Glenview, Illinois – Published monthly, the journal CHEST® features peer-reviewed, cutting-edge original research in chest medicine: Pulmonary, critical…
Glenview, Illinois – Published monthly, the journal CHEST® features peer-reviewed, cutting-edge original research in chest medicine: Pulmonary, critical care and sleep medicine and related disciplines. Journal topics include asthma, chest infections, COPD, critical care, diffuse lung disease, education and clinical practice, pulmonary vascular disease, sleep, thoracic oncology and the humanities.
Credit: Alexiane M. Blanc, MD, et al. CHEST August 2022
Glenview, Illinois – Published monthly, the journal CHEST® features peer-reviewed, cutting-edge original research in chest medicine: Pulmonary, critical care and sleep medicine and related disciplines. Journal topics include asthma, chest infections, COPD, critical care, diffuse lung disease, education and clinical practice, pulmonary vascular disease, sleep, thoracic oncology and the humanities.
The August issue of CHEST journal contains 47 articles, including clinically relevant research, reviews, case series, commentary and more. Each month, the journal also offers complementary web and multimedia activities, including visual abstracts, to expand the reach of its most interesting, timely and relevant research.
“This month’s issue has many great articles warranting a callout. One I would like to personally highlight is, ‘Provider Perspectives on and Access to Palliative Care for Patients With Interstitial Lung Disease,’ that looks at barriers to palliative care (PC) in interstitial lung disease (ILD),” says Editor in Chief of the journal CHEST, Peter Mazzone, MD, MPH, FCCP. “Despite the documented benefits of palliative care in ILD, this research shows availability of PC services is often fragmented and varies depending on caregiver practice and geographic location. For more articles focusing on equity within medicine, the journal CHEST has a dedicated topic collection that can be found here.”
Also included in the current issue of the journal CHEST:
COPD
Original research, “ Optimizing COPD Acute Care Patient Outcomes Using a Standardized Transition Bundle and Care Coordinator,” finds that the transition bundle reduced 7- and 30-day hospital readmissions but increased length of stay and emergency department revisits. A visual abstract for this research can be viewed here, and an animation of the research can be viewed here.
Critical Care
“ Targeted Temperature Management After In-Hospital Cardiac Arrest: An Ancillary Analysis of Targeted Temperature Management for CardiacArrest With Nonshockable Rhythm Trial Data” signaled that more patients had good neurological outcomes when managed with targeted temperature management (33 °C) versus targeted normothermia (37 °C). A visual abstract for the research can be viewed here, and a podcast of experts discussing the research can be found here.
Humanities
Exhalations article, “The Vexing Voyage of Vasopressin: The Consequences of Granting Market Exclusivity to Unapproved Drugs,” looks at the use of vasopressin during the COVID-19 pandemic to call attention to the perils of granting market exclusivity as a regulatory incentive.
Pulmonary Vascular
Looking at the “obesity paradox” in pulmonary arterial hypertension, “BMI and Treatment Response in Patients With Pulmonary Arterial Hypertension” found that higher BMI did not modify the treatment response for change in 6-minute walk distance but did attenuate the treatment response for functional class defined by the World Health Organization.
To view the entire August issue of the CHEST journal, visit journal.chestnet.org, and follow @journal_CHEST on Twitter for the latest journal news.
About the American College of Chest Physicians
The American College of Chest Physicians® (CHEST) is the global leader in the prevention, diagnosis and treatment of chest diseases. Its mission is to champion advanced clinical practice, education, communication and research in chest medicine. It serves as an essential connection to clinical knowledge and resources for its 19,000+ members from around the world who provide patient care in pulmonary, critical care and sleep medicine. For information about the American College of Chest Physicians, and its flagship journal CHEST®, visit chestnet.org.
SpaceX, led by Elon Musk, is unquestionably the industry leader, currently operating the largest fleet of satellites in orbit—about 50% of the global total.
The company has already completed 62 missions this year, surpassing any other company or nation, and operates thousands of internet-beaming Starlink spacecraft that provide global internet connectivity.
Starlink customers receive a small satellite dish that self-orients itself to align with Starlink’s low-Earth-orbit satellites.
Percentages may not add to 100 due to rounding.
In second place is a lesser-known company, British OneWeb Satellites. The company, headquartered in London, counts the UK government among its investors and provides high-speed internet services to governments, businesses, and communities.
Like many other satellite operators, OneWeb relies on SpaceX to launch its satellites.
Despite Starlink’s dominance in the industry, the company is set to face intense competition in the coming years. Amazon’s Project Kuiper plans to deploy 3,236 satellites by 2029 to compete with SpaceX’s network. The first of the fleet could launch as early as 2024.
The Rise of China’s Space Program
After the top private companies, governments also own a significant portion of satellites orbiting the Earth. The U.S. remains the leader in total satellites, when adding those owned by both companies and government agencies together.
American expenditures on space programs reached $62 billion in 2022, five times more than the second one, China.
China, however, has sped up its space program over the last 20 years and currently has the highest number of satellites in orbit belonging directly to government agencies. Most of these are used for Earth observation, communications, defense, and technology development.
Satellite Demand to Rise Over the Decade
Despite the internet being taken for granted in major metropolitan areas and developed countries, one out of every three people worldwide has never used the web.
Furthermore, the increasing demand for data and the emergence of new, more cost-effective satellite technologies are expected to present significant opportunities for private space companies.
In this context, satellite demand is projected to quadruple over the next decade.
A doctor working for the U.S. government in 2017 visited the China-based virus research facility that may have leaked the pathogen that causes COVID-19, and sounded the alarm on safety issues at the lab earlier than previously reported, according to documents obtained by The Epoch Times.
Dr. Ping Chen, who worked for the National Institute of Allergy and Infectious Diseases (NIAID), visited the Wuhan Institute of Virology (WIV) in October 2017 and prepared a report for her superiors after her visit.
While a version of her report obtained by a Freedom of Information Act (FOIA) request was fully redacted, Sen. Ron Johnson (R-Wis.) and his team were granted an opportunity to carry out an in-camera review of the report that had some of the redactions removed.
“It is clear to me by talking to the technician that certainly there is a need for training support” at the Wuhan lab, Dr. Chen wrote in the report, parts of which were attached to a letter sent by Mr. Johnson to Department of Health and Human Services (HHS) Secretary Xavier Becerra on Sept. 21.
The letter, which was obtained by The Epoch Times, includes fragments of Dr. Chen's report and suggests that HHS and the U.S. National Institutes of Health (NIH) were aware of safety issues at the Wuhan facility as early as October 2017.
The P4 laboratory on the campus of the Wuhan Institute of Virology in Wuhan, Hubei Province, China, on May 13, 2020. (Hector Retamal/AFP via Getty Images)
Earlier reporting based on two State Department cables and correspondence records obtained by Judicial Watch indicate that NIH was made aware of safety problems at the Wuhan lab in 2018, the year after Dr. Chen's report.
“I think the institute would welcome any help and technical support by NIAID,” Dr. Chen wrote in her 2017 report.
Mr. Johnson wrote in his letter to Mr. Becerra that Dr. Chen's 2017 report partially served as the basis for a Jan. 19, 2018, State Department cable that raised safety concerns about the Wuhan virus lab.
Evidence suggests that SARS-CoV-2, the virus that causes COVID-19, leaked from the Wuhan facility before spreading across the world. According to the so-called lab leak theory, the deadly pathogen that caused the pandemic escaped the Chinese facility, which was conducting risky gain-of-function research on bat coronaviruses that was partially funded by U.S. taxpayer dollars.
Demands
Mr. Johnson demanded that HHS provide a version of Dr. Chen's 2017 report that contains fewer redactions in order to scrutinize its contents more closely and determine how closely it aligned with the cable.
“In the public FOIA document, HHS redacted Dr. Chen’s entire report claiming that it contains privacy and deliberative information,” Mr. Johnson wrote.
“It seems apparent that the only reason that HHS redacted this information was to hide the report’s contents from the American people. Perhaps HHS did not want the public to fully understand the fact that NIH and NIAID officials were aware of safety concerns at the WIV dating as far back as 2017,” he added.
Mr. Johnson also accused NIH and HHS of obstructing his probe.
"HHS and NIH continue to obstruct my oversight efforts," he wrote. "It is unacceptable that HHS and NIH had Dr. Chen's report in its possession and only provided a slightly less redacted version for my staff to review in camera."
He demanded that HHS provide unredacted copies of Dr. Chen's report and all documents and communications relating to the report and to the Wuhan lab.
Mr. Johnson also asked for Dr. Chen to sit before a congressional panel and testify.
He set an Oct. 5 deadline for HHS to comply with his request.
HHS officials didn't immediately respond to a request by The Epoch Times for comment.
Chinese virologist Shi Zhengli is seen inside the P4 laboratory in Wuhan, China, on Feb. 23, 2017. (Johannes Eisele/AFP via Getty Images)
'Preponderance of Evidence' for Lab Leak
In August 2021, a report by Republican lawmakers noted a "preponderance of evidence" that the virus that caused the COVID-19 pandemic leaked from the Wuhan lab.
Chinese officials have denied the lab leak claim, insisting that the virus made a natural jump from animals to humans.
Rep. Michael McCaul (R-Texas) said in testimony before the Coronavirus Select Subcommittee Republicans that evidence points to a lab leak as the likely origin of the virus, saying that "it's time to completely dismiss the wet market as the source of the outbreak" and "the preponderance of the evidence that it came from the lab is very convincing."
U.S. intelligence agencies later said in a report that a natural origin and a lab leak are both plausible hypotheses but that a lack of evidence makes a definitive conclusion either way impossible.
It's a sentiment echoed by Mr. McCaul in his testimony.
"Unfortunately, we may never know for certain because the Chinese Communist Party went to great lengths to cover up this outbreak," he said. "They detained the doctors in order to silence them. They disappeared journalists. They destroyed lab samples. They hid the fact there was clear evidence of human-to-human transmission. And they have refused to allow a real investigation into the origins."
Wuhan Lab Funding Controversy
The U.S. Agency for International Development awarded a total of $1.1 million to the WIV between October 2009 and May 2019, the agency wrote in a May 2021 letter (pdf) to Rep. Guy Reschenthaler (R-Pa.).
Mr. Reschenthaler alleged that the funding was used for a study that used gain-of-function research to create "a hybrid, man-made virus by inserting a spiked protein from a wild coronavirus into a mouse-adapted SARS-CoV backbone, which could infect human airways."
The agency said the funds were channeled through EcoHealth Alliance and were meant for the purpose of advancing research on critical viruses that could pose a threat to humans. It also denied claims that the money was used for gain-of-function research, which seeks to boost viral lethality for the purpose of studying it.
In June 2022, the House Appropriations Committee approved a ban on sending any further funding to the Wuhan Institute of Virology.
More recently, the NIH quietly removed the WIV from a list of foreign facilities that are eligible to receive U.S. taxpayer funds to conduct animal experiments.
I’ve been primarily an experimental chemist – the kind of person who goes into the laboratory and mixes and stirs chemicals – since the beginning of my career in 1965. Today, and for the past 15 years, I’m a full-time historian of chemistry.
Every October, when the announcements are made of that year’s Nobel laureates, I examine the results as a chemist. And all too often, I share the same response as many of my fellow chemists: “Who are they? And what did they do?”
One reason for that bewilderment – and disappointment – is that in many recent years, none of my “favorites” or those of my fellow chemists will travel to Stockholm. I am not suggesting that these Nobel laureates are undeserving – quite the opposite. Rather, I am questioning whether some of these awards belong within the discipline of chemistry.
All of them received Nobel Prizes in chemistry – not the Nobel Prize in physiology or medicine, even though these achievements seem very clearly situated within the disciplines of medicine and the life sciences. There are many other similar examples.
These recent mismatches are even clearer when you look further back in time. Consider the 1962 Nobel Prize awarded to Francis Crick, James Watson and Maurice Wilkins “for their discoveries concerning the molecular structure of nucleic acids and its significance for information transfer in living material.” DNA, of course, is the most famous nucleic acid, and these three scientists were honored for deciphering how its atoms are bonded together and arranged in their three-dimensional double-helix shape.
While the “structure of DNA” most certainly is an achievement in chemistry, the Nobel Assembly at the Karolinska Institute in Stockholm awarded the Nobel Prize in physiology or medicine to Watson, Crick and Wilkins. Clearly, their Nobel achievements have had great consequences in the life sciences, genetics and medicine. Thus awarding them the Nobel Prize for physiology or medicine is quite appropriate.
But note the disconnect. The Nobel Prizes in chemistry in 2020, 2018 and 2015 are more life-science- and medicine-oriented than Watson, Crick and Wilkins’ for the structure of DNA. Yet the former were awarded in chemistry, while the latter was in physiology and medicine.
What is going on? What does this trend reveal about the Nobel Foundation and its award strategies in response to the growth of science?
A gradual evolution in the Nobel Prizes
Several years ago, chemist-historian-applied mathematician Guillermo Restrepo and I collaborated to study the relationship of scientific discipline to the Nobel Prize.
Each year, the Nobel Committee for chemistry studies the nominationsand proposes the recipients of the Nobel Prize in chemistry to its parent organization, the Royal Swedish Academy of Sciences, which ultimately selects the Nobel laureates in chemistry (and physics).
We found a strong correlation between the disciplines of the members of the committee and the disciplines of the awardees themselves. Over the lifetime of the Nobel Prizes, there has been a continuous increase – from about 10% in the 1910s to 50% into the 2000s – in the percentage of committee members whose research is best identified within the life sciences.
Restrepo and I concluded: As go the expertise, interests and the disciplines of the committee members, so go the disciplines honored by the Nobel Prizes in chemistry. We also concluded that the academy has intentionally included more and more life scientists on their selection committee for chemistry.
Now some perceptive readers might ask, “Is not the discipline of biochemistry just a subdiscipline of chemistry?” The underlying question is, “How does one define the disciplines in science?”
Restrepo and I reasoned that what we term “intellectual territory” defines the boundaries of a discipline. Intellectual territory can be assessed by bibliographic analysis of the scientific literature. We examined the references, often called citations, that are found in scientific publications. These references are where authors of journal articles cite the related research that’s previously been published – often the research they have relied and built on. We chose to study two journals: a chemistry journal named Angewandte Chemie and a life science journal named, rather aptly, Biochemistry.
We found that the articles in Angewandte Chemie mostly cite articles published in other chemistry journals, and the articles in Biochemistry mostly cite articles in biochemistry and life sciences journals. We also found that the reverse is true: Scientific publications that cite Angewandte Chemie articles are mostly in chemistry journals, and publications that cite Biochemistry articles are mostly in biochemistry and life science journals. In other words, chemistry and the life sciences/biochemistry reside in vastly different intellectual territories that don’t tend to overlap much.
Not letting labels be limiting
But now, perhaps a shocker. Many scientists don’t really care how they are classified by others. Scientists care about science.
As I’ve heard Dudley Herschbach, recipient of the 1986 Nobel Prize in chemistry, respond to the oft-asked question of whether he’s an experimental chemist or a theoretical chemist: “The molecules don’t know, nor do they care, do they?”
But scientists, like all human beings, do care about recognition and awards. And so, chemists do mind that the Nobel Prize in chemistry has morphed into the Nobel Prize in chemistry and the life sciences.
Since the Nobel Prizes were first awarded in 1901, the community of scientists and the number of scientific disciplines have grown tremendously. Even today, new disciplines are being created. New journals are appearing. Science is becoming more multidisciplinary and interdisciplinary. Even chemistry as a discipline has grown dramatically, pushing outward its own scholarly boundaries, and chemistry’s achievements continue to be astounding.
I can imagine an additional Nobel Prize for the life sciences. The number of awardees could expand from the current three-per-prize maximum to whatever fits the accomplishment. Nobel Prizes could be awarded posthumously to make up for past serious omissions, an option that was used by the Nobel Foundation for several years and then discontinued.
In truth, the Nobel Foundation has evolved the prizes, but very deliberately and without the major transformations that I think will certainly be required in the future. It will, I believe, eventually break free, figuratively and literally, from the mire of Alfred Nobel’s will and more than a century of distinguished tradition.
When Nobel designed the prizes named after him in the late 1800s and early 1900s, he couldn’t have known that his gift would become a perpetual endowment and have such lasting – indeed, even increasing – significance. Nobel also could not have anticipated the growth of science, nor the fact that over time, some disciplines would fade in importance and new disciplines would evolve.
So far, the extremely competent and highly dedicated scholars at the Nobel Foundation and their partner organizations – and I acknowledge with real appreciation their selfless devotion to the cause – haven’t responded adequately to the growth of the sciences or to the inequities and even incompleteness of past award years. But I have confidence: In time, they will do so.
Jeffrey I. Seeman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
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