Can marriage make you sick?

In general, it promotes health. But it might not if your relationship is troubled or your partner is ill. Here's why, and what can be done.

By Ricki Rusting

Is ongoing hostility in your marriage making you stressed or depressed? Do you have a good relationship, but your partner has a chronic disorder? In either case, watch out. Though married people, on average, have better health than others, partners in these two situations can face an increased risk of obesity, cardiovascular disease and other conditions. The risks vary, of course, but take note: If one spouse is obese, the other person’s risk for that condition doubles.

Janice K. Kiecolt-Glaser, director of the Institute for Behavioral Medicine Research at Ohio State University, and Stephanie J. Wilson, a postdoctoral researcher in Kiecolt-Glaser’s lab,study the health effects of intimate relationships and recently reviewed the topic in “ Lovesick: How Couples’ Relationships Influence Health” in the Annual Review of Clinical Psychology. Here, they explain some of the more intriguing findings. The interview has been edited for clarity.

Is it true that, overall, being married is good for you?

JKG: A bunch of different studies show that marriage, on average, is beneficial for rates of disease, recovery from surgery, cancer risk — most of the things you can look at. The effects of being single are similar in magnitude to the health risks of smoking, high blood pressure, obesity or a sedentary lifestyle.

SW: A recent meta-analysis showed that the effect of a quality marriage on physical health was about equivalent to that of daily exercise or a healthy diet. Maybe over a short time span the effects are not large, but over the course of longer periods, the benefits of a satisfying marriage add up.

Now the flip side. Studies show that the risks for obesity-related conditions rise dramatically in a person if a partner has the condition — risk doubles in the case of obesity itself and rises by more than 25 percent for diabetes and metabolic syndrome. What explains this “contagion”?

JKG: If your partner has less healthy behaviors, it gives you license, and perhaps subtle social pressure, to adopt them as well.

Being stressed by ongoing marital discord also aligns with poor health. What are common effects?

JKG: Cardiovascular disease has been well described, hypertension has been described in a variety of cases — the whole metabolic syndrome group of diseases. Marital discord doubles the risk for metabolic syndrome.

SW: A lot of the chronic illnesses that develop at higher rates in couples who are unhappy than in satisfied couples may be caused in part by inflammation. Beyond that, once a person has vulnerability to a disease, its severity can be exacerbated by marital discord. I am thinking of certain pain conditions that may not be rooted in inflammation or stress per se but, once they arise, might escalate more quickly in someone who is in a poor marriage.

Also, marital distress and depression are strong fellow travelers. An unhappy marriage is really, really fertile ground for depression, and depression has very well documented health consequences. And it goes back and forth. People who are depressed are more likely to have marital troubles, because it’s not fun to be around someone who is depressed.

It sounds as if most roads lead through inflammation.

JKG: It’s one of the central pathways we know the most about these days, although there are certainly others. Inflammation is associated with a variety of different diseases. And psychological stress can promote inflammation.

What is the biological route from stress to inflammation?

JKG: When you are stressed, stress hormones respond. For instance, norepinephrine, otherwise known as noradrenaline, is clearly very stress-responsive, and it is also a hormone that is important on the pathway to inflammation.

“If your partner has less healthy behaviors, it gives you license, and perhaps subtle social pressure, to adopt them as well.”

Janice Kiecolt-Glaser

Behaviors also change as a result of marital stress. How do they link to ill health?

JKG: Most of us don’t tend to eat more broccoli when we’re stressed, or all the things our mothers told us to do: eat healthily, exercise, drink moderately. Those are all behaviors that, with stress, get worse.

SW: Sleep is particularly important for health, too, and is disrupted by marital stress.

Can these effects contribute to inflammation?

JKG: All the behaviors we’ve been talking about are also lovely for inflammation. When you are eating a high-fat, unhealthy diet, it’s inflammation-producing. Drinking heavily, smoking, sedentary behavior — they are all associated with inflammation. Depressive symptoms have inflammatory consequences, too.

SW: Sleep disorders are also associated with much higher levels of inflammation and predispose you to a range of chronic illnesses, but we have also found that just a night or two of less sleep primes couples to have a larger inflammatory response to conflict than couples who had more sleep in the past two nights.

How does one go about showing that marital discord affects physiology?

JKG: In the earlier studies in our lab, we would bring couples in and put a catheter in their arm and ask them to discuss a disagreement, and we could watch stress hormones in the blood respond to the quality of the disagreement. When people were more nasty or hostile, we would see much larger increases in stress hormones. You could actually watch the biological consequences related to the quality of the discussion.

“So we have a triad of really unhealthy things happening associated with depression and couples’ negativity or discord.”

Janice Kiecolt-Glaser

How do you get people to have disagreements in the lab?

JKG: We have people fill out an “areas of disagreement” questionnaire, where they rate the intensity and chronicity of common marital problems — in-laws, finances, sex. Then they are asked to resolve problems they have identified as current issues, such as, “What are you going to do about Mrs. Jones’s mother who keeps dropping by unexpectedly?” We videotape that discussion and then code what the partners are doing.

What do you look for, specifically?

JKG: Bad marriages often have the same kinds of symptoms. One classic signature of distress is the demand-withdraw pattern, where one person will be saying they want a change in something and the other person doesn’t want to discuss it. Another signature is negative escalation: One person says something negative, the other person responds in kind, and it goes up and up and up.

Jan, you did a study showing that marital distress can alter metabolism in ways that promote weight gain. How did you make that discovery?

JKG: We were trying to mimic the amount of fat and calories in fast-food meals — the things that people would turn to when stressed. We brought couples into the laboratory and we fed them one of two high-fat meals (one with a healthier fat, high oleic sunflower oil, and one with a saturated fat). Both were 60 percent fat and 930 calories. We drew blood and made metabolic measurements at baseline and every two hours after the meal throughout the day, including one and four hours after the disagreement discussion.

We found a whole series of things, for both meals. When a person had a history of depression and the conflict was nastier, they had higher and more sustained rises in triglycerides, and their metabolic rate was lower: Energy expenditure went down by 128 calories. That’s not a big deal for an afternoon, but it could add more than 7 pounds of weight a year for someone with continuous stress over time. There was also higher insulin production, which is a way of telling cells to store fat.

So we have a triad of really unhealthy things happening associated with depression and couples’ negativity or discord.

Do you see gender differences in responses to marital distress?

JKG: I would argue that it’s more the woman who gets affected. A meta-analysis by a former grad student did not find that, but they did not look at the kinds of laboratory studies we do (they are costly and intense and not commonly done). In those, we clearly see that women are responding more physiologically.

There is a large psychological literature, too, showing that women remember both positive and negative events in much more detail than men; women ruminate or think about those relationship events much more than men. So it would be surprising if there were not greater health effects for women. In our laboratory studies where we had the catheter in the arm and were drawing blood during the conversation, we could really see the differences in how the women were responding compared to the men.

Research also shows that, at the other end of the spectrum, having a really good relationship can put a person at risk for health problems if the partner is ill. What goes on there?

JKG: Some of the best evidence comes from the extreme case of spouses caring for partners with Alzheimer’s disease. Years ago, we showed that the spouses’ immune systems were less likely to respond to vaccination as they should; spouses healed wounds more slowly; they had higher levels of inflammation. That’s the more extreme case, but there is now good evidence across less-dramatic illnesses that a spouse’s illness matters. And it appears to matter more in a better-quality relationship — because it affects you more directly, in some ways.

SW: Another type of lab study brings in a couple where one person has a chronic pain condition, such as knee osteoarthritis that affects the ability to get around. The pain patient would be asked to do a painful task and would be video-recorded. That video would be shown to the spouse. Spouses react with greater blood pressure increases to watching the patient in pain compared to somebody they don’t know, and beyond that, spouses who are in happy marriages show even more exaggerated effects.

Is the mechanism similar to what happens when partners have marital discord?

SW: The stressors and experiences are likely to be different — empathic processes and the stresses of care-giving, rather than noxious conflictual patterns. But the physiological pathways might be the same.

JKG: What happens in partner illness, too, is that the ill person is typically less available, so the partner loses many of the positives of marriage, such as the give and take of conversation and shared experiences.

Elderly couples in a happy marriage face a greater health risk than younger people do when a partner is ill. Why?

JKG: Older couples have longer, more intense relationships. Also, the older someone is, the more vulnerable they are physiologically. Stress for someone in their 20s is not likely to make them sick or have huge health effects, but we know that when someone is 65 or 70, noticeable declines in the immune response begin, and age-related increases in inflammation. So you’re adding stress onto physiology that is already functioning more poorly. But there is also a psychological explanation.

SW: In general, as people age, there is a decrease in the size of the social network, a greater emphasis on relationships that are emotionally meaningful. Because of that, psychological weight is placed on the marital relationship.

“Over the course of longer periods, the benefits of a satisfying marriage add up.”

Stephanie Wilson

What about the health effects of stress on gay couples or people who cohabitate?

SW: Most of the studies only recruit heterosexual married couples, and that’s the only group we can strongly generalize to. But the existing data don’t show marked differences in the process in cohabitating or homosexual couples.

Is there a particularly good way to protect health when couples have marital problems?

JKG: There is some evidence that marital problems are going to be most responsive to marital therapy (as opposed to individual therapy). It can address the utility, or lack of utility, of the way couples are thinking about particular problems.

SW: And it can encourage making an effort to take the other person’s perspective and to approach problems as a team. We only have a few studies to look to. But they’ve shown that, regardless of the specific approach, if the therapy is effective at reducing marital problems, we see a reduction in stress hormone reactivity.

To limit marital tension when one partner is ill, the advice to a spouse seems to be “Be supportive.” But how do you do that without seeming to be a nag or too critical?

SW: A lot of this work has shown that supporting the person in their independence — essentially saying, “I believe in you; this is a challenge, but you can do this” — can build a partner’s self-confidence, which is often going to be beneficial. Being empathic has also been shown to be effective — listening actively when the partner wants to share, to show that you are there as a support, and being generally loving and warm.

In your own relationships, have you used anything you’ve learned from the research?

JKG: Yes — the idea that you pay attention to your relationship; that it matters how you talk about it and think about it. And it matters that you take good care of yourself, as well as attending to your partner, when your partner is ill.

My husband has Alzheimer’s disease. When he was first diagnosed with mild cognitive impairment, I saw the train coming down the tracks. Ours is a case where our lives were very much intertwined. He was my primary research collaborator and we had a really good relationship and a closeness. So I tried to make sure that I had my own life aside from the marriage, in terms of friendships — not just couple friendships — and I tried very hard to take care of my own health. I knew all too well what happened when people didn’t take care of themselves.

Don’t breakups cause all kinds of anxiety, depression and stress too? And then there is loneliness. Which is worse for one’s health — staying in a non-ideal relationship or going it alone?

SW: The evidence is mixed. One study found that singles had lower resting blood pressure than unhappily married people but a study of people with rheumatoid arthritis found that singles and the unhappily married were in an equal amount of pain. In both cases, happily married people fared best. As for divorce, most people cope well and recover quickly post-marriage, but a consistent minority (10-15 percent) do struggle and face heightened health risks as a result. As for loneliness, it is possible to feel lonely in a marriage; surrounding oneself with other friends and family seems to be especially important for staving off loneliness in the unmarried.

Where is your research heading now?

JKG: Stephanie and I are working on a microbiome project. We are recruiting couples and getting fecal samples to look at how marital quality and marital stress are reflected in the mix of bacteria in the gut.

What would you do with that information?

JKG: The microbiome may well be an important conduit to inflammation. With what’s called a “leaky gut,” you have endotoxin, a bacterial toxin from certain bacteria, leaking across the gut barrier. That fuels inflammation. We can look at how a person’s diet affects their microbiome, whether dietary interventions might be useful for reducing inflammation in people experiencing stress in their marriage — a variety of things. So the research offers the possibility for finding interventions that we might not otherwise have thought about.

Ricki Rusting is a freelance science writer and editor based in New York.

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. 

Why three-day weekends are great for wellbeing – and the economy

lazyllama/Shutterstock

Tony Syme, University of Salford and Maria Paola Rana, University of Salford

The coronation of King Charles III has upped the UK’s public holiday count this year. The special public holiday on the Monday after the May 6 ceremony, combined with the early May bank holiday and the spring bank holiday at the end, has certainly made for a month of celebrations for many workers.

Normally public holidays in the UK – and in England and Wales in particular – are much more rare occasions. The coronation celebration brings the total to nine in 2023, which is still fewer than any EU country. Given that hours worked in the UK over the whole year are 11% higher than in Germany, for example, it is not clear that working more and having fewer holidays is a sign of economic success.

Currently, nine of the top ten most productive OECD countries, measured by GDP per hour worked in dollars, are in continental Europe. Yet this is a region with a tradition of long holidays. There is also evidence that national holidays have a small but positive impact on economic activity, or at least no ill-effect.

Having several three-day weekends in one month also brings into focus the recent four-day working week pilots (without loss of pay) in many countries. Iceland led one of the earliest large trials between 2015 and 2019, with its success seeing it rolled out to close to 90% of Iceland’s workforce. These people can now request a shorter workweek without any loss in pay.

Findings from a New Zealand trial among employees of Unilever also showed strong results against standard business targets such as revenue growth. The vast majority of participants reported feeling engaged and absenteeism dropped by 34% during the trial.

A similar six-month pilot programme took place in the UK from June to December 2022, involving 61 companies and around 2,900 workers. As with the other trials, organisers said it was a “resounding success” for the companies involved – 56 of these 61 businesses pledged to continue with the four-day week.

Paying 100% of the standard wages for 80% of the previous worktime may seem uneconomic, but the UK trial found that the “vast majority of companies were also satisfied that business performance and productivity were maintained”. Staff retention also improved with the number of people leaving the participating companies dropping by 57% during the trial.

Wellbeing and health benefits

But the most significant benefits to employees from these four-day week trials have been in terms of wellbeing. The UK trial reported that 39% of employees were less stressed and 71% said they had reduced levels of burnout by the end. The average mental health score (on a five-point scale from poor to excellent) rose from 2.95 at the beginning of the trial to 3.32 by the end – an increase of 13%. And in terms of anxiety, 54% of respondents reported a reduction in negative emotions.

A similar wellbeing boost was seen in Ireland’s four-day work week trial completed in 2022. Among the 12 Irish companies involved, employees saw a reduction in anxiety and negative feelings and an increase in positive feelings (and expressions of those feelings) throughout the trial.

The previously-mentioned New Zealand trial also confirmed the strong positive effects of a four-day week on wellbeing. Over two-thirds of participants reported a better work–life balance, and measured stress levels dropped by 33% during the trial period.

Four-day work week versus public holidays

But the benefits from four-day week trials are permanent since they accrue from a long-term change in working arrangements, at least during the trial. So, the effects of this year’s spate of May bank holidays in the UK could be different.

This was certainly shown to be the case by a study that looked at the wellbeing benefits of national holidays across 200 countries. It found that one less public holiday reduces the probability of being happy by 0.8 percentage points, but that one less public holiday had no impact on the longer-term measure of life satisfaction.

But other research shows that, although the positive wellbeing impact of public holidays may not be permanent, it does lead to an increase in social cohesion or social capital. This brings its own economic and wellbeing benefits. For all but a minority of the workforce, public holidays ensure that people are using it for leisure time. And social cohesion has long been associated with positive wellbeing.

Workplace wellbeing. PeopleImages.com - Yuri A/Shutterstock

We need to focus on workplace wellbeing more than ever. In addition to multiple high profile workplace bullying and harassment scandals recently, calls to employee assistance hotlines are at record highs due to anxiety and depression among employees. These initiatives were designed to meet demand for a range of work-related queries and advice, not to act as an emergency mental health service.

And so, the coronation public holiday may give UK workers the much-needed celebration they need. Whatever your view of the Royal family, May’s public holidays will benefit the economy, but more importantly, they will deliver a wellbeing boost for much of the country.

Tony Syme, Senior Lecturer in Economics, Salford Business School, University of Salford and Maria Paola Rana, Lecturer in Economics, University of Salford

This article is republished from The Conversation under a Creative Commons license. 

The exploitation of Hollywood’s writers is just another symptom of digital feudalism

Striking workers picket outside of Warner Bros. Studios on the second day of the Hollywood writers strike on May 3, 2023, in Burbank, Calif. David McNew/Getty Images

David Arditi, University of Texas Arlington

The current Hollywood writers strike has drawn international attention to the plight of TV and film writers in the streaming era.

Much has been made of television’s golden age, during which streaming platforms have offered audiences an abundance of well-written, highly produced television shows, often called “prestige TV.”

Whereas older television shows tended to be formulaic sitcoms or crime dramas, newer shows more closely mimic the serialized novels of the 19th century, with cliff-hangers that encourage binge-watching.

But not everyone in the industry has equally reaped the rewards. While there are certainly more writing jobs to go around, these roles often pay less and place writers on short-order contracts.

Furthermore, the unyielding demand for content, as more and more platforms compete for subscriptions, has trapped writers in what I call “digital feudalism.”

Echoes from medieval Europe

I use the phrase digital feudalism because today’s version of capitalism increasingly mirrors the transition from feudalism to capitalism in 16th-century England.

Beginning in the 16th century, the English Parliament passed a number of enclosure acts, which abolished common land and defined it as private property that the government reallocated to the elites.

These laws kicked peasants, known as serfs, off the land where they had lived and worked for generations. Many of them ended up heading to cities in order to find work. The ensuing oversupply of workers drove down wages, and many ex-serfs couldn’t find jobs or housing, becoming vagabonds.

In other words, serfs lost stability in their everyday lives as they were thrust into a new economic system.

Precarity, debt and a lack of stability are again the dominant themes in today’s digital economy.

The gig economy, in which people can juggle two or three part-time roles to make ends meet, is largely to blame. These jobs usually don’t offer full-time benefits, livable wages or job security. The roles – whether they’re working as an Uber driver, delivering food for DoorDash or cleaning homes through Task Rabbit – are often managed through digital platforms owned by powerful corporations that give their workers a pittance in exchange for their labor.

The serfs of Hollywood

So, why are TV writers feeling the pinch of digital feudalism if this is the golden age of television?

Streaming platforms like Netflix, Hulu and HBO Max brought about the golden age. But the gold prospecting has slowed, as the number of prestige TV shows seems to have hit a saturation point.

Starting in the 2010s, streaming platforms began hiring more and more writers. To lure customers, platforms needed quality content – otherwise, viewers wouldn’t continue paying the US$8 to $15 monthly cost of a subscription.

Platforms couldn’t market their content like network sitcoms, so they had to constantly develop new ideas for shows. Large stables of creative writers ended up forming the core of studio strategy.

Yet, as TV writers flocked to Los Angeles and New York City, entertainment companies took a page from the gig economy playbook in ways that worked against writers’ livelihoods.

The contracts were short and the pay lower. The formats of streaming shows – more one-off miniseries rather than sitcoms that could run for as long as a decade – rarely guaranteed work for any lengthy period of time.

Furthermore, streaming shows tend to have fewer episodes per season, with larger gaps between seasons, known as “short order.” An eight-episode season of a popular show that has a two-year gap between seasons leaves TV writers scrambling to figure out ways to pay the bills in between seasons.

Then came COVID-19. While people were stuck at home binge-watching TV, it became difficult to produce television. There was a major backlog in TV production because of the difficulties shooting TV shows in studios while complying with COVID-19 health regulations.

This created a major slowdown in TV production. At the height of the pandemic, TV studios closed to limit the number of people inside. With the slowdown of production, there wasn’t the demand for writers. As a result, many of the TV writers who had recently moved to Log Angeles and other big cities with high costs of living were faced with challenges finding jobs.

Core demands

Writers want to fix this by raising their minimum wage; they want writers for streaming platforms to receive the same royalties that theatrical film writers get; and they want to end the practice of mini rooms, where small groups of writers hash out scripts but often receive less compensation for a series that may not even get ordered.

Another key demand is to limit the use of artificial intelligence in television production.

Writers fear that studios will use AI to hire workers, select which shows to produce and, in the worst-case scenario, replace writers altogether. Interestingly, limits on AI have been the one point of contention that studios have been unwilling to even discuss.

It will be interesting to see whether the writers will be able to claw back some of the financial security that’s vanished across many industries, or if the larger economic forces that have powered the gig economy will work in studio executives’ favor.

David Arditi, Associate Professor of Sociology, University of Texas Arlington

This article is republished from The Conversation under a Creative Commons license. 

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Protect Yourself from Medicare Scams

Learn how to spot and report Medicare fraud

(Family Features) Since 1965, Medicare has provided health care coverage to millions of Americans. More than 65 million people in the United States were enrolled in Medicare as of February 2023, with more people becoming eligible and enrolling each year. Anyone on Medicare is at risk of Medicare-related fraud, and the Medicare program continues to warn people to watch out for scammers who steal Medicare Numbers and other personal information to exploit beneficiaries’ benefits.

Broadly speaking, Medicare fraud occurs when someone makes false claims for health care services, procedures and equipment to obtain Medicare payments. Medicare fraud costs taxpayers billions of dollars and puts the health and welfare of beneficiaries at risk. The impact of these losses and risks is expanding as Medicare continues to serve a growing number of beneficiaries.

“Anyone on Medicare can be a target of Medicare fraud,” said Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure. “But there are steps you can take to protect yourself and your loved ones by using CMS’ fraud tips to recognize and report potential scammers. Let’s all work together to make sure you’re not a victim of Medicare fraud.”

How to Spot Medicare Scams
There are many types of Medicare scams, taking the form of unsolicited emails, phone calls, text messages, social media posts and phony websites. Scammers often claim to be from the Medicare office, an insurance company or a government office. They’ll ask for your personal and financial information, such as your Medicare or Social Security Number, so that they can submit false claims for payment.

Remember that Medicare will never call, text, email or contact you through social media asking for your Medicare Number.

Some common Medicare scams to watch out for include:

• Offers of “free” genetic testing
• Calls or emails about free medical equipment, such as a knee brace, walker or cane
• Solicitations for other services, such as offers of “paid” clinical research trials

While this is not a comprehensive list, these examples give you an idea of how to spot potential Medicare fraud. Scammers will do their best to present these services and products as genuine in exchange for your Medicare Number.

How to Protect Yourself
Now that you know how to spot Medicare fraud, you’ll need to know how to protect yourself from potential fraudsters. Remember to:

• Guard your Medicare Number just like your Social Security card and credit card
• Share your Medicare Number only with trusted health care providers
• Review your Medicare statements, watch for services billed that look suspicious and ask questions if something looks wrong

How to Report Scammers
Reporting Medicare fraud protects you and millions of other people with Medicare and those with disabilities. If you or someone you know have experienced Medicare fraud or suspect an offer you’ve received is a scam, report it as soon as possible. You will never be in trouble for reporting fraud.

To learn more about Medicare fraud, visit Medicare.gov/fraud. To report potential Medicare fraud, you can call 1-800-MEDICARE (1-800-633-4227) or report the scam to the Federal Trade Commission at ReportFraud.ftc.gov.

Information provided by the U.S. Department of Health and Human Services.

SOURCE:
Centers for Medicare & Medicaid Services
 

Arming immune foot soldiers against cancer

Natural killer cells are born ready to attack the disease. Biologists are developing ways to make these cells tougher and more targeted.

By Eric Bender

It may be unsettling to contemplate, but the human body is constantly fighting cancer caused by genetic damage to its cells from chemicals, UV rays and biochemical mistakes. Fortunately, the immune system mops up the vast majority of those cells turning rogue — thanks in large part to early foot soldiers called natural killer cells, which are born with multiple ways to detect and destroy abnormal cells.

Scientists have long hoped to harness these vigilant natural killers for cancer therapies in the clinic. But until recently, they’ve been disappointed, as trials using transplanted natural killer cells to fight blood cancers have shown safety but little effect in slowing or stopping tumors.

In the last few years, though — following dramatic progress in immunology and genetic engineering — a wave of early clinical trials is at last giving encouraging signs.

In February, one of the first published findings in this new generation of natural killer cell trials appeared in the New England Journal of Medicine: It reported a high response rate and surprisingly low side effects among 11 patients with two forms of blood cancer when they were treated with natural killers genetically engineered to boost the targeting and destruction of cancer cells.

And natural killer cells also are starting to take on solid tumors. In December, at a cancer symposium in San Antonio, researchers reported encouraging preliminary findings in patients with metastatic triple-negative breast cancer, which is especially difficult to treat. When nine patients were given off-the-shelf natural killer cells in combination with other treatments, five of them saw their tumors shrink or become undetectable during the study period.

Immunity in action

Our immune system holds two main armies: the innate immune system and the adaptive immune system. Each includes many types of protective cells, and the two work together in complex ways to take out foreign invaders or body cells turned traitor.

The innate immune system is made up of cells already armed for all battles, such as natural killer cells, discovered and named in the 1970s. In contrast, the adaptive immune system includes the more familiar components — antibodies, T cells and B cells — that are highly specialized in their targets. Among these guardians, T cells are exquisitely tuned to defend against cells gone wrong by latching onto specific proteins on their surface.

Harnessing T cells in immunotherapies — treatments that unleash the immune system against disease — has been the greatest recent success story in cancer, with several therapies approved by the Food and Drug Administration against blood cancers. In one breakthrough treatment called CAR T cell therapy, a patient’s own T cells are withdrawn and genetically modified so that they generate proteins called chimeric antigen receptors. These CAR proteins sit in the membranes of the T cells and grab onto specific proteins on the surface of cancer cells, triggering heightened attack.

But CAR T cell therapies are not cure-alls. Many patients don’t respond. The treatments need to be managed expertly to avoid dangerous side effects. The individualized manufacturing process, done to avoid an attack by the patient’s own immune cells, is slow and extremely expensive and doesn’t always produce usable cells.

Scientists believe that natural killer cell therapies may offer major advantages in safety, cost and feasibility over CAR T treatments. For one thing, infusing natural killer cells doesn’t provoke dangerous immune overreactions or attacks against the recipient’s healthy cells, so they can be transplanted from person to person without serious side effects.

“NK cells could be universally applied to many patients as an off-the-shelf product that’s processed in a few centralized high-throughput facilities, frozen and shipped around the country quite easily, then hung up and infused from a bag just like a bag of saline,” says Clint Allen, an ear, nose and throat surgeon and cancer researcher at the National Institute on Deafness and Other Communication Disorders.

The cells are also ready from the get-go to attack every incoming threat, be it a cancerous cell or a cell that’s been infected by, say, a virus or a fungus. “The beauty of NK cells is that they can be applied to all comers,” says George Ansstas, an oncologist at Washington University School of Medicine in Saint Louis.

Moreover, natural killer cell therapies can be repeated. That may turn out to be a requirement in treating many advanced cancers, since mature natural killer cells tend not to persist in the body for as long as T cells do — typically only a couple of weeks, which may not be long enough to truly stomp out the cancer threat. The plus side is that the treatment can be repeated and any toxic side effects should be temporary.

A killing machine

Natural killer cells have two main routes for recognizing abnormal cells. In one, they directly recognize that a cell is abnormal, usually because the rogue cell is not properly producing a set of proteins that should sit on its surface and signal to the immune system that it’s human. In the other route, natural killers attach to an antibody that has been placed on the abnormal cell to mark it for destruction.

In both cases, the natural killer cell releases a flood of molecules that can kill dangerous cells and enlist the help of T cells and other immune watchdogs.

The natural killer cell therapies under study also come in an array of flavors. As they have for decades, researchers are looking for drugs that might beef up the anticancer activity of NK cells already in the body.

More dramatically, there are also dozens of early transplant trials underway, targeting blood cancers and solid tumors. The studies employ a spectrum of approaches that infuse natural killer cells as one ingredient of many in a complicated therapeutic regimen.

The sources of the cells are varied: blood donated by family members or harvested from umbilical cords, natural killer cell-derived cell lines, and induced pluripotent stem cells — adult cells that were genetically returned to an uncommitted, plastic state and then reprogrammed to behave like natural killer cells.

In a trial that began in 2014 for patients with various advanced solid tumors, for example, the natural killer cells are healthy cells donated by family members, says Monica Thakar, a pediatric hematologist-oncologist at the Fred Hutchinson Cancer Research Center in Seattle. In preliminary findings Thakar plans to present at the 2020 meeting of the American Society of Clinical Oncology (held virtually because of the Covid-19 pandemic), results in the first 15 patients were encouraging, she says, and the therapy’s toxicity low.

A variety of clinical studies are built around cells created from a cell line called NK92 that was derived decades ago from malignant natural killer cells. NantKwest of Culver City, California, has set up 20 clinical trials and administered more than 700 doses of various forms of NK92 cells, according to the company. In the latest trials, the NK92 cells have been genetically modified for greater potency and staying power.

Allen is collaborating with NantKwest to launch a trial for head and neck cancer that he had hoped to start this summer before the Covid-19 pandemic. In this study, NK92 cells have been engineered to make two proteins. One, which sits on the surface of the natural killer cell, has been tailored to attach to antibodies on the surface of cancer cells. The second protein is a molecule known as IL-2, which helps the natural killer cells survive and expand.

The trial published in the New England Journal of Medicine, meanwhile, uses natural killer cells that are derived from cord blood and engineered to make a CAR protein. The therapy is analogous to the best-performing types of CAR T cell therapies, which target blood cancers that display a protein called CD-19 on their surfaces.

This therapy, given as a single dose, performed roughly as well as the CAR T therapies, scientists at the University of Texas’s MD Anderson Cancer Center in Houston reported. Among 11 patients with advanced blood cancers, eight showed a complete remission of their disease, with none of the dangerous side effects often seen with CAR T treatments. “We were very happy and very encouraged with these results,” says MD Anderson hematologist-oncologist Katy Rezvani, who led the trial. It is now being expanded to 60 patients and Rezvani is working with Takeda Pharmaceuticals, which licensed this product, for a phase 2 clinical study.

Other clinical trials are underway, such as one started in 2019 at UC San Diego that uses natural killer cells created from induced pluripotent cells against several types of solid tumors. The trial, which is sponsored by Fate Therapeutics of San Diego and builds on research by hematologist Dan Kaufman of UC San Diego and hematologist-oncologist Jeffrey Miller of the University of Minnesota Medical School, will be followed with trials of cells that are engineered to produce a CAR protein.

Combining for the kill

Scientists also are examining ways to combine NK cell therapies with various other cancer treatments — especially other immunotherapies. There’s plenty of evidence that this could be fruitful, says Miller, who co-authored a 2019 overview of natural killer cell therapies in the Annual Review of Cancer Biology.

Miller and many other researchers see particular promise in exploiting natural killer cells with an emerging class of immunotherapies called immune engagers. These therapies take the same basic targeting strategies of CAR cells, but without reengineering the natural killer cells themselves.

Instead, scientists manufacture and then infuse into patients, molecules that are designed to attach tumor cells on one end and natural killer cells on the other — thereby stimulating the natural killer cells. The FDA has already approved one immune engager that links T cells to a type of leukemia cell. Miller and his colleagues hope to launch a similar trial for a natural killer cell engager as soon as recovery from the Covid-19 pandemic makes it feasible.

There’s no lack of ambition in natural killer cell research. Tapping into tricks developed for T cells, the efforts may soon surpass the T cell strategies in treating some diseases, particularly many solid tumors, where CAR T cells have struggled to achieve much. That’s partly because solid tumors have a huge bag of defensive tricks that make it hard for immune cells to attack, thus posing far more formidable obstacles than blood cancers for any immunotherapy.

Natural killer immunotherapy is in its infancy, Rezvani says. “We really don’t know what’s the best source for the cells. What’s the best way to expand the cells? What’s the best way to engineer the cells? What’s the best signaling molecule? There’s still so much that we need to learn.”

Explore Knowable’s coronavirus coverage

Eric Bender is a science writer based in Newton, Massachusetts, and a BioTwitter addict, @ebender00.

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. 

Can Biden and McCarthy avert a calamitous debt default? 3 evidence-backed leadership strategies that might help

Whether or not the U.S. defaults on its debt may depend on the leadership of Joe Biden and Kevin McCarthy. AP Photo/Mariam Zuhaib

Wendy K. Smith, University of Delaware

The U.S. is teetering toward an unprecedented debt default that could come as soon as June 1, 2023.

In order for the U.S. to borrow more money, Congress needs to raise the debt ceiling – currently US$31.4 trillion. President Joe Biden has refused to negotiate with House Republicans over spending, demanding instead that Congress pass a stand-alone bill to increase the debt limit. House Speaker Kevin McCarthy won a small victory on April 26 by narrowly passing a more complex bill with GOP support that would raise the debt ceiling but also slash spending and roll back Biden’s policy agenda.

Biden recently invited congressional leaders, including GOP leader McCarthy, to the White House on May 9 to discuss the situation but insisted he isn’t willing to negotiate.

Rather than leading the nation, Biden and McCarthy seem to be waging a partisan political war. Biden likely doesn’t want to be seen as giving in to Repubicans’ demands and diminishing legislative wins for his liberal constituency. McCarthy, with his slim majority in the House, needs to appease even the most hard-line members of his party.

Having studied leadership for over 25 years, I would suggest that their leadership styles are polarized, oppositional, short-term and highly ineffective. Such combative leadership risks a debt default that could send the U.S. into recession and potentially lead to a global economic and financial crisis.

While it may seem almost impossible in the current political climate, Biden and McCarthy have an opportunity to turn around this crisis and leave a positive and lasting legacy of courageous leadership. To do so, they need to put aside partisanship and adopt a different approach. Here are a few evidence-backed strategies to get them started.

1. Moving from a zero-sum game to a more holistic approach

Political leaders often risk being hijacked by members of their own party. McCarthy faces a direct threat by hard-line conservative members of his coalition.

For example, back in January, McCarthy agreed to let a single lawmaker force a vote for his ouster to win enough votes from ultraconservative lawmakers to become speaker. That and other concessions give the most extreme members of his party a lot of control over his agenda and limit McCarthy’s ability to make a compromise deal with the president.

Biden, who just announced he’s running for reelection in 2024, is betting his first-term accomplishments – such as unprecedented climate investments and student loan forgiveness – will help him keep the White House. Negotiating any of that away could cost him the support of key parts of his base.

My research partner Marianne W. Lewis and I label this kind of short-term, one-sided leadership as “either/or” thinking. That is, this approach assumes that leadership decisions are a zero-sum game – every inch you give is a loss to your side. We argue that this kind of leadership is limited at best and detrimental at worst.

Nelson Mandela, left, and F.W. de Klerk won the Nobel Peace Prize for helping end apartheid in South Africa. Jon Eeg/Pool photo via AP

Instead, we find that great leadership involves what we call “both/and” thinking, which involves seeking integration and unity across opposing perspectives. History offers examples of how this more holistic leadership style has achieved substantial achievements.

President Lyndon B. Johnson and fellow Democrats were struggling to get a Senate vote on the Civil Rights Act of 1964 and needed Republican support. Despite his initial opposition, Republican Sen. Everett McKinley Dirksen – then the minority leader and a staunch conservative – led colleagues in crossing party lines and joining Democrats to pass the historic legislation.

Another example came in 1990, when South Africa’s then-President Frederik Willem de Klerk freed opponent Nelson Mandela from prison. The two erstwhile political enemies agreed to a deal that ended apartheid and paved the way for a democratic government – which won them both the Nobel Peace Prize. Mandela became president four years later.

This integrative leadership approach starts with a shift of mindset that moves away from seeing opposing sides as conflicting and instead values them as generative of new possibilities. So in the case of the debt ceiling situation, holistic leadership means, at the least, Biden would not simply put up his hands and refuse to negotiate over spending. He could acknowledge that Republicans have a point about the nation’s soaring debt load. McCarthy and his party might recognize they cannot just slash spending. Together they could achieve greater success by developing an integrative plan that cuts costs, increases taxes and raises the debt ceiling.

2. Champion a long-term vision over short-term goals

What we call “short-termism” plagues America’s politics. Leaders face pressure to demonstrate immediate results to voters. Biden and McCarthy both have strong incentives to focus on a short-term victory for their side with the presidential and congressional elections coming soon. Instead, long-term thinking can help leaders with competing agendas.

In a 2015 study, Natalie Slawinski and Pratima Bansal studied executives at five Canadian oil companies who were dealing with tensions between keeping costs low in the short term while making investments that could mitigate their industry’s environmental impact over the long run. The two scholars found that those who focused on the short term struggled to reconcile the two competing forces, while long-term thinkers managed to find more creative solutions that kept costs down but also allowed them to do more to fight climate change.

Likewise, if Biden and McCarthy want to avert a financial crisis and leave a lasting legacy, they would benefit from focusing on the long term. Finding points of connection in this shared long-term goal, rather than stressing their significant differences about how to get there, can help shift away from their standoff and toward a solution.

3. Be adaptive, not assured

Voters often praise political leaders who act swiftly and with confidence and self-assurance, particularly at a moment of economic uncertainty.

Yet finding a creative solution to America’s greatest challenges often requires leaders to put aside the swagger and adapt, meaning they take small steps to listen to one another, experiment with solutions, evaluate these outcomes and adjust their approach as needed.

In a study of business decisions at a Fortune 500 technology company, I spent a year following the senior management teams in charge of six units – each of which had revenues of over $1 billion. I found that the team leaders who were most innovative tended to be good at adaptation. They constantly explored whether they had made the right investment and made changes if needed.

Small steps are also necessary to build unlikely relationships with political foes. In his 2017 book, “Collaborating With the Enemy,” organizational consultant Adam Kahane describes how he facilitated workshops to help former enemies take small steps toward reconciliation, such as in South Africa at the end of apartheid and in Colombia amid the drug wars. Such efforts helped South Africa become a successful multiracial democracy and Colombia end decades of war with a guerrilla insurgency.

Former Democratic Gov. Phil Bredesen, second from left, and former Republican Gov. Bill Haslam, right, have built a good relationship since leaving office despite their political differences. AP Photo/Mark Humphrey

This kind of leadership requires small steps toward connection rather than large political leaps. It also requires that both sides let go of their positions and consider where they are willing to compromise.

Biden and McCarthy could learn from two former Tennessee governors, Democrat Phil Bredesen and Republican Bill Haslam. Though they oppose each other on almost every political issue, including gun control, the two former leaders have built a constructive relationship over the years. Rather than tackle the big divisive issues, they started with identifying the small points where they agreed with each other. Doing so led them to build greater trust and continue to look for connections.

So when a gunman killed six people at a school in Nashville recently, the two former governors were able to move beyond political finger-pointing and focus on how their respective parties could work together on meaningful gun reform.

Of course, it’s easier to do this once you’re out of office and the pressure from voters and parties goes away. And although current Tennessee Gov. Bill Lee agreed on the need for gun reform, his fellow Republicans in the state Legislature balked.

A long shot, but …

And that’s why I know this is a long shot. The two main political parties are as polarized as ever. The odds of a breakthrough that leads to anything more than a last-second deal that kicks the debt ceiling can down the road remain pretty low – and even that seems in doubt.

But this is about more than the debt ceiling. The U.S. faces a long list of problems big and small, from high inflation and a banking crisis to the war in Ukraine and climate change.

Americans need and deserve leaders who will tackle these issues by working together toward a more creative outcomes.

Wendy K. Smith, Professor of Business and Leadership, University of Delaware

This article is republished from The Conversation under a Creative Commons license. 

The long-awaited mission that could transform our understanding of Mars

A next-generation instrument on a delayed Martian rover may be the key to answering the question of life on the Red Planet

By Carmen Drahl

March 17, 2022, was a rough day for Jorge Vago. A planetary physicist, Vago heads science for part of the European Space Agency’s ExoMars program. His team was mere months from launching Europe’s first Mars rover — a goal they had been working toward for nearly two decades. But on that day, ESA suspended ties with Russia’s space agency over the invasion of Ukraine. The launch had been planned for Kazakhstan’s Baikonur Cosmodrome, which is leased to Russia.

“They told us we had to call the whole thing off,” Vago says. “We were all grieving.”

It was a painful setback for the beleaguered Rosalind Franklin rover, originally approved in 2005. Budget woes, partner switches, technical issues and the Covid-19 pandemic had all, in turn, caused previous delays. And now, a war. “I’ve spent most of my career trying to get this thing off the ground,” Vago says. Complicating things further, the mission included a Russian-made lander and instruments, which the member states of ESA would need funding to replace. They considered many options, including simply putting the unused rover in a museum. But then, in November, came a lifeline, when European research ministers pledged 360 million euros to cover mission expenses, including replacing Russian components.

When the rover finally does, hopefully, blast off in 2028, it will carry a suite of advanced instruments — but one in particular could make a huge scientific impact. Designed to analyze any carbon-containing material found underneath Mars’s surface, the rover’s next-generation mass spectrometer is the linchpin of a strategy to finally answer the most burning question about the Red Planet: Is there evidence of past or present life?

“There are a lot of different ways that you can search for life,” says analytical chemist Marshall Seaton, a NASA postdoctoral program fellow at the Jet Propulsion Laboratory and coauthor of a paper on planetary analysis in the Annual Review of Analytical Chemistry. Perhaps the most obvious and direct route is simply looking for fossilized microbes. But nonliving chemistry can create deceptively lifelike structures. Instead, the mass spectrometer will help scientists look for molecular patterns that are unlikely to be formed in the absence of living biology.

Hunting for the patterns of life, instead of structures or specific molecules, has an added benefit in an extraterrestrial environment, Seaton says. “It allows us to not only look for life as we know it, but for life as we don’t know it.”

Packing for Mars

At NASA’s Goddard Space Flight Center outside Washington, DC, planetary scientist William Brinckerhoff shows off a prototype of the rover’s mass spectrometer, known as the Mars Organic Molecule Analyzer, or MOMA. Roughly the size of a carry-on suitcase, the instrument is a labyrinth of wires and metal. “It’s really a workhorse,” Brinkerhoff says as his colleague, planetary scientist Xiang Li, adjusts screws on the prototype before demonstrating a carousel that holds samples.

This working prototype is used to analyze organic molecules in Mars-like soils on Earth. And once the real MOMA gets to Mars, approximately in 2030, Brinckerhoff and his colleagues will use the prototype — as well as a pristine copy kept in a Mars-like environment at NASA — to test tweaks to experimental protocols, troubleshoot issues that come up during the mission and facilitate interpretation of Mars data.

This latest mass spectrometer can trace its roots back nearly 50 years, to the first mission that studied Martian soil. For the twin 1976 Viking landers, engineers miniaturized room-size mass spectrometers to roughly the footprint of today’s desktop printers. The instruments were also on board the 2008 Phoenix lander, the 2012 Curiosity rover and later Mars orbiters from China, India and the US.

Anyone visiting Brinckerhoff’s prototype must first pass a display case with a dismantled copy of the Viking instrument, on loan from the Smithsonian Institution. “This is like a national treasure,” Brinckerhoff says, enthusiastically pointing out components.

Mass spectrometers are indispensable tools that are used for analytical chemistry in laboratories and other facilities worldwide. TSA agents use them to test luggage for explosives at the airport. EPA scientists use them to test drinking water for contaminants. And drugmakers use them to determine chemical structures of potential new medications.

Many kinds of mass spectrometers exist, but each “is a three-part instrument,” explains Devin Swiner, an analytical chemist at the pharmaceutical company Merck. First, the instrument vaporizes molecules into the gas phase, and also gives them an electrical charge. These charged, or ionized, gas molecules can then be manipulated with electric or magnetic fields so they’ll move through the instrument.

Second, the instrument sorts ions by a measurement that scientists can relate to molecular weight, so they can determine the number and type of atoms a molecule contains. Third, the instrument records all the “weights” in a sample along with their relative abundance.

With MOMA aboard, the Rosalind Franklin rover will land at a Martian site that roughly 4 billion years ago likely had water, a crucial ingredient for ancient life. The rover’s cameras and other instruments will help to select samples and provide context about their environment. A drill will retrieve ancient samples from as deep as two meters. Scientists hypothesize that’s far enough, Vago says, to be shielded from cosmic radiation on Mars that breaks up molecules “like a million little knives.”

Space-bound mass spectrometers must be rugged and lightweight. A mass spectrometer with MOMA’s capabilities would normally occupy multiple workbenches, but it’s been shrunk substantially. “To be able to take something that can be as big as a room to the size of like a toaster or a small suitcase and send it into space is a very huge deal,” Swiner says.

The look of life

MOMA will help scientists look for telltale signs of life on Mars by sifting through molecules in search of patterns that are unlikely to be formed any other way. For instance, lipids — compounds that include building blocks of cell membranes — have a preponderance of even numbers of carbon atoms in nearly all living things, while nonliving chemistry produces a more equal mix of even and odd numbers of carbon atoms. Finding a set of lipids with carbon atoms that are multiples of a number — rather than a random assortment — is a potential signature of life.

Similarly, amino acids — the building blocks of proteins — can be created either by life or by non-biological chemistry. They come in two forms that are mirror images of each other but are otherwise identical, like left and right hands. On Earth, life overwhelmingly contains only left-handed amino acids. Nonliving chemistry makes both left- and right-handed varieties. In other words, a large excess of either left- or right-handed amino acids is more lifelike than a more even mixture.

More generally, scientists think that chemical distributions similar to these would be indicative of life even if the molecules exhibiting the patterns don’t exist in Earth biochemistry.

Previous Mars missions that included mass spectrometers ran into problems that hampered their ability to identify signs of life. Scientists took those hard-earned lessons and designed MOMA to overcome those hurdles, including one of the most troubling ones: the notorious molecule destroyer, perchlorate. Perchlorate, which also turns up in extreme Earth environments like South America’s Atacama Desert, can degrade organic molecules at high temperatures, obscuring potential signs of life.

In 2008, the Mars Phoenix lander discovered perchlorate ions in Mars soil. Two other missions, the Viking lander and the Curiosity rover, detected chlorinated hydrocarbons — possible byproducts of perchlorate reacting with Martian molecules in the high-temperature ovens of their mass spectrometers. This meant that perchlorate may have obscured any evidence of organic molecules that could indicate life.

MOMA cleverly circumvents the perchlorate problem with an ultraviolet laser. The laser vaporizes and ionizes samples in one go, with pulses of light lasting under two nanoseconds — too quick for perchlorate reactions to occur.

The laser has another benefit: It leaves molecules largely intact when giving them a charge to create ions. Viking and Curiosity generated ions by bombarding them with electrons. Those collisions didn’t preserve weak chemical bonds that can be important for determining the structures of molecules in a sample, whereas the laser keeps molecule fragmentation to a minimum. MOMA can then sort those relatively intact ions and deliberately fragment a single ion of interest in isolation, something neither Viking nor Curiosity could do. By analyzing the resulting puzzle pieces of that ion, it’s possible to determine the chemical structure of the original molecule from the Martian sample and thus identify what it is.

It will be the first time this laser technique goes to Mars, but tests on Earth suggest it will work. The prototype found traces of organic molecules even in the presence of more perchlorate than Phoenix detected in Martian soil, Brinckerhoff says. And in Mars-like samples collected in Yellowstone National Park, it detected lipids and other molecules that are more complex than ones picked up on previous Mars missions.

MOMA, like its predecessors, also has high-temperature ovens and scientists can still opt to use these instead of the laser to vaporize samples. If the laser turns up hints of amino acids, for instance, the oven option could provide information the laser cannot. When in oven mode, MOMA uses three chemical reagents that stabilize molecules to facilitate mass spectrometry. One of these, which has never before been used on Mars, is there to tell apart left- and right-handed amino acids, enabling it to make a case for living or nonliving origins in a way that prior missions could not.

MOMA won’t be the last word on whether life ever existed on Mars. Even the most tantalizing results would have to be confirmed by repeated experiments and lines of evidence from the rover’s other instruments, Vago says. Some confirmatory work also could take place through other missions or even someday from analysis of Mars samples brought back to Earth. “We will need to build a case, because otherwise nobody’s going to believe us,” Vago says.

The international team of scientists that has been working on the mission knows what they need to build that case, but until the Rosalind Franklin Rover lands on the Red Planet’s surface, they can’t get started. All of those scientists shared the disappointment in March 2022 of seeing the long-stalled mission delayed once again.

But for Brinckerhoff, that disappointment is tempered with excitement: After all, the mission is still alive. “This thing is the best of all of us,” he says, “and just to see it operate on Mars is going to be career catharsis.

Carmen Drahl is a freelance journalist and editor based in Washington, DC. Find her portfolio at carmendrahl.com and follow her on Twitter or Mastodon @carmendrahl.

This article originally appeared in Knowable Magazine, an independent journalistic endeavor from Annual Reviews. 

The coronation of King Charles III: 5 Essential reads on the big royal bash – and what it all means

A yarn of pomp and pageantry. Planet One Images/UCG/Universal Images Group via Getty Images

Matt Williams, The Conversation

The United Kingdom is about to embark on an orgy of flag-waving pomp and pageantry in celebration of King Charles III’s coronation.

Charles is already the ruling monarch, having ascended to the throne following the death of his mother Queen Elizabeth II in 2022. So this is more of a chance for him and everyone else to dress up and have a bit of an old-fashioned royal knees-up.

Despite events taking place in a relatively small island off the coast of mainland Europe, the footage of King Charles being anointed with oil and accepting the regalia of state will be broadcast across the world. Here is The Conversation’s guide on what to expect.

1. 3 days of celebration

Not content with dedicating just one day to the coronation, the Brits are putting on a three-day extravaganza starting May 6, 2023. As Pauline Maclaran from the Royal Holloway University of London explained, that Saturday will be dedicated to the actual formal proceedings. Sunday will give way to street parties across the U.K. The final installment takes place on Monday, a day when the British public will be excused from work but encouraged to spend the day volunteering.

A souvenir of the big occasion. Mike Kemp/In Pictures via Getty Images

But it won’t just be Brits marking the occasion, especially at the central event on Saturday. As Maclaran noted: “In testimony to the monarchy’s ‘soft power,’ foreign dignitaries and world leaders will be among the 2,000 anticipated guests taking their places in the abbey alongside members of the royal family. …”

2. A notable no-show

There will be one notable absence among the overseas well-wishers at the coronation: President Joe Biden.

The U.S. leader’s decision not to attend has resulted in some U.K. newspapers’ raising a stink over a “royal snub.” Not so, wrote Arianne Chernock, a royal watcher at Boston University. In fact, no U.S. president has ever attended a British monarch’s coronation.

But, Chernock notes, what is perhaps of more importance is whom the U.S. leader sends in his stead. Delving through the experiences of Biden’s predecessors, she noted: “If history is a guide, who is sent across the Atlantic will telegraph particular American ideas and aspirations. The delegation will also reflect the president’s own personal agenda.”

In the past, that has meant signaling America’s disgust at the rise of European fascism and recognizing the changing role of women in society.

3. But look who is going

Some have put Biden’s decision not to attend down to a purported animosity “Irish Joe” feels toward the British. That far-fetched theory seems even more so when you look at who is attending.

Michelle O'Neill, president of Sinn Féin – a political party that has as a central aim the end of British rule in Northern Ireland – noted in her response to the invite that while she is an Irish republican, she recognizes “there are many people on our island for whom the coronation is a hugely important occasion.”

As Peter John McLoughlin at Queen’s University Belfast pointed out, in framing language in an all-Ireland context, O'Neill was signaling her refusal to accept Ireland’s partition. But her presence nonetheless points at a meaningful commitment to the Northern Ireland peace process.

“Charles’ invitation to Sinn Féin to attend his coronation is in keeping with this process of reconciliation and the normalization of relations between Britain and Ireland. Sinn Féin’s acceptance of the invitation is part of the same effort, but also has a more political intent,” McLoughlin wrote.

4. Charles’ transatlantic cousins

Most Americans did not got an invite for the coronation. But that shouldn’t stop residents of Buckingham, Virginia, or Westminster, Colorado, from joining in the fun alongside the folk of their place namesakes in the U.K. Indeed, there might be one or two people there who can legitimately lay claim to having a bit of royal blood themselves.

Turi King, professor of genetics and public engagement at the University of Leicester in the U.K., did the number crunching and found that for those who claim any British ancestry, “the chances that not one of your 13-times great grandparents was directly descended from Edward III are tiny.” It’s all down to math, you see.

“It’s fair to ask what it really means to say that someone is a direct descendant of royalty,” King pondered. “My experience is that it means something different to each person. As a geneticist I would find it fascinating to know how I’m related to royalty, but I’d be equally interested to know about the lives of my other many ancestors. To me the most thought-provoking aspect is that we’re all related to one another.”

5. What next for Charles?

So what comes after the coronation party? For Charles it may be a right-royal hangover – one hundreds of years in the making.

Tobias Harper of Arizona State University noted that Charles faces major challenges. Many countries, including those that are part of the Commonwealth, are reevaluating their colonial past – and that leads to uncomfortable questions about the role of the British monarchy and what role, if any, the current king should have.

Meanwhile at home, he has inherited a United Kingdom that looks decidedly un-united amid the fallout of Brexit and growing fissures between the four nations it represents. And then there is Charles’ own perceived faults – his meddling in politics, which stand in contrast to his mother’s political neutrality.

“If being king in 2022 sounds tricky, it’s because it is,” wrote Harper. “Charles will struggle to serve all his constituencies well. There are many ways he can fail. It’s not even clear what ‘success’ means for a British monarch in the 21st century. Is it influence? Harmony? Reflecting society? Setting a good example? Survival?”

Matt Williams, Senior Breaking News and International Editor, The Conversation

This article is republished from The Conversation under a Creative Commons license. 

Prepárese para salvar una vida: Comprender los 2 pasos de la RCP solo con las manosv

Cada año, 350,000 personas mueren a causa de un paro cardíaco en Estados Unidos. Sin embargo, la intervención práctica de emergencia, como la reanimación cardiopulmonar (o RCP), por parte de un testigo presencial puede marcar la diferencia entre la vida y la muerte en emergencias de paro cardíaco repentino.

De hecho, si la RCP se realiza de inmediato, puede duplicar o triplicar las posibilidades de supervivencia de la víctima de un paro cardíaco, según la American Heart Association (Asociación Americana del Corazón). Durante los primeros minutos que una persona sufre un paro cardíaco, las compresiones torácicas pueden ayudar a mantener activo el flujo sanguíneo y empujar el oxígeno restante a través del cuerpo para mantener vivos los órganos vitales, lo que amplía las oportunidades de una reanimación exitosa una vez que llegue el personal médico capacitado.

Debido a que el 88 % de los paros cardíacos (una falla eléctrica en el corazón que provoca un latido cardíaco irregular (arritmia) e interrumpe el flujo de sangre al cerebro, los pulmones y otros órganos) ocurren en el hogar, a menudo es un amigo o familiar quien presencia cómo un hijo, cónyuge, padre o amigo sufre un paro cardíaco. Dado que la supervivencia puede depender de la rapidez con la que se inicia la RCP, se recomienda la RCP solo con compresiones o RCP solo con las manos a personas que ven a un adolescente o un adulto colapsar repentinamente en un entorno extrahospitalario, como en el hogar o en el trabajo, o en un parque.

“Al capacitar a las personas en RCP solo con las manos, las estamos preparando para que actúen si un ser querido necesita ayuda, ya que la mayoría de los paros cardíacos ocurren en el hogar”, dijo el Dr. Anezi Uzendu, MD, Cardiólogo intervencionista y voluntario de la American Heart Association.

Como parte de la iniciativa del Día Nacional de la Reanimación Cardíaca (Restart a Heart Day), la American Heart Association tiene como objetivo aumentar la conciencia sobre la importancia de la RCP por parte de testigos presenciales a través de su campaña de RCP solo con las manos, respaldada a nivel nacional por Elevance Health Foundation, y proporciona estos dos sencillos pasos:

• Llame al 911 (o envíe a alguien para que lo haga).
• Presione fuerte y rápido en el centro del pecho de la persona que sufre un paro cardíaco.

Usar el ritmo de una canción familiar que tenga de 100 a 120 pulsos por minuto, como “Stayin' Alive” de los Bee Gees, puede ayudarle a mantener el ritmo de las compresiones necesarias.

"Poder realizar RCP solo con las manos de manera eficiente en el momento puede significar la diferencia entre la vida y la muerte, y al seguir estos dos sencillos pasos podemos aumentar las posibilidades de que una persona sobreviva a un paro cardíaco", dijo Shantanu Agrawal, MD, Médico de Urgencias y Emergencias certificado por la Junta y responsable de salud de Elevance Health. "Como colaboradores de larga data de la American Heart Association, seguimos enfocados en trabajar juntos para mejorar las desigualdades en salud en nuestras comunidades al ampliar el acceso a la capacitación y aumentar la cantidad de personas que aprenden y se sienten seguras al realizar RCP solo con las manos para salvar vidas".

Para encontrar más información y recursos, visite heart.org/CPR.

Barra lateral: Seis eslabones de la cadena de supervivencia extrahospitalaria en adultos
Cuando se ejecuta correctamente, una fuerte cadena de supervivencia (o una serie de acciones) puede mejorar las posibilidades de supervivencia y recuperación de las víctimas de un paro cardíaco repentino. La RCP solo con las manos es un paso crítico en la Cadena de Supervivencia de la American Heart Association, que también incluye:

• Activación de respuesta de emergencia: reconozca los síntomas de un paro cardíaco y llame al 911.
• RCP de alta calidad: presione fuerte y rápido en el centro del pecho de la víctima hasta que llegue el personal de emergencia.
• Desfibrilación: utilice un desfibrilador externo automático (automated external defibrillator, AED) para reiniciar el corazón de la víctima y restablecerlo a un ritmo saludable.
• Reanimación avanzada: los profesionales médicos proporcionan servicios médicos adicionales que salvan vidas.
• Atención posterior al paro cardíaco: traslade a la víctima a un hospital o centro de tratamiento apropiado para optimizar la supervivencia, la función de los órganos y la recuperación neurológica.
• Recuperación: los sobrevivientes reciben tratamiento adicional, observación, rehabilitación y apoyo psicológico para ayudar en la recuperación y ayudar a prevenir paros cardíacos recurrentes.

SOURCE:
American Heart Association

Small businesses seek to avoid possible credit crunch as Federal Reserve raises rates once more

Most small businesses rely on loans to finance at least some of their operations. Westend61/Getty Images

D. Brian Blank, Mississippi State University and Brandy Hadley, Appalachian State University

Small businesses – the heartbeat of the U.S. economy – are beginning to feel the pinch of tighter credit conditions as the Federal Reserve continues to increase borrowing costs.

A flurry of headlines in recent weeks has suggested a credit crunch – meaning the availability of lending gets scarcer – is already happening.

That’s in large part brought on by the actions of the Federal Reserve, which has been raising borrowing costs for companies and consumers for over a year in an effort to tame inflation and lifted rates by another quarter point on May 3, 2023. Concerns about the availability of credit have also risen as a result of a spate of bank failures, including that of First Republic on May 1.

A decline in the availability of loans and other financing poses problems for all types of companies. But this can be particularly detrimental to small businesses, which have limited resources to sustain their growth and rely heavily on regional bank financing, currently the most stressed pocket of lending.

Small but mighty

Despite their size, small businesses – typically defined as companies with under 500 employees – are a very important part of the U.S. economy.

Almost all of them, however, employ fewer than 20. And yet collectively they account for half of all private-sector workers and 44% of private-sector output.

And virtually all for-profit companies are considered small businesses.

Small businesses don’t borrow a lot of money, with the average size of their debt just US$195,000. Altogether, though, it really adds up. At the end of 2022, small businesses owed nearly $18 trillion in debt.

About 70% of small businesses have at least some outstanding debt, which they use to help cover basic operating expenses like wages, rent and inventory, as well as to invest in new equipment and the like. After individual savings, the second-most common source of capital to start a business is loans from a bank, so the ability to access capital is crucial for businesses – a lack of financing is often cited as the primary reason for failure.

While large companies have a range of financing options at their disposal, such as raising capital by selling stock or issuing convertible bonds, small businesses generally rely on bank loans for over 90% of their financing.

Consequently, if bank lending becomes harder to come by, they may need to cut spending or seek alternative sources of more expensive capital to continue investing and expanding. This could have implications for employment and commercial real estate, leading to further slowdowns in growth.

The last time small businesses faced similar financing challenges was during the 2008 financial crisis, when 1.8 million small businesses failed.

Signs of credit tightening

Whether or not the current banking turmoil is creating a serious credit crunch for small businesses remains an open question.

The stories warning of a crunch point to a variety of statistics. For example, the money supply is shrinking at the fastest pace since 1960. Bank lending fell in March by the most since the Fed began compiling the data in 1975. And the share of U.S. banks that say they’re tightening credit standards versus loosening them is at a level that has preceded the past few recessions.

But the money supply was already very elevated, commercial bank lending has recovered somewhat since March, and this is the first time in decades that credit has tightened as a result of rate increases, which is different from other recent recessions. In those cases, credit tightening may very well have been the consequence of the downturn, as opposed to the cause.

In addition, a monthly survey on small business economic trends conducted by the National Federation of Independent Business, a lobbying group, found that overall optimism remained high in March, the latest data available.

Yet the survey did find that more business owners reported that it was harder to get a loan than in the past. Banks continue to tighten their lending standards to levels approaching those seen during the pandemic as policymakers consider stricter regulations to prevent the bank crisis from spreading.

This tightening of credit could lead to decreased capital expenditures and slower payroll growth in the future. These challenges for small businesses may ultimately end up causing the economy to decelerate further after a sluggish first quarter.

When companies have limited cash during a potential downturn, bankruptcy and company failures can occur, which is almost what happened in March, when Silicon Valley Bank was on the brink of causing many companies to lose the deposits they needed to make payroll.

Room for optimism

On the bright side, companies have been bracing for reduced access to credit since at least March 2022, when the Fed began raising rates.

What’s more, they’ve been anticipating that higher rates could drive the U.S. into recession. That means they should have had plenty of time to prepare to weather most potential storms.

In addition, strong consumer spending, overall healthy bank balance sheets, steady growth in new business creation and a regulatory response that aims to ensure credit doesn’t dry up too much could help avert a credit crisis for small businesses.

But with a fourth bank failing and lingering uncertainty as to whether the quarter-point hike on May 3 will be the Fed’s last, we believe small businesses – and the U.S. economy – aren’t out of the woods quite yet.

Still, with the number of new business applications growing, we anticipate more businesses next year than the U.S. has today, and that may be welcome news for an economy trudging through a challenging environment.

This article was updated to include details of Fed rate hike.

D. Brian Blank, Assistant Professor of Finance, Mississippi State University and Brandy Hadley, Associate Professor of Finance and the David A. Thompson Distinguished Scholar in Applied Investments, Appalachian State University

This article is republished from The Conversation under a Creative Commons license.