approach to your time management?

Themed days can help you avoid multitasking

If you’re working on multiple projects at the same time, you can also use the themed days concept to avoid multitasking and stay more productive. You devote a certain day (or a couple of days) in a week to a specific project and stay brutally focused.

As mentioned, Elon Musk devotes two days to Tesla, two days to SpaceX and one day to his solar company. As an alternative, you could devote:

*two days in your company to sales and acquiring new customers,
*two days to product development,
*one day to finance,
*and one day to administration and internal affairs, or whatever else needs to get done.

If you use the concept of themed days like that, it enables you to push certain complex tasks a lot further than you could with multitasking.
Here’s how Jack Dorsey does it:

On Monday, at both companies, I focus on management and running the company. Tuesday is focused on products. Wednesday is focused on marketing and communications and growth. Thursday is focused on developers and partnerships. Friday is focused on the company and the culture and recruiting. Saturday I take off, I hike. Sunday is reflection, feedback, strategy, and getting ready for the week.

With themed days, you get rhythm, focus, and structure in your life, especially by grouping tasks and avoiding multitasking, which hinders your productivity.

And there are many ways you can use themed days to your advantage. Play with the concept, experiment, and find out what works best for you.

To sum up, there are at least three ways of using themed days:

*Have a no-interruptions day devoted to a certain important personal or professional goal you’ve been putting off.
*Use themed days to manage multiple companies, projects, or complex tasks, and devote your entire day to one of these pursuits.
*Use themed days to group specific activities and devote the whole day to them; for example, internal meetings, sales, brainstorming new ideas, strategy, marketing etc. Make sure you make a lot of progress on the selected business function that day.

It’s obvious where the biggest problem of themed days lies, and why not many people utilize the concept. It’s hard to empty your calendar.

But here, the saying: “The hard road becomes easy and the easy road becomes hard.” really applies.

If you put in the effort to empty your calendar, no matter how many people you have to say no to or reschedule, or how many other tasks have to wait, you’ll feel a special kind of happiness and excitement when you see a whole day dedicated to one thing in your calendar.

You’ll instantly know how much you can achieve that day, and you will -if you stick to the plan.

Themed weeks can be themed days on steroids

If you really want to level up your game and accelerate your progress even further, you can introduce themed weeks into your life.

Let’s do the math again. 50 focused hours of learning in a single week, compared to 3 - 5 months of learning for an hour each day. If you plan three themed weeks in a year (3 out of 52 weeks), you can learn more in those three weeks than you can learn in a whole year by learning for one hour per working day.

You can also put your skills to use sooner and it takes less self-discipline. It’s like going on holiday for a week.

You can also use the same concept to devote the whole week to a single project, and really make huge advancements, or to a certain business function,; and today, with all the rapid prototyping tools available, you could take a week to build an MVP/prototype and test your idea on the market.

The only obstacle is having enough motivation to hack your schedule.

Give themed days a test run and see for yourself

The best way to see what themed days can do for your productivity is to simply test the concept So, here’s your homework:

*Open your calendar.
*Schedule a whole day as a no-interruptions day.
*If you can’t empty your calendar in the next two weeks on working days, do it on a Saturday.
*Pick one mentally complex and demanding thing you always wanted to learn or do (personal or professional).
*Prepare a plan of what you will do or learn in those 10 hours of focused work
*Get excited and do it.

will feel a sense of achievement and see the progress that can be made with this approach.

Many great masterpieces of art were created in solitude and isolation, or, in other words, complete dedication to creation. It’s kind of the extreme version of the no-interruptions themed days.

Maybe it’s time to make room in your calendar to create in solitude and present your masterpiece to the world. Or maybe you can just use the concept to advance a project you have been hesitating on and get yourself that next promotion.Source:Web

17

Business & Entrepreneurship / Virtual tourism could offer new opportunities for travel industry, travelers

« on: September 20, 2020, 05:00:52 PM »

A new proposal for virtual travel, using advanced mathematical techniques and combining livestream video with existing photos and videos of travel hotspots, could help revitalize an industry that has been devastated by the coronavirus pandemic, according to researchers at the Medical College of Georgia at Augusta University.

In a new proposal published in Cell Patterns, Dr. Arni S.R. Srinivasa Rao, a mathematical modeler and director of the medical school's Laboratory for Theory and Mathematical Modeling, and co-author Dr. Steven Krantz, a professor of mathematics and statistics at Washington University, suggest using data science to improve on existing television and internet-based tourism experiences. Their technique involves measuring and then digitizing the curvatures and angles of objects and the distances between them using drone footage, photos and videos, and could make virtual travel experiences more realistic for viewers and help revitalize the tourism industry, they say.

They call this proposed technology LAPO, or Live Streaming with Actual Proportionality of Objects. LAPO employs both information geometry -- the measures of an object's curvatures, angles and area -- and conformal mapping, which uses the measures of angles between the curves of an object and accounts for the distance between objects, to make images of people, places and things seem more real.

"This is about having a new kind of technology that uses advanced mathematical techniques to turn digitized data, captured live at a tourist site, into more realistic photos and videos with more of a feel for the location than you would get watching amovie or documentary," says corresponding author Rao. "When you go see the Statue of Liberty for instance, you stand on the bank of the Hudson River and look at it. When you watch a video of it, you can only see the object from one angle. When you measure and preserve multiple angles and digitize that in video form, you could visualize it from multiple angles. You would feel like you're there while you're sitting at home."

Their proposed combination of techniques is novel, Rao says. "Information geometry has seen wide applications in physics and economics, but the angle preservation of the captured footage is never applied," he says.

Rao and Krantz say the technology could help mediate some of the pandemic's impact on the tourism industry and offer other advantages.

Those include its cost-effectiveness, because virtual tourism would be cheaper; health safety, because it can be done from the comfort of home; it saves time, eliminating travel times; it's accessibility -- tourism hotspots that are not routinely accessible to seniors or those with physical disabilities would be; it's safer and more secure, eliminating risks like becoming a victim of crime while traveling; and it requires no special equipment -- a standard home computer with a graphics card and internet access is all that's needed to enjoy a "virtual trip."

"Virtual tourism (also) creates new employment opportunities for virtual tour guides, interpreters, drone pilots, videographers and photographers, as well as those building the new equipment for virtual tourism," the authors write.

"People would pay for these experiences like they pay airlines, hotels and tourist spots during regular travel," Rao says. "The payments could go to each individual involved in creating the experience or to a company that creates the entire trip, for example."

Next steps include looking for investors and partners in the hospitality, tourism and technology industries, he says.

If the pandemic continues for several more months, the World Travel and Tourism Council, the trade group representing major global travel companies, projects a global loss of 75 million jobs and $2.1 trillion in revenue.

Rao is a professor of health economics and modeling in the MCG Department of Population Health Sciences.Source:ScienceDaily

18

Public Health / A surprising opportunity for telehealth in shaping the future of medicine

« on: September 11, 2020, 05:23:13 PM »

Expanded telehealth services at UT Southwestern have proved effective at safely delivering patient care during the pandemic, leading to an increase in patients even in specialties such as plastic surgery, according to a new study.

The study, published in the Aesthetic Surgery Journal, illuminates the unexpected benefits that telehealth has had during the pandemic and provides insight into what this may mean for the future of medicine in the United States.

"Prior to COVID-19, it was not clear if telehealth would meet the standard of care in highly specialized clinical practices. Out of necessity, we were forced to innovate quickly. What we found is that it is actually a really good fit," says Alan Kramer, M.P.H., assistant vice president of health system emerging strategies at UTSW and co-author of the study.

UT Southwestern was already equipped with telehealth technology when COVID-19 hit -- but only as a small pilot program. Through incredible team efforts, telehealth was expanded across the institution within days, bringing with it several unanticipated benefits for both the medical center and patients.

"The conversion rate to telehealth is higher than in person," says Bardia Amirlak, M.D., FACS, associate professor of plastic surgery and the study's senior corresponding author. The study found 25,197 of 34,706 telehealth appointments across the institution were completed in April 2020 -- a 72.6 percent completion rate -- compared with a 65.8 percent completion rate of in-person visits from April 2019.

The study notes the significant increases in the volume of new patients seen by telehealth beginning in March 2020. This resulted from a combination of relaxed regulations and an increasing comfort level with telehealth visits among physicians and patients. UTSW saw the percentage of new patients seen through telehealth visits increase from 0.77 percent in February to 14.2 percent and 16.7 percent in March and April, respectively.

Even within a niche field like plastic surgery, the implementation of telehealth has been incredibly successful, demonstrating the tractability of telehealth to a wide range of practices. From April to mid-May, plastic surgery completed 340 telehealth visits in areas such as breast cancer reconstruction, hand surgery, and wound care, with completion rates similar to the whole of UTSW. Likewise, plastic surgery also saw a large number of new patients, who comprised 41 percent of the telehealth visits.

"The fear was that the platform wouldn't be able to handle it: the privacy issues, insurance issues, malpractice issues ... but it came together well and we were able to ramp up into the thousands, and were able to not only decrease patient anxiety, but also increase many beneficial factors, such as patient access," says Amirlak.

The study reported several boons for telehealth patients, including reductions in stress, missed work, the number of hospital visits, travel time, and exposure to pathogens, in addition to improving access to care with the option for out-of-state consultations. Indeed, patients from 43 states and Puerto Rico have participated in telehealth visits at UTSW facilities since March.

Even as COVID-19 restrictions have eased in Texas, telehealth is still proving to be a major part of UT Southwestern's clinical practice. "The feedback from patients has been very positive," says Kramer. "We're now sustaining 25 percent of our practice being done virtually, a major win for our patients. It's changed the way we think about care."

Whether this trend continues into the post-COVID-19 world remains to be seen, he says. But either way, Kramer says, it is clear that telehealth will be a useful tool.

The numerous benefits that telehealth has to offer are accompanied by several challenges, however, such as the practicality and risks of remote diagnostic medicine. Though technology is starting to address some issues with the development of tools such as electronic stethoscopes and consumer-facing apps that can measure blood oxygen levels and perform electrocardiograms, for example, some argue the value of the in-person physical exam cannot be replaced. Moving forward, Amirlak says, "it will be our responsibility as physicians and scientists to recognize the potential dangers of taking telehealth to the extreme right now and missing a clinical diagnosis."

Aside from patient-facing issues, other challenges need to be included in discussions of the future of telehealth, including federal, state, and local laws; privacy concerns; and Health Insurance Portability and Accountability Act (HIPAA) regulations. Many statutes and restrictions have been loosened during the pandemic, allowing institutions like UTSW to implement telehealth rapidly and effectively. But the future of telehealth will necessitate the development of long-term regulations.

"Based on the trends, it seems that telehealth is here to stay. So it's important to think about the concerns, and based on this information, the issues that we have and how we can resolve them going forward," says Christine Wamsley, a UTSW research fellow and first author of the study. With the ramp-up of telehealth and related restrictions amid the COVID-19 pandemic, now may be the best opportunity for health care providers and governmental agencies to address these challenges and set out guidelines for the practice of telehealth. Source:Web

19

Public Health / The remarkable ways animals understand numbers

« on: September 08, 2020, 09:42:59 AM »

Humans as a species are adept at using numbers, but our mathematical ability is something we share with a surprising array of other creatures.

One of the key findings over the past decades is that our number faculty is deeply rooted in our biological ancestry, and not based on our ability to use language. Considering the multitude of situations in which we humans use numerical information, life without numbers is inconceivable.

But what was the benefit of numerical competence for our ancestors, before they became Homo sapiens? Why would animals crunch numbers in the first place?

It turns out that processing numbers offers a significant benefit for survival, which is why this behavioural trait is present in many animal populations. Several studies examining animals in their ecological environments suggest that representing numbers enhances an animal’s ability to exploit food sources, hunt prey, avoid predation, navigate its habitat, and persist in social interactions.

Before numerically competent animals evolved on the planet, single-celled microscopic bacteria – the oldest living organisms on Earth – already exploited quantitative information. The way bacteria make a living is through their consumption of nutrients from their environment. Mostly, they grow and divide themselves to multiply. However, in recent years, microbiologists have discovered they also have a social life and are able to sense the presence or absence of other bacteria. In other words, they can sense the number of bacteria.

Take, for example, the marine bacterium Vibrio fischeri. It has a special property that allows it to produce light through a process called bioluminescence, similar to how fireflies give off light. If these bacteria are in dilute water solutions (where they are essentially alone), they make no light. But when they grow to a certain cell number of bacteria, all of them produce light simultaneously. Therefore, Vibrio fischeri can distinguish when they are alone and when they are together.

It turns out they do this using a chemical language. They secrete communication molecules, and the concentration of these molecules in the water increases in proportion to the cell number. And when this molecule hits a certain amount, called a “quorum”, it tells the other bacteria how many neighbours there are, and all the bacteria glow.

This behaviour is called “quorum sensing” – the bacteria vote with signalling molecules, the vote gets counted, and if a certain threshold (the quorum) is reached, every bacterium responds. This behaviour is not just an anomaly of Vibrio fischeri – all bacteria use this sort of quorum sensing to communicate their cell number in an indirect way via signalling molecules.

Remarkably, quorum sensing is not confined to bacteria – animals use it to get around, too. Japanese ants (Myrmecina nipponica), for example, decide to move their colony to a new location if they sense a quorum. In this form of consensus decision making, ants start to transport their brood together with the entire colony to a new site only if a defined number of ants are present at the destination site. Only then, they decide, is it safe to move the colony.

The number of “dee” notes at the end of the chickadee alarm call indicates the danger level of a predator

Numerical cognition also plays a vital role when it comes to both navigation and developing efficient foraging strategies. In 2008, biologists Marie Dacke and Mandyam Srinivasan performed an elegant and thoroughly controlled experiment in which they found that bees are able to estimate the number of landmarks in a flight tunnel to reach a food source – even when the spatial layout is changed. Honeybees rely on landmarks to measure the distance of a food source to the hive. Assessing numbers is vital to their survival.

When it comes to optimal foraging, “going for more” is a good rule of thumb in most cases, and seems obvious when you think about it, but sometimes the opposite strategy is favourable. The field mouse loves live ants, but ants are dangerous prey because they bite when threatened. When a field mouse is placed into an arena together with two ant groups of different quantities, then, it surprisingly “goes for less”. In one study, mice that could choose between five versus 15, five versus 30, and 10 versus 30 ants always preferred the smaller quantity of ants. The field mice seem to pick the smaller ant group in order to ensure comfortable hunting and to avoid getting bitten frequently.

Numerical cues play a significant role when it comes to hunting prey in groups, as well. The probability, for example, that wolves capture elk or bison varies with the group size of a hunting party. Wolves often hunt large prey, such as elk and bison, but large prey can kick, gore, and stomp wolves to death. Therefore, there is incentive to “hold back” and let others go in for the kill, particularly in larger hunting parties. As a consequence, wolves have an optimal group size for hunting different prey. For elks, capture success levels off at two to six wolves. However, for bison, the most formidable prey, nine to 13 wolves are the best guarantor of success. Therefore, for wolves, there is “strength in numbers” during hunting, but only up to a certain number that is dependent on the toughness of their prey.

Animals that are more or less defenceless often seek shelter among large groups of social companions – the strength-in-numbers survival strategy hardly needs explaining. But hiding out in large groups is not the only anti-predation strategy involving numerical competence.

In 2005, a team of biologists at the University of Washington found that black-capped chickadees in Europe developed a surprising way to announce the presence and dangerousness of a predator. Like many other animals, chickadees produce alarm calls when they detect a potential predator, such as a hawk, to warn their fellow chickadees. For stationary predators, these little songbirds use their namesake “chick-a-dee” alarm call. It has been shown that the number of “dee” notes at the end of this alarm call indicates the danger level of a predator.

A call such as “chick-a-dee-dee” with only two “dee” notes may indicate a rather harmless great grey owl. Great grey owls are too big to manoeuvre and follow the agile chickadees in woodland, so they aren’t a serious threat. In contrast, manoeuvring between trees is no problem for the small pygmy owl, which is why it is one of the most dangerous predators for these small birds. When chickadees see a pygmy owl, they increase the number of “dee” notes and call “chick-a-dee-dee-dee-dee.” Here, the number of sounds serves as an active anti-predation strategy.

Groups and group size also matter if resources cannot be defended by individuals alone – and the ability to assess the number of individuals in one’s own group relative to the opponent party is of clear adaptive value.

Several mammalian species have been investigated in the wild, and the common finding is that numerical advantage determines the outcome of such fights. In a pioneering study, zoologist Karen McComb and co-workers at the University of Sussex investigated the spontaneous behaviour of female lions at the Serengeti National Park when facing intruders. The authors exploited the fact that wild animals respond to vocalisations played through a speaker as though real individuals were present. If the playback sounds like a foreign lion that poses a threat, the lionesses would aggressively approach the speaker as the source of the enemy. In this acoustic playback study, the authors mimicked hostile intrusion by playing the roaring of unfamiliar lionesses to residents.

Lionesses decide to approach intruders aggressively only if they outnumber the latter — an example of an animal’s ability to take quantitative information into account

Two conditions were presented to subjects: either the recordings of single female lions roaring, or of groups of three females roaring together. The researchers were curious to see if the number of attackers and the number of defenders would have an impact on the defender’s strategy. Interestingly, a single defending female was very hesitant to approach the playbacks of a single or three intruders. However, three defenders readily approached the roaring of a single intruder, but not the roaring of three intruders together.

Obviously, the risk of getting hurt when entering a fight with three opponents was foreboding. Only if the number of the residents was five or more did the lionesses approach the roars of three intruders. In other words, lionesses decide to approach intruders aggressively only if they outnumber the latter – another clear example of an animal’s ability to take quantitative information into account.

Our closest cousins in the animal kingdom, the chimpanzees, show a very similar pattern of behaviour. Using a similar playback approach, Michael Wilson and colleagues from Harvard University found that the chimpanzees behaved like military strategists. They intuitively follow equations used by military forces to calculate the relative strengths of opponent parties. In particular, chimpanzees follow predictions made in Lanchester’s “square law” model of combat. This model predicts that, in contests with multiple individuals on each side, chimpanzees in this population should be willing to enter a contest only if they outnumber the opposing side by a factor of at least 1.5. And that is precisely what wild chimps do.

Staying alive – from a biological stance – is a means to an end, and the aim is the transmission of genes. In mealworm beetles (Tenebrio molitor), many males mate with many females, and competition is intense. Therefore, a male beetle will always go for more females in order to maximise his mating opportunities. After mating, males even guard females for some time to prevent further mating acts from other males. The more rivals a male has encountered before mating, the longer he will guard the female after mating.

It is obvious that such behaviour plays an important role in reproduction and therefore has a high adaptive value. Being able to estimate quantity has improved males’ sexual competitiveness. This may in turn be a driving force for more sophisticated cognitive quantity estimation throughout evolution.

One may think that everything is won by successful copulation. But that is far from the truth for some animals, for whom the real prize is fertilising an egg. Once the individual male mating partners have accomplished their part in the play, the sperm continues to compete for the fertilisation of the egg. Since reproduction is of paramount importance in biology, sperm competition causes a variety of adaptations at the behavioural level.

In both insects and vertebrates, the males’ ability to estimate the magnitude of competition determines the size and composition of the ejaculate. In the pseudoscorpion, Cordylochernes scorpioides, for example, it is common that several males copulate with a single female. Obviously, the first male has the best chances of fertilising this female’s egg, whereas the following males face slimmer and slimmer chances of fathering offspring. However, the production of sperm is costly, so the allocation of sperm is weighed considering the chances of fertilising an egg.

Males smell the number of competitor males that have copulated with a female and adjust by progressively decreasing sperm allocation as the number of different male olfactory cues increases from zero to three.

Cowbird females watch out for host nests in which the number of eggs has increased since her first visit

Some bird species, meanwhile, have invented a whole arsenal of trickery to get rid of the burden of parenthood and let others do the job. Breeding a clutch and raising young are costly endeavours, after all. They become brood parasites by laying their eggs in other birds’ nests and letting the host do all the hard work of incubating eggs and feeding hatchlings. Naturally, the potential hosts are not pleased and do everything to avoid being exploited. And one of the defence strategies the potential host has at its disposal is the usage of numerical cues.

American coots, for example, sneak eggs into their neighbours’ nests and hope to trick them into raising the chicks. Of course, their neighbours try to avoid being exploited. A study in the coots’ natural habitat suggests that potential coot hosts can count their own eggs, which helps them to reject parasitic eggs. They typically lay an average-sized clutch of their own eggs, and later reject any surplus parasitic egg. Coots therefore seem to assess the number of their own eggs and ignore any others.

An even more sophisticated type of brood parasitism is found in cowbirds, a songbird species that lives in North America. In this species, females also deposit their eggs in the nests of a variety of host species, from birds as small as kinglets to those as large as meadowlarks, and they have to be smart in order to guarantee that their future young have a bright future.

Cowbird eggs hatch after exactly 12 days of incubation; if incubation is only 11 days, the chicks do not hatch and are lost. It is therefore not an accident that the incubation times for the eggs of the most common hosts range from 11 to 16 days, with an average of 12 days. Host birds usually lay one egg per day – once one day elapses with no egg added by the host to the nest, the host has begun incubation. This means the chicks start to develop in the eggs, and the clock begins ticking. For a cowbird female, it is therefore not only important to find a suitable host, but also to precisely time their egg laying appropriately. If the cowbird lays her egg too early in the host nest, she risks her egg being discovered and destroyed. But if she lays her egg too late, incubation time will have expired before her cowbird chick can hatch.

Clever experiments by David J White and Grace Freed-Brown from the University of Pennsylvania suggest that cowbird females carefully monitor the host’s clutch to synchronise their parasitism with a potential host’s incubation. The cowbird females watch out for host nests in which the number of eggs has increased since her first visit. This guarantees that the host is still in the laying process and incubation has not yet started. In addition, the cowbird is looking out for nests that contain exactly one additional egg per number of days that have elapsed since her initial visit.

For instance, if the cowbird female visited a nest on the first day and found one host egg in the nest, she will only deposit her own egg if the host nest contains three eggs on the third day. If the nest contains fewer additional eggs than the number of days that have passed since the last visit, she knows that incubation has already started and it is useless for her to lay her own egg. It is incredibly cognitively demanding, since the female cowbird needs to visit a nest over multiple days, remember the clutch size from one day to the next, evaluate the change in the number of eggs in the nest from a past visit to the present, assess the number of days that have passed, and then compare these values to make a decision to lay her egg or not.

But this is not all. Cowbird mothers also have sinister reinforcement strategies. They keep watch on the nests where they’ve laid their eggs. In an attempt to protect their egg, the cowbirds act like mafia gangsters. If the cowbird finds that her egg has been destroyed or removed from the host’s nest, she retaliates by destroying the host bird’s eggs, pecking holes in them or carrying them out of the nest and dropping them on the ground. The host birds better raise the cowbird nestling, or else they have to pay dearly. For the host parents, it may therefore be worth to go through all the trouble of raising a foster chick from an adaptive point of view.

The cowbird is an astounding example of how far evolution has driven some species to stay in the business of passing on their genes. The existing selection pressures, whether imposed by the inanimate environment or by other animals, force populations of species to maintain or increase adaptive traits caused by specific genes. If assessing numbers helps in this struggle to survive and reproduce, it surely is appreciated and relied on.

This explains why numerical competence is so widespread in the animal kingdom: it evolved either because it was discovered by a previous common ancestor and passed on to all descendants, or because it was invented across different branches of the animal tree of life.

Irrespective of its evolutionary origin, one thing is certain – numerical competence is most certainly an adaptive trait.Source:BBC

20

Public Health / Research compares T cell responses to SARS-CoV-2 and influenza

« on: September 05, 2020, 03:01:17 PM »

As the COVID-19 pandemic continues to grow, scientists are focusing on understanding how the host immune system responds to the virus in order to better shape public health responses and develop effective vaccines. A new study published on the preprint server medRxiv* in September 2020 reports the T cell memory response to the SARS-CoV-2 spike protein, recombinant nucleocapsid protein, and other pooled peptides derived from convalescent patients.

The current study included 13 and 1 patient who had tested positive for SARS-CoV-2 and SARS-CoV, respectively. The median age was 53, with all participants being within 90 days of the first symptom.

Antibodies in COVID-19

Adaptive immunity is vital for viral clearance and protective immunity. Most earlier studies show the development of specific IgGs against the spike protein and the receptor-binding domain (RBD) of the virus, in addition to neutralizing antibodies within 2-4 weeks of the infection. Some researchers suggest that antibody responses are transient in mild infection, but others claim to have detected ongoing antibody responses for at least 3-4 months. While IgG antibody peaks and then declines slowly, IgA responses are early and short in duration.

T Cell Responses Required for Protective Immunity

Not only is cellular immunity required for virus neutralization, but CD4 and Tfh responses are a crucial component of antibodies with high affinity for the virus and long-lasting protection, making them essential for protective immunity. Earlier studies on SARS-CoV show that T cells specific to the virus last for 11 years or more, while specific antibody responses wane over 3-5 years.

T cells reactive to the N peptide at 17 years from SARS-CoV infection cross-react with the N peptides from the current virus SARS-CoV-2. Most COVID-19 cases show both CD4 and CD8 responses to varying viral antigens in both acute infection and in the convalescent phase, mostly Th1 type. In many cases, severe illness is associated with the most robust immune response, making it a matter of uncertainty as to why immune clearance does not occur in all cases.

Strong CD4+ T Cell Response

The researchers detected CD4 T cells against the S antigen in just over half and three-quarters of donors as shown by the production of IFN-γ and TNF-α, respectively. Against the N protein, the percentage was ~40% and 60% based on these two cytokines, respectively.

Thus, over 90% of convalescent donors had specific CD4 T cell responses against one or more viral antigens at 4-10 weeks from symptom onset, with an IL-2, TNF-α response being predominant. The low CD8 T cell response might be because of the poor recognition of whole protein antigens by these cells.

None of the samples from healthy donors in March 2020 showed T cell responses to any of the viral proteins, but they did in almost every case of influenza antigen exposure. This absence of cross-reactivity is attributed to the insensitivity of the assay.

Multifunctional CD4 T Cells in Influenza

When it came to cytokines, 80% of anti-S CD4 T cells produced only a single cytokine, while in influenza, multiple cytokines were produced. In fact, the frequency of CD4 T cells producing all cytokines was ~9% in influenza vs. ~3% in spike-exposed T cells. The former also had a markedly higher proportion of cells that produced IFN-γ to those secreting TNF-α, at all grades of disease.

Among the latter phenotype, for both S and influenza reactive CD4 cells, most were central memory T cells. The specific recall was seen for all cases exposed to influenza but ~70% and 85% for spike and N proteins, respectively. Though these cells were activated, not all produced cytokine, however.

Overall, therefore, the findings show that T cells directed against SARS-CoV-2 in early convalescence are mostly TCM in phenotype, producing more TNF-α than IFN-γ, indicating an atypical antiviral response unlike that seen in influenza.

Recall Based on Cytokines

The researchers also found that all the peripheral blood mononuclear cells (PBMCs) had anti-N TNF-α responses but only 50% against the spike and 92% against the influenza antigens. Moreover, the TNF-α responses against N were much higher than against S or influenza, while IL-2 was produced only against the latter two.

However, IL-10 was produced in response to all three, the highest being against N. IL-13 was found to be produced against both S and the influenza antigen, but the pro-inflammatory IL-6 only in response to S and N, and not in influenza. In fact, influenza exposure resulted in the highest IFN-γ production compared to either TNF-α or IL-10.

This reflects a Th1 profile, with a constant and high level of IL-10 secretion when exposed to N protein in all the convalescent COVID-19. Both pTfh and T effector cell responses correlate with neutralization titers, and the latter is highest in those who have recovered after the most severe disease.

At all grades of disease severity, however, CD8 T cell responses were significantly lower than for CD4 T cells. The former is the classical T effector cytotoxic cells that kill virus-infected cells. However, the proliferating activated CD4 granzyme+ T cells play a large role in human antiviral defenses and are present in higher proportion in samples from individuals who had moderate to severe disease. The asymptomatic donor also, however, had a high proportion of these cells.

The anti-S IL-2 pTfh cells were present at frequencies corresponding to the frequency of these proliferating spike-reactive IFN-g/granzyme B+ T cells.

Implications

The current study used recombinant proteins to assess the T cell response to antigens presented by cells and made use of the fully glycosylated spike protein to simulate the natural presentation of this antigen on the virus.

The overall T cell response to infection with SARS-CoV-2 is strong, with predominating Th1 cell responses. Inflammatory CD4 responses may contribute to the severity of the disease. The researchers also found that in some donors, T follicular helper cells in peripheral blood (pTfh) produce IL-2 and express CCR7+CXCR5+ cells in response to SARS-CoV-2 antigens. The frequency of these cells is strongly related to serum neutralization assays as well as to RBD-IgA, but overall, this response is lower than in influenza.

The CD4 memory T cell response was strong in over 90% of cases of exposure to the influenza H1N1 strain. The reason is not the low dose of the spike protein or the use of the whole influenza virus vs. recombinant spike proteins. However, it could be due to the fact that only two SARS-CoV-2 proteins were used.

Secondly, the predominance of IL-2 and TNF-α over IFN-γ in CD4 T cells responses to this virus contrasts with the IFN-γ-dominant response in influenza. This change in the Th1 profile may result in increased inflammation and impaired viral clearance compared to influenza. Moreover, this pattern is independent of disease severity.

However, specific T cells secreting multiple cytokines are significantly fewer in severe COVID-19 and may mirror T cell exhaustion irrespective of the duration of exposure. The high IL-10 secretion is probably from monocytes or NK cells responding to activated T cells, while IL-6 is from monocytes. The high IL-10 may cause poor antigen presentation and immunosuppression, and this finding may shape future vaccine design.

Most CD4 T cells appeared to be of the central memory cell subtype with a lower ratio of interferon-gamma to TNF-α, compared to the changes in the same donors exposed to influenza. This difference is independent of the severity of the disease.

Conclusion

The SARS-CoV-2 infection resulted in the production of T cells with reduced functional range compared to those found in influenza, perhaps the outcome of T cell exhaustion. N protein exposure resulted in high IL-10 levels, which may have caused immunosuppression. Granzyme B/IFN-γ-producing CD4 and CD8 T cells showed a proliferative response on exposure to pooled peptides, predominantly the former. T follicular helper cell elevations to spike or N protein, and anti-RBD IgA, were correlated with neutralizing activity in serum as well.Source:Web

21

Public Health / How the science of epigenetics is revolutionising skin care

« on: September 03, 2020, 12:27:36 PM »

It’s tempting to think of skin as a simple protective layer. But that’s just the beginning. Skin is a fantastically complex organ. It cools us and keeps us warm. It helps us sense the external environment. And it is self-repairing, thanks to the tireless work of armies of molecular machines that repair damage, rehydrate tissue and stimulate new cell growth, much of this work completed at night.

Just how this repair work is coordinated and controlled is a heavily studied topic. In recent years, researchers have discovered a class of molecules in the body that help control how genes work, translating the impact of diet and lifestyle into physical effects on the aging process, including in skin.

Epigenetics is the study of the way genes are controlled, or expressed, in the body. Our genes are influenced by a range of factors in the environment. Whereas some biological markers can switch genes on and off, a class of molecules known as microRNAs act almost like dimmer switches, tuning the activity of a gene up or down. These epigenetic changes are thought to play important roles in human health, including in ageing.

Epigenetic signals

This class of molecules plays a vital role in keeping us healthy, but also seems to influence how skin ages, says Nadine Pernodet, vice president of research and development in skin biology and bioactives at Estée Lauder. By understanding the role of these molecules in young skin cells, she says we can hope to unveil critical processes to support the repair of older skin cells.

“If we understand what’s occurring naturally in the skin, and which epigenetic signals are firing that create damage or support repair, it would give us more tools and power to help slow down the ageing process and to help to repair the look of skin over time,” says Pernodet.

For the past thirteen years, her group’s work has focused on epigenetics and skin. All cells in your body contain the same set of DNA but end up working in very different ways. For example, a liver cell looks and acts very differently than a brain cell even though they have the exact same DNA. And the reason they act differently is because of epigenetics. Therefore, it is imperative to specifically study the cell type of interest.

Thousands of these tiny microRNA molecules have been identified in humans, and they are thought to target over 60 per cent of human genes, says Pernodet. And the molecules can impact genes in multiple ways and can trigger different responses in different cell types.

MicroRNAs influence how cells develop and die, as well as how our bodies control metabolism and respond to stress, among other things. And while the field is still young, these molecules are being explored as potential markers to diagnose some diseases and treat others. “Now that scientists are looking at these in different fields, we are seeing that microRNAs are involved in basically everything,” says Pernodet.

When Pernodet and her colleagues set out to look for microRNAs that might play a role in skin ageing, they looked at how levels of microRNAs change as we age. At the same time, they were also interested in circadian rhythms – specifically, how biological processes in the skin change with the time of day.

Previous research suggests that our skin provides a more effective barrier during the day, when its key role is protecting us from environmental damage, whether that be from UV light, pollution or anything else we might encounter that could potentially cause damage. Overnight, the focus is on repairing damage that has occurred during the day, says Pernodet. “Skin naturally produces proteins and lipids to rebuild its barrier to be ready for the next morning,” she says.

“Unfortunately, this beautiful, perfect machinery becomes dysregulated due to exposure to pollution, stress, lack of sleep, or ageing,” says Pernodet. So her team set out to find microRNAs that are not only linked to ageing, but which are also linked to the skin’s circadian rhythm.

Pernodet’s team have identified a microRNA that appears to do just that. They began by looking at the levels of 80 known microRNAs in skin cells taken from people aged 19, 27, 40 and 62. One molecule jumped out. Levels of mir-146a appeared to decline with age. But the molecule also seemed to interact with a gene called PER1, which is known to code for a protein that helps maintain circadian rhythms.

Anti-ageing markers

Further research revealed that levels of mir-146a are linked to a host of anti-ageing markers in skin. As levels of mir-146a decline, so do levels of collagen – a protein key to skin’s structure. At the same time, with less mir-146a, skin cells appear less able to respond to the damaging effects of UV light, and less able to repair cellular damage, says Pernodet.

In attempting to halt this trend in older skin, Pernodet’s team worked with a collaborator to identify compounds that might increase mir-146a levels. The search identified an extract from the African baobab tree Adansonia digitata.

When Pernodet’s team applied this extract to skin cells in the lab, they saw dramatic results. Within 48 hours of treatment, 62-year-old cells started to show levels and distribution of mir-146a closer to those of 19-year-old cells. Treated cells were also better at regenerating after 7 days of treatment. “This in vitro testing showed cell numbers increased by more than 40 percent, which is going to help the skin visibly rebuild over time,” says Pernodet.

Pernodet’s team then combined the extract with other repair ingredients. The resulting combination was shown in in vitro testing to improve the ability of 62-year-old cells to recover from cellular damage caused by UV light, and to increase significantly the production of collagen.

This area of science is just emerging. Pernodet plans to identify other microRNAs that might play a role in skin ageing and will soon begin collaborating with a research team at the University of California Irvine to that effect. “We identified this one, but I’m sure there are others to discover,” she says. “I think we are going to see an explosion in this field – not only for us in the cosmetics industry, but all over.”Source:Web

22

Public Health / Lockdown may have lasting effects on friendships

« on: August 26, 2020, 09:57:17 AM »

"Friendships can deteriorate very quickly if you don't invest in them - it probably only takes about three months," says evolutionary psychologist Prof Robin Dunbar.

So the social strain of lockdown, while hopefully short-term, could have some long-term effects on some friendships, he says.

In a paper in the Royal Society journal, Proceedings A, Prof Dunbar has delved into the ways in which our social connections will be changed by lockdown.

The University of Oxford academic's insight into those effects comes from a social world far from Zoom quizzes and Whatsapp groups. The roots of our friendships, he says, lie in the social lives of non-human primates.

For many of those primates, strong social bonds - being part of a "stable group" - means protection from predators and rivals.

That goes some way to revealing why many of us treasure our closest friends as though our lives depend on them. In our evolutionary history, they did.

And those bonds require a great deal of maintenance.

One-in, one-out

In both monkeys and humans, research shows that the quality of a relationship - measured by how likely a fellow monkey, ape or human is to step up and defend you - depends directly on the time invested in it.

"We have to see people surprisingly often to maintain a friendship," explains Prof Dunbar, from the University of Oxford. And, because nurturing friendships requires all that time and cognitive capacity, we can only keep up a limited number of social connections.

"In lockdown, many people are forming new friendships with people on their street and in their community for the first time," says Prof Dunbar.

"So when we emerge from lockdown, some of our more marginal friendships might be replaced by some of these new ones."

One impact of this is something that has been called "relationship funnelling" - an effect picked up by a large survey that social scientists carried out in France during the highly restrictive lockdown there.

Put simply, while some friendships were prioritised and even strengthened through care and increased communication, other more marginal connections just "fizzled out".

One major problem resulting from this "fizzling" is any lasting impact on older people's friendships.

"When we're older, we generally find it more difficult to make new friends," says Prof Dunbar.

"And the biggest single factor affecting health, wellbeing, happiness - even the ability to survive surgery or illness - is the number of high-quality friendships you have."

Needing a hug

So long as it is temporary, our closer, more valued friendships should survive intact through lockdown - reinforced at least in some part, by the time we are still able to spend with our friends online.

Dr Jenny Groarke from Queen's University, Belfast, has been studying loneliness during the pandemic.

"People are using digital modes of communication to meet their social needs, but they're less satisfied with the quality of this form relative to face-to-face contact," she says.

"[This] lower satisfaction with the quality of digital social contact, we found, was associated with higher loneliness."

This concurs with the findings of Prof Dunbar's research into social behaviour. There's no substitute, he says, for close, face-to-face encounters.

Part of that is the human need for touch.

"People [in our surveys] also spoke about missing physical touch, and finding it 'bizarre' and 'not normal' to go so long without touching people," says Dr Groarke.

And looking to our closest primate relatives - the chimpanzees - touch is not only "normal", it's socially vital.

Chimps often spend hours each day grooming one another. This close, strictly one-to-one, stroking and parasite-picking is not just about hygiene. Research shows it reinforces social bonds and triggers the brain to release innate, pain-relieving and pleasure-boosting chemicals called endorphins.

However, as a large number of our modern human interactions move online, our own brains are still wired to respond to a similar gentle touch (providing, of course, that it is wholly invited and appropriate).

We, like our primate cousins, have a specialised system of nerve fibres that pick up and transmit the sensation of touch from our skin to those endorphin-releasing bundles of brain cells.

Scientists studying this touch-triggered system of pleasure have even carried out experiments revealing that the more "human-like" the sensation of being stroked on our forearm is, the "more pleasant" it feels.

As researchers reported in a recently published study in the Journal of Experimental Psychology: "Perceiving gentle touch as human appears to promote pleasure possibly because this serves to reinforce interpersonal contact as a means for creating and maintaining social bonds."

That gives new physiological meaning to the feeling of needing a hug from a friend.

"We make physical contact all the time," says Prof Dunbar. "There are strict natural rules about who we can touch, but with close friends and family, we pat on the back, we touch a shoulder…

"Because it's below the horizon of consciousness, we don't appreciate how important it is to us."

Fortunately though, for humans, there are other social activities that activate the brain's pleasure centres - many of which can be done at a social distance or online. Laughing, singing, dancing and eating and drinking alcohol together have all been found to release endorphins and play a role in the upkeep of our all-important social bonds.

For most of us, Prof Dunbar says reassuringly, this time of social distance will be a sad but temporary frustration. But we will have to put in the time to repair locked-down relationships.Source: BBC Health

23

Public Health / Older adults with existing depression show resilience during the pandemic

« on: August 22, 2020, 05:16:23 PM »

A study involving older adults with pre-existing major depressive disorder living in Los Angeles, New York, Pittsburgh, and St Louis found no increase in depression and anxiety during the COVID-19 pandemic.

Researchers from five institutions, including UCLA, found that the older adults, who were already enrolled in ongoing studies of treatment resistant depression, also exhibited resilience to the stress of physical distancing and isolation. The findings were published in peer-reviewed journal, The American Journal of Geriatric Psychiatry.

"We thought they would be more vulnerable to the stress of COVID because they are, by CDC definition, the most vulnerable population," said Helen Lavretsky, MD, a professor-in-residence of psychiatry and biobehavioral sciences at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA. "But what we learned is that older adults with depression can be resilient. They told use that coping with chronic depression taught them to be resilient"

For the study, researchers conducted interviews with the participants, all of whom were over the age of 60, with an average age of 69, during the first two months of the pandemic. Using two screening assessments of depression and anxiety, PHQ-9 and PROMIS, researchers found no changes in the participants' depression, anxiety or suicidality scores before and during the pandemic.

Researchers further determined that:

* Participants were more concerned about the risk of contracting the virus than the risks of isolation.
* While all maintained physical distance, most did not feel socially isolated and were using virtual technology to connect with friends and family.
* While they were coping, many participants said their quality of life was lower, and they worry their mental health will suffer with continued physical distancing.
* Participants were upset by the inadequate governmental response to the pandemic.

Based on the findings, the study authors wrote that policies and interventions to provide access to medical services and opportunities for social interaction are needed to help older adults maintain mental health and quality of life as the pandemic continues.

Lavretsky said many participants reported their quality of life to be lower, and they worried that their mental health will suffer with continued physical distancing. She said further research is needed to determine the impact of the pandemic over time.

She added that the findings offer takeaways for others while weathering the pandemic. "These older persons living with depression have been under stress for a longer time than many of the rest of us. We could draw upon their resilience and learn from it."

The study identified several self-care and coping strategies used by the participants, which included maintaining regular schedules; distracting themselves from negative emotions with hobbies, chores, work or exercise; and using mindfulness to focus on immediate surroundings and needs without thinking beyond the present.

The authors further emphasized that access to mental health care and support groups, and continued social interaction are needed to help older adults whether the pandemic.

Researchers from the University of Pittsburgh, Columbia University College of Physicians and Surgeons/the New York State Department of Mental Health, Washington University in St. Louis and the Centre for Addiction and Mental Health/University of Toronto.

The study was funded by the University of Pittsburgh Department of Psychiatry.Source:Science Daily

24

Public Health / Isolation, Disruption and Confusion: Coping With Dementia During a Pandemic

« on: August 19, 2020, 05:28:25 PM »

GARDENA, Calif. — Daisy Conant, 91, thrives off routine.

One of her favorites is reading the newspaper with her morning coffee. But, lately, the news surrounding the coronavirus pandemic has been more agitating than pleasurable. “We’re dropping like flies,” she said one recent morning, throwing her hands up.

“She gets fearful,” explained her grandson Erik Hayhurst, 27. “I sort of have to pull her back and walk her through the facts.”

Conant hasn’t been diagnosed with dementia, but her family has a history of Alzheimer’s. She had been living independently in her home of 60 years, but Hayhurst decided to move in with her in 2018 after she showed clear signs of memory loss and fell repeatedly.

For a while, Conant remained active, meeting up with friends and neighbors to walk around her neighborhood, attend church and visit the corner market. Hayhurst, a project management consultant, juggled caregiving with his job.

Then COVID-19 came, wrecking Conant’s routine and isolating her from friends and loved ones. Hayhurst has had to remake his life, too. He suddenly became his grandmother’s only caregiver — other family members can visit only from the lawn.

The coronavirus has upended the lives of dementia patients and their caregivers. Adult day care programs, memory cafes and support groups have shut down or moved online, providing less help for caregivers and less social and mental stimulation for patients. Fear of spreading the virus limits in-person visits from friends and family.

These changes have disrupted long-standing routines that millions of people with dementia rely on to help maintain health and happiness, making life harder on them and their caregivers.

“The pandemic has been devastating to older adults and their families when they are unable to see each other and provide practical and emotional support,” said Lynn Friss Feinberg, a senior strategic policy adviser at AARP Public Policy Institute.

Nearly 6 million Americans age 65 and older have Alzheimer’s disease, the most common type of dementia. An estimated 70% of them live in the community, primarily in traditional home settings, according to the Alzheimer’s Association 2020 Facts and Figures journal.

People with dementia, particularly those in the advanced stages of the disease, live in the moment, said Sandy Markwood, CEO of the National Association of Area Agencies on Aging. They may not understand why family members aren’t visiting or, when they do, don’t come into the house, she added.

“Visitation under the current restrictions, such as a drive-by or window visit, can actually result in more confusion,” Markwood said.

The burden of helping patients cope with these changes often falls on the more than 16 million people who provide unpaid care for people with Alzheimer’s or other dementias in the United States.

The Alzheimer’s Association’s 24-hour Helpline has seen a shift in the type of assistance requested during the pandemic. Callers need more emotional support, their situations are more complex, and there’s a greater “heaviness” to the calls, said Susan Howland, programs director for the Alzheimer’s Association California Southland Chapter.

“So many [callers] are seeking advice on how to address gaps in care,” said Beth Kallmyer, the association’s vice president of care and support. “Others are simply feeling overwhelmed and just need someone to reassure them.”

Because many activities that bolstered dementia patients and their caregivers have been canceled due to physical-distancing requirements, dementia and caregiver support organizations are expanding or trying other strategies, such as virtual wellness activities, check-in calls from nurses and online caregiver support groups. EngAGED, an online resource center for older adults, maintains a directory of innovative programs developed since the onset of the COVID-19 pandemic.

They include pen pal services and letter-writing campaigns, robotic pets and weekly online choir rehearsals.

Hayhurst has experienced some rocky moments during the pandemic.

For instance, he said, it was hard for Conant to understand why she needed to wear a mask. Eventually, he made it part of the routine when they leave the house on daily walks, and Conant has even learned to put on her mask without prompting.

“At first it was a challenge,” Hayhurst said. “She knows it’s part of the ritual now.”

People with dementia can become agitated when being taught new things, said Dr. Lon Schneider, director of the Alzheimer’s Disease Research Center at the University of Southern California. To reduce distress, he said, caregivers should enforce mask-wearing only when necessary.

That was a lesson Gina Moran of Fountain Valley, California, learned early on. Moran, 43, cares for her 85-year-old mother, Alba Moran, who was diagnosed with Alzheimer’s in 2007.

“I try to use the same words every time,” Moran said. “I tell her there’s a virus going around that’s killing a lot of people, especially the elderly. And she’ll respond, ‘Oh, I’m at that age.’”

If Moran forgets to explain the need for a mask or social distancing, her mother gets combative. She raises her voice and refuses to listen to Moran, much like a child throwing a tantrum, Moran said. “I can’t go into more information than that because she won’t understand,” she said. “I try to keep it simple.”

The pandemic is also exacerbating feelings of isolation and loneliness, and not just for people with dementia, said Dr. Jin Hui Joo, associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “Caregivers are lonely, too.”

When stay-at-home orders first came down in March, Hayhurst’s grandmother repeatedly said she felt lonesome, he recalled. “The lack of interaction has made her feel far more isolated,” he said.

To keep her connected with family and friends, he regularly sets up Zoom calls.

But Conant struggles with the concept of seeing familiar faces through the computer screen. During a Zoom call on her birthday last month, Conant tried to cut pieces of cake for her guests.

Moran also feels isolated, in part because she’s getting less help from family. In addition to caring for her mom, Moran studies sociology online and is in the process of adopting 1-year-old Viviana.

Right now, to minimize her mother’s exposure to the virus, Moran’s sister is the only person who visits a couple of times a week.

“She stays with my mom and baby so I can get some sleep,” Moran said.

Before COVID, she used to get out more on her own. Losing that bit of free time makes her feel lonely and sad, she admitted.

“I would get my nails done, run errands by myself and go out on lunch dates with friends,” Moran said. “But not anymore.”Source:khn.org

25

Public Health / The algorithms that make big decisions about your life

« on: August 18, 2020, 10:31:29 AM »

Thousands of students in England are angry about the controversial use of an algorithm to determine this year's GCSE and A-level results.

They were unable to sit exams because of lockdown, so the algorithm used data about schools' results in previous years to determine grades.

It meant about 40% of this year's A-level results came out lower than predicted, which has a huge impact on what students are able to do next. GCSE results are due out on Thursday.

There are many examples of algorithms making big decisions about our lives, without us necessarily knowing how or when they do it.

Here's a look at some of them.

Social media
In many ways, social-media platforms are simply giant algorithms.

At their heart, they work out what you're interested in and then give you more of it - using as many data points as they can get their hands on.

Every "like", watch, click is stored. Most apps also glean more data from your web-browsing habits or geographical data. The idea is to predict the content you want and keep you scrolling - and it works.

And those same algorithms that know you enjoy a cute-cat video are also deployed to sell you stuff.

All the data social-media companies collect about you can also tailor ads to you in an incredibly accurate way.

But these algorithms can go seriously wrong. They have been proved to push people towards hateful and extremist content. Extreme content simply does better than nuance on social media. And algorithms know that.

Facebook's own civil-rights audit called for the company to do everything in its power to prevent its algorithm from "driving people toward self-reinforcing echo chambers of extremism".

Insurance

Whether it's house, car, health or any other form of insurance, your insurer has to somehow assess the chances of something actually going wrong.

In many ways, the insurance industry pioneered using data about the past to determine future outcomes - that's the basis of the whole sector, according to Timandra Harkness, author of Big Data: Does Size Matter.

Getting a computer to do it was always going to be the logical next step.

"Algorithms can affect your life very much and yet you as an individual don't necessarily get a lot of input," she says.

"We all know if you move to a different postcode, your insurance goes up or down.

"That's not because of you, it's because other people have been more or less likely to have been victims of crime, or had accidents or whatever."

Innovations such as the "black box" that can be installed in a car to monitor how an individual drives have helped to lower the cost of car insurance for careful drivers who find themselves in a high-risk group.

Might we see more personally tailored insurance quotes as algorithms learn more about our own circumstances?

"Ultimately the point of insurance is to share the risk - so everybody puts [money] in and the people who need it take it out," Timandra says.

"We live in an unfair world, so any model you make is going to be unfair in one way or another."

Healthcare

Artificial Intelligence is making great leaps in being able to diagnose various conditions and even suggest treatment paths.

A study published in January 2020 suggested an algorithm performed better than human doctors when it came to identifying breast cancer from mammograms.

And other successes include:

a tool that can predict ovarian-cancer survival rates and help determine treatment choices
artificial intelligence from University College, London, that identified patients most likely to miss appointments and therefore need reminders
However, all this requires a vast amount of patient data to train the programmes - and that is, frankly, a rather large can of worms.

In 2017, the UK Information Commission ruled the Royal Free NHS Foundation Trust had not done enough to safeguard patient data when it had shared 1.6 million patient records with Google's AI division, DeepMind.

"There's a fine line between finding exciting new ways to improve care and moving ahead of patients' expectations," said DeepMind's co-founder Mustafa Suleyman at the time.

Policing

Big data and machine learning have the potential to revolutionise policing.

In theory, algorithms have the power to deliver on the sci-fi promise of "predictive policing" - using data, such as where crime has happened in the past, when and by whom, to predict where to allocate police resources.

But that method can create algorithmic bias - and even algorithmic racism.

"It's the same situation as you have with the exam grades," says Areeq Chowdhury, from technology think tank WebRoots Democracy.

"Why are you judging one individual based on what other people have historically done? The same communities are always over-represented".

Earlier this year, the defence and security think tank RUSI published a report into algorithmic policing.

It raised concerns about the lack of national guidelines or impact assessments. It also called for more research into how these algorithms might exacerbate racism.

Facial recognition too - used by police forces in the UK including the Met - has also been criticised.

For example, there have been concerns about whether the data going into facial-recognition technology can make the algorithm racist.

The charge is facial-recognition cameras are more accurate at identifying white faces - because they have more data on white faces.

"The question is, are you testing it on a diverse enough demographic of people?" Areeq says.

"What you don't want is a situation where some groups are being misidentified as a criminal because of the algorithm."Source:BBC

26

Public Health / Mental well-being of Community Health Workers during COVID-19?

« on: August 12, 2020, 10:55:30 AM »

Are we doing enough for the mental well-being of Community Health Workers during COVID-19?

CHWs engaged in contact tracing, transport, screening, and follow-up of patients with COVID-19 are at risk of developing psychological distress and mental health symptoms. A mental health response is therefore needed to support CHWs during and after the coronavirus response reaches crisis levels in local regions. This response should recognize the unique needs and challenges of male and female providers. Around the world, some health systems are developing and implementing strategies to offer such support to formal frontline care workers. However, evidence-based guidelines to inform mental health care for CHWs, especially during public health emergencies, remain scarce.

How do organisations support the mental health and well-being of community health workers?

We aimed to explore the availability of resources that support the mental wellbeing of CHWs in LMICs during the COVID-19 pandemic in collaboration with the Thematic Working Group on Community Health Workers of Health Systems Global. We crowdsourced resources via a Google survey from 25th May to 8th June 2020. Overall, 103 participants responded from 23 countries (Figure 1). Sixty-one responses were included in the final analysis as the rest were either duplicates, from representatives at the same organisation, or empty responses. Both The George Institute and the Thematic Working Group thank all those who participated in the survey.

Representatives of 57.4% of the organisations reported noticing mental health symptoms among CHWs. Of those reporting mental health systems, 76.5% noted core mental health symptoms such as anxiety, depression, and increased stress, the second leading group of symptoms (70.5%) were undifferentiated (e.g. somatisation, fatigue, insomnia etc), followed by complaints of high workload and burnout (14.8%).

Approximately half (50.8%) of all organisations reported that they offered some mental health interventions such as training for mental health support (online or face- to-face) (22.8%), psychosocial support (WhatsApp group, peer support) (61.3%), pharmacotherapy (9.7%), increased supervision (6.5%), and rehabilitation for other mental health disorders (6.5%). Most of the mental health services were delivered in India (45.2%). We did not seek to explore the implementation and uptake of the reported interventions.

Of the organisations offering support, six were international NGOs/Foundations; two were Universities/Research centres; 18 were local hospitals/clinics/community-based organisations, three were Ministry (all national-level), and one was unknown type. These data suggest that most mental health support is provided by local organisations and institutions.

Conclusion: CHWs working during COVID-19 must be given the space to talk about their feelings and take care of their own mental health. However, they are facing challenges while performing their tasks therefore need to be supported through evidence-based interventions which are low-cost, accessible, gender-sensitive and easily implemented.

Key messages

* Fifty-seven percent of organisations involved in the survey noticed mental health signs and symptoms such as anxiety, depression and stress among CHWs during the COVID-19 pandemic
* Approximately fifty percent of organisations provided some mental health support to CHWs such as online training, peer support via WhatsApp
* These interventions have not been evaluated so far
* More effort is needed to support the mental health and wellbeing of CHWs in LMICs during and after the pandemic

Next steps: We plan to have a workshop to identify strategies for:

* disseminating  gender-sensitive resources to CHWs, especially those working in LMICs, that can help them manage symptoms of anxiety, depression, and other symptoms of mental distress;
* encouraging uptake of such resources, despite stigma around mental illness and competing demands on the CHWs’ time;
* developing a plan for evaluating the acceptability and effectiveness of these resources during the COVID-19 pandemic.Source:George Institute for Global Health, Australia.

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Public Health / Preventing the next pandemic

« on: July 27, 2020, 07:49:23 PM »

How $30 billion can prevent the next COVID-19

Thus far, COVID-19 has cost at least $2.6 trillion and may cost ten times this amount. It is the largest global pandemic in 100 years. Six months after emerging, it has killed over 600,000 people and is having a major impact on the global economy.

"How much would it cost to prevent this happening again? And what are the principal actions that need to be put in place to achieve this?" asked Andrew Dobson, a professor of ecology and evolutionary biology at Princeton. He and colleague Stuart Pimm of Duke University assembled a team to seek answers.

Their team has now written a Policy Forum article for the journal Science, a research-based opinion piece. In it, the multidisciplinary group of epidemiologists, wildlife disease biologists, conservation practitioners, ecologists and economists argue that an annual investment of $30 billion would pay for itself quickly.

"There have been at least four other viral pathogens that have emerged in the human population so far this century. Investment in prevention may well be the best insurance policy for human health and the global economy in the future," Pimm said.

Two major factors loom large as drivers of emerging pathogens: destruction of tropical forests and the wildlife trade. Each has contributed two of the four emerging diseases that have appeared in the last 50 years: COVID, Ebola, SARS, HIV.

Both deforestation and the wildlife trade also cause widespread damage to the environment on multiple fronts, so there are diverse benefits associated with reducing them, note the researchers. Increased monitoring and policing of these activities would allow future emerging viruses to be detected at a much earlier stage, when control could prevent further spread.

All the credible genetic evidence points to COVID-19 emerging from a bat species traded as food in China. The wildlife trade is a major component of the global economy, with principal economic products including food, medicine, pets, clothing and furniture. Some of these are traded as luxury goods, which can create an intimate association that enhances the risk of pathogen transmission to the merchant or the buyer. Wildlife markets are invariably poorly regulated and unsanitary.

The organization tasked with monitoring international wildlife trade -- the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) -- has a net global budget of "a mere $6 million," said Dobson. "Many of the 183 signatories are several years in arrears in their payments."

The monitoring of this trade needs to be expanded, the authors argue. In particular, scientists need vital information about the viral pathogens circulating in potential food and pet species. They suggest using regional and national wildlife trade monitoring groups, integrated with international organizations for monitoring animal health.

Monitoring and regulating this trade will not only ensure stronger protection for the many species threatened by the trade, it will also create a widely accessible library of genetic samples that can be used to identify novel pathogens when they emerge, say the authors. It will also generate a genetic library of viruses with two key roles: more speedily identifying the source and location of future emerging pathogens, and developing the tests needed to monitor future outbreaks.

Ultimately, this library will contain the information needed to speed the development of future vaccines.

Although there have been calls to close the "wet markets" where wild and domestic animals are sold, to prevent future outbreaks of emerging pathogens, the authors acknowledge that many people are dependent on wild-sourced foods and medicines, and suggest that better health oversight of domestic markets is required.

They suggest that the risk of new viruses emerging can be mitigated if more people are trained in monitoring, early detection and control of pathogens in wildlife trade, and working with local communities to minimize risks of exposure and onward transmission.

"In China, for example, there are too few wildlife veterinarians, and the majority work in zoos and animal clinics," said co-author Binbin Li, an assistant professor of environmental science at Duke Kunshan University in Jiangsu, China.

"Veterinarians are on the front line of defense against emerging pathogens, and globally we desperately need more people trained with these skills," noted Dobson.

The expansion and development of better ways to monitor and regulate the wildlife trade could be done for around $500 million a year, which the authors call "a trivial cost" when compared with the current costs of COVID, especially considering the add-on benefits such as curbing wildlife consumption and sustaining biodiversity.

Slowing tropical deforestation would also slow viral emergence, plus it would reduce carbon inputs into the atmosphere from forest fires and protect forest biodiversity. On the other hand, it reduces revenues from timber, grazing and agriculture.

Is it worth foregoing these tangible, but economically focused, benefits? The authors undertake this part of their cost-benefit analysis from two complementary economic perspectives: first ignoring and then including the benefits of carbon stored as a hedge against climate change. They make no attempt to put a value on the loss of biodiversity.

The Policy Forum article sharply focuses on the bottom-line costs needed to prevent the next COVID.

"Pathogen emergence is essentially as regular an event as national elections: once every 4 to 5 years," said co-author Peter Daszak, an epidemiologist with Ecohealth Alliance in New York, pointing to numerous studies. "New pathogens have appeared at roughly the same rate as new presidents, congressmen, senators and prime ministers!"

"We may see the costs of COVID soar to beyond $8 to $15 trillion with many millions of people unemployed and living under lockdown," said co-author Amy Ando, a professor of agricultural and consumer economics at the University of Illinois-Urbana Champaign.

The annual cost of preventing future outbreaks is roughly comparable to 1 to 2% of annual military spending by the world's 10 wealthiest countries. "If we view the continuing battle with emerging pathogens such as COVID-19 as a war we all have to win, then the investment in prevention seems like exceptional value," Dobson said.Source: Princeton University

28

Public Health / Championing primary health care: now more than ever

« on: July 20, 2020, 06:25:08 PM »

“Covid-19 will be a great leveller – it will affect us all!” some proclaimed early in 2020. How empty these words proved to be. Covid-19 is exposing entrenched inequities across and within countries and forcing us to reckon with that.

It is clear that there are intimate links between social determinants of health, multiple chronic conditions and susceptibility to death from Covid-19. We are witnessing tragic disparities in mortality depending on whether these risk factors are present or not. Indeed, the burden of chronic physical conditions (or non-communicable diseases (NCDs)) such as diabetes and heart conditions is rising and was already augmenting existing burdens of infectious diseases, maternal and child health problems, and nutritional conditions in health systems which are poorly oriented towards managing and preventing multiple health conditions.

Covid-19, NCDs and poverty, recently described as a perfect storm, represent a global health emergency on a scale which is difficult to comprehend let alone respond to. Indeed, the demands that will be placed on weaker health systems will be felt for many years to come on a scale yet to be imagined.

Whilst we scramble for solutions to contain this horrible disease, we must also recognise that Covid-19 joins a long, grim list of urgent societal challenges. Alongside a multitude of health challenges sit conflict, climate change, food insecurity and poverty. Covid-19 is exposing vulnerabilities within and across health, food, and economic systems.

It has particularly exposed fragility across highly varied health systems and led to a realisation that strong, proactive primary health care and public health systems are critical. An account from Ghana reminds us that the frontline of every robust health system is primary health care and it must be protected at all times. Vertical programmes designed to tackle diseases in isolation – even in a pandemic – do not correlate with healthcare workers daily experience of treating people. Not diseases, but people. With our complex lives, our individual and societal behaviours, our belief systems all impacting on our health and health care needs.

Providing integrated, equitable access to promotive, preventive and curative healthcare close to people’s homes is a central pillar to any Universal Health Coverage (UHC) initiative, and indeed central to pandemic planning. Primary health care is inherently universalist in approach, striving to be effectively all things to all people; 90% of the care to 90% of the people over 90% of their lifetime. Strengthening primary health care in planning and preparation for a pandemic response can allow health systems to pivot and respond to repeated shocks as well as provide for ongoing health needs in the recovery phases.

Yet under-resourced primary healthcare workforces pose a particular challenge to resilient health systems. Back in March this year, the George Institute India published a rapid evidence synthesis highlighting the opportunities to enhance the well-being and contribution of frontline health workers in primary healthcare systems tackling the Covid-19 pandemic.

It is absolutely critical that primary healthcare workers, an oft-neglected cadre within the health system, are equipped with the skills to safely screen, triage and care for people with Covid-19 whilst simultaneously looking after other health needs and ensuring continuity of routine healthcare services which keep their populations healthy.

The international responses to Covid-19 have clearly demonstrated that a ‘Global North teaches Global South’ attitude is inappropriate. This pandemic has shown that even the best resourced countries, cushioned by strong health systems and armies of scientific advisors, can still respond in deeply inadequate ways to public health emergencies. Many low-income and middle-income countries, in comparison, have substantial experience in managing infectious disease outbreaks and have deployed context-specific containment strategies in a highly effective manner. Strategies such as effective contact tracing and the value of community health workers in controlling pandemics (when deployed effectively) are two such examples of excellence in pandemic control that have been led by Global South nations.  And around the world, exemplary political and technical leadership combined with sufficiently integrated primary care and public health systems seem to be critical success factors.

But there is a long way to go before we will see the primary health care sector being sufficiently supported to fulfil its potential. Despite the momentum generated by the Astana Declaration, the global monitoring report on UHC 2030 demonstrates significantly delayed progress in realising Universal Health Coverage through primary care systems. We need only look at per capita expenditure on health to understand, that failure to prioritise investment in primary healthcare has created fragmented systems.

The consequences of this under-investment are strained capacity, inefficient linkages to care, limited facility capability, inadequate prevention and promotion activities and large access barriers to high quality care (with attendant effect on DALYs and on mortality). This is fertile ground for the (accidental or intentional) neglect of economically and socially marginalised groups, fundamentally violating the UHC principle of leaving no one behind.

As a primary health care champion, Primary Care International (PCI) is quickly adapting its offerings to meet current needs, much in the way that a strong primary health care system must. We are responding to requests from front-line healthcare workers across the globe by providing open access to newly created Covid-19 e-learning resources for those working in resource-limited settings, tackling a range of topics from screening and triage, clinic operations, health workforce planning through to continuity of essential services including mental health. These have been co-created by our own networks in partnership with guest writers and partners, drawing from a wide pool of knowledge and expertise, and have now been accessed in more than 75 countries. We are also providing technical and clinical support to new and existing partners as they pivot and re-align health services. We are particularly glad to partner with humanitarian organisations for whom the challenges are multiplied, including supporting the WHO Covid-19 response in Syria. Looking ahead, many more of PCI’s primary healthcare resources and services will be moving online as we adjust to some kind of ‘new normal’.

It’s clear that we all need to learn to live with risk and precarity – for the more privileged among us this is a steep learning curve. For a great many more, this is unfortunately business as usual. We must surely recognise that we are in this together. But will our leaders find the moral courage to work collaboratively and build back better?Source: Web

29

Public Health / Ecosystem degradation could raise risk of pandemics

« on: July 01, 2020, 08:25:24 PM »

Environmental destruction may make pandemics more likely and less manageable, new research suggests.

The study, by the University of the West of England and the Greenpeace Research Laboratories at the University of Exeter, presents the hypothesis that disease risks are "ultimately interlinked" with biodiversity and natural processes such as the water cycle.

Using a framework designed to analyse and communicate complex relationships between society and the environment, the study concludes that maintaining intact and fully functioning ecosystems and their associated environmental and health benefits is key to preventing the emergence of new pandemics.

The loss of these benefits through ecosystem degradation -- including deforestation, land use change and agricultural intensification -- further compounds the problem by undermining water and other resources essential for reducing disease transmission and mitigating the impact of emerging infectious diseases.

Lead author Dr Mark Everard, of the University of the West of England (UWE Bristol), said: "Ecosystems naturally restrain the transfer of diseases from animals to humans, but this service declines as ecosystems become degraded.

"At the same time, ecosystem degradation undermines water security, limiting availability of adequate water for good hand hygiene, sanitation and disease treatment.

"Disease risk cannot be dissociated from ecosystem conservation and natural resource security."

Dr David Santillo, of the Greenpeace Research Laboratories at Exeter, added: "The speed and scale with which radical actions have been taken in so many countries to limit the health and financial risks from COVID-19 demonstrate that radical systemic change would also be possible in order to deal with other global existential threats, such as the climate emergency and collapse of biodiversity, provided the political will is there to do so."

The researchers say the lesson from the COVID-19 pandemic is that societies globally need to "build back better," including protecting and restoring damaged ecosystems (in line with the goals of the 2021-2030 UN Decade on Ecosystem Restoration) keeping the many values of nature and human rights at the very forefront of environmental and economic policy-making.Source:ScienceDaily

30

Public Health / Adolescents from disadvantaged neighborhoods show gene regulation differences

« on: June 23, 2020, 05:48:33 PM »

Tougher childhood marks genes related to chronic inflammation, tobacco smoke, air pollution and lung cancer.

An 18-year study of 2,000 children born in England and Wales found that young adults raised in communities marked by more economic deprivation, physical dilapidation, social disconnection, and danger display differences in the epigenome -- the proteins and chemical compounds that regulate the activity of their genes. The findings suggest that gene regulation may be one biological pathway through which neighborhood disadvantage 'gets under the skin' to engender long-term health disparities.

The neighborhood a child grows up in may influence their health for years to come in previously invisible ways.

A long-term study of 2,000 children born in England and Wales and followed to age 18 found that young adults raised in communities marked by more economic deprivation, physical dilapidation, social disconnection and danger display differences in the epigenome -- the proteins and chemical compounds that regulate the activity of their genes.

The researchers say the study lends support to the hypothesis that gene regulation may be one biological pathway through which neighborhood disadvantage "gets under the skin" to engender long-term health disparities.

The differences were identified in genes previously linked to chronic inflammation, exposure to tobacco smoke, outdoor air pollution, and lung cancer and may put these people at risk for poorer health later in life. Epigenetic differences remained even after taking into account the socioeconomic conditions of children's families, and were seen in young adults who did not smoke or display evidence of high inflammation.

"These findings may help explain how long-term health disparities among communities emerge," said Aaron Reuben, a Ph.D. candidate at Duke who was the study's lead author. "They also tell us that children who look the same physically and are otherwise healthy may enter adulthood wired at the cellular level for different outcomes in the future."

It's not possible to know yet whether these differences are lasting or could be modified, Reuben said. "That is something we will need to continue to evaluate."

The study, appearing this month in the journal JAMA Network Open, drew from diverse data sources to characterize the physical, social, economic, and health and safety characteristics of children's neighborhoods across their childhood and adolescence. Data were gathered from local government and criminal justice databases, systematic observation of neighborhood conditions (via Google Street View) and detailed surveys of neighborhood residents. Researchers combined this high-resolution multi-decade neighborhood data with epigenetic information derived from blood drawn from participants at at age 18.

"The research is an important reminder that geography and genes work together to shape our health," said Avshalom Caspi, the Edward M. Arnett Professor of Psychology & Neuroscience at Duke and a senior author on the study.

In a journal commentary that accompanied the study, psychiatric epidemiologist at Harvard Medical School Erin Dunn noted that neighborhood-induced gene regulation differences "are likely implicated in many adverse health outcomes, spanning from mental health disorders to cancer, obesity, and metabolic diseases." She writes, "I hope that studies like this by Reuben and colleagues will prompt researchers to explore these complex concepts and to bridge social determinants of health with epigenetic processes."

The research was supported by the UK Medical Research Council (UKMRC), the US National Institute of Child Health and Human Development (NICHD), the US National Institute of Environmental Health Sciences , Google, the American Asthma Foundation, the Jacobs Foundation, and a joint Natural Environment Research Council, UKMRC and Chief Scientist Office grant (NE/P010687/1). Data-support was provided by Duke University's Social Science Research Institute and the North Carolina Biotechnology Center.Source:ScienceDaily