Culture

COLUMBIA, Mo. - In the midst of a pandemic that has claimed more than 2 million lives worldwide and disrupted nearly every facet of society since it appeared more than a year ago, understanding the factors that create and facilitate disease outbreaks is more important than ever. Now, researchers at the University of Missouri have determined that cognitive biases -- patterns of errors in thinking that affect judgments and behaviors, often unconsciously -- can help create and worsen foodborne disease outbreaks.

"Unethical behavior isn't always intentional; conflicts of interest and other unconscious motivations can lead people to behave in ways that help outbreaks emerge and spread," said Harvey James, associate director of the division of applied social sciences and a professor of agricultural and applied economics in the MU College of Agriculture, Food and Natural Resources (CAFNR). "If we can understand what motivates a store owner to re-open too early or a food producer to cut corners, then we can create better policies and regulations that nudge people in the right direction without restricting their freedoms."

James and Michelle Segovia, an assistant professor of agricultural and applied economics in CAFNR, were eager to apply the science of behavioral ethics to the field of food safety. Behavioral ethics examines why people make ethical and unethical decisions; to see how those choices might contribute to a foodborne disease outbreak, the researchers turned to the case of Jensen Farms.

In 2011, the Colorado cantaloupe producer was found to be responsible for an outbreak of Listeria at its packing plant that led to one of the worst foodborne illness outbreaks in U.S. history, resulting in 33 deaths across 28 states. The outbreak occurred despite Jensen Farms having recently audited their food safety procedures and installed new cleaning equipment.

To explain this contradiction, the researchers identified several forms of cognitive bias at work. Motivated blindness, for instance, encourages a person or company to advance their own interests without accounting for conflicts of interest. In the case of Jensen Farms, James and Segovia theorized that motivated blindness was to blame for the choice to hire a lenient auditor that deemed the company's food safety procedures "superior."

In addition, the researchers emphasized the unconscious nature of cognitive biases with an example of omission bias, in which the lack of action, rather than a specific harmful action, can create unfortunate consequences. Though Jensen Farms possessed equipment capable of cleaning cantaloupes with an antibacterial wash, the antibacterial function was not used prior to the outbreak.

"Jensen Farms believed they were making their cantaloupes safer even as they failed to take actions that could have prevented an outbreak," James said. "This is a perfect example of the fact that unethical behavior does not need to be a conscious act. There isn't always an easy 'villain,' so if laws and policies only address people who are intentionally propagating an outbreak, we are missing a big part of the picture. This study is a step toward recognizing the immense consequences of inadvertent and unintentional behavior."

While COVID-19 is not considered a foodborne illness, James believes that the lessons learned about cognitive biases from the study are relevant to the current pandemic. Motivated blindness, for example, could explain why some restaurants and other businesses have refused to abide by lockdown orders for fear of losing business. Herding behavior -- a bias that occurs when people follow the crowd even if they disagree with the crowd's behavior -- explains the surge in demand for certain essential items and subsequent nationwide shortages.

March 9, 2021 - Although the prevalence of opioid use among Black people is comparatively low, the rate of opioid deaths has increased the sharpest and fastest among that population in recent years, according to an article in the March/April issue of Harvard Review of Psychiatry. The journal is published in the Lippincott portfolio by Wolters Kluwer.

The review by Ayana Jordan, MD, PhD, of Yale University School of Medicine and colleagues stresses how important it is to develop much better evidence on how the opioid crisis has affected Black communities. "Focusing on the unique needs of Black people who use opioids is warranted to increase treatment initiation and adherence among a population less likely to engage with the traditional health care system," according to the authors.

Key themes in understanding and responding to the opioid crisis in Black communities

As the opioid epidemic has unfolded, most studies have focused on white populations, with limited inclusion of Black individuals. "Over the past decade, opioid overdose rates among Black people have been rising, resulting in an increasing need to obtain timely information," Dr. Jordan and coauthors write.

Dr. Jordan and coauthors performed a comprehensive review of the research literature to identify evidence relevant to opioid use among Black people. The researchers analyzed 42 studies providing up-to-date information on key themes, including:

Opioid use rates. National studies have reported relatively low rates of opioid use, especially prescription opoids, by Black individuals, compared to white individuals. However, those studies have often excluded or under-represented people with low incomes, those experiencing homelessness or unstable housing, and those who are incarcerated. All of these populations include disproportionately high numbers of Black people, due to the effects of structural racism.

"Thus, the prevalence of opioid use among Black people may be underestimated," Dr. Jordan and coauthors write. "It is also likely that the absence of culturally informed interview techniques could lead to underreporting of prescription opioid misuse in the Black community."

Overdose risk. Even though Black people are less likely to use opioids, those who start using are at higher risk of dying from an overdose than those from other races. Evidence also suggests that deaths due to synthetic opioids - particularly fentanyl - are rising rapidly among Black people.

Treatment for opioid use disorder. Research finds that Black people are less likely than white people to have access to opioid and other substance treatment options in their geographic communities and care networks. In one study, 15.5 percent of Black patients diagnosed with opioid use disorder (OUD) received treatment, compared to 21 percent of white patients. Evidence suggests that even after they receive care, Black patients have lower treatment completion rates, likely due to social determinants such as unemployment, access to transportation, and absence of culturally informed care.

Prescription opioid use. Black patients are less likely than their white counterparts to receive prescription opioid medication for pain. For Black patients who do receive opioids for treatment of non-cancer pain, there are persistent disparities in ongoing pain management, including lower daily doses and fewer days' supply of opioids, compared to white patients.

Social determinants of health. A handful of studies are beginning to document that social determinants of health - a wide range of conditions affecting many different behavioral or health outcomes - are the key drivers of opioid use and overdose risks among Black people. The authors note that more investigation needs to be undertaken to determine how social determinants of health, such as access to education, job training, food, transportation, and technology, can be harnessed to facilitate better access to opioid treatment for Black patients. The authors note that a better understanding of the social determinants of health affecting OUD among Black people is crucial for the development of "culturally acceptable treatment settings, where Black people are more likely to access care."

Dr. Jordan and colleagues see "great opportunity" for new research to understand and respond to the impact of the opioid crisis in Black communities. Priorities must include increased funding specifically earmarked by governmental agencies for research that addresses racial disparities in OUD. Dr. Jordan and colleagues conclude, "Building on the information presented here will promote better care of this population, with the hope of improving health outcomes."

Broad political, economic, and social factors influence disciplinary punishment. In particular, over the last half century, such considerations have shaped jurisdictions' use of the death penalty, which has declined considerably since the 1990s. A new study examined the factors associated with use of the death penalty at the county level to provide a fuller picture of what issues influence court outcomes. The study concludes that partisan politics, religious fundamentalism, and economic threat influenced local decisions about the death penalty. The study also found that the size of the African American population, which prior state-level studies have found to be associated with use of the death penalty, was not directly associated with the recent decline in the use of this punishment.

The study, by researchers at Missouri State University and American University, will appear in Criminology, a publication of the American Society of Criminology.

"It is essential to examine the local political environment and the composition of jurisdictional populations to capture the processes that influence local trial court outcomes," suggests Ethan Amidon, associate professor of criminology and criminal justice at Missouri State University, who led the study. "Although we found support for a number of perspectives that have been identified in prior state-level studies, our findings indicate that these relationships are more complex when considered at the local, decision-making level."

In the last 30 years, national reliance on the death penalty has declined across all states--from a late 20th century peak of 330 death sentences in 1994 to 32 death sentences in 2016. Most counties have also used the death penalty less.

In this study, researchers examined a variety of issues associated with the use of death sentences across three decennial periods from 1990 to 2010. They studied information from 2,572 counties or county equivalents, using information from the U.S. Census Bureau's decennial reports and its American Community Survey; they also considered information from a database that contains death sentences by county from 1991 to 2017. Prior research has studied this information primarily from a state perspective.

Among the factors examined were the percentages of people in each county who voted for the Republican presidential candidate, were religious fundamentalists (based on church membership data), were of different races and ethnicities, and were unemployed. The study measured each county's tradition of vigilantism by tallying the lynching rate in each jurisdiction.

To control for factors that could influence the use of the death penalty, the study considered several variables, including each county's number of homicides, rate of violent crime (homicides, robberies, rapes, and aggravated assaults), and rate of property crime (burglaries, larcenies, and car thefts). The study also considered total population and income inequality, as well as rates of divorce and poverty in each county.

The researchers concluded that several factors are associated with county-level reliance on the death penalty:

The degree of public support for Republican presidential candidates was directly associated with greater reliance on the death penalty over the study period. Given that the death penalty has declined over the last three decades, this means that the decrease in the use of this punishment was more gradual in jurisdictions with a growth in support for Republican presidential candidates, who tend to espouse law and order positions.

Counties with larger Protestant fundamentalist populations imposed death sentences to a greater degree, on average, than counties with smaller such populations. This contributes to a degree of persistence in the death penalty in jurisdictions where citizens remain strongly committed to fundamentalist ideologies.

The size of economically marginalized populations within counties was directly related to greater reliance on the death penalty. This relationship inverted once the size of the unemployed population reached a tipping point.

Neither the size of a county's African American and Hispanic populations nor its history of vigilantism was directly related to its jurisdictional use of the death penalty. However, the size of the African American population was associated indirectly with reliance on the death penalty in terms of its influence on jurisdictional unemployment.

The authors note their study is missing data on factors such as the percentage of religious fundamentalists and crime rate variables, and a few of the measurement procedures used by some of their sources changed across the study period, including those that provided crime data.

"Even as reliance on capital punishment has waned in the early 21st century, the nature and severity of penal punishments have continued to be shaped by the broader social, political, and economic landscapes in which they are immersed," according to John Eassey, a researcher in residence in the Justices Programs Office at American University, who coauthored the study.

In a new study in PNAS, an international team of researchers including scientists from the Max Planck Institute for Chemical Ecology has shown that Arabidopsis thaliana plants produce beta-cyclocitral when attacked by herbivores and that this volatile signal inhibits the methylerythritol 4-phosphate (MEP) pathway. The MEP pathway is instrumental in plant growth processes, such as the production of pigments for photosynthesis. In addition to down-regulating the MEP pathway, beta-cyclocitral also increases plant defenses against herbivores. Since the MEP pathway is only found in plants and microorganisms, but not animals, knowledge of a signal molecule like beta-cyclocitral opens up new possibilities for the development of herbicides or antimicrobial agents that block this pathway (Proceedings of the National Academy of Sciences of the United States of America, March 2021, doi:10.1073/pnas.2008747118).

Trade-offs between defense and growth processes in plants

Researchers have long known that plants have limited resources that they can invest in defense against enemies or in growth and reproduction, depending on their environmental conditions. Many studies have already shown that plants increase their defenses when attacked by insects producing, for example, toxins or inhibitors of digestive enzymes that harm their attackers. However, much less is known about how herbivore attack affects growth processes in the plant. "We wanted to investigate how herbivory might affect photosynthesis and the methylerythritol 4-phosphate (MEP) pathway, a pathway making metabolites for growth that is directly supplied from photosynthesis," says first author Sirsha Mitra, who had started working on this project at the Max Planck Institute and is now an assistant professor at Savitribai Phule Pune University in Pune, India.

The MEP pathway has been a research topic at the Max Planck Institute for Chemical Ecology in Jena for several years "The MEP pathway makes the building blocks for plant isoprenoids or terpenoids, a very large family of plant metabolites involved in growth, defense and signaling," says Jonathan Gershenzon, the head of the Department of Biochemistry and one of the authors.

Beta-cyclocitral activates defense and inhibits growth

The international research team, which also included partners from the Universitat Ramon Llull in Barcelona, Spain, the Technical University in Lyngby, Denmark, and the University of Toronto, Canada, demonstrated that plants of the thale cress Arabidopsis thaliana which were fed to caterpillars of the African cotton leafworm, a generalist feeder that attacks many different plant species, increased defenses while simultaneously reducing growth processes. Using a variety of techniques from molecular biology and analytical chemistry, as well as caterpillar bioassays, the scientists were able to show that a specific volatile compound, beta-cyclocitral, formed by cleavage of beta-carotene due to a reactive form of oxygen, was responsible for this shift of resources. While beta-cyclocitral acts as a chemical signal to increase defenses, it simultaneously decreases the formation of compounds in the MEP pathway by directly inhibiting the rate-controlling enzyme of this pathway. "Of particular importance to our study was the exposure of plants to isotopically labeled carbon dioxide (13CO2) instead of the dominant atmospheric carbon dioxide (12CO2). Carbon dioxide is easily introduced into the MEP pathway via photosynthesis. This allowed us to track how the metabolic flux in the MEP pathway changed when plants switched to a defensive mode after herbivore attack and beta-cyclocitral slowed down the MEP pathway," says Louwrance Wright, one of the lead authors who is now working in South Africa. Caterpillars feeding on plants treated with beta-cyclocitral exhibited decreased growth in comparison to caterpillars feeding on untreated plants. This is further evidence of the importance of this volatile signal for plant defense.

Potential benefits in agriculture and medicine

When plants are attacked, they may have to stop growth processes in order to release sufficient resources for their defense. Beta-cyclocitral signaling is a mechanism that precisely controls this shift in resources. Beta-cyclocitral, or a more stable derivative, could therefore be applied to crops to stimulate defenses during a pest outbreak. "Since the MEP pathway is found in all plants and many microorganisms, but not in animals, it is of particular interest for the development of herbicides, as well as drugs with antimicrobial activity," says Jonathan Gershenzon, explaining the potential applications of this research. Further studies in India will now investigate whether beta-cyclocitral can increase insect resistance in crops, such as tomatoes, and whether it interacts with other already known defense signals.

Brazilian researchers who study a native venomous fish have confirmed a route to drug development for the treatment of chronic inflammatory diseases such as multiple sclerosis and asthma.

The venomous toadfish Thalassophryne nattereri contains a peptide (TnP) with anti-inflammatory and anti-allergic potential. Confirmation of this potential has now come via the zebrafish Danio rerio, a popular aquarium species native to South Asia that shares 70% of its genome with humans and is widely used as a model for in vivo trials in drug development.

The researchers tested TnP in D. rerio to measure its toxicity. In a little over a year, their research showed that the peptide is safe. It did not cause cardiac dysfunction or neurological problems in the toxicity tests they performed.

The study was conducted at Butantan Institute's Special Laboratory for Applied Toxinology in São Paulo (Brazil) by researchers affiliated with the Center for Research on Toxins, Immune Response and Cell Signaling (CeTICS), one of the Research, Innovation and Dissemination Centers (RIDCs) funded by São Paulo Research Foundation - FAPESP.

In addition to proving the peptide's safety when used as an anti-inflammatory agent, the results reinforce the importance of D. rerio as an alternative animal model for drug development that saves time and money.

Preclinical trials are important to prove the efficacy (therapeutic activity) of molecules in vivo and to evaluate adverse effects and safety. In drug discovery, 98% of the compounds tested in animals are abandoned before clinical tests.

In an article published in Toxicology Reports, the researchers say peptides represent about 2% of the world drug market but even so account for a market share worth about USD 20 billion.

"The results highlight a wide therapeutic index for TnP with non-lethal and safe doses from 1?nm [nanometer] to 10?μm [micrometer], without causing neurotoxicity or cardiotoxic effect. The low frequency of abnormalities [caused] by TnP was associated with the high safety of the molecule and the developing embryo's ability to process and eliminate it. TnP crossed the blood-brain barrier without disturbing the normal architecture of forebrain, midbrain, and hindbrain [the three main developmental divisions of the brain]," the authors write.

The study resulted from the master's research of João Batista-Filho, supervised by Mônica Lopes Ferreira and Carla Lima da Silva. It used the Zebrafish Platform, launched in 2015 by CeTICS (read more at: agencia.fapesp.br/22156/).

The Zebrafish Platform is available to scientists for research, offers courses on zebrafish management and biology, and does scientific dissemination. More than 160 researchers at 100 private and public institutions currently collaborate via Zebrafish Network, also created by CeTiCS.

"Science dies out without investment and FAPESP's commitment to this platform is now bearing fruit," Ferreira told. "Cutting-edge research is being done here, alongside preclinical trials that are important both to academia and industry."

Zebrafish have been used for decades in trials held in other countries, she said, adding that Brazil is closing the gap and that the animal's rapid life cycle accelerates the research process.

The freshwater species is easy to manage, reproducing fast, developing from egg to larva in 48-72 hours, and reaching adulthood at only three months of age. Zebrafish embryos are transparent and the effect of a compound on the animal's organs can easily be observed, for example.

History

Ferreira and collaborators discovered TnP (T. nattereri peptide) in 2007. Meanwhile, Lima had standardized laboratory tests to evaluate multiple sclerosis in rodents. The two researchers decided to work together to test TnP's efficacy in treatment of the disease, concluding for its anti-inflammatory and immunomodulatory functions.

The TnP family encompasses synthetic peptides containing a sequence of 13 L-amino acids in their primary structure. Synthetic products derived from TnP have been patented in at least nine countries including the US, India and Japan, as well as the EU. In Brazil, a patent application has been filed in partnership with the pharmaceutical company Cristália.

Studies conducted by the group with mice between 2013 and 2015 had already demonstrated that TnP can treat multiple sclerosis, delaying the onset of severe symptoms and improving clinical signs of the disease.

Multiple sclerosis is a chronic autoimmune inflammatory disorder of the central nervous system, in which the immune system attacks the myelin sheath that protects nerve fibers in the brain, spinal cord and optic nerves, disrupting communication with the rest of the organism. It can cause muscle weakness, vision loss, pain, and impaired motor coordination. It affects some 2.5 million people worldwide, including about 35,000 in Brazil, according to the Brazilian Multiple Sclerosis Association (ABEM).

Safety

In the article published in Toxicology Reports, the researchers say drug-induced cardiotoxicity is the main reason for drug withdrawal from the market. "For instance, between 1994 and 2006, 45% of discontinued medications had adverse effects such as cardiac ischemia and arhythmogenesis. In this line zebrafish has emerged as a model organism for cardiovascular research, investigating gene function and modeling a variety of human disease side-effects of chemotherapeutic drugs or particularly to screen drug candidates," they note.

For Batista-Filho, the study provides more evidence for the value of the zebrafish model in preclinical research. "It doesn't substitute mice, but avoids future expense on molecules that may not be promising or prove too toxic in previous phases," he said when asked about reservations regarding the use of zebrafish in trials compared with rodents.

Advocating investment in science and research in Brazil, Batista-Filho said he was overjoyed to achieve publication of his master's dissertation in a scientific journal. "I'm delighted," he said. "Publication is a milestone for any scientist. You focus on the good that research can do, but publication is recognition for the team's hard work."

Health care systems could save lives and minimize losses by optimizing resource allocation and implementing mitigation strategies, according to two new studies. Colorado State University researchers explored how our health care systems might perform under multiple disasters and multiple waves of COVID-19, and how we can keep them functioning when we need them most.

In the first study, published in Nature Communications, Civil and Environmental Engineering Ph.D. student Emad Hassan and Associate Professor Hussam Mahmoud investigated the compound effects of pandemics and natural disasters on health care systems. They combined wildfire data with projections of the spread of COVID-19 to evaluate different strategies for managing patient demand in the event of concurrent disasters. They found that better resource allocation and mitigation strategies, such as organized evacuation, protecting shelter residents and using non-acute hospital beds, could result in fewer COVID cases and deaths.

"We showed that applying these measures can substantially reduce disease spread and improve patient outcomes," Hassan said.

A one-two punch

Wildfires occur every year in the U.S., and they increase the demands on our health care systems. Wildfire smoke victims may require some of the same resources needed by COVID patients, such as ventilators. For these reasons, Hassan and Mahmoud chose to study wildfire in conjunction with the pandemic.

To measure hospital functionality under the simultaneous burdens of pandemic and wildfire, Hassan and Mahmoud used a health care system model they developed previously and a new disease transmission model they created to predict the number of people in different stages of COVID-19. They modified a well-known disease transmission model, SEIR, to include additional stages of the disease.

SEIR stands for Susceptible, Exposed, Infectious and Recovered. The CSU researchers augmented the model to include susceptible, insusceptible, exposed, infective, quarantined, hospitalized, ICU admitted, ventilator-dependent, recovered and deceased.

Bracing for more waves

Using the two models they developed, along with publicly available data on the number and type of beds available in each hospital, Hassan and Mahmoud:

-Calculated the extent of disease transmission under various scenarios in every county in the U.S.
-Determined the risk of easing restrictions and the resulting shortage of beds by type - inpatient vs. intensive care, for example.
-Identified the counties where patient demand could exceed health care system capacity and presented mitigation strategies that could reduce the number of cases requiring medical services.

Their analysis, published in PLOS One, predicts how additional waves of COVID-19 might unfold.

The study shows that stricter COVID-19 preventive measures - including mask mandates, social distancing, and shutting down schools, workplaces and indoor activities - could reduce the number of hospitalized cases by as much as 12.8%. On the other hand, lifting restrictions could cause a spike in hospitalizations 13.7 times higher than the second wave's peak - pushing hospitals in many counties beyond their capacity.

"It really is an effective way of reflecting on additional requirements for health care systems to support additional waves," Mahmoud said.

Hassan and Mahmoud hope planners, policymakers and state officials can use their research to make decisions about additional resources and when to ease restrictions. Their disease transmission model, which predicts how many patients will be in each stage of the disease, could help hospitals allocate resources accordingly.

Odds of a double disaster trending upward
Until recently, Hassan and Mahmoud's research has focused on natural disasters and community resilience. When the World Health Organization declared a global pandemic, they shifted their focus to include pandemics, realizing the loss of life from a pandemic is far greater than the death toll from individual natural disasters.

"The reality of it is pandemics happen more often than extreme events, and the losses are obviously off the charts," Mahmoud said. "We know it will happen again in 100 years, if not less."

Hassan and Mahmoud hope their work will help improve health care management in the future, which promises more frequent and more devastating natural disasters with climate change and population growth.

"We've got to figure out how we can optimize our societies to handle all these stressors, while continuing to prosper," Mahmoud said.

DALLAS (March 9, 2021) - Better brain health and performance for humankind is one step closer to reality with the successful trial of the groundbreaking BrainHealth Project. A cross-disciplinary team with the Center for BrainHealth® at The University of Texas at Dallas unveiled an easy-to-use online platform that delivers a novel, science-backed approach to measuring, improving and tracking one's own brain fitness.

A key innovation of the Project centers on the BrainHealth Index™ (BHI), which is based on a multidimensional definition of brain health and its upward potential. The BHI is a composite derived from a series of best-in-class assessments that explore multiple aspects of an individual's cognitive capacity, as well as their sense of well-being, quality of social interactions and complexity of daily routines. The result is a personalized score that becomes an individual's baseline, and that in theory has no upper limit.

"What gets measured gets managed," said Sandra Bond Chapman, PhD, lead author and chief director of the Center for BrainHealth. "For the first time ever, the BrainHealth Index gives individuals a comprehensive snapshot of their own brain's health and performance levels, which allows them to make meaningful, measurable improvements that will translate into greater quality of life no matter their starting point."

Brain Health Accessible to All

The science establishing the brain's lifelong ability to change, strengthen and adapt has been clearly demonstrated over the past three decades. Since its inception in 1999, the Center for BrainHealth has been at the forefront exploring the brain's upward potential, both in fundamental cognitive neuroscience research and also in transforming discoveries into actionable protocols that are demonstrated to work.

The just-completed BrainHealth Project trial adapted these proven protocols into a methodology that combines live virtual coaching with personalized training through an app-like online platform. The limitless scalability of this approach means that people everywhere can have access to transformational science through The BrainHealth Project.

"The BrainHealth Project heralds the accessibility of brain health for all," said Sandra Bond Chapman, PhD, founder and chief director of the Center for BrainHealth and the study's lead author. "Anyone and everyone will now have the ability to discover the unique strengths and abilities of their own brain, and to begin learning brain-healthy habits that they can adopt for measurable, lifelong impact. This is how The BrainHealth Project can play a critical role in making brain health equitable for all."

The study, soon to be published in Frontiers in Public Health, featured a 12-week trial that included 180 healthy adults between the ages of 18 and 87. Participants began by taking a set of assessments regarding their levels of cognition, well-being, daily-life complexity and social interaction. Researchers applied a proprietary algorithm to create a composite score for each individual - their personal BrainHealth Index. Participants then had one-on-one live coaching sessions with a trained clinician to understand their BHI and to set personal goals. Over the following weeks, they engaged in self-paced online training punctuated by two additional coaching sessions to review progress and fine-tune goals. The trial culminated with a second BHI.

"Learning about my brain health and how to keep strengthening it has been an enriching and positive experience in every respect," said a 69-year-old female participant. "The strategies were more personally meaningful and applicable to my daily life than I had even imagined, and there is no doubt my brain health has improved as a result of using them throughout my day."

Promising Results

Individual participant changes in the BHI ranged from a 38% decrease to a 60% improvement. Almost 80% of participants showed positive change in their BHI, and half of the participants showed at least a 10% increase, with no difference among men and women. Furthermore, the ability to create and sustain change did not depend on age - countering a commonly held misperception that the brain loses its ability to get stronger and work better as we get older (see Figure 1).

The contribution to these gains came from all domains of brain health: cognition, well-being, interaction and daily life. Some individuals improved due to increased resilience and decreased anxiety, whereas others improved due to increased innovation and social engagement.

Further analysis led to the discovery that various elements of brain health cluster in distinct ways, cutting across the domains of brain health. The researchers identified three sets of data points that tend to correlate most closely:

Resilience - measured through a person's level of meaningful activities, happiness and social support available to them

Fortitude - emotional stability derived from a sense of being anchored to something bigger than oneself, and influenced by levels of happiness, stress and anxiety

Clarity - one's ability to see a way forward by employing logical reasoning, possibility thinking, solitude to solve problems, and an ability to synthesize information rather than getting bogged down in the details

These findings reinforce the emerging understanding of brain health as a dynamic, synergistic whole. "Being able to understand brain health through the lens of these three factors was incredibly empowering for participants," said BrainHealth clinician Stacy Vernon, MS, LPC, NCC. "It helped them identify specific areas in their lives that contributed to their ability to thrive during the worst of times and to make adjustments in real time to keep gaining momentum."

The research team was encouraged to confirm that more than 90% of participants in the trial signed up to continue with the Project over the long term. "The true power of the BrainHealth Index emerges over time, as people track and sustain change in their own performance. When they begin to see the tremendous agency they have over their own brain health - their capacity for innovation, problem solving, decision making and so much more, it is truly transformative," said Dr. Chapman.

Getting Personal

The study found that the more people engaged in training and practicing new brain-healthy habits, the more their BHI tended to improve over the three-month trial. Gains were greatest for those who completed interventional training, and they leveled off when additional content provided was purely informational (see Figure 2). Participants who completed none of the training had an average 0% improvement on the BHI; those who completed all the interventional modules (cognitive training stress) had an average 15% improvement on the BHI. Beyond those modules - informational content only - there was no additional improvement on the BHI.

Individual results were driven by each participant's unique combination of factors making up their BHI, as well as the personal goals they established during one-on-one coaching sessions. Feedback from participants further underscored how powerful personalization can be. Periodic one-on-one coaching sessions emerged as one of the most compelling aspects of the trial, setting it apart from typical "brain training" apps and online games.

There was nothing automated about this experience. The composite making up each participant's BrainHealth Index was completely unique to them, and the regular coaching sessions allowed participants to set specific goals for themselves and track their progress with support and guidance from a trained clinician.

This innovative approach also taught participants to focus on their own strengths and performance, empowering each person to continue becoming the best version of themselves - another person's score and even population "averages" are not relevant or actionable.

"Until recently, I never considered that having a brain health coach could improve mental performance just as my yoga instructor and golf coach help me improve in those areas," said a 74-year-old male participant. "I am learning that brain performance can be measured and improved. I wish I had access to many of these tools while I was still working and building my career; however, I feel like my brain health and overall well-being are moving in the right direction, and that feels good at any age."

A Silver Lining from the Pandemic

As the study was conducted during the height of COVID-19, researchers were able to investigate effects of the pandemic on participants' brain health. The vast majority of participants felt heightened stress, worry and anxiety related to their health and economic well-being, and that of their loved ones.

Gaining new insights into the brain's immense ability to adapt and innovate provided the context and practical steps many needed to overcome new challenges. One 43-year-old female participant experienced the extra isolation of moving to a new city during 2020, in addition to working in an industry severely impacted by the pandemic. Once she began to see innovative solutions to some of her most significant challenges at work, she reported her stress level decreased and her sleep improved. She reported, "I finally started to feel like myself again."

Addressing a Global Crisis

The pandemic has wreaked havoc on the health and stability of individuals and economies alike over the past year, exposing multiple crises - job loss coupled with deep and permanent shifts across all industries, high rates of depression and suicidality that show no signs of letting up, and sclerotic education systems struggling to prepare the next generation to tackle the new challenges that lie ahead.

Within these crises also lies an urgent obligation to create a new and better path for the future. People everywhere will need to draw on their resilience, fortitude and clarity to solve the unpredictable future and challenges ahead and pave new avenues to thrive.

A healthy brain, optimized to function at its best, makes every aspect of life better. Armed with a new understanding of the brain's lifelong upward potential and our ability to affect it, better brain health and performance at the population level can lead to transformational worldwide change.

The workplace presents one clear example. Organizations that invest in employees' brain health and performance as a critical, measurable asset as well as a competitive advantage will position themselves to reap the rewards of a more purpose-driven, engaged and innovative workforce. At a large scale, better brain health in the workplace can spur economic transformation.

The Center for BrainHealth is part of an international collaboration that recently developed a science-based plan for economic recovery called the Brain Capital Grand Strategy. One key will be the BrainHealth Index, which has now been tested and proven through the just-completed study and could serve as a predictor of when a community, corporation or country has the wherewithal to be resilient.

"The pandemic exposed several economic challenges including the need for many workers to reset and reskill, and the need for companies to maximize their most important asset, the brain trust of their employees," said Tom Leppert, co-leader of The BrainHealth Project. "Better brain health and brain productivity can lead to significant increases in workforce output around the world, unlocking and unleashing untapped reservoirs of economic growth potential."

Public Health - Left of Boom

The potential for improved public health is just as vast. An array of population health challenges today - chronic stress, depression, anxiety, isolation, suicidality, Alzheimer's and more - are centered on the brain. An early, proactive focus on brain health can enable people to build reserve and resilience that might mitigate or even prevent decline stemming from disease, disorder or injury.

"Most people don't even think about their brains until something happens to it - boom!" said Geoff Ling, MD, PhD, a professor and physician with Johns Hopkins and a co-leader of The BrainHealth Project. "By strengthening the brain's health and function before anything ever happens to it - getting 'left of boom' - we are giving ourselves a tremendous level of protection to mitigate, overcome or even avoid some of the tough challenges that may lie ahead."

Furthermore, the demonstrated effectiveness of the online and virtual delivery for all aspects of the Project underscores the scalable opportunity for this telehealth model.

Birth of a Movement

Having successfully tested the online delivery mechanisms for the BrainHealth Index and the self-paced training modules through this trial, The BrainHealth Project will continue to scale up exponentially over the next several years, with the potential to reach millions of people worldwide, of all ages (8-100) and circumstances.

"For millions of people, their minds are a mystery to them - like computer software without a toolbar to control how it operates. The BrainHealth Project offers that toolbar to help everyone build brain health and all its emotional, social and cognitive aspects," said Ian Robertson, PhD, co-director of the Global Brain Health Institute, professor emeritus at Trinity College-Dublin, and co-leader of The BrainHealth Project.

"There is simply nothing more important than brain performance. A brain that can think critically, function under stress, be resilient in the face of trauma - a brain that is thoughtful, creative, socially active. We all need and want that kind of brain," said Admiral William McRaven (ret.), spokesperson for The BrainHealth Project. "This is an opportunity to fundamentally change the world."

Precision Health Fueled by Big Data

As tested in this trial, The BrainHealth Project will generate unprecedented amounts of data over time related to the BrainHealth Index, training utilization, mastery of new brain-healthy habits and more. This vast, anonymized data will be shared openly with collaborating researchers to uncover new insights and pave the way for precision health on a level never before seen.

"Robust data analysis and ongoing machine learning algorithms will one day allow us to move from precision health to predictive health with individualized modeling," said Dr. Chapman. "Scaling these individualized evidence-based brain health protocols will ultimately move global public health to an entirely new level."

"A generation ago, the aerobics revolution created a new awareness of our power to make our hearts healthier through exercise, which eventually led the medical establishment to embrace proactive, preventive protocols," said Mark D'Esposito, MD, neurologist and cognitive neuroscience professor at UC Berkeley. "Today, science has brought us to the cusp of a brain health revolution, and we can now envision a time when getting a check-up from the neck up will be part of every routine physical."

A New Funding Model

A revolution of such magnitude cannot be driven by scientists alone. It takes a united effort from people with influence in every level of society. The trial received visionary support from multiple philanthropic donors: Jean Ann Brock, Jennifer and Peter Roberts, Teresa and David Disiere, Estate of Alice Janet DeSanders, Kozmetsky Family Foundation, Peggy Dear, The Baldridge Foundation, The Joshua M. and Inette S. Brown Family Foundation, Folsom Charitable Foundation, Ellen and John McStay, Marlane Miller, John R. McCune Charitable Trust, The J. Willard and Alice S. Marriott Foundation, and J. Willard Marriott, Jr. Foundation.

"There is much work still to be done, and forward-thinking individuals and organizations will be critical partners in this endeavor," added Kevin Armshaw, director of development at the Center for BrainHealth. "As we scale up this initiative, we need support to reach and engage vulnerable communities, enact brain-centric policy, and enlist the medical community as ambassadors encouraging proactive, protective and preventive action."

Dr. Chapman said, "We are moving beyond the lab to equip all people with strategies and practices to manage their own brain health and performance. The BrainHealth Project will reach everyone around the globe who wants to better their brain's health, especially communities that are too often unseen and underserved. The science is clear, the mechanism is in place, and brain health equity for all is finally an achievable goal."

If past natural disasters have taught us anything about their effects on pregnant women and developing babies, it is to pay close attention, for the added stress will surely have an impact on them. Amanda Venta, associate professor of psychology at the University of Houston, is sounding that alarm as it relates to the COVID-19 pandemic in a newly released study published in Child Psychiatry & Human Development.

"There is strong evidence to suggest that the coronavirus pandemic will affect mothers and infants through immune pathways that, in previous research, have been shown to link stress and social isolation during the pre- and post-natal periods with deficits in maternal mental health and infant well-being and development across developmental stages," reports Venta.

Research is clear about the link between the mind and body and maternal stress having toxic inflammatory effects on both mothers and infants.

"A pregnant mom's immune system translates to her baby, so when she releases inflammatory cytokines, which can be in response to stress, those get passed to the baby both before birth and through breast milk," said Venta. "When we see elevated inflammatory cytokines in babies, we know there is increased risk for later developmental problems."

One of the studies Venta used in her summary was "Project Ice Storm," which examined effects of in utero exposure to varying levels of prenatal maternal stress resulting from the 1998 Quebec ice storm, which left millions of people without electricity for up to 40 days. Follow-ups with children until the age of 19 showed significant effects on temperament, behavior, motor development, physical development, IQ, attention and language development.

And though there is no current data yet linking mothers' stress during the COVID-19 pandemic to infant outcomes, now is the time to start taking stock, according to Venta.

"We know that when moms are socially isolated it increases stress. We need to do something from a research standpoint, and we need to do things differently clinically. When moms are supported by their partner, family and friends, or even their doctor, those kinds of social relationships can reduce inflammation," said Venta, who speaks from the trenches. She is five months pregnant and her Ob/Gyn has yet to ask if she is isolated, stressed, or feels supported-- questions that are currently far outside the standard of prenatal care.

The report concludes that research on the psychological and biological cascades of stress and social isolation on mothers and infants is needed immediately and recommends specific areas for future research:

Assess infant developmental and maternal mental health outcomes during COVID-19 and in the aftermath

Examine mechanisms of resilience and risk

Pilot interventions for immediate use

"We must move quickly to understand the risk of long-term adversity for these families and, relatedly, identify protective factors that can be leveraged to mitigate the catastrophe of adverse outcomes for this birth cohort," said Venta.

Wormholes play a key role in many science fiction films - often as a shortcut between two distant points in space. In physics, however, these tunnels in spacetime have remained purely hypothetical. An international team led by Dr. Jose Luis Blázquez-Salcedo of the University of Oldenburg has now presented a new theoretical model in the science journal Physical Review Letters that makes microscopic wormholes seem less far-fetched than in previous theories.

Wormholes, like black holes, appear in the equations of Albert Einstein's general theory of relativity, published in 1916. An important postulate of Einstein's theory is that the universe has four dimensions - three spatial dimensions and time as the fourth dimension. Together they form what is known as spacetime, and spacetime can be stretched and curved by massive objects such as stars, much as a rubber sheet would be curved by a metal ball sinking into it. The curvature of spacetime determines the way objects like spaceships and planets, but also light, move within it. "In theory, spacetime could also be bent and curved without massive objects," says Blázquez-Salcedo, who has since transferred to the Complutense University of Madrid in Spain. In this scenario, a wormhole would be an extremely curved region in spacetime that resembles two interconnected funnels and connects two distant points in space, like a tunnel. "From a mathematical perspective such a shortcut would be possible, but no one has ever observed a real wormhole," the physicist explains.

Moreover, such a wormhole would be unstable. If for example a spaceship were to fly into one, it would instantly collapse into a black hole - an object in which matter disappears, never to be seen again. The connection it provided to other places in the universe would be cut off. Previous models suggest that the only way to keep the wormhole open is with an exotic form of matter that has a negative mass, or in other words weighs less than nothing, and which only exists in theory. However, Blázquez-Salcedo and his colleagues Dr. Christian Knoll from the University of Oldenburg and Eugen Radu from the Universidade de Aveiro in Portugal demonstrate in their model that wormholes could also be traversable without such matter. The researchers chose a comparatively simple "semiclassical" approach. They combined elements of relativity theory with elements of quantum theory and classic electrodynamics theory. In their model they consider certain elementary particles such as electrons and their electric charge as the matter that is to pass through the wormhole. As a mathematical description, they chose the Dirac equation, a formula that describes the probability density function of a particle according to quantum theory and relativity as a so-called Dirac field.

As the physicists report in their study, it is the inclusion of the Dirac field into their model that permits the existence of a wormhole traversable by matter, provided that the ratio between the electric charge and the mass of the wormhole exceeds a certain limit. In addition to matter, signals - for example electromagnetic waves - could also traverse the tiny tunnels in spacetime. The microscopic wormholes postulated by the team would probably not be suitable for interstellar travel. Moreover, the model would have to be further refined to find out whether such unusual structures could actually exist. "We think that wormholes can also exist in a complete model," says Blázquez-Salcedo.

Delaying second doses of COVID-19 vaccines should reduce case numbers in the near term. But the longer-term case burden and the potential for evolution of viral "escape" from immunity will depend on the robustness of immune responses generated by natural infections and one or two vaccine doses, according to a Princeton University and McGill University study published March 9 in the journal Science.

"Several countries including the United Kingdom and Canada have stated that they will delay second doses of COVID-19 vaccines in response to supply shortages, but also in an attempt to rapidly increase the number of people immunized," said lead author Chadi Saad-Roy, a Ph.D. candidate in Princeton's Lewis-Sigler Institute for Integrative Genomics.

"The original clinical trials of the vaccines, plus subsequent epidemiology, are quite optimistic regarding the efficacy of the first dose," Saad-Roy said. "However, we are still uncertain how the strength and duration of immunity from a single dose -- or the full two-dose course or natural infection, for that matter -- will persist in the longer term."

"These will all impact the dynamics of future outbreaks," said co-author Simon Levin, Princeton's James S. McDonnell Distinguished University Professor in Ecology and Evolutionary Biology and an associated faculty member in the High Meadows Environmental Institute (HMEI).

The researchers used a simple model to project forward the incidence of COVID-19 cases, as well as the degree of immunity of the population, under a range of vaccine dosing regimes and assumptions related to immune responses.

"Given the immunological and epidemiological uncertainties driving these outcomes, simple models are an essential tool to explore future possibilities," said senior author Caroline Wagner, an assistant professor of bioengineering at McGill University.

"The model, for example, allows for the assumption that immune responses after a single dose will be weaker than those following natural infection or two doses," said co-author Andrea Graham, a Princeton professor of ecology and evolutionary biology and associated faculty member in HMEI. "That appears to be consistent with early reports from countries that have rapidly deployed vaccines according to a delayed second-dose schedule."

The study found that one-dose strategies may, as expected, reduce case numbers in the short term by more rapidly immunizing a greater number of individuals. However, if immune responses after one dose are less robust, subsequent epidemic peaks may be larger.

"More optimistically, we find that as vaccine capacity increases, increasing vaccination rates or changing the dosing regime to be closer to the recommended two-dose schedule can mitigate these longer term epidemiological effects, which is important for public health planning," Wagner said.

Another important outcome associated with imperfect immune responses is the potential for viral immune escape. To start addressing this complex issue, the authors adapted an existing simple 'phylodynamic' model for viral immune escape developed by co-authors Bryan Grenfell, the Kathryn Briger and Sarah Fenton Professor of Ecology and Evolutionary Biology and Public Affairs; Oliver G. Pybus, professor of evolution and infectious disease at the University of Oxford; and Edward C. Holmes, an ARC Australian Laureate Fellow and professor at the University of Sydney; along with other colleagues not involved with the current work.

The theory of viral immune escape predicts that in individuals with partial immunity, moderate selection pressure combined with sufficient viral transmission could drive viral evolution. Here, the authors explore this possibility along with a range of other scenarios, including the more optimistic case of minimal potential for adaptation in hosts with waned immunity following one or two vaccine doses.

"At least one variant has already emerged that may be adapted for partial immune escape," Holmes said.

"Simple theory underlines that the evolution and transmission of variants by infected hosts with intermediate levels of immunity may be important," added Grenfell, who is an associated faculty member in HMEI. "Therefore, the strength and duration of immunity, and particularly the effect of these on retransmission, are key parameters to determine."

"Our results are strongly dependent on the robustness of immune responses following one and two vaccine doses, but ultimately these clinical parameters are largely unknown," explained co-author Michael Mina, an assistant professor at the Harvard School of Public Health and Harvard Medical School.

"Moving forward, it will be critical to get a better handle on these in order to make sound public policy decisions," Mina said. "We suggest that randomization of dose intervals early in vaccination campaigns and careful monitoring of viral loads and immune markers in vaccinated individuals as well as those who have had natural infections and their contacts may be important approaches for doing so."

One intuitive finding that the paper emphasizes is that very low rates of vaccine administration may be associated with larger case numbers and, possibly, more elevated potential for viral adaptation.

"This strongly underlines the importance of equitable global vaccine distribution, as immune escape in one location will rapidly spread," said C. Jessica E. Metcalf, an associate professor in ecology and evolutionary biology and public affairs at Princeton and also an associated faculty member in HMEI.

"The models are relatively simple conceptually, but they illustrate the complexities of the problem and highlight the challenges that we still face," said Michael Boots, professor of integrative biology at the UC Berkeley who was not affiliated with the study. "This important piece of work provides a framework that we can use to inform our approach going forward and moreover identifies the key knowledge gaps that we need to address."

Members of the COVID-19 Primary Care Database Consortium explain how the use of big data containing millions of primary care medical records provides an opportunity for rapid research to help inform patient care and policy decisions during the COVID-19 pandemic. Established in April 2020, the Consortium brings together experts in big data, epidemiology, intensive care, primary care and statistics, as well as journal editors, patient and public representatives, and front-line clinical staff from the universities of Oxford, Cambridge, Southampton, Bristol and Nottingham

The consensus statement that the consortium has developed and described in the article aims to facilitate transparency and rigor in methodological approaches, as well as consistency in defining and reporting cases, exposures, confounders, stratification variables and outcomes in relation to the pharmacoepidemiology (i.e. the potential influence of old and new drug therapies on outcomes) of COVID-19. This is important, the authors write, because the vast majority of drugs for common conditions such as hypertension, diabetes or heart failure are prescribed in primary care practitioners in the U.K. For example, ACE-inhibitors widely prescribed by primary care doctors may impact COVID-19 outcomes. Using big data in collaborative databases may help answer questions about the interactions between medicines and COVID-19 outcomes.

Members of the Perelman School of Medicine at the University of Pennsylvania and its health system developed and implemented a new model of collaborative care called The Penn Integrated Care (PIC) program. PIC includes a resource center to support intake, triage and referral management and collaborative care services in primary care practices. PIC was created to increase access to and engagement with mental health professionals to improve mental and physical health outcomes. Primary care physicians were able to refer patients with any mental health symptom or condition to PIC. In 12 months, 6,124 unique patients were referred from eight primary care clinics to either the PIC Resource Center or were connected with a mental health professional. Most were triaged to collaborative care or specialty health care with active referral management.

Among patients enrolled in collaborative care, the mean length of treatment was 7.2 encounters over 78 days. Remission of symptoms was achieved by almost 33 percent of patients with depression and almost 40 percent of patients with anxiety. Stakeholders viewed the program favorably. Primary care physicians perceived they were providing patients with higher quality care, and patients appreciated having someone to talk to in addition to, or instead of, receiving a medication prescription. Results provide insight into a model for launching and implementing collaborative care to meet the needs of a diverse group of patients who have a full range of mental health conditions often seen in primary care.

RIVERSIDE, Calif. -- Variants of the coronavirus are appearing in different parts of the world, many of them spreading with alarming speed. One contagious variant is the South African, or SA, variant, identified by an international team of researchers, including biomedical scientists from the University of California, Riverside.

"The new COVID-19 variants are the next new frontier," said Adam Godzik, a professor of biomedical sciences in the UC Riverside School of Medicine and a member of the research team that made the discovery. "Of these, the SA and Brazil strains are most worrying. They have mutations that make them resistant to antibodies we generate with existing vaccines. It is commonly believed we are in a tight race: Unless we vaccinate people quickly and squash the pandemic, new variants would dominate to the point that all our COVID-19 vaccines would be ineffective."

Godzik and Arghavan Alisoltani-Dehkordi, a postdoctoral researcher who joined his lab two years ago, helped characterize the new SA variant by providing its spike protein structure using computer simulations.

Study results appear today in Nature.

Alisoltani-Dehkordi, who was a postdoctoral fellow at the University of Cape Town in South Africa before she joined UCR, mentioned that research teams at the University of KwaZulu-Natal in South Africa and the University of Cape Town discovered the new lineage -- or variant -- of SARS-CoV-2, the virus that causes COVID-19, from samples collected between Oct. 15 and Nov. 25, 2020, in three South African provinces. By early November, this variant rapidly became the dominant variant in samples from two provinces.

"Each SARS-CoV-2 variant has specific mutations defining it," Alisoltani-Dehkordi said. "Professor Godzik and I used computer modeling to suggest possible structural and functional consequences of spike protein mutations in the SA lineage. Our analysis, confirmed also by several other research groups, shows that some of the mutations potentially result in a higher transmissibility of the virus and a weaker immune response."

The SA variant has been detected in at least 40 countries, including the United States.

"This variant is probably spreading in areas where it has not been sequenced and is, therefore, not identifiable," Godzik said. "In the U.S., sequencing is still a slow process. In many parts of the country, including Riverside, we have no information whatsoever about variants."

Initial research on the SA variant suggested it could be resistant to antibodies, which could reduce the efficacy of vaccines.

"That's when it received a high level of interest," Godzik said. "Subsequent research confirmed it is resistant to vaccines and is spreading. South Africa is doing a good job, however, at controlling the variant through quarantining and other measures."

All the newly emerged SARS-CoV-2 variants of concern in the United Kingdom, South Africa, Brazil, and California show common mutational signatures. But each of these variants also has a unique set of mutations. For example, the SA and Brazil variants have two unique mutations on spike proteins K417N and E484K, respectively.

"Our preliminary findings indicate that some of the spike mutations may be associated with increased transmissibility of the SA variant," Alisoltani-Dehkordi said. "The full significance of spike and other genome mutations in this new lineage, however, is yet to be determined. It needs to be stressed that we do not have enough evidence confirming the higher disease progression, severity, or mortality rate associated with the SA lineage compared to other lineages. But the high transmissibility and unusual divergence of the SA lineage and other recently emerged lineages compared to the wild type creates a high demand for the systematic surveillance of SARS-CoV-2 strains and early detection of variants before they turn into outbreaks."

Godzik explained there is no single COVID-19 virus. Instead, a population of viruses exists that constantly evolve. Variants, which also evolve, acquire mutations and could undergo viral escape at any time.

"It is hard to say there is only one SA variant," he said. "One way to understand this is to imagine that this variant is the major branch of a tree, which has many smaller branches. Some of these smaller ones may grow faster than others and assume more importance. This dynamic process is hard to predict."

Godzik predicts COVID-19 will be a constant presence in our lives, much like the flu.

"It takes six months to develop a flu vaccine," he said. "Models predict the evolution of the flu virus and vaccines are produced before the variants show up. If the predictions are good, the vaccines work. If they miss, a heavy flu season follows. This is how COVID-19 will likely behave. A lot of effort will be invested in predicting what will happen the following year, vaccines would then be updated, and people will need to get a booster shot."

New study finds the skyrocketing cost of drugs in U.S. used to treat hookworm and other soil-transmitted parasites increases patient costs, suggests decreased quality of care

A new study finds that the increasingly high prices in the United States of the drugs used to treat three soil-transmitted helminth infections--hookworm, roundworm (ascariasis), and whipworm (trichuriasis)--is not only the major driver for the increase in costs to patients with either Medicaid or private insurance, but it also may have a damaging impact on the quality-of-care patients receive as clinicians shift their prescribing patterns to more affordable yet less-effective medicines covered by insurance.

The drugs of choice recommended by the Centers for Disease Control for treating these infections--albendazole and mebendazole--have seen some of the highest price increases of drugs on the U.S. market. There are limited alternative drugs available.

The peer-reviewed study was published this week in the American Journal of Tropical Medicine and Hygiene (AJTMH) by a team of social scientists and infectious disease experts at the U.S. Centers for Disease Control (CDC), the University at Albany - SUNY, Northeastern University, HealthPartners Institute, and the University of Minnesota.

The researchers reported that "the percentages of patients prescribed the appropriate standard of care treatment with private insurance for all three infections during the study period was consistently less than 70%, and in the case of hookworm diagnosed in those with private insurance, less than 30% of patients received the standard of care prescription drug. This rate of appropriate treatment is disturbingly low. "

While these neglected parasitic worm infections are relatively uncommon across the U.S., there are pockets where the diseases are more prevalent, particularly rural areas with limited plumbing and poor sanitation. A study published in 2017 in AJTMH found that more than one in three people sampled in a poor area of Alabama tested positive for traces of hookworm, a gastrointestinal parasite though to have been eradicated from the U.S. decades ago.

A research team at Johannes Gutenberg University Mainz (JGU) in Germany has developed a completely new, environmentally-friendly electrochemical procedure for producing sulfonamides rapidly and inexpensively. Sulfonamides are used in many drugs including antibiotics and Viagra as well as in agrochemicals and dyes, which makes them an important class of molecules for the pharmaceutical and chemical industries. While to date it has been necessary to use corrosive chemicals, high temperatures, and expensive metal catalysts to produce sulfonamides, the new method requires only cheaper starting materials, electrical current, and largely safe solvents. The researchers recently reported their findings in the journal "Angewandte Chemie International Edition". "The conventional procedure requires three reaction stages, with each stage driving up manufacturing costs by a factor of two to five. With the new method, just one reaction stage is needed. That makes it readily scalable and it can thus be applied on a technical scale," said Professor Siegfried Waldvogel, head of the research team and spokesperson for JGU's cutting-edge SusInnoScience - Sustainable Chemistry as the Key to Innovation in Resource-efficient Science in the Anthropocene research initiative.

The starting materials for the new reaction are molecules in the substance classes amines and aromatics as well as the pollutant sulfur dioxide, which is a waste product of many industrial processes. In effect, the new method makes it possible to convert this unwanted material into valuable products: The amines react with the sulfur dioxide in solution, producing amidosulfinate as an intermediate product. This makes oxygen and sulfur available to react with the aromatic molecules that have already been oxidized using an electrical current. However, it is necessary to prevent the bond formation of the oxygen during this process. "We do this by using a suitable solvent - and that is the really clever bit," Waldvogel pointed out. The solvent forms strong hydrogen bonds with the oxygen atoms, thereby rendering them inactive - and clearing the way for the formation of the desired sulfur-carbon bonds. After the reaction, the solvent can be redistilled and used again. "Our technique of electrochemical production of sulfonamides represents a completely new approach in chemistry that can now be applied to a number of other reactions. In a sense, we opened a door and found a variety of new possibilities," concluded Waldvogel, who is one of the world's leading scientists working in the field of electrosynthesis.