Category: Study

Breathing in air that has even low levels of pollution poses a threat to older adults’ heart and lungs, a new study warns.

Researchers analyzed medical records of more than 63 million Medicare patients from 2000 to 2016. They found that long-term exposure to low levels of air pollution could increase the risk of pneumonia, heart attack, stroke and the irregular heart rhythm known as atrial fibrillation, or a-fib.

The threat to the seniors’ heart and lungs was seen even at levels of air pollution below national standards, according to findings published Monday in the journal Circulation.

Researchers assessed three components of air pollution — fine particulate matter, nitrogen dioxide and ozone. Each unit of increase in levels of those pollutants was associated with thousands of hospital admissions a year, the study found.

The findings show that air pollution should be considered a risk factor for heart disease and lung disease, the researchers said.

“People should be conscious of the air quality in the region where they live to avoid harmful exposure over long periods of time, if possible,” said lead author Mahdieh Danesh Yazdi, a postdoctoral research fellow at Harvard T.H. Chan School of Public Health.

“Since our study found harmful effects at levels below current U.S. standards, air pollution should be considered as a risk factor for cardiovascular and respiratory disease by clinicians, and policymakers should reconsider current standards for air pollutants,” she added in a journal news release.

Air pollution can harm the heart and lungs by triggering inflammation in the heart and throughout the body, the researchers said.

In terms of specific pollutants, higher risks of heart attack, stroke, a-fib and flutter, as well as pneumonia were associated with long-term exposure to particulate matter.

Long-term exposure to nitrogen dioxide was associated with an increased risk of stroke and a-fib.

Pneumonia was the only condition associated with long-term exposure to ozone. Researchers noted there are no national guidelines for safe or unsafe long-term ozone levels.

“When we restricted our analyses to individuals who were only exposed to lower concentrations of air pollution, we still found increased risk of hospital admissions with all of the studied outcomes, even at concentration levels below current national standards,” Danesh Yazdi said.

More than half of the study population is exposed to what U.S. benchmarks deem low levels of these pollutants, she said.

-upi

LONDON: Scientists at the University of Cambridge working with an anti-viral coating technology called DioX believe that it could protect face mask users by killing the deadly coronavirus in as little as an hour.

According to ‘The Daily Telegraph’, the invisible coating on facemasks attacks the virus by rapturing its outer layer, effectively eliminating all new mutant variants, including the UK’s so-called Kent variant and the South African variant.

“The antiviral agent within the coating of the mask kills the virus by breaching its protective outer membrane, which is known as its envelope. Unlike other parts of the virus, the membrane remains the same regardless of any type of mutation. Hence this way of attacking the pathogen will work on any new variant of coronavirus,” Dr Graham Christie, senior lecturer at the Department of Chemical Engineering and Biotechnology at the University of Cambridge, told the newspaper.

“In fact, you could mutate the entire genome of the virus and it would have no effect on the envelope. We expect to see the same response regardless of the strain of coronavirus because structurally they are all very similar,” he said.

The technology called DiOX is based on quaternary ammonium salts – organic compounds widely used in the textile industry for their antimicrobial properties. Laboratory tests showed that the mask coated with it killed 95 per cent of pathogens on its surface within one hour and they were undetectable after four hours.

Experts say the action of the antiviral agent continues to work because it is unaffected by changes in the spike protein of the virus, which is the method by which coronavirus mutates.

“The variants that we are seeing occur in the spike proteins that stud the surface of the virus rather than the membrane of the envelope,” said Dr Christie.

“It is the genetic information that encodes this protein that is mutating, and this is leading to very slight structural changes in the shape of the spike. However, the envelope is derived from part of a human cell that the virus grabs from its host in order to protect its genetic material. It is made from lipids, which unlike the proteins do not change,” he said.

According to the newspaper report, the mask is reusable and can be washed up to 20 times, albeit subject to a reduction in efficacy after multiple washes. During the study, the mask was tested on a coronavirus called MHV-A59, which is genetically and structurally very similar to SARS-CoV-2.

“The Cambridge work followed industry standards for the testing of viruses on material,” said Andy Middleton, co-founder of LiquidNano, the UK company which commissioned the study.

“It also made some critical adaptations to give it a more ‘real-world’ relevance. This included conducting splash tests to mimic sneezing, helping to ensure the tests were as rigorous as possible. We have taken a proven antiviral agent and developed it for fabric in order to create a user-friendly mask,” he said.

DioX D4 claims to offer a patented technology for inhibiting the growth of a wide array of bacteria, mould, mildew, algae, fungi, and yeast on textile materials.

The novel antimicrobial agent provides an invisible microbiostatic coating to inhibit the growth of odour causing bacteria. Given the coronavirus pandemic, DiOX D4 said it has also been independently tested to rapidly reduce bacterial and viral pathogens, “greatly limiting the risk of contact contamination and infection”.

If proved effective in further analyses, the technology could offer an additional layer of protection against deadly viruses over time.

-economictimes

A Covid-19 expert says huge events such as Cheltenham Festival and massive weddings likely won’t happen again for a “few years” due to the threat still posed by the virus.

Tim Spector, professor of genetic epidemiology at King’s College London, said Britons should expect some changes to large gatherings for some time despite the mass vaccination programme.

Spectators are currently banned from attending sporting events and large weddings cannot take place under existing restrictions aimed at curbing the spread of coronavirus.

In 2020, the four-day Cheltenham Festival, which ended just over a week before England was plunged into its first lockdown, controversially went ahead despite calls for it to be scrapped as the Covid crisis rapidly worsened.

Large crowds at the Cheltenham Festival on March 13
Cheltenham Festival was blamed for helping to acceleratae the spread of Covid in the UK (Image: Getty)

The mass gathering, of more than 250,000 people over the four days, likely helped “accelerate the spread” of coronavirus across the UK and contribute to an increase in Covid-19 deaths, it has been claimed.

Other large gatherings and sporting events, including Premier League and Champions League football matches with packed stadiums, were still being held at that time.

In recent months, police forces have shut down a number of large weddings that breached lockdown rules, including one attended by about 150 people at the Yesodey Hatorah Senior Girls’ School in north London.

Professor Spector said on Sunday that some changes to large gatherings are likely to be in place for “the next few years”.

He told Times Radio: “I can’t see us suddenly having another Cheltenham Festival with no regulations again, I can’t see us having massive weddings with people coming from all over the world, I think for the next few years those days are gone.

“I think we should still continue to do the easy things, keeping our distance from each other in public, masks, handwashing etc, these things don’t cost really anything to do.”

He added: “I think we need to get used to that and that will allow us to do the things we really want to do more easily and more readily.”

Addressing infection rates as seen in his Zoe Covid Symptom Study UK Infection Survey, he said: “We’re moving towards where rates are generally much lower everywhere, we’re seeing about one in 170 people on average affected.”

Asked at what level he would say it is sensible to start easing restrictions, he replied: “I think around one in 250 would be where I start to become more comfortable, but it also depends on the context at the time and things like hospitals and death rates as well, because I don’t think we should be fixated on any one particular parameter, we’ve got to look at the overall picture.”

Professor Spector said he believed reinstating the rule of six allowing people to meet outdoors should be “definitely encouraged” around the same time as primary schools begin to return.

Schools in England are expected to reopen from March 8 with a staggered return of pupils.

Under the Government’s three-phase plan for easing the third national lockdown, pubs and restaurants could be allowed to reopen in April, though there will still be some restrictions, it is reported.

It is said that punters will be encouraged to drink outside.

From the coronavirus to Brexit, this is an era of great change and uncertainty. Events in Parliament have rarely been so crucial – or confusing.

Our daily politics newsletter is there at 8.30am to guide you through these turbulent times.

Written by the Mirror’s Head of Politics Jason Beattie it includes sharply-written commentary, a concise overview of events in Westminster and a sprinkling of gossip. There’s then a 4.30pm bullet-point update with the day’s headlines.

Asked about whether private gardens were safer than outdoor pubs or restaurants, he said: “My personal view, and I’m not speaking for anyone here, is actually sometimes a beer garden is more controlled than people’s homes and gardens.

“Generally most establishments are well behaved and I think they clean the tables and people keep their distance and I see no reason why we couldn’t move towards that in places that are well set up for it.”

As the UK emerged from the peak of the pandemic’s first wave in April last year, Sir David King, the Government’s chief scientific adviser from 2000 to 2007, said Cheltenham Festival could have helped to “accelerate the spread” of coronavirus.

In May last year, Professor Spector said Cheltenham Festival and Liverpool’s Champions League match against Atletico Madrid, attended by about 52,000 people at Anfield, contributed to an increase in coronavirus deaths in the UK.

He said the events had “caused increased suffering and death that wouldn’t otherwise have occurred”.

Data from his Zoe app showed that Cheltenham and the North West both became “key hotspots” for the virus, he added.

By then several European countries and cities had already imposed lock downs.

Mass gatherings were banned just over a week later when the first lockdown was imposed.

The Government and the racing industry have said they followed the advice available at the time.

Cheltenham insisted it was not possible to know how or where people had contracted the virus.

-mirror

Human activities such as farming and construction are threatening the survival of scores of wild species by forcing them to travel more to avoid mankind’s impact, research showed yesterday.

According to the United Nations’ biodiversity panel, more than three quarters of land and 40 per cent of Earth’s oceans have already been “severely degraded” by humans.

Its landmark biodiversity assessment in 2019 drew on a large body of research into how human activities are impacting nature.

But there have been relatively few studies looking at specific species and how human influence is changing their behavior.

Researchers in Australia looked at the impact of activities such as roads, tourism, recreation, hunting, shipping and fishing on 167 species, from the 0.05-gramme sleepy orange butterfly to the two-tonne Great White shark.

They found that most species had increased the distance they travel due to human influence ― by 70 per cent on average.

In a third of species, movement had either increased or decreased by half, according to the study published in the journal Nature Ecology & Evolution.

“This tells us that humans have widespread impacts on animal movement, but in many cases these are going undetected and unaddressed,” lead author Tim Doherty, from the University of Sydney, told AFP.

“In everyday life, we generally only see animals in the wild for short periods and don’t get a proper understanding of how they move around and use space.”

‘Cascading impacts’

Doherty said that since many species, including most mammals, spend nearly all their energy on hunting for food and finding mates, the additional energy required to relocate away from humans was an unwelcome survival challenge.

“However, animals will often move further in response to disturbance to ensure their survival, for example by seeking shelter, finding food,” he said.

“Some species are able to cope with these changes better than others.”

Of the taxonomic groups studied, birds and insects moved the most on average in order to avoid coming into contact with human activity.

The study warned of “cascading impacts” to natural processes such as pollination if such displacements continued apace.

The authors said they had documented a “global restructuring of animal movement, with potentially profound impacts on populations, species and ecosystem processes”.

They called for better preservation of natural habitats through increasing protected areas and managing construction and tourism, as well as seasonal curbs on hunting during species’ breeding periods. 

-malaymail

It is time to start solving the mystery of Long Covid, an aspect of the pandemic blighting millions of lives, the World Health Organization’s leader on post-Covid conditions told AFP.

Little is known about why some people, after coming through the acute phase of Covid-19, struggle to recover and suffer ongoing symptoms including tiredness, brain fog, cardiac and neurological disorders.

At this stage of the pandemic, the world is fixated on vaccine roll-out and new, more contagious variants of the coronavirus.

However, Long Covid deserves similar urgent attention, said Janet Diaz, the clinical care lead in the WHO’s emergencies programme, ahead of a push for a globally-unified approach to the problem.

“We still don’t fully understand what Long Covid is,” Diaz told AFP in an interview outside the WHO’s headquarters in Geneva.

“There’s quite a bit to learn, but I am confident that the scientific community is really rallying around.”

Tellingly, Long Covid does not yet have a proper name.

The WHO currently calls it post-Covid condition, while other terms in circulation include post-acute Covid syndrome and Covid long haulers.

Building up a picture

The WHO is hosting a first global seminar on Long Covid on February 9. It will bring scientists, experts and clinicians together to define the condition, give it a formal name and harmonise study methods.

“It’s a condition that needs further description, further understanding of how many are affected and further understanding of what is causing it, so we can better prevent, manage and treat it,” said Diaz, 48, a US respiratory physician and intensive care doctor.

She said British and other studies suggested potentially one in 10 cases may have prolonged symptoms one month after infection, but there was no picture yet of how long those conditions might persist.

The elderly and those with underlying conditions are most at risk of serious disease from Covid-19.

But the profile of Long Covid patients does not match. It affects people with varying degrees of severity of disease and “seems to potentially also include younger people”, including children, said Diaz.

While the pandemic response priority remains preventing people from catching the virus and falling ill, treating coronavirus cases “must also now include care after the acute illness… until you get back to full health”, Diaz said.

Cracking the code

Diaz said fatigue seemed to be the most common symptom, with others including post-exertional malaise, cognitive dysfunction or brain fog, shortness of breath, heart palpitations and neurological problems.

“How these are all related — that’s what we don’t understand. Why would one person get this, and the other person get that?” asked Diaz, saying researchers needed to crack the underlying mechanisms of the disease that were causing these persistent symptoms.

“Is it something due to the virus? Due to the immune response? If we had a better idea, we could start to target some interventions to reduce symptoms.”

Diaz said a “tremendous amount” of research was underway, largely classic observational studies following discharged patients.

The first Covid-19 cases were discovered in China in December 2019. But it was only when Long Covid started appearing on the radar months later that mystified sufferers began reaching out and joining the dots themselves.

“That’s been a tremendous movement,” said Diaz, who took on the Long Covid remit in October.

In the first wave of the pandemic, struggling health care systems got patients through the acute illness, “but then didn’t realise they weren’t recovering to their previous health”.

She said the patient-led research had driven scientists to do further studies, and “collaboratively we should get to an answer quicker”.

‘Stay hopeful’

The February 9 seminar, at which scientists will present their latest findings, will be the first in a regular series.

“Right now, we probably have enough descriptive data to start to bring it all together,” said Diaz.

Besides agreeing a definition and a name, the meeting will launch a standardised data collection methods for monitoring patients, and start opening doors towards clinical prevention and management.

“We quickly have to build our understanding from each other’s experiences,” Diaz said.

Crucially, donors will be taking part, and are “really aware” of the pressing need for Long Covid funding, she added.

In a message to the potential millions still suffering long after they are officially considered recovered, Diaz said: “Stay hopeful”.

“People may have prolonged symptoms, but we do know people are recovering. It may take a long time, but they are still recovering to previous health. We’re with you.”

-malaymail

Virtually all global warming since the industrial era is caused by manmade emissions, according to research published yesterday that concludes Earth’s natural processes contribute only “negligibly” to climate change.

Near-surface air temperatures have increased on average around the world just over one degree Celsius since the mid-19th century.

That 1C increase has already seen more frequent and powerful extreme weather events such as droughts and floods, as well as superstorms made more deadly by rising seas.

The 2015 Paris climate accord commits nations to limit global temperature rises to “well below” 2C (3.6 Fahrenheit) and to a safer cap of 1.5C if possible.

An international team of researchers wanted to better quantify how much warming can be directly contributed to human activity ― in the form of greenhouse gas emissions and land use change ― and how much is down to so-called “natural forcings”.

These include phenomena such as large volcanic eruptions and changes in the Sun’s energy output, and are often cited as drivers of warming by climate sceptics or deniers.

The researchers examined 13 different climate models to simulate expected temperature changes under three main scenarios: one in which just aerosol affected temperature, one where only natural forcings occurred, and another where greenhouse gas emissions are factored in.

Writing in Nature Climate Change, they found that human activity had contributed 0.9-1.3C to global temperatures ― exactly consistent with the 1.1C of warming observable today.

“Our results clearly show that climate warming is primarily caused by humans,” Nathan Gillet, from the Canadian Centre for Climate Modelling and Analysis, Environment and Climate Change, told AFP.

Although the pandemic saw planet-warming emissions nosedive by about 7 percent in 2020, concentrations of carbon pollution continued to rise.

The United Nations says it would take emissions to fall by similar levels to 2020’s every year this decade in order to keep the 1.5C goal in play.

‘1.5C maybe not achievable’

As a result of intensive shuttle diplomacy, the Paris deal isn’t explicit in how warming is measured ― that is, to what extent it is manmade and against what temperature base line.

But yesterday’s research found that depending on the range of estimation, manmade warming “may already be close to the 1.5C threshold”.

“If human-induced warming is at the lower end of our estimated range, the 1.5C Paris goal is still achievable with ambitious and prompt reductions in emissions,” said Gillet.

“If it is at the upper end of the range, the 1.5C goal may not be practically achievable, but prompt and ambitious mitigation action would still allow us to meet the Paris goal of keeping warming well below 2C.”

The authors said it was crucial to better quantify historic human-induced warming in order to more accurately calculate Earth’s remaining carbon budget ― how much more we can pollute without breaching the Paris goals.

Gillet said such estimates “can help guide mitigation policies in individual countries to meet the Paris goals”. 

-malaymail

The company’s New Shepard rocket passed its 14th test, carrying a dummy nicknamed ‘Mannequin Skywalker’ 300,000 feet into the air.

The life-sized flight dummy sat in one of the six crew capsule seats to measure the vehicle’s overall performance during the test flight. Both the New Shepard rocket and the capsule landed successfully.

‘The success of this flight puts us one really big step closer to flying astronauts,’ launch commentator Ariane Cornell said from company headquarters in Kent, Washington. ‘There’s going to be a lot of fun ahead in 2021.’

Blue Origin plans to launch paying passengers – tourists, scientists and professional astronauts – on brief flights over remote desert in west Texas.

It is also working on a bigger rocket, New Glenn, that would blast off from Cape Canaveral as well as a lunar lander for astronauts under Nasa’s Artemis moon programme.

The capsule soaring on Thursday featured the latest crew upgrades: microphones and push-to-talk buttons for the six seats, wall panels to muffle engine noise, a safety-alert system, and temperature and humidity controls to keep passengers comfortable and the big windows free of fog.

The launch and landing team was scaled back because of the pandemic. New Shepard is named after the first American in space, Alan Shepard. New Glenn honours John Glenn, the first American in orbit.

Bezos founded Blue Origin in 2000 and established the launch facility in West Texas in 2015. Like Elon Musk’s SpaceX, it plans to shuttle humans into space for tourist trips and also transport astronauts to the moon.

-metrouk

At least half of COVID-19 transmission globally may have been caused by symptom-free infected people unknowingly spreading the virus to others, a study published Thursday by JAMA Network Open found.

In addition, nearly one in four cases of virus spread involves infected people who remain asymptomatic, the researchers estimated.

The findings highlight the importance of public health measures such as social distancing, mask-wearing and hand-washing — even for people who don’t feel sick — in preventing the spread of the virus, they said.

“To control the pandemic, we must address the ‘silent pandemic’ of spread from persons without symptoms,” study co-author Dr. Jay Butler told UPI.

“Community mitigation measures will continue to be important for the time being to control COVID-19 spread as vaccine uptake increases and we continue to work together to return life to normal,” said Butler, deputy director for infectious diseases at the U.S. Centers for Disease Control and Prevention.

Through Thursday morning, there have been more than 21 million confirmed cases of COVID-19 in the United States, and more than 360,000 deaths attributed to the virus, according to Johns Hopkins University.

As cases surge in many parts of the country, so-called “super-spreader” events have been reported, but the origins of many outbreaks remain unknown.

This could be due to higher-than-expected asymptomatic transmission, or spread by people who don’t feel sick, Butler and his colleagues said.

To derive their estimates of asymptomatic transmission, the CDC researchers analyzed data from 10 studies and meta-analyses, or research papers that crunch data from multiple sources, they said.

As a result, their estimates are based on data from thousands of cases globally, covering outbreaks through July, the researchers said.

After accounting for a number of factors, including the time it takes for infected people to become contagious, at least 50% of new COVID-19 cases globally may have originated from exposure to infected individuals without symptoms, they said.

Up to 59% of all disease transmission came from asymptomatic people, with 35% from those who later developed symptoms and 24% from those who never did, according to the researchers.

“More than half of new COVID-19 cases were estimated to come from infected people without symptoms,” Butler said.

“Strategically planned testing of persons who are not ill, such as those known to have been exposed to COVID-19 or those with frequent unavoidable contact with the public, can likely also reduce the spread of COVID-19,” he said.

-upi

Women who make healthy lifestyle choices, including keeping off excess body weight, can significantly reduce their risk for developing acid reflux, or heartburn, symptoms, a study published Monday by JAMA Internal Medicine found.

In addition, not smoking, drinking less coffee, eating a healthy diet and exercising regularly can further help lower their risk for acid reflux symptoms, the data showed.

“Our study demonstrates the critical importance of modifying one’s diet and lifestyle to prevent reflux symptoms,” study co-author Dr. Andrew T. Chan told UPI.

“Clinicians should use this evidence as additional incentive to counsel their patients about diet and lifestyle modifications to minimize the unnecessary use of medications,” said Chan, vice chair of gastroenterology at Massachusetts General Hospital in Boston.

Gastroesophageal reflux disease, or GERD, occurs when stomach acid frequently flows back into the esophagus, or the tube that connects the mouth and stomach, irritating its lining, according to the Mayo Clinic.

The condition, also known as acid reflux, affects nearly 30% of the U.S. population, research suggests.

For this study, Chan and his colleagues analyzed data on nearly 43,000 women aged 42 to 62 years, of whom nearly 9,300 were diagnosed with GERD.

They assessed study participants’ risk for developing GERD based on five lifestyle factors, including maintaining a healthy body weight; staying physically active; not smoking; minimizing intake of coffee, tea, or soda; and eating a healthy diet.

Not smoking and limiting coffee, tea and soda intake to two servings or less per day reduced the risk for GERD symptoms among study participants by 10%, the data showed.

Maintaining a healthy diet and exercising regularly lowered study participants’ risk for the condition by about 20%, the researchers said.

Finally, keeping to a healthy body weight dropped “the incidence of re-flux symptoms by 40%,” according to Chan.

“This is important since at present, it is far too easy to turn to medications to treat reflux symptoms,” Chan said.

“Although effective in most patients, there are lingering concerns about the long-term side effects of taking medications such as proton pump inhibitors,” he said.

-upi

Smoking regular cigarettes and vaping produces harmful health effects similar to just smoking cigarettes on their own, a study published Monday by the journal Circulation found.

Participants who smoked cigarettes and used both cigarettes and e-cigarettes had higher levels of inflammation and oxidative stress than those who did not use cigarettes or e-cigarettes, the researchers said.

People in the study who vaped exclusively also showed similar levels of inflammation and oxidative stress as those who did not smoke cigarettes or use e-cigarettes.

Inflammation and oxidative stress are key contributors to smoking-induced heart disease and have been shown to be predictors of heart attack and heart failure, among other health problems, the researchers said.

“[This study] has an important message for individuals who may believe using e-cigarettes while continuing to smoke some combustible cigarettes reduces their risk,” co-author Dr. Rose Marie Robertson said in a statement.

“This commonly-seen pattern of dual use was not associated with lower levels of inflammatory markers, and thus is not likely to offer a reduction in risk in this specific area,” said Robertson, deputy chief science and medical officer of the American Heart Association.

Cigarette smoking has long been linked with an increased risk for heart disease and death, although it appears to be on the decline, at least in the United States, according to the American Heart Association.

While use of e-cigarettes, or vaping, has grown in popularity, there has been limited research on its impact on health, the researchers said.

For this study, Robertson and her colleagues analyzed health data for more than 7,100 adults aged 18 years and older, focusing specifically on levels of inflammation and oxidative stress.

Oxidative stress is caused by increased production of free radicals — unstable atoms that can damage the body’s cells — and the inability of the body to counteract or detoxify their harmful effects, the researchers said.

It has been linked with Parkinson’s disease and Alzheimer’s disease, gene mutations and cancers, chronic fatigue syndrome and heart and blood vessel disorders, among others, according to researchers.

Inflammation occurs when the body’s immune system attempts to respond to a foreign pathogen.

Of the study participants, 59% did not use cigarettes or e-cigarettes, while nearly 2% vaped exclusively and 30% smoked cigarettes exclusively, the researchers said.

In addition, about 10% used both e-cigarettes and traditional cigarettes.

Compared to those who smoked cigarettes exclusively, people who vaped exclusively had significantly lower levels of inflammation and oxidative stress, the data showed.

However, participants who used cigarettes and e-cigarettes had levels of all inflammatory and oxidative stress biomarkers comparable to those who smoked exclusively.

The findings highlight the importance of continued public education regarding the risks of cigarette smoking and the failure of dual use to reduce risk, the researchers said.

“Some people who smoke cigarettes pick up e-cigarette use to reduce the frequency with which they smoke cigarettes, [and] they often become dual users of both products rather than switching entirely from one to the other,” study co-author Andrew C. Stokes said.

“If e-cigarettes are used as a means to quit smoking, cigarette smoking should be completely replaced and a plan to ultimately attain freedom from all tobacco products should be advised,” said Stokes, an assistant professor of global health at Boston University School of Public Health.

-upi

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