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Human Behavior

Manufacturing Today Profiles Picavi Pick-by-Vision and the Human Digital Twin – Digital Journal

Larry Olson, Senior Sales Manager at Picavi recently discussed digital twin technology in logistics in the recent issue of Manufacturing Today magazine. Picavi pick-by-vision specialists are creating a human digital twin to perfect support for warehouse staff. According to Olson, No longer are manufacturers mutually exclusive from logistics. Finished goods have to go somewhere, whether to the end-user (direct to consumer, D2C) or to a warehouse, distribution center, or third-party logistics (3PL) facility. Read more here.

When using digital twins for testing process changes, human workers are a variable for which the technology cannot account. Until recently it was difficult to incorporate the specific activities and movements in the warehouse. Pick-by-vision changed this by implementing the human digital twin. It maps a warehouse worker going about day-to-day tasks which are reflected in the human digital twin from transport routes and times to movements and scans.

These data are combined with the important operating parameters, especially tiny details which help identify areas for improvement, such as WLAN coverage or warehouse resources. This highly accurate virtual representation of the worker is continuously improved and updated. This is lean manufacturing in logistics.

The human aspect of process analysis has been neglected in many businesses throughout logistics and manufacturing industries. Although concerns about data privacy are often given as a rationale for hesitancy, the true cause runs deeper. Collecting the data necessary for the human digital twin was next to impossible prior to pick-by-vision. With the right technology accessing these data it is now quite easy to model human behavior.

Pick-by-vision unlocks the data that arises in the logistics process with business intelligence solutions. Integrated analytics create a central point for collecting, aggregating, and visualizing all the important information. These data are collected by the sensors integrated in the pick-by-vision smart glasses and are continuously updated. Users can instantly see which process steps harbor potential for time and cost savings.

Manufacturing Today magazine helps executives at the senior boardroom and production levels stay abreast of the most important operational issues in this dynamic market.

About Picavi USA

Picavi USA Pick-by-Vision solution makes it possible to visually manage the picking process for goods in intralogistics in a consistent manner. The use of this innovation maximizes productivity at warehouses and minimizes error rates. When wearing the smart glasses, warehouse workers have both hands free for their primary tasks, including picking and packing goods. Smart glasses are one of the most significant developments in order picking during the COVID-19 situation. Augmenting reality with context-based information makes work much more precise and the glasses have become an indispensable part of warehouse life during the pandemic.

Picavi USA, based in Illinois, is a subsidiary of Picavi, headquartered in Germany. Safety is the companys top priority. Call (312) 585-8312 to learn more about Picavi USA Pick-by-Vision.

Media ContactCompany Name: Picavi U.S., Inc. Contact Person: Johanna BellenbergEmail: Send EmailPhone: (312) 585-8312Address:321 North Clark Street, Suite 1425 City: ChicagoState: Illinois Country: United StatesWebsite: https://picavi.com/en/company/

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Manufacturing Today Profiles Picavi Pick-by-Vision and the Human Digital Twin - Digital Journal

Human Behavior

The outdoor mask mandate has been loosened. So why is everyone still wearing them? – The Boston Globe

I went here and there, maybe only two people did not wear masks, she said, sounding like someone caught in an episode of The Twilight Zone.

It made her so uncomfortable that she hasnt stepped outside barefaced since. It was like I was an outsider, she said.

After a year of smile-free interactions, fogged glasses, maskne, and general mask misery, you would have thought we would have ripped those things off our faces and never looked back.

But masks, we dont know how to quit you.

Why not? For starters, theres intense confusion. Can you really stay far enough away from people on the Esplanade? Then theres the political angle liberals fear theyll look like anti-maskers if they shed their facial badges. And experts in human behavior say a powerful social phenomenon, beyond even Donald Trump, also is driving the behavior.

So many people are ignoring the updated state guidelines which no longer require people to wear masks when they walk, bike, or run alone or with members of their households if they social distance that many who want to stop wearing masks are still covering their faces because its easier than dealing with the glares.

Iriss son, Erez Yoeli, a research scientist at MITs Sloan School of Management whose work focuses on altruism, says that kind of social pressure is the force driving many mask wearers now.

Until people are reasonably sure that others also know the rules have changed that a consensus has built that masks outdoors arent required theyll want to avoid looking like jerks, he said.

David Rand, an associate professor at MIT whose research bridges the fields of behavioral economics and psychology, said its a well-studied phenomenon known as a sticky social norm.

A norm got established, he said, and now, even though the rationale behind the norm has changed, the norm has not kept up. The norms are stickier than the official rules.

Amid the politicization of masks, liberals have made COVID protection or prevention behaviors part of their identity, he observed. If youve spent the past year feeling good about yourself because youre wearing a mask, how can you take it off?

Its not like wearing a mask endangers other people the way not wearing does but even so, hostility is growing toward people who are wearing masks in situations where others dont think they need to.

Priscilla Kwok, a local public school teacher, said that as she was walking to her Lyft, which requires masks, an unmasked man yelled at her: Wearing masks? You gotta be kidding me you [expletive] idiot.

Its very difficult to know what constitutes rational behavior during a pandemic like COVID-19 so theres a limit to how much you might judge anybodys choices, Nate Silver, the well-known statistician, tweeted on Tuesday.

But Id argue one sign of *irrationality* is if a person doesnt change their behavior much after being vaccinated.

For most of the year, at least in liberal Massachusetts, weve been the ones who shamed. It was our sport. But now one of our most educated suburbs, Brookline, is the one being mocked internationally for its initial refusal to lift the outdoor mask mandate.

Theyre gonna need Lin-Manuel Miranda specials to tell educated white liberals to trust the science, tweeted Astead Herndon, a CNN political analyst and New York Times reporter on May 2.

Another attack appeared a couple of days later, in the form of an Atlantic articlethat ridiculed Brookline as part of a larger trend: The Liberals Who Cant Quit Lockdown.

Part of the problem is that even people whove been waiting for this moment might not be ready. Its been a year, but it still feels too soon, especially since in the US were nowhere near herd immunity, and the question of the vaccines effectiveness against variants lingers in the publics mind.

To tell people overnight, Dont worry about it, take off your masks and enjoy life, seems confusing, said Aisha Langford, an assistant professor at NYUs Grossman School of Medicine.

We need clear messaging about whats safe and whats not, she said, so that people feel more comfortable restarting the activities they stopped during the pandemic.

Masks may have turned into a security blanket, said Barbara Kamholz, an associate professor of psychiatry at Boston University School of Medicine.

When people are in very high risk or traumatic situations they typically develop ways of coping to maximize safety, she said. In this case, wearing masks per CDC guidelines was one example of healthy, scientifically sound coping to maximize safety.

But the challenge, she said, comes now, when the state has said we can take masks off in certain outdoor situations. Because the coping behavior kept a person safe, it can be very hard to give it up.

Despite the constant messaging or perhaps because of it many people are confused about the latest rule change. Some people think the new state guidance applies only to fully vaccinated people (it doesnt).

Others dont trust the government, particularly since at the beginning of the pandemic, the CDC instructed people NOT to wear masks unless they were sick or caring for someone who was sick and not able to wear a mask. Whos to say theyve got it right this time?

In Watertown, even though she knows the new rules and trusts the CDC, Purnima Thakre cannot bring herself to walk barefaced, and allows herself only the periodic indulgence of pulling down her N95 for a quick gulp of full-strength air.

Ive gotten used to wearing masks, she said. I feel like its normal.

Beth Teitell can be reached at beth.teitell@globe.com. Follow her on Twitter @bethteitell.

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The outdoor mask mandate has been loosened. So why is everyone still wearing them? - The Boston Globe

Human Behavior

‘The only way society gets to reopen safely is if we are all vaccinated’ – UC Santa Cruz

This story is part of UC Santa Cruz's vaccination advocacy campaign, Arm in Arm, which is aimed at communicating to our campus community the importance of the COVID-19 vaccine for a safe reopening of California and UC Santa Cruz.

California now has the lowest rate of COVID-19 infections in the United States.

The San Jose Mercury News reports a major surge of hope. The states case rate is now less than a third of the United States average. Nonprofit journalism venture CalMatters ran a headline hailing Californias stunning COVID reversal.

The news may be encouraging in the nations most populous state, but UC Santa Cruzs COVID experts say this is not the time to slack off when it comes to protecting yourself against the coronavirus.

They point to a complex reality that lies beneath the optimistic headlines. Variants are surging, U.S. vaccinations are falling from their peak levels, herd immunity is still a distant goal, and there is no sure-fire way of knowing whether others around us have been vaccinated.

Thats why Associate Professor of Biomolecular Engineering Rebecca DuBois, Professor of Ecology and Evolutionary Biology A. Marm Kilpatrick, and Associate Professor of Molecular Cell and Developmental Biology Susan Carpenter are urging all unvaccinated people to book an appointment to get their shots immediately, and follow CDC safety guidelines even after the vaccinations take effect.

The only way society gets to reopen safely is if we are all vaccinated, Carpenter said. This virus will continue to thrive and mutate if we let it run rampant through communities. The only weapons we have in our arsenal against this virus are to socially distance, wear our masks, and get vaccinated.

She likened potential victims of COVID to a water source. Dry up the lake, and watch COVID shrivel up.

We need to remove [COVIDs] ability to replicate by removing its reservoir, Carpenter said. The sooner we all get vaccinated, the sooner the virus loses places to grow. We are seeing a rise in variants, and if we are not vigilant and keeping a step ahead of this virus we could end up back at the beginning. We do not want this. Right now our vaccines are working against the variants we see arising. Therefore, we are in an active race against the virus, and the only way for us to emerge victorious is to get vaccinated as soon as possible.

Safety in numbers

Mass vaccinations started in the U.S. on December 14, 2020. DuBois pointed out the vaccination rollouts have been going on long enough to show that the vaccines are extremely safe and incredibly effective.

There have been over 300 million COVID vaccine doses administered in the USA alone, with over 226 million of those doses being the Pfizer-BioNTech or Moderna vaccines, DuBois said. If there were safety concerns in those vaccines, we would have seen them by now. There have been over 8 million doses of the Johnson & Johnson vaccine administered.

DuBois, Carpenter, and Kilkpatrick agreed that the temporary pause on the Johnson & Johnson vaccine was necessary while the U.S. Food and Drug Administration and Centers for Disease Control and Prevention (CDC) reviewed six reports of blood clots among people vaccinated with the J & J shot in the United States.

I think people should view this type of scrutiny as a reassuring and positive thing, knowing that any safety concerns at all, even a possible one in a million event, is investigated thoroughly, DuBois said.

In a new report, the CDC said the blood-clot side effect is extremely rare, occurring at a rate of about 7 per 1 million vaccinated women between 18 and 49 years old," the CDC wrote. "For women 50 years and older and men of all ages, this adverse event is even more rare."

DuBois praised the Johnson & Johnson vaccine for its one-dose formulation and its ability to be stored in a refrigerator rather than an ultra-cold freezer like the Pfizer and Moderna vaccines, which will enable its distribution to hard-to-reach individuals or those who lack the ability to schedule two appointments for inoculation.

For all three vaccines now available in the U.S., the protection from COVID-19 greatly outweighs the risks of severe side effects, said Kilpatrick, who emphasized personal safety and economics as compelling reasons to get vaccinated.

Vaccines greatly reduce the chance of getting sick and dying, and also reduce the chance of transmitting the virus to someone else," he said. Reducing transmission in the community is our fastest and best way to restore our society economically and socially.

DuBois emphasized civic pride and social responsibility as reasons to get vaccinated, along with a desire for more personal freedom.

Getting a vaccine is a great way to show that you care about your community," DuBois said. In addition, it is your opportunity to safely start doing your favorite things again. I got my vaccine and got to give my 92-year-old grandma a big hug.

Even those who have recovered from COVID-19 should get vaccinated, DuBois said.

Scientists are generally observing higher levels of antibodies in vaccinated people compared to people who were naturally infected," she said. "So there is still a benefit to getting the vaccine, even if you had COVID in the past."

Is herd immunity within reach?

A strong messaging campaign is essential to achieving herd immunity, Carpenter said.

The only way we get back to 'normal' is to achieve herd immunity worldwide, she said. Therefore we need everyone to take the vaccine. The data shows that these vaccines are safe, and we see in Israel where over 50% of the population has been vaccinated just how effective their vaccine campaign has been. In Israel, society is reopened and their case rate is staying very low. This should encourage all those who are hesitant that we can get back to normal if we get vaccinated.

But in this stage of the pandemic, herd immunity remains an elusive goal, according to scientists and public health officials interviewed for a recent New York Times article.

Carpenter agreed that the numbers of people who are refusing to be vaccinated are going to inhibit the United States in getting to herd immunity anytime soon, if ever, as the article states, she said. I think it's the unfortunate reality we are facing.

It is very frustrating as the only way the pandemic ends is if we reach herd immunity, so trying to get that message out there is important.

Kilpatrick agreed that human behavior will play a strong role in whether the United States achieves herd immunity.

The herd immunity threshold, when the fraction of people that are immune is high enough so that each person infects, on average, less than one other person, can definitely be reached by a combination of vaccination and infection, but it's worth noting that the threshold level changes as social patterns change, Kilpatrick said. If we stop wearing masks and resume pre-pandemic social behavior then the threshold will be much higher than if we maintain some pandemic measures.

In some communities, even with pre-pandemic behavior, vaccination may keep immunity above the level needed to prevent the virus from being sustained locally, whereas in others lower vaccination will allow for low to moderate levels of transmission until infection leads to immunity increasing to the threshold in that community, Kilpatrick said.

The common thought among scientists is that we will not reach herd immunity to the point where this virus disappears entirely, DuBois said.

Even if the USA becomes mostly vaccinated, the rest of the world has a long way to go, so the virus will continue to spread globally, DuBois said. People should not be holding out hope that the virus will simply disappearit will keep coming back into our community and infecting susceptible individuals. However, I do think we will eventually reach a point where the majority of Americans have some level of immunity, preferably via vaccination and not natural infection, and there will be fewer cases of severe disease.

Taking precautions

The three COVID experts agree that people should also take measures to avoid getting infected if they frequently have contact with unvaccinated people.

Protection from vaccination one dose for J&J or two doses for Pfizer or Modernaagainst symptomatic and severe disease and death is relatively high, Kilkpatrick said, noting that the vaccines are 7095% effective against symptomatic disease.

Data is less robust for more severe disease, but protection is likely similar or possibly higher," he said. "But that protection rate is definitely not 100%."

As a result, people should still take measures to avoid becoming infected, and should adjust their own behavior to reflect their specific risk of severe disease and death that increase enormously with age and substantially with preexisting conditions.

Kilpatrick also noted that the vaccines are 6090% effective when it comes to reducing the chance of an infected person transmitting COVID to another person. Thats a very significant amount of protection, but it still leaves room for vigilance, he said.

Wearing masks in public is an important way to reduce the chance of becoming infected or transmitting the virus if people are indoors, Kilpatrick said. "Outdoors, masks are important if people are having close contact with other people.

Many Americans have celebrated the recently updated CDC guidelines, listing more activities that vaccinated individuals can safely resume. For example, the agency recently eased face mask guidelines for fully vaccinated people outdoors.

But we are not yet at the point where every adult has had the ability to get their full course of a vaccine , DuBois said. Until then, it is still important to wear masks.

We need to encourage the culture of mask wearing until this pandemic is over, Carpenter said. We do not know who has been vaccinated and who has not. Also remember no one under 16 has been vaccinated yet, and so I think we should be setting an example for our children and continue to wear masks until we know it is safe."

Bad information

Though the vaccine rollout has been impressive, with around 100 million Americans fully vaccinated, misinformation on vaccines and vaccine safety remain widespread and damaging, the experts agreed.

"Countering this misinformation is difficult because people often don't seek out other information, Kilpatrick said. For example, people who identify as politically conservative are currently less likely to get vaccinated. There are some strategies that appear to be effective in reaching a subset of the population that currently is not choosing to get vaccinated, but it is time-consuming and challenging. This is one of the biggest current challenges in ending the pandemic in the U.S.

Carpenter would like to believe that anyone could be persuaded to take the vaccine when presented with the facts. All scientists and medical professionals have a moral responsibility to work against misinformation, listening to people's concerns and providing them with information to help alleviate them, Carpenter said.

Engaging at a local level will be important, she said.

For those who are vaccine hesitant, it can be helpful for them to know that their friends, family, colleagues, or other trusted individuals received the vaccine," DuBois said. "So spread the word and celebrate when you get your shot."

Find information and locations to receive your COVID-19 vaccination on the UCSC Student Health Center website.

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'The only way society gets to reopen safely is if we are all vaccinated' - UC Santa Cruz

Physiology

Nobel Laureate, Leading Physiologists to Give Distinguished Award Lectures at Experimental Biology – Newswise

Newswise Rockville, Md. (April 20, 2021)Four esteemed researchers will present the American Physiological Societys (APS) most distinguished award lectures at the APS annual meeting at Experimental Biology (EB) 2021. The meeting will be held virtually April 2730. APS is pleased to recognize this years remarkable honorees, who will present their lectures throughout the EB meeting, culminating with the APS Nobel Prize Award Lecture on Friday, April 30.

Virginia Miller, PhD, FAPS, of the Mayo Clinic College of Medicine in Rochester, Minnesota, will give the 2021 Physiology in Perspective: The Walter B. Cannon Award Lecture. This lectureship is the most prestigious award that APS bestows and recognizes the lifetime achievement of an outstanding physiological scientist and APS member. Miller will present Physiology of the 70 kg (Wo)man on Tuesday, April 27, at 10 a.m.

Eric Belin de Chantemle, PhD, of Augusta University in Georgia, is this years recipient of the Henry Pickering Bowditch Award Lectureship for early-career achievement. The Bowditch award recognizes original and outstanding accomplishments in the field of physiology and is given to an APS member younger than 42 or who is fewer than eight years from the start of the first faculty or staff research scientist position beyond postdoctoral training. Belin de Chantemles lecture, Obesity-associated Cardiovascular Disease: The Exposed Secret of the Sexes, will be on Wednesday, April 28, at 10 a.m.

Scott K. Powers, EdD, PhD, FAPS, of the University of Florida in Gainesville, is the 2021 winner of the Bodil M. Schmidt-Nielsen Distinguished Mentor and Scientist Award. This award honors an APS member who has made outstanding contributions to physiological research and demonstrated dedication and commitment to mentorship. Powers will share his thoughts on mentoring in his lecture, The Process of Becoming a Good Mentor, on Thursday, April 29, in an on-demand virtual session.

Mario R. Capecchi, PhD, of the University of Utah School of Medicine, will give the 2021 APS Nobel Prize Award Lecture. Capecchi won the 2007 Nobel Prize for Physiology or Medicine for his work on targeted gene modification (creating knockout mice). He will present his lecture, The Making of a ScientistAn Unlikely Journey, on Friday, April 30, at 2 p.m.

Read more about these and other recipients of 2021 distinguished lectureships on the APS website.

NOTE TO JOURNALISTS: To schedule an interview with a member of the research team, please contact the APS Communications Office or call 301.634.7314. Find more research highlights in the APS Newsroom.

About Experimental Biology 2021

Experimental Biology is the annual meeting of five societies that explores the latest research in physiology, anatomy, biochemistry and molecular biology, investigative pathology and pharmacology. With a mission to share the newest scientific concepts and research findings shaping clinical advances, the meeting offers an unparalleled opportunity for global exchange among scientists who represent dozens of scientific areas, from laboratory to translational to clinical research.

About the American Physiological Society

Physiology is a broad area of scientific inquiry that focuses on how molecules, cells, tissues and organs function in health and disease. The American Physiological Society connects a global, multidisciplinary community of more than 10,000 biomedical scientists and educators as part of its mission to advance scientific discovery, understand life and improve health. The Society drives collaboration and spotlights scientific discoveries through its 16 scholarly journals and programming that support researchers and educators in their work.

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Nobel Laureate, Leading Physiologists to Give Distinguished Award Lectures at Experimental Biology - Newswise

Physiology

Neuroscience research identifies a new target for the treatment of alcohol-withdrawal induced depression – PsyPost

Maintaining abstinence from alcohol can be exceptionally challenging. A main goal of addiction research has been to find out exactly why its tough to give up the drink. InFrontiers in Behavioral Neuroscience,a team of researchers investigating how alcohol withdrawal leads to changes in the brain have now identified a possible new target for the treatment of depression related to alcohol withdrawal a key predictor of relapse.

Somatostatin neurons are inhibitory brake type neurons that are capable of silencing other neurons. They have recently emerged as a strong candidate for treatments of psychiatric disorders. Lead author of the study,Nigel Dao, of Pennsylvania State University in the USA, stated that little work has focused on somatostatin neurons role in addiction and we were excited to explore this uncharted territory and bring forth discoveries of new therapeutic options.

The researchers randomly assigned mice to alcohol drinking or non-alcohol drinking groups. After 6 weeks, all mice then underwent forced abstinence where they had access to water only. The mice were then tested for anxiety and depression like behaviors using the elevated plus maze, open field test, sucrose preference test and the forced swim test. The brains were then analyzed using fluorescence immunochistochemistry and electrophysiology.

The results showed that withdrawal from alcohol resulted in emotional disturbances that mimic some of the symptoms of depression seen in people, including a lack of interest in rewarding things, as well as a heightened response to stressful events.

When studying the brains of the mice, the researchers found that alcohol withdrawal produced divergent effects on the physiology of somatostatin neurons in the prefrontal cortex and ventral bed nucleus of the stria terminalis. Both brain regions are well known for their role in emotional processing and addiction.

Dao states that the effects of alcohol withdrawal appeared more pronounced in females, underscoring the complex relationship between addiction and emotional disorders seen in men and women.

The study is limited as it was conducted in mice; it therefore remains to be determined if these results can be replicated in human patients. Furthermore, the results of the study only revealed what alcohol withdrawal combined with stress exposure could do to the physiology of somatostatin neurons. Senior author of the study,Dr. Nicole Crowleyof Pennsylvania State University in the USA, stated that there is much more to do uncover how it brings about these changes on a synaptic and molecular level, adding that she wants to understand how to activate or silence these neurons as a potential treatment.

The results of this research shed light on the possibility that targeting the somatostatin neurons in the brain, might be a viable candidate for treating depression particularly related to alcohol withdrawal.

Crowley adds that if we can help people cope with the negative emotions that they feel during alcohol withdrawal, both short term and long term, we can help them maintain their abstinence.

This work was funded by the Brain and Behavior Research Foundation (NARSAD Young Investigator Award), The National Institute on Alcohol Abuse and Alcoholism (R21AA028008) and Pennsylvania State Universitys Social Science Research Institute (all awards to Crowley).

The study, Forced Abstinence From Alcohol Induces Sex-Specific Depression-Like Behavioral and Neural Adaptations in Somatostatin Neurons in Cortical and Amygdalar Regions, was authored by Nigel C. Dao, Malini Suresh Nair, Sarah N. Magee, J. Brody Moyer, Veronica Sendao, Dakota F. Brockway, and Nicole A. Crowley.

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Neuroscience research identifies a new target for the treatment of alcohol-withdrawal induced depression - PsyPost

Physiology

Hospital-Level Variation in Death for Critically Ill Patients with COVID-19 – DocWire News

This article was originally published here

Am J Respir Crit Care Med. 2021 Apr 23. doi: 10.1164/rccm.202012-4547OC. Online ahead of print.

ABSTRACT

RATIONALE: Variation in hospital mortality has been described for coronavirus disease 2019 (COVID-19), but the factors that explain these differences remain unclear.

OBJECTIVE: Our objective was to utilize a large, nationally representative dataset of critically ill adults with COVID-19 to determine which factors explain mortality variability.

METHODS: In this multicenter cohort study, we examined adults hospitalized in intensive care units with COVID-19 at 70 United States hospitals between March and June 2020. The primary outcome was 28-day mortality. We examined patient-level and hospital-level variables. Mixed-effects logistic regression was used to identify factors associated with interhospital variation. The median odds ratio (OR) was calculated to compare outcomes in higher- vs. lower-mortality hospitals. A gradient boosted machine algorithm was developed for individual-level mortality models.

MEASUREMENTS AND MAIN RESULTS: A total of 4,019 patients were included, 1537 (38%) of whom died by 28 days. Mortality varied considerably across hospitals (0-82%). After adjustment for patient- and hospital-level domains, interhospital variation was attenuated (OR decline from 2.06 [95% CI, 1.73-2.37] to 1.22 [95% CI, 1.00-1.38]), with the greatest changes occurring with adjustment for acute physiology, socioeconomic status, and strain. For individual patients, the relative contribution of each domain to mortality risk was: acute physiology (49%), demographics and comorbidities (20%), socioeconomic status (12%), strain (9%), hospital quality (8%), and treatments (3%).

CONCLUSION: There is considerable interhospital variation in mortality for critically ill patients with COVID-19, which is mostly explained by hospital-level socioeconomic status, strain, and acute physiologic differences. Individual mortality is driven mostly by patient-level factors. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

PMID:33891529 | DOI:10.1164/rccm.202012-4547OC

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Hospital-Level Variation in Death for Critically Ill Patients with COVID-19 - DocWire News

Physiology

Newest American Academy of Arts and Sciences members – Stanford Today – Stanford University News

Ten Stanford faculty members are among the 252 new members elected to the American Academy of Arts and Sciences, which honors exceptional scholars, leaders, artists and innovators engaged in advancing the public good.

From left to right starting from the top: Axel Brunger, Tirin Moore, Chang-rae Lee, Robert Byer, Fei-Fei Li, John Etchemendy, Zhenan Bao, Yakov Eliashberg, Teresa Meng and James Mattis. (Image credit: Andrew Brodhead)

The new Stanford members to join the Class of 2021 are as follows:

Zhenan Bao, the K.K. Lee Professor in Chemical Engineering, is the department chair of Chemical Engineering. She is also a member of Stanford Bio-X and the Wu Tsai Neurosciences Institute, senior fellow at the Precourt Institute for Energy, a fellow at Stanford ChEM-H, an affiliate of the Stanford Woods Institute for the Environment and a principal investigator with the Stanford Institute for Materials and Energy Sciences at SLAC National Accelerator Laboratory. Research areas in the Bao Group include synthesis of functional organic and polymer materials, organic electronic device design and fabrication and applications development for organic electronics.

Axel Brunger is a professor of molecular and cellular physiology and of neurology in the Stanford School of Medicine and professor of photon science at Stanford and SLAC. He is also a member of Stanford Bio-X and the Wu Tsai Neurosciences Institute. Brungers research focuses on studying the molecular mechanisms of neurotransmitter release and how these mechanisms relate to physiological function.

Robert Byer, the William R. Kenan, Jr. Professor, is a professor of photon science at Stanford and SLAC and of applied physics in the School of Humanities and Sciences. He is also a member of Stanford Bio-X. Byer has conducted research and taught classes in lasers and nonlinear optics at Stanford since 1969. His current research includes precision laser measurements in support of the detection of gravitational waves and laser accelerator on a chip technology.

Yakov Eliashberg, the Herald L. and Caroline L. Ritch Professor in the School of Humanities and Sciences, is a professor of mathematics. He is one of the founders of symplectic and contact topology, a field that arose in part from the study of various classical phenomena in physics that involve the evolution of mechanical systems, such as springs and planetary systems.

John Etchemendy is the Denning Co-Director of the Stanford Institute for Human-Centered Artificial Intelligence and the Patrick Suppes Family Professor in the School of Humanities and Sciences. As a philosopher, Etchemendys scholarship research interests include logic, semantics and the philosophy of language. Etchemendy also served as Stanfords 12th provost.

Chang-rae Lee, the Ward W. and Priscilla B. Woods Professor in the Department of English, is the author of six novels. His most recent book, My Year Abroad (Riverhead Books) was published earlier this year and has received much critical acclaim. Lees novels have won numerous awards and citations, including the Hemingway Foundation/PEN Award, the American Book Award and the American Library Association Notable Book of the Year Award. He has also written stories and articles for the New Yorker, the New York Times, Time (Asia), Conde Nast Traveler and many other publications.

Fei-Fei Li is the Sequoia Capital Professor in the Department of Computer Science and co-director of the Stanford Institute For Human-Centered Artificial Intelligence (HAI). She is also a member of Stanford Bio-X and the Wu Tsai Neurosciences Institute. Her current research interests include cognitively inspired AI, machine learning, deep learning, computer vision and the intersection of AI and healthcare. In the past, Li has also worked on cognitive and computational neuroscience.

General Jim Mattis, U.S. Marine Corps (Ret.), is the Davies Family Distinguished Fellow at the Hoover Institution, after having served as the nations 26th Secretary of Defense. His expertise is in national security, military history, military strategy, Iran and the Middle East. At Hoover, he is a participant in two research teams: Military History/Contemporary Conflict Working Group and the National Security Task Force.

Teresa Meng is the Reid Weaver Dennis Professor of Electrical Engineering, emerita, and a member of Stanford Bio-X. Her research has focused on low-power circuit and system design, video signal processing, wireless communications, and applying signal processing and integrated circuit design to biomedical engineering. Meng retired from Stanford in 2013.

Tirin Moore, a professor of neurobiology in the Stanford School of Medicine, is also a member of Bio-X, the Maternal & Child Health Research Institute (MCHRI) and the Wu Tsai Neurosciences Institute. The Moore lab studies the activity of single neurons and populations of neurons in areas of the brain that relate to visual and motor functions. They explore the consequences of changes in that activity and aim to develop innovative approaches to fundamental problems in systems and circuit-level neuroscience.

The American Academy of Arts and Sciences serves the nation as a champion of scholarship, civil dialogue and useful knowledge. The academy is committed to interdisciplinary, nonpartisan research that provides pragmatic solutions for complex challenges.

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Newest American Academy of Arts and Sciences members - Stanford Today - Stanford University News

Physiology

Health Academy in this month’s spotlight | News, Sports, Jobs – The Review – The Review

The ongoing pandemic has impacted the way schools in the county proceed with their normal daily activities. This means that it is uncertain when schools will be able to welcome visitors back into their buildings. We have partnered with The Columbiana County Career and Technical Center to showcase the career and technical programs that they offer so that incoming juniors can make an informed decision for enrollment in a program that will interest them. Programs will be spotlighted each month of the school year. Students who are interested in enrolling in a program for the 2021-22 school year are invited to do so by visiting the CCCTCs webpage (https://www.ccctc.k12.oh.us) and completing the enrollment application which is available now. Any questions about the programs or the requirements for enrollment should be directed to Sue Allison, guidance administrator, at (330) 424-9561 ext. 118 or sue.allison@ccctc.k12.oh.us.

The CCCTC program being featured in April is Health Academy.While the Health Academy is one program, it is unique in that there are two instructors and the program can accept 50 students as opposed to the 25 students that can be accepted into the other programs at the CCCTC. This is because in the health academy program, during the junior year students will focus on learning the basics needed (medical terminology, anatomy and physiology, and nurse aid certification) for any health-related career. During their senior year, students will make a choice to focus on preparing to follow a path for a career in patient centered care or in the emergency health care field.

Benefits of Being a

Student in the Program

Benefits of the program for students following the patient centered care path include being able to earn college credit while attending high school and increased knowledge and experience in health career fields. The CCCTC Health Academy provides high school students the opportunity to explore careers in health-related fields, learn skills, and earn certifications necessary to work and/or to continue their education in healthcare. Students enrolled in Health Academy have the opportunity to complete clinicals during their school day which provides them with experiences they would encounter when they enter the workforce in patient care facilities and hospital settings. The need for highly qualified healthcare workers is increasing which means when students complete the health academy program, they have many opportunities awaiting them in the field. Most CCCTC health academy students are already working as State Tested Nursing Assistants, Childcare Providers, or Patient Care Technicians before they graduate high school and are earning on average $10.00 -$15.00 per hour. Area Long Term Care Facilities and Healthcare Agencies recruit regularly from the Health Academy program at the CCCTC.

For those who choose to follow the emergency health care path, the focus is on learning basic emergency health care. The path that a student could follow in the emergency health care industry is starting at the entry level position of EMT which allows the students to work in the field as they prepare to become a Paramedic, Flight Medic, RN, or Firefighter. Enrollment in this program includes training students to respond to prehospital emergencies as well as providing interfacility transports.In addition, CCCTC students are given the opportunity to garner real-life experience by completing clinical rotations at several private EMS agencies, fire departments, and at East Liverpool CityHospital. The great thing about enrolling in the Health Academy program is that students who choose the focus of emergency health care during their senior year have the opportunity to become certified as Emergency Medical Technicians and work for an emergency medical response company or a fire department upon graduation and passing the required test.

Credentials and

Articulation

Agreements for

the Program

Students in the health academy earn credentials and certifications during both junior and senior year. During the junior year, students can earn STNA certification through the Ohio Department of Health. They also can earn their CPR/ First Aid through AHA. During the senior year, students again take a CPR and first aid class to become certified as healthcare providers. They also can earn additional certifications. The first is the Patient Care Technician certification (CPCT/A)through the National Healthcareer Association. A second certification they can earn is the Phlebotomy Technician (CPT) certification also through the National Healthcareer Association. Finally, seniors also become certified as Childcare Providers through the Ohio Department of Job and Family services. In addition, those following the emergency health care path can earn their EMT certification.

The Health Academy also boasts some amazing articulation agreements that can help students further their career in the health care field at a fraction of the cost. Those who choose to enroll in the adult education program at the Columbiana County Career and Technical Center are eligible to receive a $4,000 scholarship to the Practical Nursing Program which is a 12 month program that prepares students to sit for the NCLEX and then practice as a Practical Nurse. There are also articulation agreements with Youngstown State University, Ohio Valley College of Technology, and Eastern Gateway Community College. Upon meeting the requirements of the agreements, students can earn 6 credit hours toward various degrees (AAS; BSAS; BSN; BSRC) at Youngstown State University, 7 credits toward an Associate of Applied Business degree at Ohio Valley College of Technology, and 5+ credits toward an Associates of Applied Science- Laboratory Technician degree or 10 credits toward various degrees at Eastern Gateway Community College.

Student Spotlights

Since the Health Academy program is unique in that it has two instructors with two different career paths and a capacity of 50 students, each of the instructors chose an exemplary student to highlight.

Exemplary Student for Health Academy-

Patient Centered Care

Brooklyn Funari is the exemplary student for the Patient Centered Care path of Health Academy. Brooklyn is a senior from Columbiana High School. Brooklyn has already earned several certifications including CPR and First Aid certification as well as Child Care Certification. She earned her State Tested Nurse Aide certification earlierthis school year and is currently working through the CCCTC work placement program as an STNA in a long-term care facility. Soon, Brooklyn will be taking the exam to become a Patient Care Technician through the National HealthCareer Association. She is also enrolled in the Phlebotomy Certification Program and is expected to become a certified phlebotomist by the end of the school year. Brooklyn has been accepted into the Bachelor of Science in Nursing program at Kent State University main campus and will begin her nursingclasses this coming fall. Mrs. Dawson states, Brooklyn is an excellent student, is very mindful of her work and is helpful to all of the other students in the class. She is also the class president for the Health Academy CTSO organization. Brooklyn has demonstrated her leadership abilities by taking charge of sophomore visits and CTSO meetings. She isalso a member of the SkillsUSA Health Knowledge Bowl team that qualified for state competition. I am very proud of everything that Brooklyn has accomplished this year. I am confident that she will do well in the nursing program as well as in life. At the CCCTC, Brooklyn is a member of National Technical Honor Society where she holds the office of Vice President. She is also a member of the career and technical student organization SkillsUSA where she serves as the President.

Exemplary Student for Health Academy-

Emergency Health Care

Kaylee Colkitt was chosen as the exemplary student for the Health Academy- Emergency Health Care path. She is a junior from Leetonia High School. Mr. Burns describes Kaylee as an excellent student, with great attendance and displays respect for those around her. She has earned the American Heart Association Heartsaver First Aid CPR certification and is currently working on obtaining a State Tested Nurse Aide certification. Kaylees goal is to earn her STNA, EMT, and Phlebotomy certifications by the time she graduates next year. Upon graduation, Kaylee wants to attend the LPN and RN adult education programs offered by the CCCTC with a long-term goal of becoming an OB/GYN nurse. An excellent student, Kaylee has maintained a 4.0 gpa for many years. In addition, she has been active in sports and activities during her high school career. At Leetonia, Kaylee was a member of the Spanish Club. She also participated as a member of several sports teams including cross country, track, and basketball. At the CCCTC, she is a member of SkillsUSA and will be inducted into the National Technical Honor Society in May. In her free time, she likes to volunteer at the Columbiana County Dog Poundand do peoples hair. In addition to attending post-secondary schooling, Kaylee plans to travel after graduation.

Instructor Spotlights

Health Academy-

Patient Centered

Care

Pamela Dawson is the Health Academy-Patient Centered Care instructor. A lifelong resident of East Liverpool, she graduated from East Liverpool High School and only left the area for the four years that she lived in Columbus while attending the Ohio State University. Mrs. Dawson has a Bachelor of Science degree in Nursing from the Ohio State University and a Masters degree in Career and Technical Education from Kent State University. A registered nurse for 34 years, Mrs. Dawson worked in long-term care and critical care for part of her career prior to becoming a teacher. The last 23 years have been spent in the classroom teaching high school health academy. She holds many certifications including nurse aide instructor through the Ohio Department of Health, Phlebotomy instructor, and a Patient Care Technician instructor through the National HealthCareer Association. She also dedicates her time to ensure that students are learning what they are tested on by being an item writer for Webxams for the Health Sciences Career Cluster in conjunction with OSU and ODE. In addition to teaching high school health academy, she is employed as a Nurse Aide evaluator through D and S Technologies. Mrs. Dawson is responsible for teaching the Nurse Aide Certification program and Patient Centered Care.

Health Academy-

Emergency Health Care

Bill Burns, instructor of the Emergency Health Care path of Health Academy, brings a wealth of experience from his years in the field to his classroom. His teaching career spans 14 years, but his experience goes back much further. He began working in emergency services in 1977 as a volunteer firefighter and part time Emergency Medical Technician (EMT). Eventually, he secured a position as a firefighter at the East Liverpool Fire Dept and as a Paramedic at Lifeteam EMS prior to taking a teaching position. Mr. Burns earned his career tech teaching license from Kent State University. Like his counterpart in the Patient Centered Care path, Mr. Burns holds many certifications including Firefighter II, Emergency Medical Technician, Hazardous Materials Technician, Fire Instructor, and EMS instructor. Mr. Burns is responsible for teaching Anatomy & Physiology, Medical Terminology, and Emergency Medical Technician.

CCCTCs Health

Academy Program

Benefits Local

Businesses

The Health Academy program is a tremendous benefit to local businesses. There is a great demand for trained, skilled professionals in the health care field. The Health Academy program allows local businesses to immediately fill available jobs with qualified individuals right out of high school. Many of the available jobs are ones students might not even realize are a possibility for them. The Health Academy at the CCCTC provides a terrific opportunity to research some of these careers and gain a foothold in the industry. Healthcare occupations are projected to add more jobs in the next ten years than any of the other occupational groups which means local businesses will be constantly looking for qualified employees. Hiring students from the CCCTC means that local healthcare providers have a continuous pool of employees that graduate each year. Anyone thinking about going into a career in healthcare, whether straight out of high school, entering the military, or attending college, would benefit by coming to the Health Academy at the CCCTC because local businesses rely on our students to fill essential roles in the healthcare industry.

Any student who is interested in enrolling in the Health Academy Program should complete the online application now. Every program is limited in capacity, so do not hesitate to enroll to ensure you get into the program of your choice. Any questions about the programs can be directed to Sue Allison at extension 118 (sue.allison@ccctc.k12.oh.us) or Michelle Fitzsimmons at extension 158 (michelle.fitzsimmons@ccctc.k12.oh.us) at the Columbiana County Career and Technical Center.

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Physiology

The New Science of Fatigue Resistance | Outside Online – Outside

When the lab data from Nikes Breaking2 marathon project was finally published last fall, the most interesting insights were of the dog that didnt bark in the night variety. Among a group of some of the greatest distance runners in history, none of the standard physiological measurementsVO2 max, lactate threshold, running economyproduced any seriously eye-popping values. To understand why these runners were so good, the researchers suggested, we might need another variable: fatigue resistance, which they defined as the extent of the deterioration of the three [other variables] over time.

Interestingly, that same new variable pops up in a new analysis of power data from pro cyclists. An international research team led by Peter Leo, a doctoral student at the University of Innsbruck, and James Spragg, a British cycling coach, crunched the numbers from a group of elite and near-elite professional cyclists in a five-day race called the Tour of the Alps. The best predictor of race performance, competitive level, and event specialty wasnt the raw power or heart-rate datait was, once again, fatigue resistance.

The subjects in the new study, which was published in the International Journal of Sports Physiology and Performance, came from three European cycling teams: Tirol KTM, Bora Hansgrohe, and Androni Giocattoli-Sidermec. The 14 participants from Tirol KTM were all under-23 riders competing in the developmental Continental tier of cycling competition; the ten participants from the other two teams were pros. There are lots of ways of comparing the two groups of riders, from simple observations (the pros were shorter and lighter than the U23 riders) to complex analyses of their power profile (the highest power sustained for various durations ranging from five seconds to 30 minutes over the course of the five-day race).

The power profile can tell you lots of useful things about your strengths and weaknesses as a rider. If youre really good at sustaining sky-high power output for five-second bursts, that bodes well for your ability to win sprint finishes and cover sudden mid-race moves. If your 30-minute power is unusually good, that suggests you might be a climber or a time trialist. Overall, the power profiles turned out to predict almost perfectly what order the riders finished in and how far behind the leaders they were.

There was a surprise in the power profile data, though, somewhat reminiscent of the VO2 max data from Breaking2. When they compared the U23 riders to pros, there were no significant differences in the power profiles of the two groupswith the minor exception of the five-second power, which was actually higher in the U23s. Similarly, when they compared different types of cyclists like climbers and all-rounders, there werent major differences in the power profiles.

The default power profile was constructed by searching through each riders data for the entire five-day race to find, say, the five-second window with the highest average power. Same thing for ten seconds, 15 seconds, and so on up to 1,800 seconds (i.e. 30 minutes). But you can do a similar analysis while limiting your search to the highest five-second power produced after youve already done, say, 1,000 kilojoules of cycling during that days stage. According to Leo, a typical pro cyclist might accumulate 800 to 900 kilojoules of work during an hour of training, and up to 1,500 kilojoules per hour during a race.

So the researchers repeated that process to construct separate power profiles for the riders after 1,000, 1,500, 2,000, 2,500, and 3,000 kilojoules of work. Heres how the resulting power profiles looked for the professionals versus the under-23 riders:

(Illustrations: International Journal of Sports Physiology and Performance)

As youd expect, the max powers are highest for the short bursts (on the left side of each graph) and lowest for the longer durations (on the right side). For the pros, the lines are mostly bunched together on top of each other. That means that even if theyve been riding fairly hard for a few hours, they can still surge for a minute or two almost as quickly as they could when fresh. Its only at the highest level of fatigue, after 3,000 kilojoules of work, that their sprint performance starts to drop off noticeably.

In contrast, the power profiles for the U23 riders are much more spread out. Even after just 1,500 kilojoules of work, their ability to sustain high-intensity efforts is noticeably impaired. In other words, its fatigue resistance that differentiates pros from U23s.

You see something similar when you compare different styles of rider. The way they divided the riders up is a bit complicated. First they used height, weight, and body surface area to divide them into climbers (small, light cyclists ideally suited to pedaling up Alps) and all-rounders (bigger, more versatile cyclists who can sprint and time trial well in addition to climbing). Then they divided the climbers into GC (general classification) riders, who placed in the top ten of the overall race standings, and domestiques, who placed outside the top ten. Heres what their power profiles looked like:

(Illustrations: International Journal of Sports Physiology and Performance)

The difference here is even starker. The GC ridersthe ones who hope to actually win multi-stage raceshave virtually no difference in their power profile even after 3,000 kilojoules. The less accomplished domestiques show a much greater effect of fatigue. And the all-rounders have the most pronounced drop in performance, which is presumably why theyre not given the assignment of trying to win the overall race. You cant win a multi-stage tour unless your fatigue resistance is exceptional.

There are a number of nuances to consider. One is that this data was collected during a real-world race, which means that the power data reflects the particular tactics used by each team and how each stage played out. In a stage with an early breakaway, maybe no one really needed to max out their five-second power. And each riders role affects the resulting power profiles: the differences between GC rider and all-rounder profiles may be partly a result of the jobs theyre assigned.

Also, quantifying fatigue by the number of kilojoules expended is a very blunt measure. Cruising along at a steady 250 watts for an hour burns up 900 kilojoules; but so does cruising along at 230 watts with a couple of one-minute surges at 600 watts. The latter is likely to trash your legs far more than the former, and professional stage racing is full of sudden shifts between low and high intensities.

That complexity makes it hard to zero in on why some riders have better fatigue resistance than others. Fatigue, after all, has many different components: metabolic disturbances in your muscles, altered signals from your brain and through your spinal cord, depleted motivation and cognitive resources. The precise mix of these components at any given point during a five-day race will vary widely, so its not clear exactly what superpower the GC riders possess that enables them to shrug off a few hours of hard riding.

Still, when I asked Leo how to develop fatigue resistance, he did have a few practical suggestions. One is that running low on carbohydrates seems to make fatigue resistance worsean observation that dovetails with other data from the Breaking2 project, which found that taking in 60 grams of carbohydrate per hour improved fatigue resistance. In training, Leo and his colleagues hypothesize that the volume of training you do is more important than the intensity for developing fatigue resistance. And you might try including intervals or sprints toward the end of a longer ride, he suggested: four x 8:00 hard with 4:00 recovery after three to four hours of lower-intensity riding, for example.

For now, there are more questions thananswers about fatigue resistance. But I suspect well see a lot more research about it in the years to come. In longer endurance events, Leo points out, its all about how you can perform in a fatigued state, rather than a fresh state.

For more Sweat Science, join me on Twitter and Facebook, sign up for the email newsletter, and check out my book Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance.

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Physiology

Butterflies and moths look at the world differently: Blame it on evolution – Research Matters

Image by Jeremy Zero via Unsplash

The genetic makeup of butterflies and moths is similar. However, while most butterflies, which are a kind of moth, fly by the day, other moths are active at night. They possess different eyes that adapt to the surrounding lights, ranging from dazzling light to complete darkness. While the butterflies eyes enhance the clarity of images in bright light conditions, other moths eyes have evolved to help them see clearly in dim light settings. Hence, butterflies are unable to see clearly in the dark, while moths end up viewing the world a bit blurred.

All moths engage in swift flight manoeuvres, and their eyes can sense the slightest change in their environment. What causes their eyes to perform the same functions under different light conditions is not clear to scientists. Recently, researchers have studied whether the butterflies and moths activity patterns at different times of the day can explain the difference in how their eyes function. The study, by researchers from the National Centre of Biological Sciences (NCBS), Tata Institute of Fundamental Research, Bengaluru and Indian Institute of Science Education and Research Pune (IISER-Pune), was published in the Journal of Comparative Physiology A. It was supported by the Air Force Office of Scientific Research (AFOSR) and the Department of Science and Technology (DST), the Government of India.

To facilitate seeing, light-detecting cells in the retina send a signal to the brain about the ambient visual environment. An object appears to flicker when the eyes light-detecting cells can register the dark and light periods from an irregular light source. Sometimes, the interval between the dark and light periods is so small that eyes fail to detect it, and an individual perceives even a flickering object as a regular light source. Scientists refer to the frequency at which eyes fail to detect an actual flicker as the Flicker Fusion Frequency or the FFF. As the FFF can vary across species, researchers often use it to compare the visual abilities of animals. The scientists compared the FFF of the butterflies and the moths.

To do so, the researchers collected live butterflies and moths from the gardens of the NCBS campus. Their sample comprised day-flying, evening-flying, and night-flying species of these insects.

We initially measured flicker fusion frequencies just as a quick fun activity, says Sanjay Sane, a Professor at NCBS and an author of the study. In due course, as many of these insects fly past our backyards, we developed this study, he adds. The researchers, however, depended on an opportunistic sampling of butterflies and moths in the NCBS backyard.

The researchers studied how the eyes of butterflies and other moths perceive a light source at various rates of flicker. They observed that the FFF is significantly different for the two groups. Butterflies eyes are better at detecting objects with a higher rate of flickering than moths eyes. Additionally, evening-flying butterflies can detect flickering in an even broader range of frequency.

Although their eyes are not as good as ours, their ability to sense changes in their environment is superior, and hence their reactions much faster, says Sanjay.

The scientists found that the ability to detect a flicker did not depend upon whether they are day-flying or night-flying, but whether they are butterflies or other moth species. The study suggests that as the butterflies and other moth species have diverged from their common ancestors during evolution, their eyes evolved differently. As butterflies adapted to day-light lifestyles, their eyes got more sensitive to change in ambient light. If a moth has evolved a diurnal lifestyle, it still has to function with a sensitivity of eyes that is best under low light levels, explains Sanjay. It points out that evolution happens continuously and has not yet optimised every organ for its current role.

The researchers were able to compare the different groups by studying them simultaneously. Fossil records or comparisons of genes would be insufficient to make such a comparison because physiological or behavioural differences are often not captured when animals are not alive.

Our study highlights the importance of comparative work across all levels including physiological to assess how evolutionary processes work, Sanjay signs off.

This article has been run past the researchers, whose work is covered, to ensure accuracy.

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