Human Behavior

COVID-19 Vaccination Hesitancy Finds Echo in Cancer Care – OncLive

Unfortunately, not all people recognize this success or the need for vaccines that prevent infections with these dangerous pathogens. The history of vaccination hesitancy is long. In much earlier times, there was legitimate concern for both the safety and efficacy of proposed vaccine products due to the lack of a rigorous clinical trials process and formal regulatory review by experts in vaccine science, epidemiology, and statistical analysis. More recently, however, with our far greater understanding of the biology of infectious diseases, the establishment of robust and well-validated clinical trial strategies for evaluating vaccine products and scrupulous review by both governmental health agencies and external experts, the utility of a given vaccine is clear before it is approved. Mandatory reporting of adverse effects following use in the real world ensures that rare or longer-term concerns are appropriately evaluated.

Consider, for example, findings from a recent review of 57 vaccines that the FDA approved from January 1, 1996, to December 31, 2015. More than 90% of the vaccines were supported by data from randomized controlled trials, each involving a median of more than 4100 study participants.4 The authors noted that the postsurveillance mechanism worked well, with a total of 58 safety-related modifications added to the FDA-approved vaccine labels involving approximately half of the vaccines (n = 25). Most of the changes related to additional warnings that stemmed from extended experience with the vaccine. A total of 8 contraindications were added to the labels, and only 1 vaccine product was withdrawn from the market due to safety-related issues.

Restrictions on the patient populations who should be eligible to receive the vaccine was the most common change mandated by the FDA, with additional notification regarding potential allergic reactions being the second most common issue arising from follow-up review. The investigators concluded: Over a 20-year period, vaccines were found to be remarkably safe. A large proportion of safety issues were identified through existing postmarketing surveillance programs and were of limited clinical significance. These findings confirm the robustness of the vaccine approval system and postmarketing surveillance.4

Following the introduction of several COVID-19 vaccines, there were reports of a rare blood-clotting disorder associated with at least 2 of the products in noninvestigative real-world use. The events were quickly evaluated, with public health agencies making recommendations for the future delivery of these vaccines. Although the COVID-19 vaccine rollout is unprecedented in speed and scope, the process of postapproval surveillance has been shown to be robust and should serve as a source of reassurance to the public regarding the effectiveness of the initial and follow-up review process.

Unfortunately, this is an oversimplified view of the entire spectrum of the vaccination process. In a most provocative commentary, Naomi Oreskes, PhD, a professor of the history of science at Harvard University, noted that we should perhaps reassess the nature of the difficulty associated with developing and implementing an effective vaccination strategy.5 The author highlights the fact we have traditionally considered problems to be hard that are associated with major technological challenges or an understanding of highly complex theories (eg, quantum physics). The development of several highly effective COVID-19 vaccines and their release for noninvestigative administration less than 1 year follow-ing the identification of the molecular structure of the causative virus is nothing short of remarkable, yet we have struggled until recently to implement a nationwide vaccine distribution strategy. What good is a vaccine that remains in a vial rather than being injected into the arm of an individual susceptible to a COVID-19 infection?

Oreskes concludes: We call the physical sciences hard because they deal with issues that are mostly independent of the vagaries of human nature; they offer laws that (at least in the right circumstances) yield exact answers. But physics and chemistry will never tell us how to design an effective vaccination programin part because they do not help us comprehend human behavior. The social sciences rarely yield exact answers. But that does not make them easy.5

Although the COVID-19 vaccines must be regarded as truly remark-able scientific success stories,6 we are faced with the reality of human behavior, and we are learning that overcoming obstacles to existing and firmly entrenched beliefs, reinforced by social media sources and conspiracy theories, will be hard.7,8

We should recognize that this conclusion also pertains to the admin-istration of vaccines that have been documented to be both safe and highly effective in the prevention of cancer. We now have conclu-sive evidence that vaccination against the human papillomavirus (HPV) can substantially reduce the risk of developing invasive cervi-cal cancer.9 However, recent self-reported data reveal that, among 12,644 women and men aged 18 to 21 years in the United States, only 55% of women and 34% of men had received at least 1 dose of the HPV vaccine.10 Clearly, we have a long way to go to solve this hard prob-lem of increasing the delivery of this critically important cancer prevention strategy.

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COVID-19 Vaccination Hesitancy Finds Echo in Cancer Care - OncLive

Human Behavior

The Origin of COVID-19 and Preventing the Next Pandemic – War on the Rocks

Did COVID-19 originate with bats or scientists? Most experts continue to contend that the most likely origin of SARS-CoV-2 (the novel coronavirus that causes COVID-19) is a natural zoonotic spillover event between an animal reservoir (most likely bats) and humans. But over the last year of the pandemic, another theory has gained momentum: The SARS-CoV-2 virus may have resulted from an accident in a laboratory in China where scientists were working with closely related viruses. In the wake of the World Health Organization-led mission to Wuhan to examine the origins of the pandemic, proponents of the lab-leak theory have charged the investigative team with conflicts of interest, and suggested that the teams efforts failed to rule out the possibility of a lab release. Some have gone on to claim that scientists have maintained a conspiracy of silence about the possibility of a lab release in order to protect their funding or avoid a backlash from their government.

The desire to identify the origins of the novel coronavirus is perfectly understandable. COVID-19 has killed millions of people and upended everyday life. Theres an intuitive sense that finding out how the pandemic began might help to prevent another one from occurring. The Biden administration is redoubling efforts to determine the origins of COVID-19 after the intelligence community indicated that it had insufficient information to make a determination.

However, while answering the question of where the novel coronavirus came from is important, many of the most important policy decisions the United States needs to make to prevent future pandemics do not depend on viral origins. Very little about pandemic response or preparedness for future pandemics turns on the particulars of how this one started. Laboratory biosafety was already an issue before the pandemic, and the origins of this particular virus dont change the need for reform to prevent these rare but potentially catastrophic events. Regardless of how COVID-19 began, U.S. policy priorities should focus on both identifying and preventing the spread of zoonotic pathogens and bolstering safety and security in high-containment laboratories.

Preparing for the Next Pandemic

Whatever the origins of this pandemic, the United States has its work cut out to prepare for the next one. Lets assume, for the sake of argument, that the lab hypothesis is true. Efforts to prepare for natural spillover events do not then become less important. Since the 1940s, roughly 350 emerging infectious diseases have been identified. Of these, nearly three-quarters have zoonotic origins. Our understanding of how such diseases emerge is incomplete, but we know that there are a number of human behaviors that are likely contributing to this pattern: increasing demand for animal protein, factory farming and other agricultural intensification measures, wildlife trade, urbanization, extraction industries, changes in the food supply chain, and pet ownership, as well as increases in temperature, humidity, and other factors related to global climate change. Zoonotic crossover events are not limited to China, or even to Asia. Emerging infectious diseases have appeared all over the world: Zika in Latin America, Ebola virus disease in sub-Saharan Africa, H1N1 in bird reservoirs as disparate as Vietnam or Mexico; and henipaviruses in Australia. Coronaviruses have reservoirs in China, yes, but also in Africa, the Americas, the Middle East, and Southeast Asia.

If investigators are able to conclusively prove that the COVID-19 pandemic originated in a laboratory conducting research into coronaviruses, humanity will continue to confront the risk that a future spillover will result in another pandemic that is equally or more devastating. Fortunately, there are steps that the scientific community can take to manage this risk, including using predictive surveillance and developing other zoonotic risk-assessment tools. Early detection of such pathogens can help experts to isolate and contain them so that they do not spread widely. We can also promote behavioral change in high-risk populations and fund research into universal vaccines for zoonotic frequent-flyers like coronaviruses.

Lets say the converse is true, however. If evidence is found that satisfies even the most ardent lab-leak proponent that COVID-19 originated in an animal population, does that obviate the need to address laboratory biosafety and biosecurity? Absolutely not. Even as COVID-19 emerged, questions arose about the role of high-containment labs around the world. As the number of these labs increases, the risk of a consequential accident also increases.

Policymakers have debated biological safety in high-containment labs for most of this century. Biosafety, biosecurity, and awareness-raising among life scientists are ongoing topics of discussion at the Biological Weapons Convention. Biosafety is a major focus in the Global Health Security Agenda. The World Health Organization has maintained a guide for the responsible conduct of life sciences research with dual-use potential for more than a decade. In short, biosafety and biosecurity receive significant policymaker attention at the highest levels of international organizations, but that awareness doesnt necessarily translate into national-level action to manage biological risk and ensure protection from accidents. Even the states that have been most vocal in driving discussion of biosafety and biosecurity in international spheres have struggled with their own biorisk management. The United States has had a number of high profile laboratory incidents over the years, involving anthrax, highly pathogenic avian influenza, and smallpox, even as it has continued to develop and expand its high-containment lab capacity already the largest in the world.

Transparency and Biosecurity

Critics might claim that lab releases in the United States can be investigated transparently, while the potential COVID-19 release in China cannot. Indeed, China has put severe restrictions on research into the origins of the virus and prohibited scientists from speaking with journalists. During the World Health Organization-led investigation, members of the team were prevented from accessing patient data and other important research. After Australia pressed for an independent inquiry into the origins of the pandemic, China responded with threats and economic retaliation.

However, opacity surrounding public health is not a problem that is limited to authoritarian societies like China. Globally, biosafety norms are poorly implemented and reviews of biosafety and biosecurity are often conducted in secret. Even in the United States, there is no coordinated approach to laboratory biosafety or reporting laboratory accidents. As a result, public awareness of biosafety incidents often relies on local engagement between towns and specific labs, or comes from journalists filing Freedom of Information requests. The U.S. Government Accountability Office has consistently criticized U.S. biological security and safety for decades, but even recent developments in regulating the funding of potentially high-consequence gain of function research have been criticized as lacking transparency around the makeup of the review board, decision-making procedure, and notification of funded experiments. If this is the case for the United States, it is easy to imagine that other countries with less experience with biosafety and security might see it as politically advantageous to remain mum about incidents or problems. Clearly, more work is needed around the world to make sure that all countries have biorisk management policies and appropriate oversight measures in place, and that theyre open about the problems they encounter and their efforts to solve them.

Global norms and incentives are where the rubber hits the road for pandemic preparedness. Its reasonable in fact, vital to seek new ways to prevent laboratory accidents in the future. The worlds chief solution to this pandemic was the development of vaccines, a process driven by life sciences research, much of which took place in high-containment labs. Consequently, many political leaders may well choose to invest in more high-level biological research in the near future. If the solution to a lab release is more laboratory science, it makes sense to ensure that that science is carried out in a safe and secure manner. There is room for all countries to do better, and the United States should consider revitalizing its approach to promoting biosafety and biosecurity in the wake of the pandemic regardless of its origins.

As a final point, if the lab release hypothesis is true, we really shouldnt be surprised. An analysis in 2016 of gain of function research by Gryphon Scientific operated on the assumption that, eventually, a laboratory release of a potential pandemic pathogen would occur, a small number of those would lead to a local cluster, and a small number of those would seed a global pandemic. In other words, if COVID-19 did result from a lab release in China, it might simply have been bad luck, on top of whatever biosafety lapses China may have had which is all the more reason why, in addition to strengthening laboratory safety and security, the international community should do everything it can to develop appropriate infrastructure to handle a future pandemic.

Looking Ahead

There is one important scenario in which it would be absolutely vital to know the origins of COVID-19 in order to decide what to do next. If, as some scientists and politicians have suggested, the pandemic stemmed from a deliberate attempt to develop a biological warfare agent, this would have serious implications for the Biological Weapons Convention and the broader norm against the use of disease as a weapon. If a state party had violated its commitment to the treaty by developing biological weapons, the international community would need to determine how to hold that government accountable for its non-compliance a process with which states parties to the treaty have struggled in the past. Even treaties that have extensive verification provisions have grappled with what to do when a state party has demonstrably violated a treatys prohibitions. While some might criticize the Biological Weapons Convention for lacking a mechanism to verify compliance, such mechanisms dont solve the knotty political problem of what to do when flagrant violations take place. Moreover, the deliberate use of biological weapons could inspire copycat behavior by others, leading to the weakening of the norm against the use of disease as a weapon. Fortunately, to our knowledge no serious analysis of COVID-19s origins even from those who support a laboratory release hypothesis has concluded that anyone deliberately introduced the SARS-CoV-2 virus to the global population.

While its important to discover the origins of the pandemic, theres a danger in taking these efforts too far. Some have argued that conclusively demonstrating the pandemics origins in a lab release might help nations seeking to encourage China to pay financial reparations for the global economic cost of the virus to make their case. This could be a problematic approach. Not only is there no legal precedent under international law to hold a country liable for a pandemic, but in the long run this might be an unwise road for the United States, given its own history of laboratory accidents and safety lapses. Insisting that China bears responsibility for the pandemic and should be expected to pay compensation to other countries or the families of coronavirus victims could backfire in the future if the United States finds itself attempting to mitigate the consequences from a laboratory accident. Furthermore, legal efforts to blame China could fuel additional xenophobia against Asian-Americans, or even undermine U.S. foreign policy interests.

Meanwhile, the focus on where the virus came from should not divert attention from whats even more important preparing for the next pandemic. Political finger-pointing might make it far more difficult for researchers to collaborate internationally on pandemic preparedness efforts. Experts are already noting the possible implications for the National Institutes of Health and other research institutions of the growing tension between the United States and China, exacerbated by the allegations and skepticism around the viruss origins. This pandemic is far from over, despite the rollout of vaccines in the United States, and new potential pandemic diseases are already testing global health efforts elsewhere in the world. American experts therefore need to keep a laser-like focus on the real enemy: the causative agents of disease.

There will be far more blame to share if the international community becomes so fixated on the circumstances surrounding this unique case that its unable to see the big picture and predict or prepare for the next pandemic. Theres work that can be done in that respect while maintaining agnosticism about the origins of COVID-19. Regardless of the source, we need to be better prepared to respond to the next virus.

Amanda Moodie is a policy fellow at the National Defense Universitys Center for the Study of Weapons of Mass Destruction (WMD Center) in Washington, D.C. Her policy support at the center focuses on the international legal regimes that regulate the proliferation of chemical and biological weapons. She regularly serves as a member of the U.S. delegation to meetings of the states parties of the Biological Weapons Convention.

Nicholas G. Evans is an assistant professor in the Department of Philosophy at the University of Massachusetts Lowell, where he teaches biomedical ethics and security studies. He has been published in the British Medical Journal, Nonproliferation Review, and ELife. His book, The Ethics of Neuroscience and National Security, was released with Routledge in May 2021.

The views expressed in this paper are those of the authors and are not an official policy or position of the National Defense University, the Department of Defense, or the U.S. government.

Image: Xinhua (Photo by Fei Maohua)

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The Origin of COVID-19 and Preventing the Next Pandemic - War on the Rocks

Human Behavior

Odds and Ends: Knowing the Difference Between Sports Fandom and Toxicity – SportsRaid

The NBA Playoffs are here so you know this is the time when weird, out there news takes over the cycle in conjunction with the actual games. You dont know why this happens. It just does for whatever reason. The latest discussion happening in the discourse is in response to fandom and how they act during games.

So recently Atlanta Hawks All Star point guard Trae Young has joined the ranks of Reggie Miller, Michael Jordan, Scottie Pippen, Isiah Thomas, and Paul Pierce as the latest edition of Knicks Killers, supervillains who were created for the sole purpose of ruining the New York Knickerbockers chances of postseason success. To be honest, thats quite an honor! Young has even acknowledged it! His Game 1 performance was a spectacle that showcased a young star player embracing his role as the bad guy against a rival team and it was fun (if youre a Hawks fan)!

What was not fun was the ensuing vitrol and mistreatment Young and his family has received after the game. Shouting f*** Trae Young, making fun of his height and hair is all over-the-top jeering that would not be out of place in an NBA Playoff atmosphere but the fan who was trying to spit at him crossed the line, which is a disgusting display of human behavior.

I definitely didnt see it, but theres no place for that, man, Knicks All Star Julius Randle said to reporters after the incident. I dont care if its our home crowd or not, theres no place for that. Weve got to protect the players. Thats disrespectful. Yeah, its our fans and I love our fans, but you see a guy on the street, you wouldnt spit on him. You wouldnt disrespect somebody like that. I dont care what arena its in, whose fan base it is, theres absolutely no place for disrespecting anybody in any capacity and especially spitting on him. Thats just ridiculous.

It has been happening through out much of the NBA postseason. Fans have been welcomed back to the arenas after being away for more than a year due to the COVID-19 Pandemic. However in true entitled, idiotic fashion fans have been abusing players by either hurling personal attacks on players families and friends, throwing bottles, or attempting to disrupt a game by running on the court, endangering the players on the floor.

Sheesh NBA fans cant have nothing.

Look, I get it. People have been locked up in their homes for over a year. It has been a struggle trying to re-experience social norms and nobody knows when this pandemic is going to end. Sure, vaccines are readily available and the numbers of those infected by the virus have decreased over time but that does not give people the right to mistreat others, especially those who are out there providing entertainment in the world of sports.

The idiot nature of those attempting to commit actual harm to NBA athletes and those mocking athletes with nonsensical chants should not be perceived as the same. If you chant Julius Randle is overrated! then that is not exactly a harmful insult considering the season Randle had and trust he has heard worst. However, if you throw insults at Randles wife and son then you are crossing the line. You made the matter personal and have put someones well-being in danger.

Fans have rights to jeer at athletes. It is all part of the fun within the playoffs. However, people should be mindful as to how they carry themselves. That type of behavior is unacceptable and the NBA should continue to hold those fans accountable for their actions. It is impossible to police human behavior considering that nobody not even the arena personnel can keep those type of people in check. I mean it is not like you can ban 15,000 people out of a game if they all chant Kyrie sucks! In any case, people need to learn to relax and enjoy the game.

To quote the great Kevin Wayne Durant, Have some respect for the human beings and have some respect for yourself. Your mother wouldnt be proud of you throwing water bottles at basketball players or spitting on players or tossing popcorn. So grow the f up and enjoy the game, its bigger than you.

*additional content from Sporting News, House of Highlights, ESPN, NBA on TNT, Bleacher Report, NY Post

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Odds and Ends: Knowing the Difference Between Sports Fandom and Toxicity - SportsRaid

Human Behavior

Why does the coronavirus change? – Khmer Times

Variants of viruses occur when there is a change or mutation to the viruss genes. Ray says it is the nature of RNA viruses such as the coronavirus to evolve and change gradually. Geographic separation tends to result in genetically distinct variants, he says.

Mutations in viruses including the coronavirus causing the COVID-19 pandemic are neither new nor unexpected. Bollinger explains: All RNA viruses mutate over time, some more than others. For example, flu viruses change often, which is why doctors recommend that you get a new flu vaccine every year.

Is there a new coronavirus mutation?We are seeing multiple variants of the SARS-CoV-2 coronavirus that are different from the version first detected in China, Ray says.

He notes that one mutated version of the coronavirus was detected in southeastern England in September 2020. That variant, now known as B.1.1.7, quickly became the most common version of the coronavirus in the United Kingdom, accounting for about 60% of new COVID-19 cases in December. It is now the predominant form of the coronavirus in some countries.

Different variants have emerged in Brazil, California and other areas. A variant called B.1.351, which first appeared in South Africa, may have the ability to re-infect people who have recovered from earlier versions of the coronavirus. It might also be somewhat resistant to some of the coronavirus vaccines in development. Still, other vaccines currently being tested appear to offer protection from severe disease in people infected with B.1.351.

B.1.351: A Coronavirus Variant of Concern?One of the main concerns about the coronavirus variants is if the mutations could affect treatment and prevention.

The variant known as B.1.351, which was identified in South Africa, is getting a closer look from researchers, whose early data show that the COVID-19 vaccine from Oxford-AstraZeneca provided minimal protection from that version of the coronavirus. Those who became sick from the B.1.351 coronavirus variant after receiving the Oxford-AstraZeneca vaccine experienced mild or moderate illness.

The B.1.351 variant has not been shown to cause more severe illness than earlier versions. But there is a chance that it could give people who survived the original coronavirus another round of mild or moderate COVID-19.

Researchers studying placebo (non-vaccine) recipients in the South African COVID-19 vaccine trial by Novavax compared subgroups of participants who did or did not have antibodies indicating prior COVID-19. Those who did have the antibodies most likely were infected with older variants of SARS-CoV-2. They found that having recovered from COVID-19 did not protect against being sickened again at a time when the B.1.351 variant was spreading there.

Will the COVID-19 vaccine work on the new variants?Ray says, There is new evidence from laboratory studies that some immune responses driven by current vaccines could be less effective against some of the new strains. The immune response involves many components, and a reduction in one does not mean that the vaccines will not offer protection.

People who have received the vaccines should watch for changes in guidance from the CDC [Centers for Disease Control and Prevention], and continue with coronavirus safety precautions to reduce the risk of infection, such as mask wearing, physical distancing and hand hygiene.

We deal with mutations every year for flu virus, and will keep an eye on this coronavirus and track it, says Bollinger. If there would ever be a major mutation, the vaccine development process can accommodate changes, if necessary, he explains.

How are the new coronavirus variants different?There are 17 genetic changes in the B.1.1.7 variant from England, Bollinger says. Theres some preliminary evidence that this variant is more contagious. Scientists noticed a surge of cases in areas where the new strain appeared.

He notes that some of the mutations in the B.1.1.7 version seem to affect the coronaviruss spike protein, which covers the outer coating of SARS-CoV-2 and give the virus its characteristic spiny appearance. These proteins help the virus attach to human cells in the nose, lungs and other areas of the body.

Researchers have preliminary evidence that some of the new variants, including B.1.1.7, seem to bind more tightly to our cells Bollinger says. This appears to make some of these new strains stickier due to changes in the spike protein. Studies are underway to understand more about whether any of the variants are more easily transmitted.

Are coronavirus variants more dangerous?Bollinger says that some of these mutations may enable the coronavirus to spread faster from person to person, and more infections can result in more people getting very sick or dying. In addition, there is preliminary evidence from Britain that some variants could be associated with more severe diseases. Therefore, it is very important for us to expand the number of genetic sequencing studies to keep track of these variants, he says.

Bollinger explains that it may be more advantageous for a respiratory virus to evolve so that it spreads more easily. On the other hand, mutations that make a virus more deadly may not give the virus an opportunity to spread efficiently. If we get too sick or die quickly from a particular virus, the virus has less opportunity to infect others. However, more infections from a faster-spreading variant will lead to more deaths, he notes.

Could a new COVID-19 variant affect children more frequently than earlier strains?Ray says that although experts in areas where the new strain is appearing have found an increased number of cases in children, he notes that the data show that kids are being infected by old variants, as well as the new ones. There is no convincing evidence that any of the variants have special propensity to infect or cause disease in children. We need to be vigilant in monitoring such shifts, but we can only speculate at this point, he says.

Will there be more new coronavirus variants?Yes. As long as the coronavirus spreads through the population, mutations will continue to happen.

New variants of the SARS-CoV-2 virus are detected every week, Ray says. Most come and go some persist but dont become more common; some increase in the population for a while, and then fizzle out. When a change in the infection pattern first pops up, it can be very hard to tell whats driving the trend changes to the virus, or changes in human behavior. It is worrisome that similar changes to the spike protein are arising independently on multiple continents.

Are there additional COVID-19 precautions for the new coronavirus mutations?Bollinger says that as of now, none of the new coronavirus variants call for any new prevention strategies. We need to continue doing what were doing, he says.

Ray concurs: There is no demonstration yet that these variants are biologically different in ways that would require any change in current recommendations meant to limit spread of COVID-19, he says. Nonetheless, we must continue to be vigilant for such phenomena.

Ray stresses that human behavior is important. The more people who are infected, the more chances there are for a mutation to occur. Limiting the spread of the virus through maintaining COVID-19 safeguards (mask wearing, physical distancing and practicing hand hygiene) gives the virus fewer chances to change. It also reduces the spread of more infectious variants, if they do occur.

We need to re-emphasize basic public health measures, including masking, physical distancing, good ventilation indoors and limiting gatherings of people in close proximity with poor ventilation. We give the virus an advantage to evolve when we congregate in more confined spaces, he says.

Regarding coronavirus variants, how concerned should we be?Most of the genetic changes we see in this virus are like the scars people accumulate over a lifetime incidental marks of the road, most of which have no great significance or functional role, Ray says. When the evidence is strong enough that a viral genetic change is causing a change in the behavior of the virus, we gain new insight regarding how this virus works.

As far as these variants are concerned, we dont need to overreact, Bollinger says. But, as with any virus, changes are something to be watched, to ensure that testing, treatment and vaccines are still effective. The scientists will continue to examine new versions of this coronaviruss genetic sequencing as it evolves.

In the meantime, we need to continue all of our efforts to prevent viral transmission and to vaccinate as many people as possible, and as soon as we can. Hopkins Medicine

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Why does the coronavirus change? - Khmer Times

Human Behavior

NSBORO Roundup: Masks not required outdoors; Studying the Holocaust; Start Time Reminder; and No to School Choice – mysouthborough

Im rounding up some of the school related news I missed sharing recently. Some stories are from the media and others from school announcements.

Outdoor Mask Requirement lifted for elementary schools NSBORO District:

When the district announced on May 19th that masks would still be required during recess at NSBORO elementary schools, some parents objected. At the time, the Medical Advisory Team noted that they would continue to look at the data weekly and make adjustments. It appears that they did just that.

The Districts website includes the following messageto parents of PreK-5 students of a new policy that went into effect yesterday:

Beginning on June 1, 2021, and in alignment with Governor Bakers shifting the states mask mandate to a mask advisory, and the Department of Elementary and Secondary Educations updated mask guidelines, the Public Schools of Northborough and Southborough will no longer require that masks be worn by students when outdoors during recess, physical education or outdoor classroom environments, even when social distance can not be maintained. Masks are required on the bus at all times and inside the school buildings, except when eating.

In alignment with the Center for Disease Control (CDC) guidelines*, The Public Schools of Northborough and Southborough strongly encourages all non-vaccinated persons to wear masks outdoors when they are with individuals from outside their household and unable to maintain social distance. The Medical Advisory Team supports mask wearing for non-vaccinated students. (read more)

Northborough HS Class Takes Deep Dive Into What Led To The Holocaust CBS Boston:

Local broadcast news covered a Social Studies elective at the high school. (Although, the headline ignores the Regional part of Algonquins name.)

Most kids learn about the Holocaust in school, but Algonquin Regional High School in Northborough is taking it one step further with lessons on human behavior.

I think its really helped me to understand why my family was killed, said Jordan Chastanet, a senior at Algonquin.

The course is called Holocaust & Human Behavior. The elective, which is offered to juniors and seniors, is more than just a class. Its personal.

My grandmother was actually a Holocaust survivor, and two of her sisters and her escaped from the Warsaw ghetto. And Ive heard so much about my history, said Chastanet. (read and view more)

(You can also find the full course description in Algonquins Program of Studies.)

Start Time Update Planning forthe 2021-2022 School Year NSBORO District:

Recent updates from the Superintendent remind parents and students to prepare for changing start times for schools this fall.

The initiative to allow Algonquin students sleep later resulted in a radically revised 2-tiered bus schedule. Most students schools times will start and end later, except for Trottier Middle School. (The 6th-8th graders will actually start and end 13 minutes earlier.) Below is an excerpt from the update in the May newsletter with the table of Southborough start times:

Northborough & Southborough School Districts opt-out of school choice Community Advocate:

It looks like there were no surprises in the school committee votes on School Choice. As usual, all three NSBORO districts chose not to accept students from outside the district:

The Northborough-Southborough Regional School Committee unanimously voted to opt-out of the inter-district school choice program at their meeting May 19.

This decision aligns with the vote of both the Northborough K-8 and Southborough K-8 School Committee.

Although there are some advantages to school choice, such as a means to generate revenue and allow for flexibility in enrollment declines, Superintendent Greg Martineau cited disadvantages.

He explained the $5,000 in tuition the district would receive for each student would be far less than the districts per-pupil expenditure of $18,621.13 based on fiscal year (FY)2020.

The fall reopening of schools was also a concern for Martineau.

Theres no need to add another variablein terms of what the fall may look like, he said. (read more)

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NSBORO Roundup: Masks not required outdoors; Studying the Holocaust; Start Time Reminder; and No to School Choice - mysouthborough

Genetics

Research on Bizarre Rodent Genetics Solves a Mystery And Then Things Got Even Stranger – SciTechDaily

A Taiwan vole, closely related to the creeping vole described in the study. Credit: Lai Wagtail / Flickr (CC BY-NC-ND 2.0)

Open up Scott Roys Twitter bio and youll see a simple but revealing sentence: The more I learn the more Im confused. Now the rest of the scientific world can share in his confusion. The San Francisco State University associate professor of Biologys most recent research, published earlier this month in one of the scientific worlds most prestigious journals, catalogues a strange and confounding system of genes in a tiny rodent that scientists have ignored for decades.

This is basically the weirdest sex chromosome system known to science, Roy said. Nobody ordered this. But hes serving it anyway.

The owner of those chromosomes is the creeping vole, a burrowing rodent native to the Pacific Northwest. Scientists have known since the 60s that the species had some odd genes: Their number of X and Y chromosomes (bundles of DNA that play a large role in determining sex) is off from whats expected in male and female mammals.

That finding caught Roys eye when presented by a guest speaker at a San Francisco State seminar, and he realized that modern technology might be able to shed new light on the mysteries hiding in the voles DNA. After working with collaborators to disentangle the voles genetic history resulting in one of the most completely sequenced mammal genomes that exists, according to Roy the story only got stranger.

The team found that the X and Y chromosomes had fused somewhere in the rodents past, and that the X chromosome in males started looking and acting like a Y chromosome. The numbers of X chromosomes in male and female voles changed too, along with smaller pieces of DNA getting swapped between them. The researchers published their results in Science on May 7, 2021.

Drastic genetic changes like these are exceptionally rare: The way genes determine sex in mammals has stayed mostly the same for about 180 million years, Roy explains. Mammals, with few exceptions, are kind of boring, he said. Previously we would have thought something like this is impossible.

So how did the genes of this unassuming rodent end up so jumbled? Its not an easy question to answer, especially since evolution is bound to produce some strangeness simply by chance. Roy, however, is determined to figure out the why. He suspects that what the team found in the voles genome is something like the aftermath of an evolutionary battle for dominance between the X and Y chromosome.

The research couldnt have happened, Roy says, without collaborations with Oregon fish and wildlife biologists who had a creeping vole sample sitting in a lab freezer. He also teamed up with a group from Oklahoma State University when the two groups started chatting about creeping vole DNA sequences that were posted on the internet and both realized they were working on the same question.

Another key was working at a teaching-focused institution. Roy says he has the time to develop ideas with colleagues and students at SF State, and he can do research where he doesnt quite know what hell find. This is a great example of non-hypothesis-based biology, Roy explained. The hypothesis was, This system is interesting. I bet if you looked into it some more, thered be other interesting things.

It wont be the last time Roys lab goes out on a limb. He and his collaborators plan to look into the genomes of other species related to the voles to chart the evolutionary path that led to this strange system. Hell also continue DNA sequencing curiosities across the tree of life.

These bizarre systems give us a handhold to start to understand why the more common systems are the way they are and why our biology works as it does, he explained. By delving into the weirdest that nature has to offer, maybe we can come to understand ourselves better, too.

Reference: Sex chromosome transformation and the origin of a male-specific X chromosome in the creeping vole by Matthew B. Couger, Scott W. Roy, Noelle Anderson, Landen Gozashti, Stacy Pirro, Lindsay S. Millward, Michelle Kim, Duncan Kilburn, Kelvin J. Liu, Todd M. Wilson, Clinton W. Epps, Laurie Dizney, Luis A. Ruedas and Polly Campbell, 7 May 2021, Science.DOI: 10.1126/science.abg7019

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Research on Bizarre Rodent Genetics Solves a Mystery And Then Things Got Even Stranger - SciTechDaily

Genetics

DNA Markers Uncovered in Grape Genetics Research Reveal What Makes the Perfect Flower – SciTechDaily

Flower sex is an important factor when breeding for quality cultivars.

Wines and table grapes exist thanks to a genetic exchange so rare that its only happened twice in nature in the last 6 million years. And since the domestication of the grapevine 8,000 years ago, breeding has continued to be a gamble.

When todays growers cultivate new varieties trying to produce better-tasting and more disease-resistant grapes it takes two to four years for breeders to learn whether they have the genetic ingredients for the perfect flower.

Females set fruit, but produce sterile pollen. Males have stamens for pollen, but lack fruit. The perfect flower, however, carries both sex genes and can self-pollinate. These hermaphroditic varieties generally yield bigger and better-tasting berry clusters, and theyre the ones researchers use for additional cross-breeding.

Now, Cornell scientists have worked with the University of California, Davis, to identify the DNA markers that determine grape flower sex. In the process, they also pinpointed the genetic origins of the perfect flower. Their paper, Multiple Independent Recombinations Led to Hermaphroditism in Grapevine, published on April 13, 2021, in the Proceedings of the National Academy of Science.

This is the first genomic evidence that grapevine flower sex has multiple independent origins, said Jason Londo, corresponding author on the paper and a research geneticist in the USDA-Agricultural Research Service (USDA-ARS) Grape Genetics Unit, located at Cornell AgriTech. Londo is also an adjunct associate professor of horticulture in the School of Integrative Plant Science (SIPS), part of the College of Agriculture and Life Sciences.

This study is important to breeding and production because we designed genetic markers to tell you what exact flower sex signature every vine has, Londo said, so breeders can choose to keep only the combinations they want for the future.

Today, most cultivated grapevines are hermaphroditic, whereas all wild members of the Vitis genus have only male or female flowers. As breeders try to incorporate disease-resistance genes from wild species into new breeding lines, the ability to screen seedlings for flower sex has become increasingly important. And since grape sex cant be determined from seeds alone, breeders spend a lot of time and resources raising vines, only to discard them several years down the line upon learning theyre single-sex varieties.

In the study, the team examined the DNA sequences of hundreds of wild and domesticated grapevine genomes to identify the unique sex-determining regions for male, female and hermaphroditic species. They traced the existing hermaphroditic DNA back to two separate recombination events, occurring somewhere between 6 million and 8,000 years ago.

Londo theorizes that ancient viticulturists stumbled upon these high-yielding vines and collected seeds or cuttings for their own needs freezing the hermaphroditic flower trait in domesticated grapevines that are used today.

Many wine grapes can be traced back to either the first or second event gene pool. Cultivars such as cabernet franc, cabernet sauvignon, merlot, and Thompson seedless are all from the first gene pool. The pinot family, sauvignon blanc, and gamay noir originate from the second gene pool.

What makes chardonnay and riesling unique is that they carry genes from both events. Londo said this indicates that ancient viticulturalists crossed grapes between the two gene pools, which created some of todays most important cultivars.

Documenting the genetic markers for identifying male, female and perfect flower types will ultimately help speed cultivar development and reduce the costs of breeding programs.

The more grape DNA markers are identified, the more breeders can advance the wine and grape industry, said Bruce Reisch, co-author and professor in both the Horticulture and the Plant Breeding and Genetics sections of SIPS. Modern genetic sequencing technologies and multi-institutional research collaborations are key to making better grapes available to growers.

Reference: Multiple independent recombinations led to hermaphroditism in grapevine by Cheng Zou, Mlanie Massonnet, Andrea Minio, Sagar Patel, Victor Llaca, Avinash Karn, Fred Gouker, Lance Cadle-Davidson, Bruce Reisch, Anne Fennell, Dario Cantu, Qi Sun and Jason P. Londo, 9 April 2021, Proceedings of the National Academy of Sciences.DOI: 10.1073/pnas.2023548118

Funding for this study was provided by a Specialty Crop Research Initiative Competitive Grant from the USDA National Institute of Food and Agriculture.

Co-authors on the paper also include Cheng Zou and Qi Sun at the Cornell Institute of Biotechnology; Melnie Massonnet, Andrea Minio and Dario Cantu at UC Davis; Lance Cadle-Davidson at the USDA-ARS Grape Genetics Unit; Victor Llaca at Corteva Agriscience; Avinash Karn and Fred Gouker in the Horticulture Section of SIPS; and Sagar Patel and Anne Fennell of South Dakota State University.

Erin Rodger is the senior manager of marketing and communications for Cornell AgriTech.

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DNA Markers Uncovered in Grape Genetics Research Reveal What Makes the Perfect Flower - SciTechDaily

Genetics

New peanut has a wild past and domesticated present – Johnson City Press (subscription)

ATHENS The wild relatives of modern peanut plants have the ability to withstand disease in ways that modern peanut plants cant. The genetic diversity of these wild relatives means that they can shrug off the diseases that kill farmers peanut crops, but they also produce tiny nuts that are difficult to harvest because they burrow deep in the soil.

Consider it a genetic trade-off during its evolution, the modern peanut lost its genetic diversity and much of the ability to fight off fungus and viruses, but gained qualities that make peanuts so affordable, sustainable and tasty that people all over the world grow and eat them.

Modern peanut plants were created 5,000 to 10,000 years ago, when two diploid ancestors plants with two sets of chromosomes came together by chance, and became tetraploids plants with four sets of chromosomes. While domesticated peanuts traveled around the world and show up in cuisine from Asia to Africa to the Americas, their wild relatives stayed close to home in South America.

Over the past several years, researchers at the University of Georgia, particularly at the Wild Peanut Lab in Athens, have been homing in on the genetics of those wild relatives and detailing where those resiliency traits lie in their genomes. The goal has always been to understand wild peanut varieties well enough to make use of the advantageous ancient genes the ones the wild relatives have, but modern peanuts lost while holding onto the modern traits that farmers need and consumers want.

Most of the wild species still grow in South America, said Soraya Leal-Bertioli, who runs the Wild Peanut Lab with her husband, David Bertioli. They are present in many places, but you dont just come across them on the streets. One has to have the collectors eye to spot them in the undergrowth.

Those wild plants cant breed with other peanuts in nature any longer because they have only two sets of chromosomes.

The wilds are ugly distant relatives that peanut does not want to mix with, Leal-Bertioli said, but we do the match making.

Researchers in Athens and Tifton have successfully crossed some of those wild species together to create tetraploid lines that can be bred with peanuts. Those new lines will give plant breeders genetic resources that will lead to a bumper crop of new varieties with disease resistance and increased sustainability. The newly released lines wont produce the peanuts that go into your PB&J tomorrow, but they are the parents of the plants that farmers will grow in coming years.

The Journal of Plant Registrations published the details about the first of these germplasm lines this month. The lines were created by a team led by the Bertiolis, who conduct peanut research through the College of Agricultural and Environmental Sciences Institute for Plant Breeding, Genetics and Genomics. They also manage separate global research projects for the Feed the Future Innovation Lab for Peanut, a U.S. Agency for International Development project to increase the global food supply by improving peanuts.

The new lines developed by the Bertiolis are resistant to early and late leaf spot, diseases that cost Georgia peanut producers $20 million a year, and root-knot nematode, a problem that few approved chemicals can fight. Called GA-BatSten1 and GA-MagSten1, they are induced allotetraploids, meaning they are made through a complex hybridization that converts the wild diploid species into tetraploids.

The second set of new varieties comes from work done in Tifton and led by Ye Juliet Chu, a researchers in Peggy Ozias-Akins lab within the CAES Department of Horticulture. These three varieties are made from five peanut relatives and show resistance to leaf spot. One is also resistant to tomato spotted wilt virus, a disease that almost wiped out peanut cultivation in the U.S. in the 1990s.

Creating the first fertile allotetraploids is a challenge, but then scientists can cross them with peanuts and, through generations, select for the right traits. Plant breeders will be able to take these lines made from peanuts wild relatives and cross them with modern domesticated peanuts to get the best of both a plant that looks like peanuts and produces nuts with the size and taste of modern varieties, but that has the disease-fighting ability of the wild species.

In Tifton, for example, the team has crossed the wild species with cultivated peanuts to get a line thats 25% wild and 75% cultivated. Randomly breeding the two together will create some plants with small seeds, weak pegs, sprawling growth pattern and low yield, but by using genetic mapping, breeders can find the plants that carry disease-fighting genes and also have attractive market traits.

We plan to perform genetic mapping with these materials and define the beneficial wild genomic regions for molecular breeding, Chu said. We still need to define the genomic regions in the synthetic allotetraploids conferring desirable traits and specifically integrate those regions into cultivated peanuts.

While plant breeders have known the value of the diversity in wild peanut species for decades, they couldnt keep track of those valuable wild genes until recently. The peanut industry in Georgia and other states has invested in work to sequence peanuts and the two ancestor species, knowing that the work to understand the peanut genome would pay off. With genetic markers developed using the genome, breeders not only can tell that a plant has a desirable trait, they know what genome regions are responsible for that trait and can combine DNA profiling with traditional field selection to speed the complex process of developing a new variety.

It streamlines everything, David Bertioli said. You can make a cross, which produces 1,000 seeds, but before planting them, their DNA can be profiled. That way you can see that only 20 of those plants are ideal for further breeding. Forty years ago, youd have to plant them all, making the process much more cumbersome.

Marker-assisted selection for peanut breeding has been implemented in Ozias-Akins lab in Tifton for the past decade. Applying genetic markers associated with resistance from wild peanuts using this selection platform will accelerate the deliverance of peanut varieties pyramided with superior agronomic performance and strong disease resistance.

With ongoing work, the Journal of Plant Registration will document the release of other peanut germplasm with resistance to important diseases. Releasing the lines, along with the molecular markers for their advantageous traits, provides the peanut-breeding community with genetic resources to produce more resilient crops.

In the past, we knew where we were going, but it was like everyone drew their own map, David Bertioli said. Now, its like we have GPS. (Scientists) can tell each other, Here are my coordinates. What are yours? And all the data is published.

Breeders can access the seeds of the wild species crosses through the USDA-ARS National Plant Germplasm System in Fort Collins, Col., or in the U.S. Department of Agricultures Plant Genetic Resources and Conservation Unit in Griffin.

For more information about peanut research being performed at UGA, visit peanuts.caes.uga.edu.

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New peanut has a wild past and domesticated present - Johnson City Press (subscription)

Genetics

Variety is the spice of life… and key to saving wildlife – Pursuit

In the critical battle against extinction, conservationists use a variety of tactics to try to save species.

One of the most fundamental tools is maintaining the amount of variation of genetic material (DNA) in a group of animals - this is described as their genetic diversity. In general, the greater the genetic diversity, the higher chance of long-term survival.

This technique works because a wider range of genes and gene variants is more likely to enable a species to adapt to unexpected conditions, including new diseases and warmer climates.

Just like having a small pack of playing cards, if we dont have many to choose from, our options are limited.

The Tasmanian Devil has faced this issue, persisting as populations that have in the past been small, with reducing genetic diversity.

This limited genetic variation has meant the Devils immune system has reduced genetic options to adapt and fight off the contagious cancer known as the Devil Facial Tumour Disease.

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The field of conservation, genetics deals mainly with strategies to conserve or enhance genetic diversity within species populations to promote their capacity to adapt, reduce the negative effects of inbreeding and random genetic drift, and ultimately, decrease their extinction risk.

So, from a conservation genetic perspective, a high level of genetic diversity within a species population (compared with other populations from the same species) generally reflects a healthy viable population.

A recent perspective has challenged this school of thought, arguing that the amount of genetic variation present in a population is not an important consideration for their conservation.

Because this view is not supported by the literature and ignores well-established evolutionary principles, its concerning that it may affect how conservation genetic strategies are applied in future.

Genetic variation is measured by heterozygosity which is the presence of different versions of the same gene known as alleles at a number of locations across the genome of individuals.

The process of inbreeding leads to increased sameness or homozygosity that is the same versions of a gene are the same allele through mating between related individuals.

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Deleterious alleles (versions that negatively affect health) reduce the likelihood of reproducing for an individual, and are typically expressed when homozygous.

This results in a decrease the individual and population chance of survival, known as fitness, and has been seen in the Helmeted Honeyeater.

For an accurate estimation of the health of a population from a genetic viewpoint, both the diversity and sameness of genetic makeup need to be considered.

In making their arguments, the authors of the recent perspective separate the effects of genetic variation that influences traits important for survival the so-called adaptive or functional variation from genetic variation that does not, or neutral variation.

Variation in genes that directly affect disease susceptibility or drought tolerance would be regarded as adaptive, whereas variation in genes that do not affect these traits or any other traits would be regarded as neutral.

However, its not usually possible to distinguish these types of variation, so conservation genetics typically assesses variation without reference to whether it is neutral or adaptive.

In a recent publication, we discuss the difficulty associated with identifying adaptive diversity, particularly in relation to how genomic information can be used to predict the future vulnerability of species under climate change.

Within this paper, we highlight that while genomics is providing valuable insights into processes like inbreeding, theres a need to further develop approaches based on functional genes before we can use genomics to predict how species may genetically evolve to deal with future climate change.

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Increasingly, variation in conservation genetics is now being characterised based on DNA sequence variation thats scattered throughout the thousands of nucleotides that make up an organisms genome - so-called single nucleotide polymorphism or SNP markers.

This variation is regarded as a reasonable approximation of adaptive potential, particularly as adaptation involving traits like growth ability, stress tolerance and even disease tolerance are also scattered throughout the genome.

Any sign of variation in the genome is taken as a signal of variation more generally.

Research shows that when flies, birds and other organisms adapt to new environments, hundreds or even thousands of genes throughout the genome can be part of the adaptation process and that these are often inconsistent between evolutionary events, making it hard to identify specific genes involved in adaptation.

There is plenty of evidence that overall levels of genetic variation, regardless of whether its adaptive or neutral, affects the rate of adaptation of populations and high levels reduce the probability of populations becoming extinct.

The best studies come from careful laboratory experiments where a large number of populations derived from the same source, but differing in genetic variation, are compared.

Results from these experiments show that larger and genetically diverse populations have much lower extinction rates in experimental systems like flies and crustaceans.

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Under field conditions, theres also a lot of evidence that an injection of new genetic variants boosts the fitness of threatened species. This includes the genetic rescue strategy used successfully to prevent the extinction of the Mount Buller Mountain Pygmy-possum in Victoria.

The initial recovery of genetic health in these populations is partly associated with decreasing inbreeding but, in the longer term, the increase in genetic variation will be important for adaptation.

But these genetic strategies cannot succeed, without addressing threats like habitat destruction and invasive predators both of which went hand-in-hand with the genetic rescue of the Mountain Pygmy-possum.

There is no doubt that many species lacking genetic variation can still be highly successful. This includes many weedy species of animals and plants that do not have much genetic variation including pest species that reproduce clonally like many aphids.

There are also some highly invasive species in Australia that have limited diversity, including foxes, carp, and deer and more. But these species can often reproduce quickly, are freed from natural predators and competitors, and are often generalists, resulting in the quick expansion of populations and range in non-native environments.

Conservation genetics does not focus on such comparisons between species instead, it tends to focus on native species of conservation concern where the relative fitness of populations is linked directly to their relative levels of genetic variation.

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As we head into an uncertain world, it is important to ensure that threatened species have the best chance of surviving changes to their environment.

There are different ways of boosting genetic variation in populations that have become genetically vulnerable, including the deliberate introduction of individuals from other populations and the re-establishment of habitat corridors.

All of these efforts should coincide with restoration programs that help conservation-dependent species maintain large population sizes, which will in turn enable the maintenance of high levels of genetic diversity, increasing resilience and adaptive capacity.

These are key principles that must be followed given that adaptive changes to environmental stressors remain unpredictable at the genetic level, are complex involving many genes and are likely to depend on biological as well as environmental factors.

When it comes to conservation efforts in the immediate future, assessing genetic variation across a species entire genome must be pivotal in our decision making.

Banner: Mountain Pygmy Possum/ Andrew Weeks

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Variety is the spice of life... and key to saving wildlife - Pursuit

Physiology

Electrocardiogram 1: purpose, physiology and practicalities – Nursing Times

An electrocardiogram monitors the hearts electrical activity and is used in many clinical settings. This article explores how the technique works and is undertaken

An electrocardiogram assesses the hearts electrical activity; it is commonly used as a non-invasive monitoring device in many different healthcare settings. This article, the first in a three-part series, discusses cardiac electrophysiology, indications for an electrocardiogram, monitoring and troubleshooting.

Citation: Jarvis S (2021) Electrocardiogram 1: purpose, physiology and practicalities. Nursing Times [online]; 117: 6, 22-26.

Author: Selina Jarvis is research nurse, Guys and St Thomas NHS Foundation Trust.

An electrocardiogram (ECG) is a quick bedside investigation that assesses the electrical activity of the heart. It is a non-invasive, cheap technique that provides critical information about heart rate and rhythm, and helps assess for cardiac disease. ECG monitoring is used often in many different healthcare settings, including acute care, cardiac care and preoperative assessment.

This article, the first in a three-part series, discusses cardiac electrophysiology, indications for an ECG, monitoring and troubleshooting. Part2 of the series will take a methodical approach to interpretation, with a focus on cardiac ischaemia; part3 will explore cardiac rhythm and conduction abnormalities.

The heart is an organ that acts as a mechanical pump; it consists of four chambers (right and left atria, and right and left ventricles) that contract sequentially during the cardiac cycle and are regulated by an electrical conducting system. To understand the basics of an ECG, it is important to consider the normal electrophysiology of the heart, in which a cardiac electrical impulse is generated and transmitted to the heart muscle, leading to contractions (the heartbeat).

There are two main cell types in the heart:

Cardiomyocytes contract and relax in response to an electrical stimulus. During their resting state, inside the cells there are high internal levels of potassium ions (K+), compared with outside the cells; along with negatively charged proteins, which creates a chemical gradient. Outside the cardiomyocytes there are more sodium ions (Na+) and calcium ions (Ca2+) compared with inside the cell. Overall, this means there is a voltage difference across the cell membrane, called transmembrane potential (TMP). When there is net movement of Na+ and Ca2+ into the cell, TMP becomes more positive; when there is net movement of positive ions out of it, TMP becomes more negative.

In response to an electrical stimulus, cardiomyocytes become depolarised and fast Na+ channels open on the cell membrane, allowing Na+ into the cell; because this is positively charged, the TMP becomes more positive, increasing to -70millivolts (mV) (resting potential is -90mV). This is the point at which enough Na+ fast channels have opened to generate an inward Na+ current, and is known as the threshold potential. When the charge becomes greater than -40mV, L-type calcium channels open and allow an inward flux of Ca2+. This results in excitation-contraction coupling, which leads to the contraction of muscles in the heart. Following this, repolarisation occurs; the cardiac membrane potential returns to the resting state and no muscle contraction occurs.

The hearts electrical conducting system (Fig1) regulates its overall electrical activity and includes the following components:

Each heartbeat is initiated by an electrical impulse generated by the SAN; this impulse passes through the atria to the AVN, then through the right and left ventricles, the bundle of His, subsequent bundle branches and the Purkinje fibres. As a result, the atria and ventricles contract sequentially as the impulse is conducted through the different regions of the heart. In normal circumstances, the SAN is the hearts pacemaker; however, if there is a problem with the SAN, another conducting region centre such as the AVN, bundle of His or bundle branches can assume the role of the pacemaker in an occurrence known as an escape rhythm (Jarvis and Saman, 2018; Newby and Grubb, 2018).

In healthy individuals, the chambers of the heart contract and relax in a coordinated manner, referred to as systole and diastole respectively. The right and left atria synchronise during atrial systole and diastole, while the right and left ventricles synchronise during ventricular systole and diastole. One complete cycle of these events is called the cardiac cycle, during which the pressure in the cardiac chambers rises and falls, causing the opening and closure of heart valves that regulates blood flow between the chambers.

Pressures on the left side of the heart are around five times higher than those on the right side, but the same volume of blood is pumped per cardiac beat. In the cardiac cycle, blood moves from high- to low-pressure areas (Marieb and Keller, 2018).

The ECGs origin dates back to the discovery of the heart muscles electric activity. In 1901, Willem Einthoven made a breakthrough that facilitated the first steps towards electrocardiography, for which he subsequently won a Nobel Prize in 1924 (Yang et al, 2015).

ECGs are used as a technique to diagnose cardiac disease and to detect abnormal heart rhythm. They may also be used as a general health assessment in certain occupations, including aviation, diving and the military (Chamley et al, 2019). According to professional societies, adequate education for medical staff is critical for ECG monitoring and developing skills in interpreting waveforms and ECG data (Sandau et al, 2017).

In routine clinical practice, there are four main approaches to monitoring cardiac rhythm:

The 12-lead ECG is a non-invasive method of monitoring the hearts electrical activity. This bedside test can provide important diagnostic information or be used as part of a baseline assessment; Box1 outlines some indications for using it.

If there is a concern that a patients acute symptoms may have a cardiac cause, continuous cardiac monitoring might be used in a hospital setting. This may help with:

Continuous cardiac monitoring is also an important component of non-invasive monitoring of vital signs, with clinical benefits in medical ward settings (Sun et al, 2020).

The ECG is a graphical representation of the hearts electrical activity, plotting its voltage on a vertical axis against time on a horizontal axis. It is recorded onto ECG paper, which runs at a speed of 25mm per second. Standard pink ECG paper is made up of 5x5mm squares, each containing 25 smaller 1x1mm squares. The 1mm width of each small square represents 40milliseconds. On the vertical axis, the height of an ECG wave or deflection represents its amplitude (Prutkin, 2020). Fig2 shows what a normal ECG looks like and its relationship with the stages of the cardiac cycle.

During the normal cardiac cycle, the atrial contraction that takes place is associated with a P-wave (atrial depolarisation) and is of low amplitude because the muscle is relatively thin in the atria. This contrasts with the QRS complex, which represents the electrical impulse as it spreads through the ventricles (ventricular depolarisation). The first deflection of the QRS complex is the Q-wave, which is a negative wave that begins septal depolarisation. The R-wave represents depolarisation of the left ventricular myocardium and the next negative deflection is the S-wave, which represents terminal depolarisation. The T-wave occurs after that and represents the repolarisation of the ventricles.

The ECG also records a number of other parameters:

It is important to know the normal ranges for the various ECG parameters (Table1): if any measurements are outside the normal range, thought and investigation are needed to ascertain why and decide on a course of action. Parts 2 and 3 of this series will discuss this in more detail.

It is important to remember that the electrical lead actually represents the differences in electrical potentials measured in two points in space. The conduction of electrical impulses between these two points in space can be detected via electrodes that are positioned at various points on the body; this is then displayed as a waveform on the ECG machine/monitor.

There are several configurations of electrode positioning; continuous ECG monitoring uses a 3-lead configuration but the standard 12-lead ECG comprises:

To position the chest electrodes accurately, it is important to first identify the sternal angle (angle of Louis); this is done by feeling the bony prominence at the top of the sternum, which articulates with the second rib above the second intercostal space. By moving the fingers downwards, the fourth intercostal space can be felt: here, the electrodes for V1 and V2 should be placed to the right and left of the sternum respectively. By feeling the fifth intercostal space and moving the fingers to the middle of the clavicle, V4 can be placed on the midclavicular line. V3 should then be placed midway between V2 and V4. V5 is placed in the fifth intercostal space, more lateral to the anterior axillary line, and V6 is placed in the fifth intercostal space in the midaxillary line.

To record the limb leads (Fig3b), four electrodes are placed on the body. In the upper limbs, an electrode pad is placed below the right clavicle (arm), the next electrode pad is placed below the left clavicle (arm); in the lower limbs, a cable is connected to an electrode pad placed on the left hip/ankle (LL) and on the right hip/ankle (RL).

It is important to follow local policy. All of the limb electrodes are placed on bony areas, rather than muscle, to avoid motion artifact caused by muscle oscillation. Positioning electrodes in this formation allows the heart to be electrically mapped in three dimensions.

When undertaking any cardiac monitoring, the first step is to give the patient a simple explanation of the purpose of the test and what they should expect, as well as gaining their informed consent. It is important to ensure they are not allergic to the gel used on the ECG electrodes by asking if they have had any previous reactions.

It is critical that the health professional can accurately place the electrodes this will help avoid inaccurate diagnosis and treatment and it is important to have good contact between the electrode and the skin, which should be clean and dry. Excessive hair may need to be shaved and oily skin cleaned with alcohol or gauze. The electrodes are then attached to the patient in line with the machines instructions. The ECG is displayed on the machines monitor and should be checked for clarity, wave size and any interference.

Inadequate ECG monitoring can be dangerous; for example, misreading artifacts (electrocardiographic impulses unrelated to cardiac electrical activity) during ECG monitoring can be costly and cause delays to care. Other potential problems and how to resolve them are listed in Table 2.

An excellent ECG trace must be acquired to aid appropriate interpretation and provide the best care. The Society of Cardiological Science and Technologys (2020) ECG guidance has more information about the reporting standards used by professional societies.

ECG monitoring is standard for patients in a variety of settings. Understanding the basic physiology underpinning the electrical and mechanical events of the heart is crucial for ECG interpretation. Part 2 of this series will focus on this and present important ischaemic pathologies, while part 3 will cover cardiac rhythm disorders and conduction defects.

Selina Jarvis was a recipient of the Mary Seacole Development Award and is focused on improving care for patients with cardiac disease.

References

Chamley RR et al (2019) ECG interpretation. European Heart Journal; 40: 32, 2663-2666.

Jarvis S, Saman S (2018) Cardiac system 1: anatomy and physiology. Nursing Times [online]; 114: 2, 34-37.

Marieb EN, Keller S (2018) Essentials of Human Anatomy and Physiology. Pearson.

Newby DE, Grubb NR (2018) Cardiovascular disease. In: Ralston SH et al (eds) Davidsons Principles and Practice of Medicine. Elsevier.

Prutkin JM (2020) ECG Tutorial: Electrical Components of the ECG. uptodate.com

Sandau KE et al (2017) Update to practice standards for electrocardiographic monitoring in hospital settings: a scientific statement from the American Heart Association. Circulation; 136: 19, e273-e344.

Society of Cardiological Science and Technology (2020) Clinical Guidelines by Consensus: ECG Reporting Standards and Guidance. SCST.

Sun L et al (2020) Clinical impact of multi-parameter continuous non-invasive monitoring in hospital wards: a systematic review and meta-analysis. Journal of the Royal Society of Medicine; 113: 6, 217-224.

Yang XL et al (2015) The history, hotspots, and trends of electrocardiogram. Journal of Geriatric Cardiology; 12: 4, 448-456.

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Electrocardiogram 1: purpose, physiology and practicalities - Nursing Times