Damian Sendler Women of childbearing age are more likely to have diabetes mellitus than men, yet many of them go untreated or undiagnosed1. Diabetes during pregnancy can have a long-term impact on the health and well-being of the child2,3. There has been a lack of research into the link between gestational diabetes and adult disease risk in the next generation. Here, we demonstrate that pre-pregnancy hyperglycemia increases the risk of glucose intolerance in the offspring. Hyperglycemia (HG) in mice and diabetes (DM) in humans both cause lower levels of TET3 dioxygenase (the enzyme that oxidizes 5-methoxycytosine and demethylates DNA) to be expressed in oocytes. Hypermethylation of several insulin secretion genes, including the glucokinase gene (Gck), which persists from zygote to adult, is caused by insufficient demethylation by oocyte TET3 and promotes impaired glucose homeostasis largely as a result of the defect in glucose-stimulated insulin secretion. Maternal heterozygous and homozygous Tet3 deletion-derived mouse progeny both exhibit glucose intolerance and epigenetic abnormalities that are consistent with the findings of the HG mice’s oocytes, supporting these findings. Additional research shows that exogenous Tet3 mRNA expression improves the offspring’s maternal effect. Rather than a direct change in the oocyte epigenome, our findings point to an environment-sensitive window in oocyte development that confers a predisposition to glucose intolerance in subsequent generations through TET3 insufficiency. According to this study, pre-conception interventions in pregnant women may help protect their children’s health.

Treating chronic plaque psoriasis with systemic medications

Damian Jacob Sendler For those who don’t know: Psoriasis is a chronic immune-mediated disease that can manifest as itchy skin or painful joints. Despite the lack of a cure for psoriasis, a variety of treatment options allow for long-term management of the disease’s symptoms. Because there aren’t enough studies comparing these treatments side by side, it’s difficult to determine how effective each one is. For this reason, we decided to conduct a network meta-analysis.

Methods: To compare the efficacy and safety of systemic agents, small molecules, and biologics for people with moderate to severe psoriasis, and provide a ranking of these treatments based on their efficacy and safety using a network meta-analysis.

Cochrane Central Register of Controlled Trials (CENTRAL), Medline, and Embase were searched monthly through October 2021 for the living systematic review’s search methods.

Dr. Sendler RCTs of systemic treatments in adults over the age of 18 with moderate to severe plaque psoriasis, at any treatment stage, compared to placebo or another active agent are eligible for inclusion in this study. The primary outcomes were the percentage of participants who achieved clear or nearly clear skin (PASI 90) and the percentage of participants who experienced serious adverse events (SAEs) during the induction phase of therapy (8 to 24 weeks after randomisation).

We conducted data extraction, risk of bias assessment, and analysis of data from multiple studies. Pairwise and network meta-analysis (NMA) methods were used to compare treatments and rank them based on their effectiveness and acceptability (PASI 90 score) (inverse of SAEs). For the two primary outcomes and all comparisons using CINeMA, we rated the degree of certainty in the NMA evidence as “very low,” “low,” “moderate,” or “high.” When data was unclear or missing, we contacted the study authors. A treatment hierarchy of 0 percent (least effective or safest) to 100 percent was inferred using the surface under the cumulative ranking curve (SUCRA) (best for effectiveness or safety).

A total of 167 studies are now incorporated into this update, which results in 58,912 randomly assigned participants, with 67.2% of those being men and the vast majority having been recruited from hospitals. The average person was 44.5 years old, with a PASI score of 20.4 as a starting point (range: 9.5 to 39). Controlled trials were used in most cases (57 percent ). Twenty treatments were evaluated by us. There were an estimated 140 multicentric trials (two to 231 centres). One-third of the studies (57/167) had a high risk of bias; 23 had an unclear risk; and 87 had a low risk. A pharmaceutical company provided funding for the majority of studies (127 out of 167); 24 studies did not disclose their funding source. Non-biological systemic agents, small molecules, and biological treatments all showed a higher proportion of patients reaching PASI 90 than placebo in network meta-analysis at the class level. Only anti-IL23 treatment showed a lower percentage of patients reaching PASI 90 than anti-IL17. Anti-IL17, anti-IL12/23, anti-IL23, and anti-TNF alpha biologic treatments increased the proportion of patients who reached PASI 90 compared to non-biological systemic agents. PASI 90 was achieved with the following medications: infliximab RR 50.19 (95 percent CI 20.92 to 120.45), bimekizumab RR 30.27 (95 percent CI 25.45 – 36.01), ixekizumab RR 30-19 (95 percent CI 25.38 – 35.93), and risankizumab RR 30.19 (all high-certainty evidence) (RR 28.75, 95 percent CI 24.03 to 34.39). When compared to each other, the clinical efficacy of these drugs was comparable. Other anti-IL17 drugs (secukinumab and brodalumab) as well as guselkumab showed a lower proportion of patients reaching PASI 90 than bimekizumab, ixekizumab, and risankizumab. Infliximab, anti-IL17 drugs (bimekizumab, ixekizumab, secukinumab, and brodalumab) and anti-IL23 drugs (risankizumab and guselkumab) except tildrakizumab, showed a higher proportion of patients reaching PASI 90 than ustekinumab and three anti-TNF alpha agents (adalimumab, certolizumab and etanercept). We found ustekinumab was superior to certolizumab, and etanercept was superior to adalimumob and ustekinumab. Cyclosporin and methotrexate were found to be indistinguishable from apremilast. When it came to the risk of SAEs, there was no discernible difference between any of the treatments and the placebo. Methotrexate was found to have a lower risk of serious adverse events (SAEs) than most other treatments. A very small number of events with low to moderate certainty underlay the SAE analyses, however (except methotrexate versus placebo, which was high-certainty). As a result, the findings should be treated with skepticism. Other efficacy outcomes (PASI 75 and Physician Global Assessment (PGA) 0/1) showed similar outcomes to those of PASI 90. Many of the interventions did not provide information on the quality of life of their patients.

Patients with depression treated with antidepressants have improved HRQoL.

Damian Jacob Markiewicz Sendler The efficacy of antidepressant medications for the treatment of depression disorder has been supported by empirical evidence, but the medication’s effect on patients’ overall well-being and health-related quality of life (HRQoL) remains unclear. For patients with depression, this study examines the impact of antidepressant medication use on patient-reported HRQoL.

Using data from the United States’ Medical Expenditures Panel Survey for patients with depression, a comparative cohort, secondary database analysis was performed. The SF-12 was used to measure HRQoL, and the results were reported as summaries of the physical and mental components (PCS and MCS). Patients who took antidepressants were compared to patients who didn’t take them. To determine the significance of the PCS and MCS mean change from baseline to follow-up, D-I-D analyses were used in both univariate and multivariate fashions.

A total of 17.5 million adults were given a depression disorder diagnosis each year between 2005 and 2016. Antidepressant medications were prescribed to a higher percentage of females (67.9%). (60.5 percent vs. 51.5 percent of males). D-I-D univariate analysis found no significant difference between the two groups in PCS (-0.35 vs. -0.34, p = 0.9595) or MCS (1.28 vs. 1.13, p = 0.6405), despite antidepressant use being associated with some improvement on the MCS. These findings were bolstered by the use of multivariate D-I-D analyses.

Antidepressant medication does not have a long-term positive effect on HRQoL in the real world. Long-term effects of pharmacological and nonpharmacological interventions on HRQoL in these patients should be investigated in future studies, rather than just looking at the short-term effects of pharmacotherapy.

Incidence of Death from Resistance Training

All-cause, cardiovascular, and cancer mortality were examined in this study, which aimed to conduct a systematic review and meta-analyze the relationship between resistance training and mortality.

Damien Sendler Using PRISMA guidelines, a systematic review and meta-analysis was performed (International Prospective Register of Systematic Reviews CRD42019136654). Embase, Emcare, SPORTDiscus and The Cochrane Library were searched from inception to June 6, 2021, using MEDLINE (OVID). All-cause mortality, cardiovascular disease-specific mortality, and cancer-specific mortality were all reported as outcomes in the included studies. We only included research done on non-clinical adult populations (those over the age of 18) and that was written in English.

The meta-analyses drew on a total of ten different studies. Resistance training reduced the risk of all-cause mortality by 15 percent, cardiovascular disease mortality by 19 percent, and cancer mortality by 14 percent when compared to no resistance training (RR of 6 studies=0.85; 95% CI=0.77, 0.93). A dose-response meta-analysis of four studies found a nonlinear relationship between resistance training and mortality risk. Around 60 minutes of resistance training per week resulted in a 27% reduction in risk (RR=0.74; 95% CI=0.64, 0.86). There was a decrease in mortality risk reductions at higher volumes.

Damian Jacob Sendler

Resistant training is associated with a reduced risk of all-cause, cardiovascular, and cancer-specific death, according to the strongest evidence to date. Research is needed to determine if the benefits of resistance training diminish at higher volumes.

Following hypomethylating therapy, oncogene demethylation and upregulation were observed.

It is unknown whether hypomethylating agents can also reactivate and up-regulate oncogenes in cancer patients, even though they are currently used in cancer treatment.

A well-known oncogene involved in myelodysplastic syndrome and other cancers, SALL4, was tested for its effect on hypomethylating agents. When comparing pre- and post-treatment bone marrow samples from two groups of patients with myelodysplastic syndrome, researchers found a strong correlation between changes in SALL4 expression and treatment response, as well as clinical outcomes. Low or undetectable expression of SALL4 was used to study the relationship between SALL4 methylation and expression. CRISPR-DNMT1-interacting RNA (CRISPR-DiR), a locus-specific demethylation technology, was used to identify the CpG island critical for SALL4 expression.

In cohort 1, SALL4 up-regulation was found in 10% of patients (40%) and in 30% of patients (13%) after hypomethylating agent treatment, and it was linked to a worse outcome. The demethylation of a CpG island in the 5′ untranslated region of SALL4 was discovered using CRISPR-DiR. Treatment with a hypomethylating agent led to the demethylation of the same CpG region and an increase in SALL4 expression in cell lines and patients.

We found that demethylation and up-regulation of an oncogene after treatment with a hypomethylating agent can indeed occur and should be further studied, using CRISPR-DiR technology. This research was supported by a grant from the Italian Association for Cancer Research and others.

CD8+ T cell quiescence is maintained by the CD8-PILR interaction.

However, the underlying molecular mechanisms for maintaining a wide repertoire of antigens against a wide range of microbes and tumors remain largely unknown. We demonstrate here that CD8 is necessary for the maintenance of CD8+ T cells in peripheral lymphoid organs in a physiologically quiescent state. No specific antigens were required for the CD8+ T cells to acquire activation phenotypes and then die after the CD8 gene was inducibly deleted. Both in mice and in humans, PILR was found to be a ligand for CD8, and disrupting this interaction was able to break the quiescence of CD8+ T cells. In the absence of antigen exposure, the CD8-PILR interaction actively maintains the size of the peripheral T cell pool.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: Reopening large venues for sports and music events when Covid-19 infection rates and hospitalizations start to decline carries behavioral risks and mitigation options. Using four sources, we describe the variables that we believe will influence public behavior in relation to the spread of the virus. Research from non-pandemic conditions; research on behavior during an outbreak; relevant theory; and evidence and recommendations from the Scientific Pandemic Influenza Group on Behaviours for the Scientific Advisory Group for Emergencies (SAGE). To begin, we’ll go over some of the most common dangers and frameworks for analyzing crowd behavior at live events. There are several trends in UK public behavior that may interact with live event and venue openings over the next few years. Covid-19 has been linked to a range of non-pharmaceutical (i.e. behavioral) interventions, and we present a range of mitigation strategies.

Damian Jacob Sendler: Whether it’s economic, social or psychological, the live events industry has a significant impact on the world around us. Annually, the industry generates several billions of pounds in revenue for the British economy. There are an estimated 570,000 full-time equivalent jobs in the event industry as a whole, with annual spending on sporting events totaling around £2.3 billion, festivals totaling £1.1 billion, and other music events totaling £1.3 billion (Eventbright, 2016). To add to the positive effects of mass gatherings, attending such events has been linked to positive feelings (Novelli et al., 2013) and mental health and well-being (Drury, 2020, Hopkins and Reicher, 2016b).

Dr. Sendler: As a precautionary measure following the outbreak of the Covid-19 pandemic, live events around the world were closed. Government agencies, licensing authorities, and event and venue managers will think about reopening in a safe manner as infection rates and hospitalizations decline. To do this, they must first identify potential areas of risk and then devise strategies for reducing it. The purpose of this paper is to provide a behavioural science perspective on the current state of affairs in the United Kingdom (though the evidence and principles also apply to many other countries). 1 Concerts and sporting events are the main attractions at this venue. In addition to stadiums, other indoor and outdoor performance spaces, such as theaters, can benefit from some of our findings and recommendations.

SARS-CoV-2, the virus that causes Covid-19, spreads via close contact, droplets and aerosols, both in the air (especially in poorly ventilated areas) and contaminated surfaces, to other people (WHO, 2020a). By increasing the number of people who come into contact with each other, the Covid-19 pandemic is likely to be amplified (WHO, 2020b).

However, it is critical to recognize that the risk of infection spreading is not limited to the event itself. It’s not uncommon for people who are interested in attending an event to do so as part of a larger group that includes things like getting together in advance at a pub, going to the venue together for the event, and returning to the pub afterward (SPI-M-O, 2020b). It’s important to look at how people get to and from live events, as well as how they behave at all of these sites (which are generally less monitored than at venues). To deal with this, thoughtful consideration, coordination, and resourcing are required. This might entail staggered arrival and departure times, or simply providing more transportation in the days leading up to and following the event. Consider how the London Olympics coordinated the movement of hundreds of thousands of people through congested public transportation systems, and learn from the lessons learned there (IOC, 2013).

Consider both the risks of an event taking place and the risks of an event not taking place, as well. All live events were canceled in the UK and other countries at the start of the pandemic. Eventually, sporting events could be held without the presence of spectators in the stadium, but indoor music concerts were prohibited until at least the middle of 2020. However, if crowds are barred from attending football games (which take place in outdoor stadiums), they may instead gather in bars and private homes to watch the games (which, being indoors, create a greater risk of transmission). Although there are good epidemiological reasons for banning certain genres of music events, such as pop concerts, if the demographics of those affected are important (age and social class), then even if there are good epidemiological reasons for the decision (singing, dancing, and touching are more likely at pop concerts which increases the risk of transmission), it may still be seen as illegitimate, and so undercut (Reicher and Stott, 2020, SPI-B, 2020, SPI-B., 2020c).

People who attend these types of gatherings (e.g., sports and music arena events, as well as many theater, public performances) tend to have a different psychological experience than those who attend other common types of gathering such as shopping malls and transportation hubs. For the most part, people who attend the kinds of gatherings described here do so in order to socialize with others, especially those whom they perceive to share their goals – that is, to share their enjoyment of the event with others, and thus contribute to the ‘atmosphere’ (Bennett, 2015, Neville and Reicher, 2011, Templeton et al., 2020, Uhrich and Benkenstein, 2010). It is common for crowds at these events to be composed of a number of different psychological crowds (Neville and Reicher, 2011), each of which has its own level of shared social identity and the tendency to refer to itself as “we” or “us” (Drury et al., 2015, Novelli et al., 2013, Templeton et al., 2020). Two or more such psychological crowds (e.g., representing fans of each team and the police may be seen as a third group) are common at sporting events (Stott et al., 2007, Stott et al., 2001). Instead of showing up all by themselves, most people come in pairs or groups to these types of gatherings (Aveni, 1977, Neville and Reicher, 2011). They interact with strangers differently (in both quality and quantity) because they see the rest of the crowd at the event as “us,” rather than as mere physical crowds where there is no sense of shared identity or psychological unity (such as those at a shopping center or transportation hubs), despite this (Drury et al., 2015, Hopkins et al., 2019, Neville and Reicher, 2011, Novelli et al., 2013). Aside from the fact that many attendees have a digital network outside of the event itself, there will be a number of people they already know in attendance at these events (Billings et al. 2017; Lacasa and colleagues, 2016). As a result, a wide range of individuals from various social media platforms can engage in meaningful conversation (e.g., geographically, occupationally).

When compared to being in a physical crowd (e.g., a shopping mall crowd), people in a psychological crowd exhibit more of the following behaviors: proximity seeking (Neville et al., 2020b, Novelli et al., 2010, Novelli et al., 2013); interaction/talking (Dury et al., 2015); intimacy/touching (Hopkins et al., 2019, Neville and Reicher, 2011); mirroring of actions and (Hopkins and Reicher, 2017). Importantly, this applies to both total strangers and passing acquaintances in the crowd, as well as to friends and family members gathered together for a celebration.

Additionally, the physical environment of the venue, such as the flow and density of people, will influence how people behave in a crowd psychologically (Templeton et al., 2018). People may have to shout and stand closer to each other in order to communicate at loud music concerts (Graham, Wells, and West, 1997), and alcohol consumption can lead to increased risk-taking (Graham, Wells, and West, 1997), all of which increase the risk (Memish et al., 2019). In the following section, we discuss the importance of the physical environment in a COVID-19-mitigated event’s health outcomes.

When it comes to these types of gatherings, general or societal norms like politeness conventions shape behavior. However, group norms specific to a particular culture or genre moderate the crowd’s characteristic behaviors. Queues outside music venues, for example, are social systems with a set of rules (e.g., no pushing in), but some artists’ fans may have a set of additional rules for the queue (Helweg-Larsen and LoMonaco, 2008). If you’ve never been to a rock concert, for example, you might be surprised to learn that moshing (intense physical contact) (Spencer, 2014) is governed by a set of informal rules that limit the ‘violence’ to the area directly in front of the stage (Tsitsos, 1999).

All high-risk behaviors at large gatherings (singing, chanting, and dancing, drinking alcohol, and sharing food) have one thing in common: they tend to be normative to the group (Hopkins and Reicher, 2020, Stott et al., 2001, Stott et al., 2007). This could imply a number of things. To begin with, it means that the group expects and values them (Pearson, 2012). Second, it means that others join in when others begin (Mann et al., 2013). When people are more emotionally invested, their behavior will continue to be in line with these norms, but in a more extreme manner (rather than abandoning the norms) (Spears, 2021).

If you’re trying to stop these behaviors by coercively “policing” them out, it can lead to conflict and a loss of trust in the authorities (Reicher and Stott, 2020). In the case of preventing football fans from jumping up and down and cheering when a goal is scored, it is unlikely that simply prohibiting these behaviors and punishing those who violate the prohibition will be seen as legitimate (Reicher and Stott, 2020). Even attempts to prohibit the consumption of alcoholic beverages during football games, such as tailgating, can have the unintended consequence of raising the risks associated with other activities (Pearson and Sale, 2011).

Instead of chanting, shouting and hugging when a goal is scored, crowd members can work together to develop less risky expressions of these norms (Hopkins and Reicher, 2020). After that, we’ll talk about this.

To better understand how the pandemic affected crowd behavior at live events, it is important to look at broader trends in public beliefs and behaviors before and during the epidemic. Since physical distancing has been a key mechanism for preventing transmission and may be difficult to maintain at live events, proximity behaviors are particularly important. At present, there are four phases of the pandemic in the UK: (1) normal times, (2) the peak of “lockdown” (summer 2020), (3) when “lockdown” eases (spring/summer 2020), and (4) when an additional “wave” of transmission occurs (fall/winter 2020). (from September 2020). Afterwards, we examine how these trends may interact with live-event behavioral policies.

People’s desire to keep their distance from each other when they sit, stand, or move together varies depending on whether they are in a physical or psychological crowd (Neville and Reicher, 2011). Behavioural differences can be explained by varying levels of identity. When one’s personal identity is at stake (such as in crowded shopping malls or transportation hubs), people tend to keep their distance from random passersby (Novelli et al., 2010). Strangers are more likely to feel comfortable in close proximity at sporting events, festivals, music events, and some religious gatherings, where the proximity of others is not perceived as an invasion of personal space but rather as a shared’social identity space’ that is tolerable and even positive (Novelli et al., 2010, Novelli et al., 2013). People can also feel more secure in such close proximity during these kinds of events (Alnabulsi and Drury, 2014).

Damian Jacob Markiewicz Sendler: At an average of 135.1 cm, social interaction occurs between strangers in a formal setting and 91.7 cm between friends, according to research from 42 countries (Sorokowska et al., 2017). Smaller distances are more comfortable in psychological crowds than in physical ones. The most densely populated areas of a concert hall, for example, are often referred to as “the atmosphere” by some (Novelli et al., 2013). In front of the stage at these kinds of events, there is often a huge crowd (up to 9 people per square metre). Similar densities can be found in the bar area as well (although not as deep). In addition, restrooms are places where crowds congregate during intermissions in performances or games, resulting in an increase in population density. People will tolerate, enjoy, and even seek proximity in these areas around the venue and engage in forms of intimacy typical of psychological crowds (such as touching, coming close to others to speak into their ear, sharing drinks, and greeting others with handshakes, kisses, and hugs) in these places (Neville and Reicher, 2011).

This general tendency toward closer proximity and greater intimacy in psychological crowds can be overridden in certain circumstances by specific social norms, and this must be remembered. Even in large gatherings, such as religious festivals, some people show their intimacy with others by not interacting with them and allowing others to devote themselves to spiritual pursuits (Reicher et al., 2020). ‘Normative override’ may be useful in developing mitigations against proximity at live events, as we explain below (Drury et al., 2020).

A decrease in the percentages of people saying they adhered to all behavioral regulations, including physical distancing, was first noted in the UCL weekly survey on May 20 (Fancourt et al., 2020b), but the ONS survey on May 29 continued to show high observance of physical distancing (ONS, 2020b). After much media hoopla (including the use of terms like “freedom pass” and “end of lockdown”) and public debate, the Department of Homeland Security decided to relax some of the “lockdown” restrictions on July 4th. There were only about half of respondents who consistently maintained physical distancing in mid-July from the ONS (2020c) and the UCL survey (Fancourt et al., 2020c). There are a number of factors that could play a role in these trends (Drury et al., 2021): the decline in trust in the government, the decline in the sense of national unity, and the decline in the perception of risk (Duffy and Allington, 2020). (ONS, 2020b). Adherence and distancing remained high throughout the summer and early autumn, with little evidence of public ‘fatigue’ (Michie et al., 2020)

This spike in Covid-19 cases in the United Kingdom occurred from September 2020 to mid-November (Independent SAGE, 2020). By October, public stress levels had reportedly risen, indicating that people were becoming more aware of the danger (Fancourt et al., 2020d). As the number of cases and deaths continued to rise, a second UK-wide “lockdown” was put in place. Even though compliance with behavioral measures like distancing rose slightly in the summer months, it was still lower than in the spring lockdown (Fancourt et al., 2020e).

Live events may be affected by changes in general adherence. There are other developments (such as reopening of public schools and universities) that may also signal that the virus has receded and that precautionary measures (such as physical distance) are no longer necessary. (SPI-M-O 2020a; SPI-M-O 2020b; SPI-M-O 2020c). Not just at live events, but more broadly, this could lead to a rise in risky behavior, at a time when seasonality and the restart of school may significantly increase infection rates.

There are also reasons to believe that the impact of current social trends on proximity behaviors at large venues and live events could be moderated by (1) other behavioral trends and (2) interventions.

Damien Sendler: Some required behaviors, such as distancing, have seen a decrease in adherence, while others, such as closeness, have seen an increase. In July 2020, a survey of 2,237 UK residents found a significant rise in the use of face masks, from 19% in April to 70% in July (Allington et al., 2020). Face masks are widely believed to help reduce the spread of coronavirus (81% of people believe this), and in England, face masks will be required to be worn on public transportation and in retail establishments beginning on June 15, 2020 and July 24, 2020, respectively. ‘Covid-secure’ behaviors appear to be gaining traction, with 88% of respondents reporting that they wash their hands more frequently (Allington et al., 2020). Self-report may overstate the extent of these behaviors, and they are lower in some segments of the community more likely to attend live events (such as younger adults; Fancourt et al., 2020d), but as protective health behaviors become more widely accepted and normalized, it will be easier to implement them in public settings.

Damian Sendler

It may be easier to support and encourage protective health behaviors like mask wearing, physical distancing, and increased hand hygiene in venues where live events are held. As a result, it’s possible that they’ll help normalize and spread these behaviors. As a result of the shared identities and commitments to future events and the economic survival of the host (e.g. local football clubs, music venues), these events also represent opportunities to promote or reinforcing already normalized protective health behaviors, such as mask wearing, physical distance, and increased hand hygiene.

Other pandemic examples have shown that public perception that government decisions were incorrect (and required backtracking) has serious consequences for the public’s trust in government and thus their compliance with government advice (Fancourt et al., 2020f, Wright et al., 2020). Sporting authorities were widely criticized for holding large-scale events in March, when infection rates were on the rise (e.g., Wood and Carroll, 2020). If the reopening of events is linked to an increase in the number of cases, this will have a negative impact on public confidence in the pandemic’s management. However, evidence from autumn 2020 shows that the public supports tighter restrictions (YouGov, 2020), equity and therefore the legitimacy of some restrictions have become a concern for the government (Swift, 2020). If some live events are halted while others are not, the imposition of new restrictions could lead to discontent and even conflict (Reicher and Stott, 2020).

There are many factors to consider, including the local context and the prevalence of infection, when deciding whether or not to reopen. Health and Safety inspectors must also develop, validate, and monitor a comprehensive Covid safety plan. We’ve outlined a few specific ways to reduce the risk.

A month in advance, in keeping with the communication/co-production strategy outlined above, it may be beneficial to create a series of communications for attendees of the events/venues. Training courses can also be designed and run with and for staff responsible for public safety and public-facing roles at the event. A review of counter-terror training courses with industry stakeholders operating in crowded places in the UK identified the need for the inclusion of evidence-based design and evaluation to increase the likelihood of organisational learning (Aplin and Rogers, 2019). (Aplin and Rogers, 2019).

Since face coverings cannot completely prevent transmission (especially if they are not very well fitted), it will be necessary to establish with participants new norms for avoiding activities like cheering, chanting, dancing, or jumping, as described above – including alternatives to these activities.

Despite our best efforts, we could not come to a consensus on whether or not alcohol should be banned, so we urge further investigation. Alcohol has long been associated with the loss of self-control and inhibition that can accompany binge drinking (Graham et al., 1997), and there is new evidence to suggest that people who frequent bars and pubs are becoming less concerned with adhering to physical distance rules as their consumption increases (Fitzgerald et al., 2021). Evidence from football suggests that a more nuanced approach to controlling the availability of alcohol should be taken into consideration (Pearson, 2012, Pearson and Sale, 2011). Providing easy access to booze can be useful. Football stadiums may see an increase in early and staggered attendance if alcohol is served in the seated areas, reducing the strain on transportation and entry points, as well as concourses and areas near the restrooms. Their levels of drinking can be monitored as well as their behaviour, and they would not congregate as much as they would otherwise do in pubs prior to the event. As with pubs, any transgressions can lead to ejections, showing strong norm enforcement on the part of the stadium authorities. Fans may gather in pubs ahead of time, stay as long as they can to “load up” on beers before entering stadiums where a ban on alcohol could lead to traffic congestion at stadium entrance points and bathrooms (because they need to access them to urinate having drunk heavily before entry). In addition, they may be more difficult to control because they will be intoxicated when they arrive, and there will be no opportunity to use a graduated and differentiated approach to behavior management. An approach which enables alcohol to be served in the stadium in the way outlined (Pearson and Sale, 2011) could be combined with a communication strategy that discourages fans from ‘loading’ on alcohol before the game.

Damian Jacob Sendler

We could create a set of communications with and for the audience that cover these various points and that they would need to see and agree upon before attending the event. People might have to fill out a form before purchasing tickets online, for example, to accomplish this.

It’s critical to think about sanctions or incentives to encourage adherence to COVID-mitigated guidelines in addition to communication. There are two ways to go about this, just like when it comes to curbing violent or racist behavior in sports. However, this can also be applied at the organizational level. As a result, in football stadiums, those who break rules can be identified and sanctioned, such as being barred from the stadium. While sanctions can be imposed at the individual level, they can also be applied collectively. The club as a whole could be punished, including fines, fans barred from the ground, docking of points or even (as has been discussed in Scotland when players violated guidelines) stopping the sport altogether if there is a significant level of violation of the rules. Any sanctions must be used carefully and consistently, accompanied by strong messaging (using the principles of co-production and using ingroup voices as advocated above), in order to maintain their legitimacy. Individuals can be prevented from acting irresponsibly by creating strong collective pressures through the proper application of these tools.

Live event industry closure has already had a significant impact on society, and it is expected to have even more in the future. More than half a million jobs in the event industry are at risk, according to figures from the Event Industry Board published in December 2020. If live events are not resumed, three quarters of companies are expected to fold before February 2021. (Stainton, 2020). Such damage to the sector’s culture and psychology is likely to have a significant impact. For instance, the resurgence of illegal raves and unlicensed block parties was seen in 2020 after the closure of licensed events over the summer (SPI-B, 2020c). The risks of reopening live events and large venues must be understood and minimized. The field of behavioral science is well-suited to offering suggestions and assistance in this regard.

The types of live events covered in this article are mainly those where the attraction is to meet other like-minded individuals. For the most part, large social networks that aren’t normally in close proximity to one another are most at risk of virus spread in settings where there is a high degree of shared identity and, as a result, trust and intimacy. Risks associated with contact and proximity can be found at events that allow people to freely stand or move and where there is noise, music, or alcohol.

In addition, the degree to which people interact with each other during an event varies. People may not be able to freely stand while watching a sporting event in a stadium, but they can do so when getting refreshments. You can’t just apply a universal solution because it won’t work for every situation.

There are a number of methods available for reducing these dangers. There are several things that can help, such as redesigning and reorganizing the environment to allow for adequate ventilation, reducing the number of people in a space, requiring the use of face-coverings, providing refreshments in the seats, and setting up multiple hand-sanitizing stations.

Like other intimacy-related behaviors, the tendency of people in psychological crowds to move closer to each other can be influenced by specific group norms. For reshaping collective practices in a way that is less risky, an understanding of crowd psychology and, more specifically, the specific social identities of specific crowds is a powerful tool. It’s critical, however, that this is done with members of the group, led by members of the group, and communicated via members of the group.

Consider the fact that most venues have sophisticated surveillance and communication systems in place that can be particularly beneficial in terms of developing new methods of improving adherence. On the contrary, travel, gathering (e.g., in a pub) before and after the event pose the greatest challenges. This is why a holistic approach to risk assessment and plans for reopening live events must be taken in order to ensure their safety.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: Commercial gambling has been severely impacted in many jurisdictions around the world as a result of the lockdown response to the COVID-19 pandemic. Survey data and findings related to gambling and gambling disorder will be described in this review.

Damian Jacob Sendler: Cross-sectional assessments (n = 11, 65 percent) and longitudinal assessments (n = 6, 35 percent) comprised the majority of publications that met the inclusion criteria. In light of the closure of land-based casinos, all studies found a decrease in gambling frequency and expenditure. In both the general population and the gambling population, the percentage of people who increased their overall gambling or their online gambling was estimated to be variable. During the lockdown, increased problem gambling severity, younger age groups, and males were the most consistent correlates of increased gambling.

Dr. Sendler: There is evidence to suggest that the COVID-19 pandemic’s impact on gambling and problematic gambling may be both positive and negative, depending on the individuals affected. Both the reduction in overall gambling, as well as the increase in some vulnerable groups, need to be assessed in follow-up studies. People with gambling addictions should be considered a vulnerable group in the short-term.

COVID-19 has had a significant impact on commercial gambling around the world as a result of the global response. During the first phase ‘lockdown’ in March and April 2020, many land-based gambling venues, including casinos, bingo halls, horseracing tracks, bars and clubs with electronic gambling machines (EGMs), lottery retailers, betting shops, and poker rooms, were forced to close. During the second wave of restrictions, some venues have closed while others have reopened partially or completely. As with the pandemic itself, the future availability of gambling is unknowable and unsure. These effects’ impact on individuals is examined in this paper, which summarizes the available evidence.

The availability of land-based gambling decreased at the same time that online gambling sites were operating. It was reported in the media that the pandemic served to promote this increasingly popular gambling format, and that the business had prospered. Most online gambling sites include a wide range of gambling options such as lottery ticket sales and casino table games such as roulette, blackjack and craps, as well as slot machines, online poker and sports wagering options. All other types of gambling, except sports betting, have been available from both legally regulated and unregulated site operators, despite the decline or cessation of professional sports around the world. As a precaution against the worst effects of a pandemic, some countries have restricted advertising [7] and imposed a daily betting cap [8].

People who engage in recreational gambling risk harming themselves and their families, as well as their communities [9–10]. It’s a behavior that has the potential to become addictive and, in some cases, lead to a gambling disorder (GD). In GD, people continue to gamble despite negative consequences, give more importance to gambling than other life interests, and have less control over their involvement in gambling. [11] EGMs and certain casino table games are considered particularly problematic for people with GD, who tend to gamble more frequently on all forms of gambling [12].

Because of the lack of restrictions on how and when it can be accessed, its solitary nature, and the wide range of gambling options, online gambling is seen as a particularly problematic gambling format. Online gamblers are more likely to suffer from GD than those who only gamble in land-based casinos [13,14]. However, it’s not clear which factor causes the other. Online gambling may have a link to GD because it gives those with GD more and more flexible options for accessing gambling than does traditional gambling. As a result, many online gamblers are also regulars at brick-and-mortar casinos. As a result of the pandemic lockdown of land-based gambling venues, one significant concern has been raised that individuals will begin to engage in online gambling for the first time, and this involvement will increase their vulnerability to negative consequences and GD. Another concern is that people who already gamble online will become more engaged, which could lead to an increase in their risk of developing a problem with gambling.

People’s desire to gamble may be affected by the pandemic’s social and financial effects, as well as the availability of gambling. The pandemic’s stress and social isolation can lead to gambling as an emotional escape, a well-known and frequently occurring motivation for gambling that is linked to GD [12]. People in recovery from GD may also be more likely to relapse because of these effects [17,18]. Gambling can be a way for people to deal with the financial stress of job insecurity and unemployment [19]. People who engage in gambling-like behavior, such as speculative stock trading, have been identified. Reports indicate that new investors used stock trading as a distraction during the lockdown and that major trading platforms added millions of new accounts in the first four months of this year [20,21]..

The closure of land-based gambling establishments may also have a positive impact on people with GD. People may be motivated to cut back or stop gambling if gambling is less readily available to them [22]. Canadian gambling helpline calls decreased after the closure of the casinos [23], indicating that fewer people were having acute gambling-related issues.

Because of the ongoing nature of the pandemic, any immediate effects on gambling and GD are likely to diminish or vanish altogether as the disease progresses and is finally eradicated. In addition to qualitative and mixed methods research designs, cross-sectional and longitudinal surveys are essential for monitoring the effects [15]. Individual gambling and GD are the focus of this review, which identifies and describes survey data and findings to date. For example, we looked for peer-reviewed journal articles, conference proceedings, and unpublished manuscripts.

Damian Jacob Markiewicz Sendler: All 17 studies found a decrease in gambling frequency and spending, which is not surprising given the closure of land-based gambling establishments. Participants in two studies were asked to explain why they had cut back on their gambling. Participants in a New Zealand study were given a list of reasons by the Health Promotion Agency. The most common reason people reduced their online gambling was to save money (50 percent), followed by not wanting to gamble in front of their family (15 percent), believing they were gambling excessively (13 percent), and having someone suggest they reduce their online gambling (11 percent ) [39]. There was an online weighted panel in Great Britain that used open-ended questions and then presented a checklist to assess the reasons for gambling less In the open-ended questions, the most common responses were: not watching live sports (22%), shopping less generally (13%), occasionally playing the lottery (9%), lack of interest (8%), and having less money (8 percent ). Most frequently mentioned in the list were no desire to gamble (30%), occasional gambling (28%) and only betting on sports events that are cancelled (28%).

There was a wide range in the percentage of participants in both the general population and the population that gambles who reported an increase in overall gambling. Given the study methodology, these estimates are not likely to be accurate. Studies 29 and 30 used convenience samples, which were drawn from social media and previous research participants, respectively. Unweighted online panels were used in the other two estimates [33,39]. It’s impossible to accurately estimate prevalence using either of these designs.

Studies on online gambling have increased significantly over the past few years. YouGov weighted panel in Great Britain [31] provided the lowest estimate, which showed an increase of online gambling from 1.5% in October 2019 to 2.3% in May 2020. In contrast, the two highest estimates, 31% 37 and 26% 24, were based on online surveys of past year gamblers. There was an estimated increase in online gambling between 11% and 20% without taking into account the most extreme or most conservative estimates.

During the pandemic, a subset of people saw an increase in their gambling, which was examined in numerous studies. There were four studies that found an association between an increase in problem gambling severity index score and an increase in gambling [31–35,41]. Increased gambling was found to be associated with moderate risk, but not with problem gambling, according to a single study [30]. Five studies [24,26,28,35,39] found that younger age was a significant correlation, one of which also found that older age was a correlation [26]. Three studies [26,31,35] found an increased risk in men, while another [29] found an increased risk in women. Increased gambling was also made possible by more people working full-time [28,29] and earning more money [41]. Addiction to alcohol (33), marijuana (37) and cocaine (29) were all found to be significant in a single sample. Finally, nonsmokers [29] and New Zealanders who identify as Maori [39] were both more likely to report an increase in their gambling habits.

Damian Sendler

There were two studies that looked at how people viewed the reasons or motivations for their increased gambling. Among the reasons given for gambling by the Health Promotion Agency in New Zealand were boredom (34 percent), financial pressure (28 percent), the need for relaxation (25 percent), online social occasions (16 percent), and stress (13 percent) (15 percent ). A YouGov survey conducted in the United Kingdom found that 12 percent of respondents cited boredom as their top concern, followed by making money (55 percent ). Boredom (52 percent) and the chance to win money (40 percent) were the most frequently cited reasons for completing a checklist (48 percent ).

Damien Sendler: The Ontario survey, on the other hand, looked at the reasons why people gamble online [37,38]. (versus change in gambling). Gambling to recoup lost money and to earn money were both linked to job losses and other negative financial consequences as a result of the COVID-19. Gambling was linked to reduced work hours because of its calming effect on people who were anxious or depressed. The severity of problem gambling was also higher in those who said the pandemic influenced their decision to gamble online in this study [37].

Three studies [26,29,40] reported a follow-up assessment following a lockdown. Lockdown-increased gamblers in Great Britain were assessed in early August during a “relaxation of lockdown restrictions” period and found that 48 percent of those gamblers had maintained or increased their activity. Ethnicity, lower education, non-student status, and smoking were all associated with this. One study in November of Australia’s post-lockdown gambling market discovered an increase in activity compared to lockdown levels for the majority of gambling types, with some returning to 2019 levels [26] Similar to the findings from the Great Britain study, these risk factors included being an ethnic minority, smoking, and having a lower level of education. A post-lockdown re-evaluation in June 2020 in New Zealand found that the reduction in gambling compared to pre-pandemic levels was maintained, and that the percentage of people worried about their gambling fell from 17 percent to 11 percent during the lockdown [26].

COVID-19’s effect on gambling has been studied by a large number of independent researchers, but the quality of these studies varies greatly. In spite of the wide range of differences, there are some consistent patterns across jurisdictions. In the first place, the expected decrease in gambling frequency and expenditure occurred during the lockdown when land-based opportunities were reduced. Due to lack of accessibility, financial constraints, and a lack of interest among the general public, some have suggested that participation should be curtailed. People’s histories of gambling involvement are likely to be revealed in post-pandemic follow-up studies.

Damian Jacob Sendler

People who started or increased their online gambling involvement were also found to have increased their gambling involvement. Despite the fact that the results of various studies differ, there is some agreement on the existence of certain vulnerabilities. Higher levels of problem gambling were a consistent predictor of an increase in gambling. Additionally, younger age groups, males, and those with mental health issues have been found to be linked to gambling addictions. In addition, boredom and financial constraints were frequently cited as sources of inspiration. These indicators can be used to create a detailed picture of those who are most in need of health education, prevention, and treatment. Ethnicity, lower educational status, nonstudent status, and smoking have been identified as possible predictors of those who continue to gamble after a lockdown. It’s unclear if this rise will persist after the pandemic stress has subsided.

For the most part, researchers used cross-sectional studies that drew on reports of people’s gambling habits before the pandemic. After the pandemic is over, researchers can use the data collected from these surveys to make comparisons about the post-pandemic situation and its implications. Even before the onset of COVID-19, at least four longitudinal studies have gathered data on gambling. However, with the exception of Leonard and his colleagues, it is not clear if any further follow-ups are in the works. Auer et al.[25], who focused on online sports bettors, reported behavioral data from an online operator in their investigation A self-report survey is used in the other three longitudinal studies [26,31,36]. The best methodology [42] was used in all cases to collect data on gambling participation separately for each type of gambling activity. Researchers in the United Kingdom, such as YouGov, and in Australia, such as Biddle et al. (the Life in Australia panel), drew on long-standing general population panels to look at a variety of variables, including gambling. Due to the fact that participants can opt in or out of a survey that is specifically targeting gambling, these studies provide the most accurate estimates of prevalence. An existing Canadian online panel of people who were regular gamblers when recruited in 2018 was used in the Leonard and colleagues study [36]. Allows for the identification of differences in characteristics and trajectories among gamblers of various levels of involvement.

Despite the fact that the results of these studies were generally consistent, it is always beneficial to gather additional data to confirm and contextualize findings. In the YouGov panel study, for example, a small subset of individuals was interviewed in detail as part of the qualitative component. The pandemic effect in Sweden was assessed using industry sales data rather than individual gambling reports in one study that was excluded from this review. The study also found a 13% drop in overall gambling, with an increase in online casino gambling, but not in online gambling as a whole, according to the findings. Because of the difficulty in distinguishing between short-term effects of the pandemic and longer-term trends like the general decline in gambling participation seen in many developed gambling markets [45], this triangulation is critical. Post-pandemic gambling may be affected by the lingering effects of the pandemic or by preexisting trends.

Some people may see a decrease in current or future gambling problems as a result of taking COVID-19, but for others, it may lead to an increase in current or future problematic gambling. There are no clear long-term consequences of either the reduction in overall gambling or the increase in some vulnerable groups. Land-based gambling was unavailable in all jurisdictions at the time of the surveys reviewed in this paper. There will be more variation in the gambling landscape in terms of restrictions (land-based casino openings, online betting caps) which will complicate examination of overall trends during any follow-up studies. Individuals with gambling and other comorbidities need to be identified as a vulnerable group in the short term.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: Among our society’s most pressing public health issues is Alzheimer’s disease and associated dementias (ADRD). Adverse drug reactions (ADRD) are a major problem in low-income countries around the world [1]. As treatment options for ADRD are limited, the best course of action is prevention [1]. In order to meet this challenge, new intervention targets are urgently required. Purpose in life is an underappreciated but intriguing target for intervention.. Study findings suggest that a sense of purpose may be a powerful protective factor for healthy cognitive aging [2] and protects against ADRD risk factors that can be modified [3]. (e.g., physical inactivity, problems sleeping, elevated body weight [3]). Developing a stronger sense of purpose in life may have long-term benefits, such as reducing the risk of developing dementia.

Damian Jacob Sendler: It’s possible for a person to have a strong sense of purpose while also having a strong sense of triviality, and vice versa [4]. For example, two people may engage in the same behavior, but only one of them considers it to be meaningful. It’s possible to measure a person’s sense of purpose, despite the fact that it’s subjective. Having a sense of purpose can lead to feelings of motivation, drive, and direction in one’s life [4]. In terms of health outcomes, people who have a greater sense of purpose live longer and are less likely to develop diseases. An active life is linked to better cognitive health, according to recent research.

Dr. Sendler: The concept of a meaningful life encompasses a wide range of sub-concepts, including purpose, and it is important to remember this. Although there is a theoretical difference between meaning in life and purpose in life, the cognitive correlates are similar [6]. Purpose in life and healthy cognitive aging are our primary goals. If you are looking for a sense of purpose in your life, you may want to look for a sense of meaning in your life.

To better understand how a sense of purpose in life is linked to various aspects of dementia, including behavioral and clinical risk factors in adulthood before dementia, markers of cognitive health prior to dementia, markers of cognition during the transition to dementia, and better outcomes after diagnosis.

Older adults with a greater sense of purpose in life tend to perform better on tasks measuring episodic memory and verbal fluency before they become impaired [6]. To put it another way, they are able to remember more words (episodic memory) and quickly list examples of a category (e.g., animals; verbal fluency). Key indicators of cognitive health are the ability to remember and organize information, which is critical in older adults’ ability to maintain their independence. Additionally, how people perceive their cognition is a significant predictor of cognitive decline. Individuals may notice a decline in their cognitive abilities before deficits on standard cognitive tests are detected. Individuals with a higher sense of purpose, like those with a lower one, perceive their memory function to be better than those with a lower one, and these perceptions persist over time [7]. When combined with a slow walking speed, poor memory takes on a greater significance. A person is more likely to develop incident dementia if they have both motoric cognitive risk syndrome (MCR) and normal cognitive decline (NCD). Again, purpose serves as a powerful protective factor: People with a greater sense of purpose are less likely to develop MCR over the course of a decade [8].

To conclude, it’s no surprise that those who have more purpose in life are less likely to suffer from Alzheimer’s disease [9] and dementia [10] as they age. Indeed, a recent meta-analysis of six prospective studies found that even after accounting for sociodemographic, clinical, and behavioral risk factors, a greater sense of purpose is consistently associated with lower risk of developing dementia [10]. Anyone, even those with the lowest risk profiles, can develop ADRD at some point in their lives. It’s important to remember that having a goal in mind even after impairment has set in is associated with better outcomes. One of the most challenging aspects of caring for someone with dementia is dealing with the behavioral and psychological symptoms (BPSD) (e.g., uncontrolled temper, confusion). A knowledgeable proxy reports that people in their final year of life who self-reported having a greater sense of purpose before the onset of cognitive impairment have fewer BPSD [11]. People with dementia who report feeling a sense of meaning in their lives are more dedicated to achieving their goals, which in turn increases their feelings of momentary meaning [12].

Damian Jacob Markiewicz Sendler: Cognitive outcomes may be influenced by greater engagement, which is at the heart of a sense of purpose. Through better clinical and behavioral profiles, better cognitive outcomes can often be achieved (e.g., fewer chronic diseases, greater physical activity). While clinical and behavioral factors are linked to such profiles, they only account for a small portion of the relationship between dementia risk and these factors [9, 10]. People who are actively involved in their daily lives have higher levels of emotional resilience, persistence, attention, effort, and social integration [4], all of which may help protect their brains from damage. To maintain cognitive function in older adulthood, these different forms of engagement may help build both the brain reserve (e.g., stronger neuronal connections and synapses) as well as cognitive reserve (e.g., the ability of the brain to cope with changes caused by age and pathology) [13].

Damian Jacob Sendler

Research on purpose in life and cognition has relied heavily on samples from the United States and Europe. Many more studies are needed to see if purpose has the same protective associations in non-Western countries, such as cultures that are more collectivistic, practice different religions and have a different political structure, etc. However, emerging evidence from Western cultures shows that purpose is widely protective. However, studies that look for moderators show that the cognitive outcomes associated with purpose are similar across age, sex/gender and ethnic groups [9–10].

This suggests that a strong sense of purpose may be more protective in environments with a lower level of economic resources. There was a positive association between purpose and episodic memory in 30 countries in a meta-analysis of 32 countries, and the association was slightly stronger in lower-income countries as measured by GDP. Individuals with a greater sense of purpose were found to be more adept at mental tasks such as memory recall, even in economically challenging circumstances. According to this preliminary study, purpose appears to provide protection for people of all demographic groups, but it appears to provide even greater protection for the most vulnerable, suggesting that its benefits are not restricted to those with the greatest financial means.

Damian Sendler

Damien Sendler: People who have a strong sense of purpose in life are more likely to have better cognitive outcomes. Basic science knowledge on an attractive target is required to begin developing behavioral interventions, and this evidence is consistent with Stage 0 of the Stage Model for Behavioral Intervention Development. Following the development or adaptation of behavioral interventions for a sense of purpose and the initial testing of these interventions, the next step is the development of basic experimental work. There is evidence that purpose can be temporarily increased and that such manipulations have an effect when compared to control conditions [14] in other domains of research. They could be modified and expanded to show proof of concept in terms of cognitive outcomes (e.g., whether participants perform better on cognitive tasks after induced to feel more purposeful).

Early evidence suggests that cancer patients’ sense of purpose (and meaning) grows as a result of intervention [15]. There is still room for more research into the best methods for increasing meaning and purpose in life (e.g., life story interventions, mindfulness interventions, etc.), as well as whether this effect extends to other populations, particularly those who are at high risk of cognitive impairment (i.e., intervention studies typically include both meaning and purpose in the outcome measurement, and the two could be differentiated better). Such interventions could then be tested to see if increased purpose sustains a better cognitive function over time.

ADRD risk can be reduced while supporting healthy cognitive aging through behavioral interventions. It is our hope that by bringing together the promising observational evidence for a sense of purpose in life, high-quality research will be galvanized to examine experimentally whether purpose in life has a causal effect on cognition. Using such evidence could then lead to the development of an evidence-based intervention for better cognitive outcomes for seniors, given the demand for new behavioral interventions to decrease cognitive decline and the risk of dementia.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: No doubt about it, a country’s economy, scientific and technological advancement, and human civilization as a whole are all dependent on the exploration of outer space. The human body is subjected to a variety of stressors in space, including a long period of confinement in a small, hermetically sealed space. As a result, the astronaut’s immune system is adversely affected by a host of external factors. Using ground-based experiments, we can better understand how confinement in a small space affects both the immune system’s activation and its dynamic changes. Such an approach also allows for the estimation of the impact of additional psychological stress on immunity, particularly in relation to the immune system’s reserve capacity. A sealed chamber appears to be an ideal location for developing new methods for selecting crew members and developing countermeasures in the event that the immune status of the astronauts deteriorates. An attempt was made to gather data on how human immunity changes in isolation experiments, including short and long-term experiments in hermetically sealed chambers with an artificial environment and in Antarctic winter-over.

Damian Jacob Sendler: As an integral system, immunity is highly complex, with a divaricate web of both direct and indirect interactions with other physiological systems. As a crew member on a space mission, one’s immune status is critical to ensuring the crew’s health, vitality, and productivity. To understand how spaceflight affects the immune system, it is necessary to look at both the standard values for various indicators and how they change over time for each individual. A sealed chamber or Antarctic station can be used as a model for a space station, spaceship, or an on-planet station to conduct experiments of various durations. This is necessary for future missions to Mars and the Moon ( Figure 1 ). The immune system can be influenced by a variety of factors unique to each platform ( Table 1 ). An array of variables influences the immune system during short- and long-term orbital missions. Besides microgravity, stress and living in a hermetically sealed space with an artificial microclimate are necessary for astronauts. It was possible to observe changes in the quantity and functioning of immunocompetent cell subpopulations, as well as the sensitization of lymphocytes to allergens of bacterial and chemical nature (4–9). There was also a decrease in the delayed hypersensitivity reaction during the long-term mission to “MIR” (10–12). This suggests that cell-mediated immunity is malfunctioning. Multiple well-documented cases of reactivation of such viruses as HHV, EBV, CMV, and Varicella zoster virus were found in blood, saliva, and urine samples from astronauts (13, 14). In the course of their stay on the spacecraft, researchers observed changes in subpopulation composition and adaptive immunity cell function. Memory T cells and effector CTLs (CD3+CD8+ cytotoxic lymphocytes) increased moderately, while the population of naive CTLs decreased simultaneously. In addition, the number of cytokine-producing lymphocytes decreased by a negligible amount during the flight (15). This study shows that the distribution of different lymphocyte subpopulations did not change significantly during the mission.

Dr. Sendler: When activated immunocompetent cells were reactivated, significant shifts in the production of cytokines and their ability to activate were also reported Staphylococcus enterotoxin failed to activate T cells, and the production of IFN-, IL-10, IL-6, and TNF-a decreased. Additionally, the number of lymphocytes capable of reacting to viral particles was reduced in a similar manner. The number of cytokines in astronauts’ blood plasma increases during long space missions, while mitogen-activated cultured T cells produce less of these cytokines (16). Leukocyte counts in astronauts rose as a result of these changes, researchers found. Similar post-flight changes in the immune system’s functioning are observed both immediately after landing and during reintegration into normal life on Earth. These deviations from pre-flight characteristics can be triggered by prolonged effects of stress during the flight, as well as additional loads imposed during the landing process. Natural killer (NK) (CD3-CD16+CD56+) activity decreased, lymphocyte proliferation decreased, and IFN- synthesis decreased in the crew members after 140 days of mission (6, 17–21). After 48 hours of incubation with specific activators, postflight data from the “MIR” station crews (whose missions ranged from 66 to 126 days) showed a decrease in the expression of CD25 by T cells (14). There was also an increase in the relative quantity of B and T cells (including memory cells), as well as granulocytes and a decrease of monocytes after several short and long Space Shuttle missions. These changes in the immune system were found to be quantitative and functional. A Th2-dominant cytokine profile of T-cell response was also observed, with IL-10 production dominating over IFN- as a result of this shift (22). A decrease in NK cells and their ability to kill cancer cells, as well as a decrease in the number of T-cells and an increase in the number of T-helper cells and CD4+CD45RA+-cells, were found in the post-flight period of the ISS crews’ investigations, as well as an increase in the total number of the major populations of immunocompetent cells (23, 24). This shift in T-cell cytokine profile is confirmed by data gathered from crew members’ post-flight examinations of their cytokine profiles (19).

More than one researcher has found evidence of virus reactivation in the astronauts’ bodies, both during and after the flight. In addition, post-flight studies on innate immunity show that space flight conditions have a noticeable impact on it. After completing a mission, the production of IL-6, IL-10, and TNF-a by activated monocytes in culture was especially reduced (by 40-45 percent) by the inhibition of IL-6 synthesis by monocytes, as well as the decrease in CD62L and HLA-DR on the surface of monocytes (29). Other studies have shown an increase of monocyte and granulocytes in the first day after landing, as well as an increase in TLR2+ and HSP60 and HSP70-rich granulocytes; however, the relative quantities of these two proteins decreased; the latter is a major ligand for Toll-like receptors. These findings support the hypothesis that factors associated with space travel alter the function of innate immunity (30). TLR expression on the surface of monocytes and granulocytes as well as the expression of genes coding for proteins from the TLR intracellular signaling pathways were found to vary widely among individuals during the first post-flight day. The averaged values, however, did not reveal any significant differences between pre- and post-flight measurements. It’s clear from the data presented above that the effects of long-duration space flight stress factors on the immune system are primarily manifested in the reduced reserve capacity of various immune-competent cells to respond, their phenotypic changes, a quantitative decrease in their effector response through production of cytokines, and a qualitative shift in their cytokine profile. A six-month mission on the International Space Station (ISS) has confirmed that the findings outlined above persist during spaceflight (31, 32).

Specific immunological countermeasures should be developed while keeping in mind the wide individual variability of changes in immunological parameters that reflect individual susceptibility to the factors of spaceflight. Because future space missions to Mars and the Moon are expected to last for an extended period of time and require an unprecedented level of crew autonomy, the impact of flight stress on the health of astronauts will be magnified. Earth-based experiments that examine the effects of isolation in a hermetically sealed space with an artificial microclimate on the immune system are of particular importance because of the mission’s stressors.

An in-depth examination of immunity as an integrated system must take into account the interdependence of its components. It is important to consider the interactions of the immune system with other physiological systems (nerve system, endocrine system), as well as the individual reactions of test subjects, when conducting research on the immune system’s role in maintaining homeostasis. Developing effective countermeasures and rehabilitation systems for future space missions should be the primary goal of these studies, as well as the detection of precise markers of a current state of immunity for its correction. Human labor’s global expansion necessitates experiments with long-term confinement in a sealed chamber, which has implications for the significance of these experiments (e.g., during the development of the sea shelf). Furthermore, the results of these studies can be used to help alleviate the negative effects of the general trend toward a sedentary lifestyle and less physical activity in daily life.

Microgravity, stress, altered nutrition, physiological isolation, and radiation are just some of the stressors that affect humans during spaceflight (33). It is possible to conduct human research in a safe and low-cost environment using science capabilities that are not constrained as is the case in an actual flight experiment (34). Recent research suggests that stress, rather than microgravity or radiation, is the primary cause of immune dysfunction in cosmonauts and astronauts (35). This bodes well for the development of biomedical countermeasures by using ground analogs that closely mimic the isolation and stress of spaceflight. Closed chamber confinement in a simulated vehicle for an extended period of time may be particularly useful as an analog because it allows the immediate processing of biomedical samples in a fully capable laboratory environment, despite the existence of terrestrial “deployment” analogs (undersea, Antarctica, etc). In the 1960s, the Institute of Biomedical Problems of the USSR Ministry of Health (now IBMP RAS) designed and built an Earth-based Scientific-Experimental Complex to conduct confinement experiments in a sealed chamber (the so-called NEK). A pressurized facility with an artificially controlled environment was created by academician S.P. Korolev and used for a variety of investigations, including immunological ones (36). The life support systems that were later used in manned space missions and orbital station flights were also developed in this country. A number of changes were made to the North Korean facility, including the expansion of living space and facilities for testing equipment and countermeasures, such as simulators of physical loads and devices that allow people to perform physical tasks. The IBMP crew experimented in the NEK for both short-term (during the course of the mission to the Moon) and long-term experiments (within the frames the mission to Mars program working out). No international standard exists to describe the conditions of experiments with confinement, such as measured parameters that characterize the state of human immune system, age of the test subjects, times of bio-sample collection, seasons, and general experimental conditions such as gas composition, pressure, and temperature in different isolation projects.. Isolation studies can be difficult to conduct because of this.

The immediate processing of biomedical samples in a fully equipped laboratory is made possible by terrestrial analogs with closed chamber confinement in a simulated vehicle for prolonged periods of time. With regard to the fundamental studies of the interaction between the immune system and the microbiota in our digestive tract, ground analogues could also be used as a platform.

Immune homeostasis requires a healthy microbiome. A large portion of the immune system’s development has been devoted to protecting the host from various microorganisms (37). As a result of dysbiosis, the immune system may overreact, leading to increased production of inflammatory cytokines, T cell imbalances, and even autoimmune diseases (38–40). It’s no secret that the microbiome of humans is influenced by factors associated with space travel. Microbiological controls ensure that astronauts and crew members participating in isolation experiments have only a small chance of being exposed to a wide range of pathogenic strains; as such, the opportunistic microflora plays an important role in dysbiosis on Mars. Several space missions and experiments conducted over the course of the space age have documented changes in bacterial species composition, gene expression, and protein production during and after flight (41). Human microbiota undergoes similar changes in terrestrial isolation studies, which is interesting. A decrease in intestinal and integumentary tissue colonization resistance, as well as dysbiotic changes, occur when a healthy subject is exposed to an environment with altered parameters. The microflora of the test subjects changes dramatically when they spend time in a hermetically sealed chamber with its own microclimate. The dysbiosis is caused by a decrease in the number of Bifidobacteria and Lactobacilli in the intestinal microflora. Initial microecological conditions have a significant impact on the severity of the microflora dysbiosis. Staphylococcus aureus and gram-negative bacteria were found in the mucous membranes of the nasal cavity, mouth, and throat of crew members in a hermetically sealed chamber, indicating the presence of opportunistic microflora activation (42). Up until recently, it was impossible to establish a link between immune system function and changes in the microbiota caused by space flight-associated factors (22). Pioneering research, however, provided the first evidence of human immunity and gastrointestinal microflora interfacing during space flights.. Several pro-inflammatory cytokines, including IL-1, TNF-, IL4 and IL-8, were found to be negatively correlated with the abundance of OTU000010 of the genus Fusicatenibacter in this study. There was a negative correlation between changes in OTU000011 of the genus Dorea and increases in certain cytokines (namely IL-1a and 1ra as well as MIP-1) that occurred during the space missions. In the meantime, it’s impossible to tell which came first: an increase in pro-inflammatory cytokines or a decrease in bacteria OTU count (43). There are still many unanswered questions about the relationship between the human immune system and microbiome, but this study’s findings are encouraging. Probiotics and other supplements, like prebiotics or special diets, appear to be viable spaceflight countermeasures (22).

Damian Sendler

Gender-specific immune reactions to extreme environmental factors could be addressed in terrestrial analogs. Several studies have found that immune responses differ between men and women. More powerful cell-mediated responses and increased production of immunoglobulins are seen in women (44, 45). As a result, women have higher levels of resistance to bacteria and viruses, and as a result, they recover more quickly than men (46, 47). Non-reproductive organ cancers and various types of hematologic malignancies are more common in men. Males are far more likely than females to develop the types of cancer listed above, which are both more common and more deadly (48). Women, on the other hand, have a higher risk of developing autoimmune disorders than men. Whitacre CC says that women have a higher risk of developing autoimmunity than men: more than 70% of people who have autoimmune diseases are female (49). Some of these discrepancies could be explained by the influence of hormones like testosterone, estrogen, and progesterone on the functional activity of immune cells (47). Exploration missions may reveal immune system differences between men and women. Unfortunately, according to recent articles based on completed space-flight studies, analyses of sex-determined changes have not been carried out to date (50). There were no significant differences in cytokine production or leucocyte subsets between men (n=10) and women (n=16) at German Antarctic Research Station Neumayer III during the winter in Antarctica (51). No sex-related differences in DCs and TLRs+ monocytes were found in a 17-day isolation in a sealed chamber study (52). There are two possible explanations for this phenomenon, in our opinion. That the immune system’s current state cannot be accurately described by available statistics and other statistically limited parameters is the most likely first cause. One possibility is that men and women’s immune responses to space-related factors may not be significantly different, but the immune response to different antigens may be altered. Experimental testing is required for both hypotheses.

For long-term interplanetary missions, as well as for the construction of long-term planetary bases, which is a long-term goal of space exploration, a thorough study of infectious disease cases, chronic inflammation, allergic reactions and other consequences of immune system disruption in isolation is required. Extrapolating from the currently accumulated data on immunological changes during orbital missions alone does not seem sufficient in this regard. Longer mission durations and greater mission autonomy are expected with the upcoming exploration programs to the Moon, Mars, and other celestial bodies. Long-term isolation experiments using the NEK pressurized facility were therefore required in light of the foregoing.

Damien Sendler: Isolation and confinement model experiments show similar changes in a person’s immune system to those seen in the real spacecraft. It is clear from this evidence that ground-based studies of the effects of space flight can benefit greatly from the use of experimental models like this one. This is especially important in light of long-term space mission planning, where such preliminary detailed modeling will reveal and, with high probability, prevent a number of serious risks to future space explorers’ health and normal performance. Such experiments have many drawbacks, including a long duration and a large amount of data to process. However, these drawbacks are more than compensated by the reduction of risks that could jeopardize not only the mission’s success, but also the lives and health of astronauts.

Damian Jacob Sendler

It is noteworthy that the changes in immunological parameters in the isolation and confinement experiments showed such wide individual variation. The search for a “universal set of parameters” or an ensemble of interdependent changes in various parameters, considered as a single functional ensemble, is one of the more promising lines of research in isolation and confinement models. In order to produce a simple and accurate express diagnosis of the current immune state, and to predict its future development, we should focus on these sets. In addition, current research focuses primarily on the adaptive immune system’s changes. In order to further develop the aforementioned strategy, it will be necessary to carry out experiments of varying durations and investigate aspects and features of immunity that have been understudied in the context of space travel and isolation………………………………………….. Pattern-recognition receptors and dendritic cells, which serve as a functional link between the innate and adaptive immune systems, as well as the changes in gene expression in various populations of immunocompetent cells, are of particular interest in this regard in the study of innate immunity……….

In order to complete the task outlined above, it is also necessary to conduct studies on the effects of isolation and confinement on the parameters of other regulatory systems, such as the nervous and endocrine systems, as they all interact. All three systems (immune, nervous, and endocrine), as well as blood biochemical parameters and immunological parameters, must be thoroughly correlated in order to determine the relationship between the various changes observed.

As previously mentioned, the immune system can be altered by the stresses of spaceflight, including microgravity, isolation, stress, and radiation, increasing the risk of clinical illness for astronauts and cosmonauts on long-duration missions into deep space. Patients with Zoster, for example, have dysregulation patterns that are similar to these (82). It is necessary to create countermeasures. Due to their very nature, studies of human spaceflight are severely restricted. On-board processing and analysis capabilities are limited and up/down mass bound biological investigations are constrained by these constraints. Aside from expanding scientific investigation and characterizing physiological dysregulation, ground analogs of spaceflight offer a chance to triage various countermeasures for spaceflight without the constraints of a real-life spaceflight experiment (34).

Damian Jacob Markiewicz Sendler: As compared to Antarctica or subsea deployment, chamber isolation allows for an almost unrestricted scientific approach due to the proximity of full laboratory or medical facilities. SAHC, a variety of physical training loads, stress-relieving exercises, and the use of pharmacological medicines, probiotics, or vitamins are some of the available countermeasures (2). It is necessary to assess the countermeasures’ principled appropriateness in experimental confinement, as well as the timing of their implementation and the most effective doses, combinations, and application times. This must be done with consideration for the wide range in individual reactions of crew members and the fundamental data gathered from a thorough investigation of the immune system’s components. Some evidence suggests that the ISS’s immunity has benefited from the countermeasures already in place (35). An international team of translational space scientists has developed a new international immune countermeasure protocol in light of the greater magnitude of stressors and clinic risk associated with deep space missions and the fact that most ISS countermeasures do not translate to deep space vehicles (83). Long-term confinement in a high-fidelity vehicle simulation like NEK/SIRIUS may be the ideal platform for this type of countermeasure validation..

A unique array of fundamental scientific data, as well as countermeasures and practical training systems for astronauts, will be gained by conducting terrestrial confinement studies. Those who will join the upcoming interplanetary expeditions and inhabit planetary and near-planetary stations will benefit the most. If this system is successfully tested in the most extreme conditions of outer space, it can be well adapted to the needs of terrestrial medicine in extreme situations, support and rehabilitation of people in forced isolation and hypokinesia conditions, including commercially based systems.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: The purpose of this conceptual review paper is to respond to the recent Frontiers in Psychology special issue on “Positive Psychology in Foreign and Second Language Education: Approaches and Applications,” which calls on language education researchers around the world to study positive emotions, positive personality traits, and positive institutional tendencies and their implications for language education systems, stakeholders, and policy practices To put it another way, we explain how positive emotions can lead to flourishing and growth in any area of life, including L2 learning and teaching, by drawing on the broaden-and-build theory of positive emotions. When it comes to L2 learning and teaching, we introduce and conceptualize seven instances of positive psychology variables such as academic engagement, joy, regulation of emotions, grit, love of pedagogy, resilience, and well-being. Thus, theoretical and pedagogical implications for improving language education systems and their various stakeholders are derived. Conclusions and recommendations for future research are provided to expand the existing literature on positive psychology in the field of L2 education are provided at this juncture.

Damian Jacob Sendler: The purpose of this conceptual review paper is to familiarize language education researchers, practitioners, instructors, and learners with the main tenets of positive psychology and their application in second/foreign language (L2) education research, which is addressed in a recent Frontiers in Psychology special issue. Instead of introducing the origins, principles, and theoretical contributions of positive psychology to L2 education, we present some key factors that merit further empirical investigation and evidence from a positive psychology perspective. This review differs significantly from that of Dewaele et al. (2019a) in this regard. Emotions in Second Language Acquisition: A Critical Review and Research Agenda by Dewaele and Li (2020) differs from this review in that they focus on emotions, their different phases, theories, methodological issues and an agenda for L2 education.

Dr. Sendler: Educational researchers have spent a long time investigating negative emotions like anxiety (Marcos-Llinás and Garau, 2009) and burnout (Vaezi and Fallah, 2011) in the educational context. After becoming dissatisfied with the constant emphasis on negative emotions, researchers inspired by the positive psychology movement realized that not everything is negative and set out to investigate and promote eudemonic well-being. Seligman and Seligman and Csikszentmihalyi (2000) introduced positive psychology in their seminal work, which aimed to advocate a shift in the focus of psychology from merely focusing on fixing the negative and problematic aspects of life to developing positive qualities (Gao et al., 2020). (MacIntyre, 2021). Later, Peterson (2006) defined “the scientific study of what goes right in life, from birth to death and at all stops in between” as “the positive psychology of what goes right” (p. 4). A similar argument has been made by Seligman and Csikszentmihalyi (2014), who argue that psychology should shift its focus away from identifying and solving problems to the subjective experiences that are valued by individuals.

Positive psychology (Mercer, 2021) focuses on people’s strengths rather than their flaws when dealing with life’s challenges (Mercer, 2021). (Jin et al., 2021). Positive psychology, on the other hand, focuses on the positive emotions, strengths, and aspects of human experience and psyche that have been overlooked in psychology for decades (Oxford, 2016). The goal of positive psychology is to bring out the best in each person, to focus on their unique strengths, and to create an environment that encourages their growth and happiness (Lopez, 2008). As a result, positive psychology focuses on the growth, fulfillment, flourishing, and resilience of individuals in all aspects of their lives, including education (Seligman, 2011).

According to Seligman and Csikszentmihalyi (2014), the foundations of positive psychology are positive institutions, positive personality traits, and positive experiences, all of which include positive emotions. Positive institutions are the least studied of the three, as psychological research has focused on positive character traits and feelings (MacIntyre, 2016). As a result, researchers in this field focus on three aspects of emotions: (1) the individual (i.e., positive personality characteristics or traits), (2) the subjective (i.e., positive emotional experiences), and (3) the group (i.e., positive support from institutions and society) (Gabry-Barker, 2021). Empathy, happiness, contentment and contentment, as well as optimism, tolerance, flow and love can all contribute to a person’s sense of satisfaction, self-efficacy, and success (Seligman, 2011; Fathi et al., 2021).

The broaden-and-build theory of positive emotions, which emphasizes how positive emotions like love, interest, joy, and contentment broaden one’s “momentary thought-action repertoire,” is the theoretical foundation of positive psychology (Fredrickson, 2004, p. 1367). Emotions that are positive, rather than negative, can lead to the development of one’s physical, psychological, intellectual and social resources. This is in contrast to the narrowed mindsets that are triggered by negative feelings (Fredrickson, 2004). In his work, MacIntyre (2016) cites Snyder and Lopez’s (2009) work to present a partial list of 36 positive psychology factors, such as attachment security, benefit-finding, mindfulness, life longing, an optimistic explanatory style, personal control, positive growth, self-verification, happiness and resilience as well as a sense of humility and positive ethics.

Following a brief discussion of how positive psychology came to be in the first place, it is now time to look at how it can be applied to L2 learning and teaching.

Early researchers like Arnold (1999), Arnold and Fonseca (2007), and Arnold and Fonseca Mora (1999) highlighted the importance of positive emotions and affectivity in L2 learning and teaching (2011). However, a positive renaissance in language education did not occur until relatively recently, following the rapid emergence and rapid flowering of positive psychology in general education (MacIntyre and Gregersen, 2012; Lake, 2013). There has been a shift in focus from studying negative emotions like anxiety, boredom, and burnout (Marcos-Llinás et al., 2009), to the investigation of both positive and negative factors involved in the process of L2 teaching and learning (Pawlak et al., 2020). (Chaffee et al., 2014; Dewaele and MacIntyre, 2014; Kruk, 2019, 2021). Instead of approving of negative feelings and separating them from their positive counter-parts, the broaden-and-build theory of psychology asserts that negative and positive feelings cannot be easily separated and, in many instances, even complement each other. Applied positive psychology in L2 education disputes this assertion (MacIntyre and Gregersen, 2012). Learning and teaching a second language can be made more enjoyable and meaningful by positive emotions, which can help L2 instructors and learners cope better with various challenges in the instructional context (Gregersen, 2013).

It was thanks to MacIntyre and Mercer’s special issue on positive psychology and Sarah Mercer’s pioneering conference on Psychology of Language Learning in Graz in 2014 that the foundations of positive psychology in L2 education were strengthened. An important step in this direction was taken by this line of research, which was inspired by the discovery of “foreign language enjoyment” (Dewaele and MacIntyre, 2014). Accordingly, in subsequent empirical studies, factors like anxiety in foreign language classes and a bad learning environment, as well as positive factors like happiness, emotional intelligence, love, and pride, were studied in order to realize the power of positive emotions in creating a balance (Chaffee et al., 2014; Dewaele and MacIntyre, 2014; Gregersen et al., 2014).

MacIntyre et al. (2016), Gabry-Barker and Gaajda (2016), and the second conference on positive psychology in SLA at the University of Jyväskylä in 2016 all contributed to a rapid rise in the use of positive psychology in L2 education. Since 2016, there has been a significant increase in the number of applied linguistics research papers that adopt a positive psychology perspective in L2 education and are published in more prestigious journals (Dewaele et al., 2019a). Mercer (2016), Oxford (2016), MacIntyre et al. (2019) among others theoretically contributed to this field.

MacIntyre (2016) identifies four of the many positive psychology contributions that have been made over the past 20 years that have direct application in L2 education. Negative and positive emotions, as well as the role they play in the educational outcomes of L2 teachers and students, are two of the most promising topics in L2 education, and future research in this area will greatly benefit from the empirical and theoretical uniqueness of negative and positive emotions (Li et al., 2020). Character strengths model (Park et al., 2004) is the second major contribution to L2 education from positive psychology that could be applied. It summarizes strengths and virtues under six overarching categories of justice; transcendence, humanity; temperance, courage; and wisdom. Applied to L2 education, this model demonstrates how L2 teachers and students can thrive and flourish by enhancing their character strengths (MacIntyre, 2021).

The third contribution focuses on the transition from PERMA to EMPATICS in positive psychology as a means of understanding well-being (Oxford, 2016). Positive emotions, Engagement, Relationships, Meaning in life and Accomplishment (PERMA) are all components of the PERMA model introduced by Seligman (2011). There should be a positive interaction between all of these elements, as a result of which the individual’s well-being will be realized in this model (Mercer and Gregersen, 2020). Emotion and empathy, meaning and motivation, perseverance, including hope, resilience, and optimism, (4) Agency and autonomy, (5) Time, (6) Hardiness and habits of mind and (7) Intelligences, (8) Character strengths, and (9) Self factors were later added to the model and renamed EMPATHICS (self-verification, self-esteem, self-concept, and self-efficacy). New empirical and pedagogical horizons are opened for SLA researchers based on this theoretical model. As argued by Oxford (2016), EFL/ESL language teaching and learning have not addressed many of the EMPATHICS factors such as character strengths, hope, empathy and resilience, which means that positive psychology research can benefit from attention to these important factors.

One of the most important concepts in positive psychology is flow, which is discussed in this paper as the final contribution to L2 education research. flow is a state of positive well-being that occurs when individuals are operating at the edge of their capabilities, where abilities and challenges work together harmoniously, creating a feeling that one is so engrossed in the task at hand that he/she loses track of time. (Cikszentmihalyi, 1990). Even though little research has been done on flow in the domain of SLA (Liu and Song, 2021), it is a promising research avenue for a future as L2 learners’ experience of flow influences their attainment and success in L2 learning directly.

Seven examples of positive psychology factors that should be examined by researchers in the field of L2 learning and teaching are presented in the following section after we have explained their prominence in L2 education.

FLE was introduced by MacIntyre and Gregersen (2012), arguing that positive achievement emotion can help learners build resources for better language learning, broaden their perspectives, and increase their engagement in the language learning process (Pekrun, 2006), (Jin and Zhang, 2019). To achieve this goal, students must be confident in their ability to complete the task at hand (the control element) as well as have a positive attitude toward the learning material (the positive attitude component) (Mierzwa, 2019). People who enjoy what they’re doing tend to continue doing it, and this leads to greater success and fulfillment in life. Teachers can help their students overcome their fear of speaking a foreign language by focusing on positive emotions (Dewaele et al., 2018; Dewaele and Dewaele, 2020). There has been a great deal of study done on the foundational language element (FLE) in the context of language learning (e.g., Li et al., 2018; Jin and Zhang, 2019). FLE has been shown to improve academic performance (Jin and Zhang, 2018; Li et al., 2020), L2 motivation (MacIntyre, 2016), and social-behavioral learning engagement, according to the research that has already been done (Dewaele and Li, 2021).

There is a strong consensus among researchers that teacher-related factors play a more significant role in the success of FLE than learner factors. Teachers’ FLE was found to be influenced by emotional support, humor, friendliness, respect for students, tone of voice, and general upbeat mood (Dewaele et al., 2019c). This means that teachers have a significant impact on the ecology of foreign language learning by helping students have fun. According to a methodological perspective, the participants’ voices were heard in descriptions of FL classroom activities or in subsequent interviews (e.g., Dewaele and MacIntyre, 2014, 2019; Li et al., 2018; Li, 2020).

“An underestimated and not fully explored emotion,” says Mierzwa in 2019. (Mierzwa, 2019, p. 173). However, recent studies on FLE have been conducted from a variety of perspectives, including scale development, expansion of the FLE nomological network, individual focus, and longitudinal focus (Elahi Shirvan and Taherian, 2018; Elahi Shirvan and Talebzadeh, 2018, 2020; Jin and Zhang, 2019; Elahi Shirvan et al., 2020, 2021; Talebzadeh et al., 2020). As a result, it’s no longer an undervalued feeling. FLE research can still move forward by expanding the range of time frames, shifting from simple correlational designs to more complex statistical techniques that capture the dynamic interactive variables, and conducting further exploratory and experimental research in classrooms.

Damian Sendler

Well-being is a key component of positive psychology. According to Oxford (2016), it is important to emphasize that “positive psychology is all about human well-being” (p. 21). Generally speaking, well-being refers to an individual’s sense of well-being, including their physical and mental health, as well as their ability to perform at work (Garg et al., 2014). Individuals flourish and grow as a result of well-being, which is a positive health-related outcome (Seligman and Csikszentmihalyi, 2000). Positive interpersonal relationships, self-acceptance, personal growth, a sense of direction in life, environmental mastery, and self-determination are all included in Ryff’s (1989) definition of well-being. With Seligman’s PERMA model (2011), happiness is defined as the result of positive interactions between people, accomplishment, meaning, positive feelings and involvement with the ultimate goal of discovering meaning (Mercer and Gregersen, 2020). Understanding and promoting teachers and students’ emotional and psychological well-being is critical in the field of second language education because it is at the heart of language teaching and learning (Mercer, 2021). Teachers and students both benefit from well-being, which can lead to better emotional and academic experiences, such as students’ higher FLE (Proietti Ergün and Dewaele, 2021). (Greenier et al., 2021). Student well-being is a topic that has received less attention than teacher well-being. A promising avenue for future research in domain-specific areas such as L2 learning can be found in this direction.

Damian Jacob Markiewicz Sendler: It has long been recognized that resilience is a dynamic, modifiable process that occurs over time and reflects the ability to adjust to different circumstances or situations and enhance one’s effectiveness when confronted with unfavorable conditions. This quality has a significant impact on the general and language education domains (Bobek, 2002). Resilience is essential for both teachers and students because teaching and learning are both stressful and emotionally draining (Gu and Day, 2013). A person’s ability to cope with adversity by utilizing all of his or her resources can be defined as resilience in the educational context (Gu and Day, 2013). To thrive rather than just survive in institutions, universities, or schools, teachers or students need to develop a resilience that allows them to deal with the challenges and stressors of the educational environment (Gloria et al., 2013). Teachers in the field of language instruction can develop their personal and professional resilience through the relationships they build with their students, which allows them to discover the meaning and purpose of their work and take meaningful action as a result (Hiver, 2018). Learner motivation, well-being, and teaching enjoyment have all been linked to resilience in the classroom (Kim and Kim in 2021; Proietti Ergün & Dewaele, 2021). In spite of its prominence, resilience needs more attention to its measurement, contributors, and potential consequences, as there is a limited body of research evidence on this concept in the literature on language education (Hiver, 2018).

When it comes to helping L2 students and teachers succeed in the educational environment, another aspect of positive psychology to consider is emotion regulation (Greenier et al., 2021). There are a variety of behavioral, physiological, and cognitive processes that one can use to control their emotional experiences and expressions (Gross and John, 2003). The process by which a person assesses, modifies, or regulates his or her emotions in order to achieve specific life goals is defined by Thompson (2008) as an extrinsic and intrinsic process. The ability to control when and how one expresses and experiences one’s emotions is seen by Gross (1998) as an interpersonal undertaking. Emotional regulation strategies are used frequently by both effective teachers and students. Even though some of the time they may down-regulate bad feelings, at other times they may up-regulate good feelings in order to enhance their performance and create a more enjoyable learning environment (Teng and Zhang, 2018; Greenier et al., 2021).

Emotional control in the language classroom is critical to the success of both teachers and students, as well as to the success of the teaching process itself (Ghanizadeh and Moafian, 2010; Teng and Zhang, 2016). It is only through the ability to control one’s emotions that educators are able to effectively confront difficult situations and come up with workable solutions (Ghanizadeh and Moafian, 2010). Research on emotion regulation in language education is scarce, despite its importance for educational outcomes and quality (Bielak and Mystkowska-Wiertelak, 2020). Dewaele and Dewaele (2020) believe that while emotions are key to language education, they have been largely ignored in SLA research. A variety of L2 academic factors, including psychological well-being, engagement, self-efficacy, reflection, and burnout have all been linked to improved emotional regulation, including research by Greenier et al. (2021) and Fathi et al. (2021) as well as Fathi et al. (2021). (Ghanizadeh and Royaei, 2015). There are hopes that following the recent blossoming of positive psychology in L2 education, more studies on how L2 teachers or students up-regulate or down-regulate their positive and negative emotions, respectively, will be conducted in the near future following the recent flowering of this field.

Emotional, cognitive, and behavioral aspects of academic engagement are all considered desirable student experiences in the language learning domain (Jiang and Zhang, 2021; Khajavy, 2021). (Reschly and Christenson, 2012). Learners’ behavioral engagement refers to how eager they are to take part in tasks and lessons in real life (Mercer, 2019). Students’ feelings of devotion and attachment to a task are considered emotional engagement. In order to be cognitively engaged, one must be sufficiently challenged intellectually and absorbed in their work (Reschly and Christenson, 2012). As Reschly and Christenson (2012) put it, engagement is “a new kid on the block” in comparison to other well-established and extensively researched constructs like motivation (Hiver et al., 2021). (p. 4). Encountering students has grown in popularity in educational research despite its relative youth (Mystkowska-Wiertelak, 2020).

Damien Sendler: Scholars in SLA, such as Hiver, have made significant contributions to extending student involvement into L2 education. A language learner’s level of L2 engagement is defined by Hiver et al. (2021) as the extent to which the learner is engaged in the task at hand. Mercer and Dörnyei (2020) asserted that the development of communicative language ability necessitates the active participation of language learners who are willing to engage. Many language education stakeholders believe that fostering student engagement is a key factor in increasing L2 students’ long-term success and attainment (Mercer, 2019). Survey instruments designed and piloted by Hiver et al. (2020b) to measure the level of engagement in the language learning context across behavioral, emotional and cognitive dimensions have sparked the expansion of research in this area. The field of language learning research is still young, having only begun to investigate L2 involvement in relation to learning different languages in various contexts and cultures (Hiver et al., 2020a). There is a strong correlation between students’ L2 engagement and their teacher’s care and rapport, nonverbal immediacy, and credibility behaviors (Derakhshan et al., 2021a), emotional grit (Khajavy), and enjoyment (Dewaele and Li, 2021), willingness to communicate (Mystkowska-Wiertelak, 2021), and bilingual/biliteracy learning (Zhang et al., 2012).

In Duckworth et al. (2007), grit is defined as a person’s persistence, passion, and effort in pursuit of long-term objectives. Grit, to them, was a multidimensional quality that encompassed both a consistent level of interest and a persistent level of effort. The first dimension deals with the ability to remain engaged in a project despite setbacks and difficulties, while the second focuses on the willingness to put in extra time and effort even in the face of setbacks. Having a growth mindset is linked to greater academic success because of one’s perseverance (Steinmayr et al., 2018). Grit’s malleability is one of its best features; this means that it can be improved in the classroom through intervention and instruction (Clark and Malecki, 2019). L2 teachers can better prepare their students for the hardships and difficulties that come with learning a new language by making use of the malleability of grit. Grit has been found to have a positive effect on academic outcomes such as academic achievement, enjoyment, and willingness to communicate (Akos and Kretchmar, 2017). (Teimouri et al., 2020). Even though this non-cognitive concept has attracted the attention of language education researchers in recent years (e.g. Khajavy et al., 2020), there are still a few studies in this domain, and more research in this area is needed to expand our understanding of the role of this factor in language learning.

Damian Jacob Sendler

Positive psychology advocates love as a desirable emotion that can help people grow, develop, and find meaning in their lives (Fredrickson, 2004; Seligman, 2011). Specifically, in the educational context, love is viewed as a meaningful and positive learning experience that can be applied. According to Loreman (2011), students’ emotional and social development is greatly influenced by the presence of love in their lives. John Lock, a well-known educator, also believes that successful instruction can only occur in a loving environment. Freire, likewise, emphasized the fact that both studying and teaching are acts of affection (Yin et al., 2019). The importance of love is also reflected in Maslow’s (1954) hierarchy of needs: people can only achieve self-actualization if their belonging and love needs are met. When we talk about pedagogy that we love, we’re really talking about how much we care about our students. As a result teachers must be caring, supportive, and sensitive to their students, as well as respectful and understanding of them. Students’ functioning and potentials can be strengthened by a caring teacher’s guidance and encouragement. When it comes to language learning, love has the potential to be a motivating factor in the process, as well as an effective coping mechanism.

The goal of education, according to a loving pedagogical approach, is more than just the transmission of information. Pedagogy that encourages students and teachers to work together to find new information and pushes them to go beyond their own boundaries is a great way to teach (Yin et al., 2019). Loreman (2011) proposed a “pedagogy of love” model, which includes the nine main components of kindness, sacrifice, acceptance, bonding, forgiveness, empathy, community, passion, and intimacy. This topic has been understudied in both general and language education, despite its importance. A large, multinational study was conducted, to our knowledge, to revalidate the Dispositions toward Loving Pedagogy (DTLP) Scale in the context of L2 education and examine its relationship with creativity and work engagement of EFL/ESL instructors, to try to bring loving pedagogy into the realm of language education research for the first time (Derakhshan et al., 2021b). L2 researchers are encouraged to immediately shift their attention to this fledgling area of study in light of the significance of love in language pedagogy.

To begin with, there has been a lack of attention to the emotional and personal investment of ESL/EFL teachers in their professional performance up to this point. In order to effectively teach a language, one must not only convey content and pedagogical knowledge while employing the most up-to-date teaching methods and techniques (Pishghadam et al., 2019), but also engage students on an emotional level by engaging them in meaningful dialogue and fostering an enjoyable learning environment (Xie and Derakhshan, 2021). Educators and trainers of future and current language teachers can benefit from the information presented in this paper by incorporating positive psychology and its associated factors into their training programs, workshops, and courses. Teachers-in-training can learn about the movement of positive psychology, its main tenets, its prominence in L2 learning and teaching, and the potential teacher or student positive variables that may contribute to desirable academic outcomes in such programs (Gabry-Barker, 2021).

Aiming to improve both teachers’ professional effectiveness and students’ L2 achievement and success, teacher educators should arm future language teachers with a solid foundation of knowledge about positive psychology concepts like flourishing under adversity, resilience, and positive emotions. Teachers play a significant role in creating a learning environment that can help students succeed academically, according to previous research (Dewaele and Dewaele, 2020). As a result, pre- and in-service teachers should be instructed on how to create a fun learning environment by showing respect and care for students, building on positive teacher-student interpersonal relationships, and increasing interest in the target language, which will help learners sustain their engagement with L2 learning.

It is equally important that the criteria used by teacher recruitment committees to select high-quality educators include not only their content and pedagogical knowledge but also their interest in and commitment to their own professional development, as well as their familiarity with emerging educational theories and movements (such as positive psychology and the broaden-and-build theodicy). The committees can, for example, inquire of the teacher candidates about the methods they plan to use to improve FLE in their students. In previous studies, it has been found that teachers’ encouragement and friendliness to students can help foster the development of FLE in the classroom (Mercer and Dörnyei, 2020). Teachers who are aware of how important positive teacher-student relationships, positive emotional experiences, and positive environmental factors play a role in students’ success can be targeted by the authorities in charge of recruiting effective language teachers.

Positive psychology studies in L2 education, as documented in the existing literature, have some limitations that need to be acknowledged. Many positive educational factors have yet to be thoroughly studied. According to MacIntyre (2016) and Kim and Kim (2021), some positive variables like L2 motivation have been extensively studied worldwide (e.g., MacIntyre, 2016; Kim and Kim, 2021). (Hiver et al., 2020a). Language researchers and practitioners are obligated to investigate various positive educational variables across cultures, instructional contexts, teachers’ instructional experiences, learners’ stages of development, or grad students’ linguistic proficiency. (Seligman, 2011; MacIntyre, 2021) (Pishghadam et al., 2021b). A single study may be able to examine the effects of more than one such variable on a specific individual’s variables simultaneously, even in the future.

As for data collection methods, most empirical studies in this area have been quantitative, with close-ended questionnaires used to elicit participants’ opinions and perspectives on the variables being studied (e.g., Derakhshan, 2021; Khajavy, 2021). Student engagement has traditionally been measured through self-report surveys and questionnaires despite the fact that a few qualitative studies have used qualitative data collection instruments (e.g. Pavelescu and Petri, 2018; Dewaele and Pavelescu, 2021). However, because of the inherent limitations of this type of data collection method, such as the possibility of data skewness, participant bias, and the lack of real-time data, they recommend that educational researchers use other methods such as observations, expert ratings of engagement, interviews, and real-time sampling methods, they recommend that they use. Since quantitative studies using closed-ended questionnaires can only yield limited amounts of real-time data, it is recommended that future researchers switch to qualitative or mixed-methods research in order to obtain a more comprehensive picture of the phenomena they are studying. A variety of instruments, such as narrative writing, audio journaling and field notes or diaries, can be used in these types of research methods. More studies can be done in the future examining the perceptions or experiences of a few individuals and obtaining rich data from them, rather than conducting large-scale studies that collect data from a large sample. Individuals’ perspectives, experiences, and behaviors can shift or remain stable over time as a result of longitudinal studies.

In addition, while research has been conducted all over the world, it has been focused on a single location. Only Dewaele and MacIntyre (2014, 2019) and Dewaele et al. (2019b) studies with international samples have empirical evidence on cross-cultural studies, which seek to unravel how individuals from different cultural contexts conceptualize, perceive, and experience positive emotions and characteristics. This is critical because culture is a major factor in shaping and reshaping our mindsets (Pishghadam et al., 2021a). The authors of this study and their co-researchers have begun a new series of cross-cultural studies on positive teacher, student, or institution-related variables such as teacher rapport, credibility, care, stroking behaviors (a type of teacher care), work engagement, psychological well-being, students’ willingness to attend L2 classes, L2 engagement, and loving pedagogy in the Iranian, Polish, and other cultures (e.g., Derakhshan et al., 2021a,b; Greenier et al., 2021; Pishghadam et al., 2021a). However, there is still a need to investigate positive psychology issues in other cultural contexts. As a result, future L2 researchers are urged to continue this line of cross-cultural positive psychology research and expand the established theories and areas of research across the world.

Fourth, technological advancements have impacted every aspect of human life, and language education is no exception. For today’s language students and teachers, the digital world opens up a world of possibilities. In times of crisis, such as the COVID-19 pandemic, where language instruction could be severely disrupted, online learning offers a convenient way to practice language skills with native and non-native speakers from a variety of cultural backgrounds (Wang and Derakhshan, 2021). In the literature on virtual language education, positive educational factors have a prominent place. Resilience, loving teaching, engagement, perseverance, and grit should be studied in both traditional and digital learning environments to understand how each of the two learning systems might affect language learning or teaching.

Few studies (Li and Xu, 2019) have examined how the positive psychology variables can be integrated into L2 education programs to improve key stakeholders, such as language teachers and students, in an effort to enhance their thinking and functioning. Studies have shown that positive traits like FLE, perseverance, and involvement can help students achieve their academic goals (e.g., Teimouri et al., 2020), but few studies have shown how these traits can be strengthened through intervention and instruction. Experimentation on a specific positive academic variable can be used to fill this research gap by exposing a group of language learners or instructors to the treatment and seeing how explicit instruction can enhance their perceptions and experiences.

There are many ways to incorporate positive psychology into L2 learning and teaching, but this conceptual review aims to show that it is still in its infancy. So this fertile area of research is eagerly open to empirical investigations on its under-represented aspects by language researchers around the world to precipitate the expansion of this line of research.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler, M.D. – Among the most recent developments are a better understanding of autistic people’s co-occurring mental health conditions, a growing evidence base for interventions to address these conditions, the development and implementation of new models of mental health services to support this population, and a substantial increase in mental health services and implementation research focused on autism. There is a lack of community-based mental health interventions for autistic people, as well as a shortage of qualified workers, a jumbled and disjointed system of mental health services, and disparities based on race, ethnicity, and socioeconomic status in access and quality.

Damian Jacob Sendler: Autism spectrum disorder (ASD) is a constellation of social communication difficulties and restricted, repetitive patterns of behaviors or interests that have strong genetic underpinnings and appear early in life. The prevalence of autism spectrum disorders (ASDs) in children and adolescents is on the rise, with the current US youth estimate standing at 1 in 54 [2]. There has been a lot of debate among autism researchers, practitioners, and self-advocates about whether to use identify-first or person-first language [3–4]. The autistic community’s rights and preferences were taken into consideration when drafting this review, which is why we opted to use identity-first language (e.g., “autistic person”).

Dr. Sendler: Across the lifespan, many autistic individuals have co-occurring mental health issues that necessitate transdisciplinary care. People with autism are more likely to suffer from disorders such as attention deficit hyperactivity disorder (ADHD), anxiety, sleep disorders, disruptive behavior and depression [11]. [11] Prevalence in clinically referred samples is significantly higher than in population-based or registry studies. A person’s quality of life can be harmed even more by co-occurring mental health conditions than by their core autistic characteristics [12]. Mental health issues persist and often worsen in adults, despite the fact that most studies to date have focused on autistic children [13–17].

It is important to examine and address co-occurring mental health conditions as well as the mental health service needs of autistic individuals, evidence-based mental health treatments, and capacity building for autistic individuals’ mental health services. [18, 19]. For autistic people of all ages, this review summarizes recent advances and ongoing gaps in quality mental health care. Because Medicaid-reimbursed healthcare and public education services are the primary sources of funding for autism care in the United States, we focus on findings from research conducted in these systems.

Mental health services include a wide range of treatments (including both medication and non-medication approaches) and resources (which address challenges to mental health, but may not be directly therapeutic). People who are in need of mental health services include those who have been diagnosed with a mental illness and those who need treatment for a variety of mental health issues. Psychologists, social workers, psychiatrists, primary care physicians, and other allied health professionals provide mental health services. Mental health services for autistic people can be provided in a variety of settings depending on funding, the severity of the client’s mental health needs, and other factors.

The prevalence of co-occurring mental health conditions, including trauma and gender dysphoria, has increased in autistic individuals, despite previous studies showing a high prevalence of these conditions [11]. For autistic individuals, there is growing attention to the fact that they have higher rates of suicidal thoughts and behaviors compared to the general population [20], with co-occurring mental health conditions documented as a risk factor for suicide attempts and deaths.

More attention is being paid to the mental health needs of autistic adults and females with autism, two groups that have been historically understudied and underserved as we learn more about the wide range of co-occurring mental health conditions. Adult autistics face a higher than average risk of mental health issues, with more than half meeting criteria for a co-occurring mental illness [14]. Primary co-occurring mental health concerns change over the course of development, making a lifespan approach essential. Depression and suicidal thoughts are more common in adolescents than in children [15, 22]. Autistic women, according to newly emerging research on gender differences, have higher rates of internalizing disorders [23] and experience particularly elevated rates of suicidal thoughts and behaviors [21, 24]. Autistic adults and autistic females face significant barriers in accessing quality mental health services, despite the prevalence of co-occurring mental health conditions and the resulting impairment they experience as a result.

Co-occurring mental health conditions in ASD have been the focus of intensive research to date [28, 29, 30]. [31••] For youth, this work has taken two approaches: (1) developing interventions specifically tailored to the needs of autistic individuals and (2) adapting existing evidence-based interventions (EBIs) for use with autistic youth. For example, tailoring or adding EBI elements to fit the unique characteristics and needs of the autistic individual (e.g., increasing parent involvement, adding visual supports, incorporating focused interests and using more concrete language) is the most common EBI adaptation. In order to improve the fit of the intervention, increase engagement, and promote the generalization of skills at home, these modifications are essential For autistic children who also suffer from anxiety, an EBI (cognitive behavioral therapy) tailored to their specific needs has been shown to have greater efficacy than either a standard EBI or treatment as usual [32].

Families of autistic children often need assistance in accessing and participating in mental health services. In order to increase access to diagnostic and intervention services, family navigation is an evidence-based case management practice that combines motivational interviewing, service navigation, and collaborative problem solving. [33, 34] ASD and co-occurring mental health needs are adapting family navigation [33, 34]. Co-occurring mental health needs have been identified, managed, or linked to mental healthcare in primary care settings by other service delivery models. People who are most at risk of health disparities can be reached easily by primary care. For autistic individuals, primary care may be less stigmatizing and more comprehensive than collaborative care models [35]. ECHO’s autism program [36, 37] and the Access to Tailored Autism Integrated Care model [38, 39] are two recent examples that are accumulating evidence of their feasibility, acceptability, and adoption.

Damian Sendler

Another recent development is the increasing use of implementation science methods, models, and measures in community mental health services to reduce the gap between research and practice. Transdisciplinary implementation science has emerged as a means of accelerating the uptake of evidence-based policies, practices and programs into routine healthcare systems. A similar gap in quality and access has been addressed in autism [40,41]. Thus, the field has begun to move beyond a “train and hope” model of translating EBIs into local practice. Adoption and maintenance of EBIs in service contexts require a focus on both the characteristics of EBIs and the use of systematic strategies to implement EBIs. An important part of this project involves the involvement of community partners and stakeholders. EBIs are made more feasible and acceptable in community settings through close collaboration with relevant community stakeholders, and they address community-identified needs or implementation gaps for organizations, providers, and autistic individuals. This is important. Both providers and organizations have made notable progress toward implementing EBIs with autistic children in community-based children’s mental health settings [42, 43••]. In addition, these efforts have used hybrid effectiveness-implementation designs that simultaneously focus on the clinical EBI and key implementation factors, processes, or strategies [45]. Using a combination of efficiency and implementation trial designs, we can both speed and improve the translation of research into routine practice and improve the quality of mental health services provided to autistic people. When applied to research translation, the use of implementation science frameworks and methods represents a significant step forward in ensuring that the significant efforts made to develop and adapt EBIs thus far have a beneficial effect on public health.

Damian Jacob Markiewicz Sendler: There are still many critical gaps in our understanding of autistic people’s mental health needs and mental health services. Few autistic people receive EBIs as part of their mental health treatment [46]. [46] People in the community may not use these practices because of a variety of reasons. There has been little focus on older and/or transition-age youth in the testing of most mental health interventions for autistic children and adolescents, according to a recent review [47]. To meet the mental health needs of autistic individuals, who typically have multiple co-occurring conditions, this narrow focus restricts our ability. The review also found that there was a lack of representation of community mental health service providers who are typical of the clinical workforce. There was a significant overrepresentation of white youth in the efficacy trials of cognitive behavioral therapy for autistic children, as well as a significant underrepresentation of Black and Latino youth and families from low socioeconomic status backgrounds [48]. Findings like these point to an important hole in our understanding of how these interventions work as treatments and whether or not they are appropriate for the wide variety of people who are treated for mental health issues within communities.

Most EBIs for mental health were developed and tested in academic or medical research settings with extensive expertise and resources [31••], as opposed to being developed for community implementation by providers with limited autism training and resources. As a result, these interventions are less likely to be adopted in community settings. As an example, an EBI may not have been designed to fit most community service delivery models because of its structure (e.g., length of treatment sessions) or delivery format (e.g., group-based).

The lack of mental health clinicians trained to work with autistic individuals is another major barrier to quality mental health services [25•, 49•, 50, 51, 52••, 53]. Due to their limited training and experience, mental health clinicians who regularly treat psychiatric conditions like anxiety and depression lack the confidence to treat these same conditions in autistic clients [25•, 50, 53]. Mental health clinicians who specialize in autism can be difficult to find, as they tend to be based in university or urban areas, where they are more difficult to access. Because ASD has traditionally been seen as primarily affecting children, providers who specialize in working with adults are more likely to lack autism-specific training [53].

Damian Jacob Sendler

As autistic people transition from youth-serving systems to adult-serving systems, there are difficulties in determining eligibility, accessing care, and aligning this with funding appropriateness [55]. For autistic individuals, these complexities are exacerbated because they may be eligible for additional autism-specific services that are typically funded differently than both general healthcare and mental healthcare. Such services as applied behavioral analysis (ABA) are frequently coordinated and funded by state systems for developmental disabilities. Applied behavior analysis and mental health services can be confusing to providers, caregivers, and autistic people alike, especially when it comes to determining which is more appropriate for an individual. Service reimbursement policies that distinguish between eligibility for developmental disability and mental health services may explain some of this muddle [56, 57]. Families of children with autism who also have mental health issues face a similar challenge, as the educational and healthcare systems don’t always see eye-to-eye, making it difficult to connect care and raising questions about how mental health services should be funded and delivered in schools.[58, 59]

Last but not least, the problems highlighted in this section are made worse for people of color and those living in poverty [52••, 60–63]. For autistic children, racial and ethnic disparities in access and quality of services have been found in a recent systematic review. Specifically, families of color and lower income reported reduced service access and quality and greater unmet service needs than white, higher-resourced families. In a study of Medicaid-enrolled autistic children, Black, Asian, and Native American/Pacific Islander children received fewer outpatient services relative to white children [65••]. In addition, a large statewide survey of autistic adults and their caregivers on a waiting list for home- and community-based Medicaid services found that Black autistic adults had significantly greater unmet needs for mental health services, relative to white autistic adults [66••]. These documented disparities for autistic individuals are not exclusive to mental health services (e.g., allied health services [67], healthcare transition services [68]). (e.g., allied health services [67], healthcare transition services [68]). In order to improve equity in the provision of evidence-based mental healthcare for autistic people, more research is required to identify and test structural changes.

Damien Sendler: We need a different approach to developing and testing mental health interventions (e.g., “designing for dissemination” [69, 70]) to address the issue that EBIs were not designed for community implementation. Using implementation science methods early in the research-to-practice translation pipeline can help ensure the uptake and sustainability of EBIs in community care [56, 71]. A crucial part of this procedure is the involvement of stakeholders from the community and academia [72]. Autistic people’s and their caregivers’ voices must be heard if services are to be made more accessible and of higher quality, according to new research [73,74]. There are numerous barriers preventing minority families from participating in research, which must be overcome in order for intervention research to be successful (e.g., distrust of the research process [75]). For autistic individuals, more research is required on cultural adaptations to EBIs. To ensure that the mental health intervention evidence base is applicable to autistic individuals and families from diverse and minoritized backgrounds, these collective efforts are essential.”

Second, we need more mental health clinicians and other professionals who are willing and able to work effectively with autistic people to address the limited capacity of the workforce. [25•] We recommend incorporating autism-focused curricula and training opportunities for healthcare professionals across the spectrum of specialties and mental health disciplines, from pre-service to post-service education. Co-occurring psychiatric conditions in autistic people, as well as the assessment and management of suicide risk, should be included in training [78]. Providers’ willingness and capacity to accept autistic people as clients or patients must be addressed through systemic/policy and organizational strategies as well (e.g., broadening or clarifying service eligibility to include autism in both youth and adult service systems, increasing dissemination of mental health EBIs for autistic individuals [79]). Autism is only one facet of the problem of a shrinking pool of qualified workers, and addressing it will likely necessitate major adjustments to preservice education, continuing education, supervision and reimbursement models.

Third, we need to integrate autism mental healthcare into existing systems and improve communication between systems in order to address the disconnected service systems. To address the current disjointed organization of public services, this process will involve developing and testing new policy and fiscal innovations [56]. Because autism care necessitates a multi-system approach, effective communication between systems is essential [80]. National Association for Dual Diagnosis [81] provides useful tools and resources for improving interagency collaboration, particularly between the mental health and developmental disabilities systems.

While acknowledging the impact of racism on autism research and clinical practice is important, we must also continue to focus on the needs of autistic people. It is possible to implement meaningful changes in policy, research, clinical practice and implementation science through the use of a number of recent articles [82–86]. Both race and place must be taken into consideration when promoting equity in autism research, service access, and care quality. For example, the underrepresentation of Black researchers and clinicians in the autism field must be taken into consideration. It is possible to promote systemic change and reduce inequities in mental health services by looking at autism research and clinical practice through a social justice lens.

It’s encouraging to see recent progress in autistic people’s mental health services and implementation research. It’s important to note that there are still significant gaps in access and quality in mental health services for autistic individuals, particularly those from low-income families and racial/ethnic minorities. Organizational and financial aspects of mental health services must be given special attention in order to implement this change. An overview of recent research and recommendations for addressing key issues is provided in this review, with a primary focus on publicly funded mental health services in the United States of America. Other service types and international efforts, particularly in low- and middle-income countries, could be the focus of future work. Co-occuring psychiatric conditions in autistic individuals have made significant progress, but we still need to work on developing community-based interventions that can be used, training and rewarding the workforce to provide them, and modifying policies to align with best practice. Autism research must take a systems- and equity-oriented approach if it is to close these gaps.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: There is a lack of information on older age bipolar disorder (OABD). Late onset (LOBD) and early onset (EOE) patients are the two major groups of patients with a history of mental illness (EOBD). The purpose of this literature review is to shed light on specific aspects of OABD, such as epidemiology, aetiology, and treatment outcomes. Bipolar disorder and the term “aged” or “geriatric” or “elderly” were used in a Medline literature search conducted between 1970 and 2021, using MeSH terms. Examining the cross-references and doing a hand search in textbooks led to the discovery of additional literature. Existing guidelines for treating OABD have concluded that it should be treated similarly to working-age bipolar disorder, with special attention paid to side effects, somatic comorbidities and specific risks of OABD. Lithium is a safe drug for OABD patients, both in mania and maintenance, if monitored and aware of possible toxic drug interactions. In bipolar depression, lamotrigine and lurasidone could be considered. Instead of second generation antipsychotics, mood stabilizers are the preferred treatment for long-term care. Treatment with electroconvulsive therapy (ECT) for mania, mixed states and depression is recommended in the event that medication is ineffective. Psychotherapy and psychosocial interventions may also play a role in the treatment of BD in old age. Lithium, antiepileptics like valproic acid and lamotrigine, and lurasidone for bipolar depression are all recommended treatments for OABD, though the evidence for these is still weak. OABD appears to be best treated with a combination of psychosocial and pharmaceutical interventions. An evidence-based treatment algorithm must include more research on the best pharmacological and psychosocial approaches to treating OABD.

Damian Jacob Sendler: The number of people over the age of 65 is expected to rise at an alarming rate. Since 1980, the percentage of people aged 60 and over has doubled. By 2050, the percentage of people over the age of 80 in developed countries will quadruple. Because of this, it is reasonable to assume that the number of elderly patients with bipolar disorder will increase in the same way.

Dr. Sendler: Few studies have been conducted on geriatric mania or bipolar disorder (BD). Adults and adolescents of working age were the focus of previous large epidemiologic studies in BD (e.g. Mania in old age was previously thought to be less prevalent, making it less of a focus for research [2,3,4]. It was assumed that the overall prevalence of bipolar disorder in the elderly was much lower than the 1 percent found in the general population.

When it comes to the rate of diagnosis change from unipolar to bipolar I, Angst and coworkers [5] found that the rate of change was only 1.5%. Older age bipolar disorder (OABD) would rise, while unipolar depression would decline. The prevalence of bipolar disorder in older patients differs only slightly from the prevalence in younger patients, according to a record analysis of 35,000 community patients [6]. According to more recent epidemiological studies, between 0.5% and 1.0% of people over the age of 65 have bipolar I or II disorder [7,8]. In particular settings, such as nursing homes, the prevalence has been found to be 3–10 percent [9,10]. Older inpatients with psychiatric disorders have a 6-percent incidence of manic episodes, with 44 percent having a late onset of mania. As many as 25 percent of the bipolar population (aged 60 or older) are elderly patients, and 70 percent of the elderly bipolar patients are female. The subgroup known as late onset bipolar disorder (LOBD) is made up of patients who first experienced manic symptoms after the age of 50, according to several studies [7,10,13,14]. The so-called “early onset” patients are a second subgroup of elderly BD patients with a long clinical history (EOBD).

Research on the age at which people become vulnerable to developing bipolar disorder has been sparse, with only a few studies focusing on this issue. According to the age at which the primary symptoms of BD appeared, Bellevier and colleagues [15,16,17] divided their patients into three categories: early, middle, and late, with mean age at onset of 17, 27, and 46 years, respectively. There were distinct and homogenous groups in terms of clinical symptomatology and genetic vulnerability factors within each of the two groups studied. A similar phenotype distinction was made by Azorin and colleagues in patients with early, middle, and late-onset BD [18].

It is the goal of this educational literature review to summarize the still limited knowledge of OABD and its epidemiology, aetiology, and treatment outcomes.

OABD patients, it is generally agreed, are a diverse group. LOBD and EOBD are two of the most prominent groups.

However, a consensus has emerged that the age at which an individual’s OABD transitions into adulthood is around 60 years old [10,19]. Isbd’s taskforce suggests that the cut-off point be set at 50 years, given the reduced life expectancy in BD and to avoid only studying “the healthy cohort who survive into what our society generally considers elderly age (60+ and beyond).” Similarly, there is some ambiguity about the cut-off point for EOBD and LOBD within the OABD group, as brain-morphological changes due to neuroprogression begin much earlier in life. According to [19], the ISBD taskforce recommends setting a 40-year age limit between EOBD and LOBD.

EOB and LOB are two distinct forms of BD. Bipolar II disorder is more common in LOBD patients than EOBD patients, according to one study [21]. One’s genetic predisposition to the disease is strongly linked to one’s family history, while the opposite is true for those with LOBD. In a retrospective study of 50 mania patients over the age of 65, for example, 28% of the patients had their first manic episode and 71% had a comorbid neurological disorder [27]. There is, however, a discrepancy in organic factor data. It was noted by Almeida and colleagues [28] that only a small percentage of elderly bipolar patients had a detectable organic substrate. Differences between the two groups, according to the authors, are more likely to be explained by differences in illness duration and progression, with organic conditions in LOBD patients having less clinical significance. Because neurological symptoms are often subtle and, with an obvious psychiatric symptomatology, the majority of patients might not undergo in-depth somatic diagnostics, it’s possible that only a small percentage of LOBD patients — in Almeida and colleagues’ study, 2.8% — are diagnosed with organic affective disorder. According to the DSM-5 [29], a bipolar diagnosis can also be made in the presence of another medical condition (i.e., “bipolar and related disorders due to another medical condition”), thereby avoiding this diagnostic dilemma. Although this approach may be useful in the clinical setting, further aetiological research is clearly incompatible with this method.

When it comes to early-onset breast cancer (EOBD), genetic risk factors appear to play a significant role, but the same cannot be said for late-onset breast cancer (LOBD). Adverse drug effects, including those for somatic conditions, such as inflammation and neoplasia, stroke or head injuries, play an important role in the development of LOBD [30–31]. Mania secondary to a drug, metabolic, or somatic condition is defined as a full-blown manic episode that meets categorical diagnostic criteria [33].

Some studies have found that up to 43 percent of older adults who suffer from mania have symptoms of a brain disorder. According to a study by Subramaniam and colleagues, LOBD patients had significantly more risk factors for cardiovascular disease than EOBD patients [39]. Unipolar depression is a risk factor for cerebrovascular disease and dementia in later life, as well as for depression itself. Each new episode of depression increases the risk of developing dementia, according to Kessing and Andersen [42]. Dementia develops in about one-fifth of OABD patients, which is more than three times the percentage of age-matched controls (7%) [43]. Alzheimer’s disease and vascular dementia are the most common conditions afflicting those with BD. Patients with LOBD may be at a greater risk of developing dementia than those with EOBD, as LOBD patients already exhibit greater cognitive impairment than EOBD patients. Verbal memory and executive function are two areas in which LOBD patients have a hard time. Semantic fluency is also worse in LOBD patients compared to EOBD patients [44].

Damian Sendler

So far, there isn’t enough evidence to say whether or not OABD has a better prognosis or a worse course than BD in people of working age. Older people have more time spent depressed and less time in manic or mixed states of mind, according to the BD polarity shift hypothesis [45]. Psychotic and mixed symptoms are more common in older adults than in younger people [10,46]. Although OABD patients appear to respond and recover similarly to younger patients in the short-term, in general and regardless of age, there is strong evidence of a progressive and deteriorating course over the course of a lifetime, with increasing sensitization leading to more relapses following every mood episode [49, 50, 51]. In accordance with this, a large naturalistic study found that OABD sufferers may be more susceptible to relapse or recurrence. It has also been found that the inter-episode intervals between subsequent episodes are getting shorter [52-53-54]. A comparison of the long-term course of OABD patients and working-age BD patients yielded only minor differences in the long-term outcomes. The average duration of follow-up was five years. Depressive, manic, and mixed symptoms accounted for 15% of the follow-up time for OABD patients (61.6 years 8.3 years), and 4.2 2.6 episodes per year were observed in this group. In the multivariate analysis, there were no significant differences between OABD and BD in working-age patients in terms of episode density or mood instability. Subsyndromal manic symptoms were found to have a greater impact on functional outcomes in OABD than in the control group. OABD patients have lower hospitalization rates, which may be due to a decrease in the severity of subsequent episodes [56] as well as a decrease in suicide rates [10,37,57], both of which are likely due to the fact that elderly patients are a more carefully selected survival cohort.

There are more severe and atypical symptoms in the first manic episode for patients with early-onset bipolar disorder (EOBD) compared to those with later-onset bipolar disorder (EOBD). When compared to EOBD mania, LOBD mania typically has fewer and milder manic symptoms [61]. LOBD patients, on the other hand, are more likely to be irritable, develop treatment resistance, and die earlier [62].

There is a lack of consistency in the data on suicidality. Suicidality rates have been found to be higher in EOBD patients compared to LOBD patients in both directions [60, 18].

Overall, it appears that the acute—especially manic—symptoms are more pronounced in EOBD, while maintaining cognitive functioning is more difficult in LOBD patients [26]..

Azorin and colleagues’ study, which has already been mentioned, found that BD patients with early, middle, and late onset showed distinct phenotypes [18]. There were more single young men in the early onset subgroup who had severe mania and psychotic features, a subcontinuous illness with substance use and panic comorbidity, a higher rate of suicidal thoughts, and temperamental components that shared hypomanic characteristics with the general population. Those who had symptoms that appeared later in life had a milder profile, with more depressive temperaments, alcoholism, and other medical conditions. It’s possible that differences in illness characteristics may also lead to differences in educational attainment, stable relationships, social adjustment, and resources to cope with the disease; however this hypothesis must be backed up by data before it can be considered a fact.

Damian Jacob Markiewicz Sendler: Patients over the age of 65 or 70 are typically excluded from BD medication studies, which focus on patients in the working population. Until now, there has been no large-scale, randomised and placebo-controlled study on the efficacy and tolerability of medication in OABD patients. Neither EOBD nor LOBD were mentioned in any of the cited studies. Consequently, it is not clear whether there is a difference between the two groups in terms of their response to pharmacotherapy and the side effects of their medication.

There were two randomized, double-blind comparison studies in acute mania in the Medline database (comparing lithium to valproate [63] and lithium to memantine [64]). To round out our research, we found a post-hoc analysis [65] that combined the results of two studies testing quetiapine monotherapy in patients under 55 years of age, in addition to one looking at bipolar depression (the results of two placebo-controlled studies testing lurasidone for six weeks, each randomized and double-blinded]) and one looking at maintenance (a post-hoc analysis of two double-blind maintenance studies comparing lamotrigine, lithium and a placebo [12]). A few guidelines have been compiled on the management and treatment of BD in old age, despite the lack of evidence (e.g. First-line treatment for old-age BD should be similar to that for working-age BD, with special consideration for patients’ vulnerability to side effects, somatic comorbidities, and specific risks in elderly patients, such as the use of antipsychotics in cerebrovascular disease [71]. [71].

A randomized, controlled comparison study against valproate found that lithium and valproate were both equally effective in treating acute mania [63]. There were no significant differences in length of stay or improvement in symptoms between patients receiving lithium, valproic acid, or carbamazepine as monotherapy [72]. Lithium and valproic acid both had comparable antimanic effects in a retrospective study conducted by Chen and colleagues [73]. STEP-BD data also support the use of lithium; 79 percent of elderly patients with bipolar disorder achieved remission after 8 weeks, and 42 percent of these had lithium prescribed as a monotherapy. Other open studies have shown that valproic acid alone or in combination with lithium can be used as an acute antimanic agent. Study in 70 elderly bipolar patients with acute psychosis who were taking valproic acid and memantine found that memantine reduced the YMRS score significantly, but there was no improvement in cognition [64]. Pooled data from two quetiapine monotherapy clinical trials also showed quetiapine to be superior to placebo in patients under the age of 55 years old [12]. Asenapine, carbamazepine, gabapentin, and clozapine have also been shown to be effective in the treatment of geriatric mania [83, 84, 85].

Damian Jacob Sendler

After 12 weeks of treatment with an open-label combination of lamotrigine and another antidepressant, the results were promising, but further controlled studies are needed to confirm these findings [86].

Lurasidone is effective in the treatment of acute bipolar depression as a monotherapy, but not in the treatment of refractory patients, according to a post-hoc analysis. There were two 6-week, randomized, double-blind studies with placebo controls: one on monotherapy [87] and the other on lithium or valproic acid as an add-on treatment [88]. In the OABD, where the MADRS score changed from baseline to endpoint, lurasidone was found to be superior to a placebo in the monotherapy study. The adjunctive lurasidone and a placebo showed no difference in the second study.

Damien Sendler: Antidepressant controlled studies in elderly with acute bipolar depression were not found. OABD patients have a lower natural chance of experiencing a manic recurrence, which may make them less vulnerable to manic switches than younger patients [45]. Although serotonin-reuptake inhibitors (SSRIs) are generally well tolerated and safe, additional health benefits, such as a reduction in mortality from myocardial infarction [89], may also be gained from their use.

Inflammation, oxidative stress, and mitochondrial dysfunction have recently been linked to the progression of BD [90]. A four-week open add-on study in geriatric BD patients with depression found that Coenzyme Q10, a mitochondrial modulator and antioxidative substance, significantly reduced MADRS scores [91]. However, there are no further confirmatory studies.

The treatment of choice for mania and depression when medication fails is electroconvulsive therapy (ECT), which can also be used as a continuation treatment [93]. ECT has been shown to improve both mood and cognitive symptoms in elderly patients with unipolar depression [94,95,96]. Older people with bipolar disorder (BD) who are resistant to medication, refuse fluids and food, or have severe suicidal thoughts could benefit from ECT, according to Greenberg and Kellner [97]. Research into the efficacy and safety of ECT in elderly patients with bipolar disorder (BD) is needed, however.

OABD patients may have fewer clinically significant manic mixed episodes because the polarity shifts with age, with more time spent in depression and less time spent in manic or mixed states; however, older studies report similar figures of mixed features in OABD and younger BD patients [46]. However, Young and colleagues [63] also randomized 28 mixed patients, but this sample size was too small to allow for a separate analysis of their findings. As a result, it’s still not clear if patients with OABD and mixed states should be treated differently than those with BD who are younger.

OABD has not been the subject of a controlled randomized maintenance study. 98 patients with BD-I, aged 61.0 6.0 (range 55–82), were studied in two double-blind maintenance studies comparing lithium, lamotrigine, and a placebo [98,99]. The only reasonable evidence comes from this post-hoc analysis. The most important result was the reduction in the amount of time needed to intervene in the event of an impending mood episode. After adjusting for an index episode, there was no difference between the three arms in terms of preventing any mood episode. To prevent depressive episodes, lamotrigine was superior to lithium (p=0.01), but lithium did not differ from placebo (p=0.08) in this comparison. When compared to a placebo, lithium (but not lamotrigine) significantly prolonged the time until intervention for a manic/hypomanic/mixed episode. After adjusting for an index episode, the results were insignificant.

Lithium had no effect on either mania or depression in OABD patients despite this study’s findings that lamotrigine is an effective treatment for depression, but not for mania. First-line treatment for OABD maintenance is considered to be lithium, which has been shown to be effective in preventing depression and mania.

Antipsychotic drugs in the maintenance treatment of OABD have only a small body of evidence to support their use [101]. Treatment discontinuation, switch, adjunctive medication, hospitalization, suicide attempt, and death in a historical BD cohort were studied by Tournier and colleagues [102] using the French national health database. Both mood stabilizers and second generation antipsychotics (SGA) were used to treat the patients in this study, as well as a combination of the two classes in some cases. SGAs were found to have a higher failure rate than mood stabilizers among patients ages 65 and older (n = 3862). Early discontinuation, psychiatric hospitalizations, and death occurred more frequently in SGA patients. Patients who received SGA as a monotherapy or in combination with mood stabilizers died at higher rates than those who did not [102]. Death rates may be negatively impacted by the metabolic syndrome-related effects of several atypical antipsychotics [103,104]. As a result, mood stabilizers rather than SGAs appear to be the treatment of choice for OABD in the absence of convincing evidence for their use in elderly BD patients.

However, there are important safety considerations for OABD when using mood stabilizers. lithium has been shown to have a negative impact on renal, thyroid, and parathyroid function in the elderly, and this may pose a problem. It has also been found that valproic acid can cause kidney failure [105]. When renal function stops, the dosage of lamotrigine needs to be adjusted. As far as side effects and safety are concerned, we recommend that you consult the comprehensive literature [19,106,107] for more information. In addition, older people are more likely to be prescribed drugs for somatic disorders in addition to those for mental health issues. Toxic symptoms can occur when lithium is administered in combination with angiotensin converting enzyme (ACE) inhibitors, calcium antagonists, thiazide diuretics and loop diuretics, COX-2 inhibitors, and non-steroidal anti-inflammatory drugs [108]. Aspirin, digitoxin, phenytoin, and lamotrigine all interact with valproic acid, and these interactions must be considered [109].

Cognitive behavioral therapy, psychoeducation, family-focused therapy, and interpersonal and social rhythms therapy are some of the best-evidenced psychotherapeutic approaches to BD [110]. There is less evidence that psychotherapies are effective in the treatment of bipolar disorder in OABD. The treatment of choice for older adults with bipolar depression (e.g. [111,112]) appears to be a combination of psychosocial and pharmacological treatments, as it is for working-age BD patients, with similar response rates. There is a clear need for a psychoeducational approach in older BD patients, as Cruz and colleagues found that non-adherence and a lack of knowledge about bipolar disorder and the need for treatment were significantly worse [113]. For middle- and older-aged adults, Depp and his colleagues developed and tested a medication adherence program. According to their pilot study, their psychosocial program was found to be effective in improving not only adherence, but also depressive symptoms and quality of life. OABD may also benefit from newer psychotherapeutic techniques that incorporate the use of technological devices. Fortuna and colleagues showed that older adults with serious mental illness and limited technical abilities can use smartphone apps for self-management if they are designed appropriately [115]. [115]

Further studies are urgently needed on this under-researched patient population. According to the consensus, the OABD patient population is multifaceted, with LOBD and EOBD being the two main groups of patients. When it comes to treating alcoholism, current studies don’t differentiate between alcoholism with alcohol dependence (EOBD) and alcoholism with alcohol dependence (LOBD).

Lacking data, current guidelines recommend treating older adults with obsessive-compulsive disorder (OABD) as if they were younger adults with BD, paying particular attention to their vulnerability to side effects and somatic comorbidities, as well as their specific risks.

Lithium is a safe drug for the treatment of manic episodes as well as for the maintenance therapy of OABD if it is monitored regularly and properly. Lamotrigine and lurasidone have some evidence for use in the treatment of bipolar depression. There have been no controlled trials on the use of antidepressants for OABD, but SSRIs are well tolerated, safe, and may have additional health benefits. In the case of OABD mixed states, no recommendations can be made. When it comes to OABD maintenance therapy, mood stabilizers rather than SGAs appear to be the preferred medication.

Electroconvulsive therapy is the treatment of choice for both mania as well as depression when medication fails.

For OABD patients as well as for young BD patients, psychoeducation is essential. For OABD patients and for maintenance, combined psychosocial and pharmacological treatments appear to be the treatment of choice. It remains to be seen whether treatment algorithms for EOBD and LOBD should differ or whether more research into OABD in general is required.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: Humans have a fundamental right to health, which is rooted in our values as a fundamental necessity of life. Individuals, families, communities, and the economy all benefit from it. The world was caught off guard and unprepared when the coronavirus disease-2019 (COVID-19) pandemic broke out. Everyone’s health and economic systems were put to the test. Several ethical questions have been raised about the management of human endeavor and liberty, particularly public health control measures. Anxieties and panic drive decisions on pandemic control measures, which are complicated by the need to prioritize public good over individual rights. 

Damian Jacob Sendler: In order to control the pandemic, global cooperation is being put to the test. It is the duty of national governments to safeguard the public’s health because it is in everyone’s best interest. The best available epidemiological data from pandemic disease dynamics should not be used as a basis for making decisions based on political considerations. There is a strong emphasis on honesty, trust, human dignity and the importance of adherence to values such as solidarity and reciprocity as well as accountability, transparency, and justice. Academic databases and health-related organizations’ websites were searched for relevant publications. When it comes to dealing with the COVID-19 pandemic’s ethical issues, I use the standard ethical principles of autonomy respect, beneficence, nonmaleficence, and social justice (fair distribution). 

Dr. Sendler: WHO guidelines are used to control the pandemic at the country level, it has been observed. The complex bottlenecks of allocation and distribution need to be addressed as WHO distributes vaccines to less developed countries through the COVAX strategy. Vaccines must be distributed in a fair and equitable manner throughout the world, and a fair and transparent system is needed to make this possible. 

First, the current SARS–COV–2 pandemic is the third known pandemic of an animal coronavirus resulting in a severe acute respiratory syndrome (SARS-COV–2 [COVID-19]). 

[1] In light of the COVID-19 pandemic, world leaders, policy-makers, and public health authorities have been compelled to make ethically challenging decisions about public health containment measures. COVID-19 is a topic of ethical concern to the public health community on a global scale. Against the backdrop of the various values and norms that democratic societies present, decisions made under democratic norms must be justified and communicated in a transparent manner. Ethical accountability is crucial in this situation as well. As a result, making tough choices, including trade-offs, is unavoidable. Public health ethics has a wider dimension of not only health and disease but also of social justice and public trust. The centrality of public goods, freedom, justice, reciprocity, and solidarity are also emphasized in this statement. [2,3,4] Biologically, pandemics have a wider social, political, and cultural dimension. [5] 

One can see this in action in the COVID-19 pandemic, where politics openly clash with science (epidemiology). It is unavoidable that ethical dilemmas will arise in the face of the ongoing pandemic. Science must be respected and listened to in this situation because the public health measures being implemented to counter the pandemic are in everyone’s best interest. However, the most important aspect of science is the application of value judgments. [6] Responsibility to care, health, non-discrimination, equity, severity and liberty must be taken into account when making decisions during pandemics. Public protection from harm must also be taken into account. Public trust must also be taken into account. Since more and more epidemiological facts are emerging about the COVID-19 pandemic, it is critical that public health authorities and political decision-makers communicate their responses to the pandemic in a way that is transparent, accountable, and well-justified. [7,8,9,10] There must be mechanisms in place that allow for two-way feedback on pandemic control measures, lockdowns, and their impact on citizens in order to encourage compliance. [2,11,12] This is critical because the measures have a disproportionate impact on various public sectors. 

Damian Sendler

We are all interconnected in a globalized world, and the pandemic has exposed our human frailties. There is no one nation capable of mounting a sufficient response to control the pandemic. An effective and timely notification of an epidemic to the international community obligates countries to help prevent the disease from spreading. [13] Reciprocity and solidarity impose a duty on countries that are not directly affected by the pandemic to provide logistical support to countries that are. 

There’s no better time than now to reflect on how ethics in health care settings has fared as the world adjusts to the “new normal” situation created by the COVID-19 pandemic. Public health ethics considers not only the health of the population, but also the impact of social, political, religious, legal, economic, and societal structures on health and other issues. Because of this, it is imperative that the global response to the pandemic be organized and coordinated. 

As the world faces or is affected by serious infectious diseases, ethical and legal questions will continue to arise. A growing awareness of the ethical implications of public health issues has emerged as a result of recent pandemics of HIV/AIDS in the 1980s[14], multi-drug resistant tuberculosis in the 1990s[15], and the SARS pandemic in 2003[16,17]. When the outbreak of COVID-19 began late in 2019, like SARS, the world was taken by surprise, as there was initially no specific case definition, no diagnostic test kits, and to date, no effective treatment for the disease. 

Damian Jacob Markiewicz Sendler: WHO says the disease’s epicenters are in the Americas (the United States and Brazil) and Asia Pacific (India), where there have been over one million cases and tens of thousands of deaths as of the time of this writing. First wave of pandemic “apparently” finished, with some countries entering second wave and others transiting into third wave. Despite this, epidemic curve has not been flattened. Evaluation of the global public health response to COVID-19 should focus on surveillance and isolation as well as social seclusion, travel restrictions, universal masking and traceable contact (CT). Ethical and legal principles that will guide future public health approaches or interventions, as the world faces the second wave of the pandemic, and even prepare for the future, will be based on this empirical evidence Public health measures frequently raise complex questions about the relationship between the state and its citizens and organizations affected by public policies. [8] As a result, maintaining public trust and confidence may be made easier by focusing on ethical issues during the outbreak and adopting an ethical approach. 

The following are the four cardinal ethical principles that should guide everyone involved in health care: Respect for autonomy, beneficence, non-maleficence, and fairness in the distribution of resources. [19] Medical professionals’ ethical obligations must be demonstrated in their actions. Other important public health ethical principles come into play during a pandemic, such as the obligation to protect public health, the duty of care and public goods, and the rights of individuals to privacy and freedom of expression. [2] 

Even though the harm principle[20] restricts individual choice during epidemics and pandemics, it is critical to protect human dignity at all costs. Fairness and justice must be upheld throughout the process. People should be treated with dignity and fairness in society at large. Risk should be minimized to the greatest extent possible when implementing pandemic control interventions. 

The ability to effectively communicate risk and other critical information is critical to gaining public trust and confidence in the response to the contagion. Citizens need timely, open, and honest information in order to make well-informed decisions about their lives.[21] Ensuring timely and accurate information as well as technical explanations for decisions taken are available to support informed reporting requires active media engagement. [2] It is emphasized that authorities should neither downplay the risks that may lead to higher rates of preventable infections with consequent excess morbidity and mortality, nor overstate the risks that may lead to panic or a lack of public trust and its aftermath. 

COVID-19 has been declared a public health threat, and the government has additional legal powers to control the disease once it has been declared by the government to be a serious and imminent threat. 

[22] If an infected member of the community poses a threat to public health, the state has a responsibility to take public health measures such as restricting movement, quarantine, and isolation. These measures may restrict freedom in the short term, but they are necessary. 

Damian Jacob Sendler 

For public health interventions, epidemiologic data are critical. Data collection that does not reveal a person’s identity (anonymized data) is needed for this, but it is not considered intrusive. Individuals’ right to privacy is violated if nonanonymized data is used. Against this backdrop, it’s important to remember that collecting non-anonymized data about individuals, even without their consent, may be ethically justified if it prevents significant harm to others. Health care providers can report cases of notifiable diseases (COVID-19) to authorities as part of their “duty to care” and “common good” obligations. In this case, there is no need for permission from those who have been infected, and the data can include personal identifying information. Surveillance as a public health tool and privacy claims have been questioned as a result. [23,24] The use of pandemic surveillance data for research may pose ethical issues, such as the ownership and copyright of the information. [25,26] 

Dr. Sendler: In order to effectively control any infectious contagion, contact tracing (CT) is essential. A lack of preparedness and adequate information led to the inability to trace exposed/suspected cases during this current COVID-19 pandemic. There are a number of issues that need to be addressed, including people who are unwilling to provide correct contact information upon arrival in the country, the sensitive nature of providing personal data that may infringe on an individual’s right to privacy, fear of stigma, and forced isolation or quarantine in unsanitary facilities. It’s possible that asymptomatic people will find it difficult to accept this. Digital technology has provided us with an enabling environment to develop CT apps to ease this process. COVID-19-related information may be provided by these apps; quarantined individuals may be monitored and their movements traced; users may be warned of their potential exposure to SARS-COV-2 and the virus’ transmission dynamics may also be assessed by these apps[24,27]. Ethical and moral questions have arisen as a result of the widespread use of these apps, including concerns about data security. 

Digital surveillance technologies, including CT apps, have been examined as part of the COVID-19 pandemic response by advisory bodies and experts. 

[28] An important consideration is how to strike a balance between the rights of individuals and the interests of the community at large. When surveillance data is made public, as with SARS, it can draw unwanted attention and even harm to people of a certain ethnicity or nationality. [29] There was a lot of negative connotation attached to the disease because it originated in China. Discrimination, stigma, and racism against Chinese citizens were also evident in the United States. Stigma, group prejudice, restriction of movement, universal masking (wearing a mask in public places), and other activities must be addressed with sound political judgment based on scientific evidence as the number of cases from the pandemic continues to rise around the world. 

In public health practice, these two preventive measures have been used for a long time. In the past, a variety of interventions were used to combat various infectious diseases. Factors such as the pathogen’s mode of transmission, infectiousness and infectivity (virulence), the time it takes to incubate, and the risk groups it affects must be taken into account. 

Venice, Italy, made history seven hundred years ago when it established the modern basis for dealing with pandemics by creating a massive public health response. 

[30] What happened in Europe during the Black Death (Bubonic plague) and how the Republic of Venice used quarantine to contain the scourge is an excellent example of good public health practice. [30,31] The Venetian Islands of Lazzaretto Vecchio and Nuovo were turned into places of quarantine and seclusion during the Second World War, respectively. As a result, it is understandable that the two terms are frequently used as synonyms. Restrictions on a person who is known to be infected are referred to as “isolation.” Patients with COVID-19 were initially treated in specialized isolation units. People were advised to self-isolate at home and only the most serious cases were taken to the hospital for monitoring and treatment as cases grew in number. However, a healthy person or group suspected of having been exposed to an infectious disease (COVID-19)[20,32] and developing the disease is subject to quarantine (Italian word-quaranta, which means “40 days”). 

Restrictions on travel are also common in the United States when it comes to quarantine. Quarantine and isolation can be done voluntarily or in accordance with the letter of the law. [32] SARS epidemic in 2000–2003 necessitated isolation, quarantine, surveillance, CT and restrictions and/or advisory warnings on travel by the World Health Organization (WHO). The quick interruption of transmission was attributed to these strict measures. Some people questioned whether or not these measures violated people’s personal liberties in the name of reducing disease risks for others. [20] 

It’s upsetting that the current isolation and quarantine policies around the world have resulted in so many problems. Because of human nature and/or behavior, some situations necessitate the use of forced restrictions, even if they are preferable to voluntary restrictions. Is it possible for an individual to influence a state’s decision to declare a threat to public health during a pandemic? To what extent do those who have been infected have the right to choose where and how they are quarantined? How much help do these people get while they are in a state of isolation? 

Consider the ethics of limiting social contact or freedom of interaction in this context. A legitimate and fair process is defined by the government’s health authorities in this case. Key elements of a fair process, however, include openness about the decision-making process, appeals to reasonable health care rationales, and procedures for revising decisions in light of challenges. [35] 

Disclosing the reasons and rationales behind decisions is essential to a fair process. When it comes to the administration of justice, no information should be kept a secret. Decisions are more likely to be accepted and adhered to if people understand the reasoning behind them. [36] Misconceptions about those in quarantine and isolation must be dispelled through public education in order to keep them from being stigmatized and harassed. 

One of the most important non-pharmaceutical public health (non-pharmaceutical) preventive measures in the fight against the spread of COVID-19 has its own set of challenges in the context of its implementation. Our social interactions have been profoundly altered as a result of lockdowns and social distancing measures. The days of handshakes and hugs with people in person are over. The long-standing social norms that were once a part of life on Earth have all but vanished as a result of the various degrees of social distance experienced around the world. 

Although the World Health Organization (WHO) recommends a distance of 2 m, in practice this has been between 1 and 2 m. While it is not autocratic to demand that people maintain physical distance in order to save lives, requiring it without providing the means to do so is autocratic. One meter of physical separation reduces risk by 82% in medical and community settings, according to a lancet report. At a distance of 1 meter more, the relative protection is increased by more than twice as much. [38] 

Locating available real estate is a major challenge in urban areas with high densities, especially in developing countries (or developing countries). There are many instances where individuals have chosen to exempt themselves from the measure based on their own understanding of the risk. Is it fair to open markets and shopping malls while keeping places of worship and educational institutions closed to the public? Is there a right of choice for an individual in this situation, given that the order has already been enforced and determined? Can those living in IDP camps who have been displaced by natural or man-made disasters be punished for disobeying these rules? To what extent is it just and fair to apply a common sanction to those who, for reasons of ignorance or incompetence, failed to observe the social distance? The COVID-19 pandemic has raised a number of ethical issues. 

For symptomatic cases, this can be used as a stand-alone test, or as part of a CT scan for suspected cases. According to the World Health Organization’s declaration on January 30, 2020 that a global pandemic public health emergency had been declared, both developing and developed countries had reported a lack of preparedness for testing. Taking standardized tests can be agonizing for those who are subjected to the stress, anxiety, and social stigma that go along with it. 

What is the reward or incentive for those who test positive for a disease that has no known cure? A positive patient who has travelled hundreds of kilometers in a country that does not even have basic information on its citizens is difficult to track down as people continue to defy travel bans. What incentive is there for volunteers (like whistle blowers) who provide information about their contact with known positive cases without fear of force or coercion? Whether or not the testing is voluntary or mandated. Is it permissible for an asymptomatic person to refuse testing? Is it fair and reasonable to conduct mass testing as a public service?? Is it possible to have an effective, well-coordinated CT program to contain the pandemic now that we’ve gone so far into community transmission, given the current testing strategy? As the restrictions on lockdown are eased, this will be an even greater challenge. 

When it comes to the development of COVID-19 vaccines (COVAX), the virus and humanity are at odds. It is a moral and ethical obligation for humanity to vaccinate the world in order to ensure that everyone is protected from disease. All people around the world must unite in a global effort against the COVID-19 pandemic and treat the vaccines as global public health resources. When it comes to containing the COVID-19 virus, the world has paid little attention to the shared mission, vision and sacrifice. We will face a test of humanity if we don’t make vaccines widely available, accessible, and affordable. [39] There is a possibility that vaccinating the entire world could serve as a barometer. 

COVID-19 vaccines were initially concerned, and a recent report from the United States found that only 49% of Americans planned to be vaccinated against SARS-COV-2. 

[41] It was because of a lack of trust that these fears were born. [42,43] One of the biggest obstacles to successfully vaccinating the entire population against diseases like COVID-19 is vaccine hesitancy. Covid-19 vaccines, on the other hand, were developed at a rapid pace, raising guanine concerns about the vaccine’s safety. The World Health Organization has ranked it as one of the top ten global health threats. [43,44] Getting vaccinated is influenced by a variety of factors, including a person’s sense of civic duty and social solidarity. 

It is clear that we live in a globally interconnected and solidaristic society as the COVID-19 pandemic continues to test our global interconnectedness and solidarity. Public health ethics, individual rights and liberty, and human rights have been questioned by the pandemic. The adoption and implementation of pandemic response policies must be based on soundness, transparency, and responsiveness to ensure respect for these ethical values and principles. [55] Adopting a cooperative, equitable, and fair global distribution strategy for COVID-19 vaccines has been shown to improve economic and health outcomes. [56] 

The importance of ethical standards and accountability is magnified during times of crisis. There is a duty of care for health care providers, governments around the world, and policymakers to protect public health. As a result, the COVID-19 pandemic can be contained thanks in large part to the numerous public health precautions put in place. 

It is morally correct to prioritize the well-being of the greater good. The pandemic necessitates difficult, but unavoidable, political and social choices that are both ethically significant and complex. Governments have a responsibility to ensure public trust by providing timely and accurate information and allowing for open discussion on all decisions made. 

Last but not least, governments must ensure that those who are subject to restriction orders receive the basic necessities in an equitable and nondiscriminatory manner. Even though the WHO guidelines may not be a one-size-fits-all model, each country’s context should be taken into consideration. 

The WHO COVAX program is a good first step toward ensuring that vaccines are available to all, particularly in less developed countries. COVID-19 pandemic can be controlled fairly through our shared human values, responsibilities, and equitable and cooperative strategies by all nations of the world to promote long-term well-being and development. 

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: COVID-19 has had a major impact on the mental health care system. In terms of preventing the spread of the virus, treating patients with COVID-19 in an inpatient psychiatric setting presents numerous difficulties. At the New York City-based Gracie Square Hospital, a freestanding mental health facility, patients with COVID-19 who require inpatient psychiatric care have their own specialized wing. Treatment refusal, difficulty complying with safety precautions due to psychosis, agitated behavior, and staff psychological well-being were some of the difficulties we encountered. Reforming protocols, expanding the use of technology, creating a supportive platform, and standardizing clinical practice were all things we discussed. While treating COVID-19 patients, we face many challenges. This paper outlines our strategies for dealing with these issues.

Damian Jacob Sendler: Public health officials around the world have expressed concern about the new coronavirus, known as COVID-19, which can cause a wide range of symptoms, from mild illness to death. The WHO declared COVID-19 a pandemic in March 2020, and the United States declared a national emergency due to the outbreak [1].

Dr. Sendler: The COVID-19 crisis in the United States was centered in New York City, which was the worst-hit city in the country. One thousand people were killed by the pandemic’s first month in New York City, the city’s Health and Mental Hygiene Department reported [2].

Damian Sendler

NYC hospitals were severely impacted by the CoViD-19 pandemic. Hospital bed capacity was reduced as a result of the rapid spread of the COVID-19 virus and the rising number of patients who needed to be treated. Some hospitals have converted their psychiatric beds to critical care in order to meet rising demand [3]. Psychiatric disorders were more likely to be diagnosed in the wake of the COVID-19 pandemic, but it also increased the number of patients who needed hospitalization because of their pre-existing mental illness [4, 5].

Inpatient units at Gracie Square Hospital are part of the New York Presbyterian (NYP) Regional Hospital Network, a freestanding psychiatric hospital in New York City. During the pandemic, the hospital continued to accept and treat patients in need of inpatient psychiatric treatment. On the inpatient wards, concerns were expressed about the spread of COVID-19 and how to control it. As a result of this unprecedented occurrence, the hospital established the city’s first unit dedicated solely to the care of COVID-19 patients experiencing an acute mental health crisis. Together with the leadership of NYP, Gracie Square Hospital worked to improve patient care and lessen the effects of the pandemic on individuals and the hospital.

It was imperative that the CDC’s recommendations and safety measures be implemented across the board at Gracie Square Hospital. Patients and staff members were encouraged to use social distancing techniques to avoid close contact, and the CDC’s website was monitored for any changes. The CDC website was also monitored, and a multidisciplinary team of doctors and psychiatrists was assembled. Infection control guidelines were followed, hand hygiene and disinfection were improved, and the CDC website was monitored for any changes.

Patients with mental health conditions had difficulty giving consent to treatment, impaired judgment, treatment refusals, uncooperativeness, difficulties complying or understanding social distancing, aggression and psychosis as a result of the COVID-19 outbreak while implementing the recommendations of the CDC. Some patients were unable to adhere to isolation protocols because of behavioral dysregulation. When agitated, some patients spit or drank alcohol-based hand sanitizer, which was a violation of safety protocols.

Accordingly, the mental health COVID unit at Gracie Square Hospital was converted from one of the hospital’s general mental health units. In order to minimize the risk of exposure to patients and staff, the unit was dedicated solely to the treatment of COVID-19 patients who require psychiatric care. In light of the outbreak’s rapid evolution, this conversion was completed on time. For this patient population, the hospital established a multidisciplinary team. IPC at New York Presbyterian Hospital (NYP) was also providing ongoing clinical advice, including protocols and individual patient consultations on a daily basis.

Damian Jacob Markiewicz Sendler: During the COVID-19 pandemic, researchers discovered how little is known about the pathogenesis of this virus and how little is known about its clinical manifestations in the medical literature. The CDC and WHO, for example, were constantly revising their estimates of how COVID-19 spread. Close contact and droplets in the lungs were the only known transmission routes [6]. Airborne transmission may be possible, according to some evidence [7]. Additionally, the virus has been discovered in samples of the digestive system, saliva, feces, and urine [8].. A molecular test, a rapid antigen test, and a serology antibody test developed by the CDC were all given the green light by the FDA [9]. The gold standard for diagnosing COVID-19 is the detection of viral nucleic acid. As a result, false-negative results are possible when trying to detect COVID-19 nucleic acid [10].

Damian Jacob Sendler

Many studies have shown that COVID-19 has a wide range of clinical manifestations, but little is known about them [11]. To treat COVID-19 symptoms and prevent complications, there was no FDA-approved antiviral medication until recently. In October 2020, the FDA approved the antiviral drug, remdesivir, for the treatment of COVID-19 patients, but only in a hospital setting capable of providing acute clinical care.

Many public health measures were implemented as a result of the wide range of clinical presentations. Among other things, the Centers for Medicare & Medicaid Services (CMS) ensured that hospitals could handle a surge in patients with COVID-19. [13] The CDC used a variety of public strategies to control the outbreak, including isolation, quarantine, social distancing, and community containment. An emergency use authorization for the first dose of the COVID vaccine in people 16 and older was granted by the FDA in December 2020 [15].

There were some patients who needed inpatient care during the outbreak, despite CDC and WHO recommendations for out-of-hospital treatment. Special consideration had to be given to psychiatric inpatients because of the unique clinical challenges they face. COVID-19 quickly spread through a psychiatric unit in a South Korean hospital, infecting 101 out of 103 patients. In an effort to keep the virus contained within the hospital, psychiatric COVID-19 units were created [16]. Covid-19 patients who require inpatient psychiatric treatment can be treated in a unit created by the University of Rochester Medical Center and an Israeli psychiatric hospital [17, 18].

Gracie Square Hospital, on the other hand, has a special unit for COVID-19 patients. Rapidly changing conditions necessitated constant revision of protocols and safety measures. During the months of April and May of 2020, our psychiatric unit received a total of 48 patients with COVID-19. COVID-19 was detected in 33 patients referred from the ER and medical floors, and they all tested positive prior to their admission. At our hospital, fifteen patients tested positive during their stay on non-COVID-19 units and were transferred to the psychiatric COVID-19 unit. The maximum number of patients was 26. At the time of admission, all patients had typical symptoms such as fever, cough, and sore throat, but they were not ill enough to be admitted to the medical ward. As a result, ten patients were discharged and eight patients were taken to the emergency room because of respiratory complications during their stay. At the end of the day, 40 patients were discharged. Once the psychiatric COVID-19 unit was up and running, all of the staff remained unfazed.

There has been a rapid shift in mental health practice as the level of clinical uncertainty and unique circumstances surrounding the COVID-19 pandemic have emerged. Contingency plans must be devised to deal with the unique challenges faced by patients in the inpatient psychiatric setting when dealing with COVID-19 transmission [19].

Damien Sendler: COVID-19 acute psychiatric patients are clinically complex and require multidimensional treatment approaches, as demonstrated by our experience on the psychiatric COVID-19 unit at Gracie Square Hospital in New York. Patients’ vulnerability can be assessed; infectious disease consultations are available; clinical activities can be reorganized to maintain safety; technology can be expanded; staff mental health can be maintained; safety measures can be optimized; and patient education and standardization can all be considered as part of these approaches.

Psychiatric facilities need to share their knowledge and strategies in order to prevent the spread of this pandemic among patients. Longitudinal studies can be conducted to examine the effectiveness of dedicating a psychiatric unit for COVID-19 patients in reducing morbidity and mortality associated with the virus while providing acute mental health care, despite the difficulties of conducting research during a public health crisis [4].

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: Homelessness is a major public health problem that disproportionately impacts people with mental illness. There were 552,830 persons suffering homelessness on a particular night in 2018 based on a point-in-time count [3]. However, in 2000, it was estimated that between 2.3 and 3.5 million individuals [4] were homeless at any given time [5.] While the overall rate of homelessness in the United States has decreased over the last ten years, it has climbed in 12 states and certain areas [5]. Homelessness has climbed by 17% in San Francisco, 42% in Alameda, and 43% in Orange County during the previous two years in California [6]. Officials in Los Angeles have declared a public health crisis due to the rise in the number of homeless people and fatalities among them [7]. Issues like housing instability, economic shock-induced homelessness, or living in two places at once may be important even in areas where homelessness is on the decline [9].

Damian Jacob Sendler: Even in places where homelessness is not on the rise, psychiatry residents are likely to treat homeless patients because of the high incidence of mental illness among those who are homeless [10, 11]. Psychiatrists trained in broad public psychiatry do not have the therapeutic skills and expertise essential to treat patients who are homeless. However, approximately 60 percent of psychiatric residency programs include instruction and clinical rotations that concentrate on homelessness, and only 11 percent of these programs are accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Dr. Sendler: When it comes to psychiatry residency, there’s a typical situation that’s been documented by Braslow and Messac [14]. The authors describe a patient with a history of prolonged homelessness who shows up in an ED with psychotic symptoms and begs for treatment. There are several instances when the patient’s psychiatry resident sees that he has comparable concerns, thus she chooses to release him from the ED. The patient’s result was described as “dismal,” and he is presently in prison awaiting trial on felony charges, according to the authors.

Resident training may help improve outcomes in these situations by teaching specific clinical skills and strategies. Research on mental illness in those who are homeless is reviewed here. Following this, we examine the present situation of psychiatry residency training in the area of homelessness in the United States today. For psychiatry resident training programs, we suggest a set of educational objectives and didactics focusing on homelessness. We have also offered ways for programs to include education on homelessness into current didactics for those lacking the ability to construct a new set of didactics. As a result, we hope that this paper will serve as a wake-up call for residency directors to guarantee that the next generation of psychiatrists are prepared to care for the homeless.

Damian Sendler

The area of mental health has played a significant role in addressing homelessness for a long time. 28 percent of the homeless population has a persistent mental disease. Between 4.4 to 16 percent of the homeless population is thought to have schizophrenia, while 11.4 percent of the homeless population has serious depression [16,17]. 37.5 percent of people with major mental illness who are homeless expressed suicidal thoughts in the preceding month, and more than half had attempted suicide in their lives, according to a survey of people with homelessness.

30 percent to 49 percent of homeless persons in the United States suffer from a substance use disorder (SUD), which has catastrophic consequences: drug overdose is the primary cause of mortality for homeless people [19]. In a study of emergency department patients, those who were homeless had greater rates of alcohol abuse, binge drinking, and illicit substance use than those who were housed [20]. Drugs and alcohol may be used as a technique of coping with physical pain or emotional discomfort in older persons who are suffering homelessness. Despite provisions in the Affordable Care Act defining substance use treatment as an essential health benefit [23] and the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) [24], many studies have found barriers to access to mental and behavioral health services for people experiencing homelessness [22].

Because the stresses of homelessness are distinct from the stresses of living in poverty when housed, it is crucial to recognize them. Food insecurity, bad health, and criminality may all be a problem for a patient who lives in poverty but has a safe place to reside. Loss of home, on the other hand, puts patients at risk for a worsening of all of these conditions. As a result, they may be cut off from their friends and family, as well as their jobs and their sense of purpose (Ijadi-Maghsoodi et al., manuscript in progress). Some destitute patients may be compelled to participate in “survival sex,” which is exchanging sex for necessities like food and shelter. [25] (Ijadi-Maghsoodi et al., manuscript in progress). Without a place to call home, patients may neglect their medical and mental health needs owing to competing demands, or they may be reluctant to take sedatives at night for fear of becoming sleep deprived in an unsafe environment. Mental and physical health might be harmed as a result of these pressures.

The most effective doctors, researchers, and advocates for these patients may be developed with specific training, but any psychiatrist can interact with persons who are suffering homelessness. Psychiatry residency programs might include homelessness into their curriculum in a variety of ways. Public psychiatry focuses on populations and services that are underfunded and understaffed. Residents who participate in public psychiatry training are exposed to specialized interdisciplinary services for underprivileged groups at an early stage of their training. Exemplifying this concept include the street psychiatric rotations at UNC-CH and Brown University-Boston, as well as an elective at the West Los Angeles Veterans Administration’s Interprofessional Academic Homeless Patient Aligned Care Team (HPACT).

As part of the ACGME educational competence for systems-based practice, residents may learn about homelessness. Teaching residents how to use system-level resources for the benefit of patients has been adopted by educators. Examples of systems-based practice educational interventions, such as a patient screening for housing status, include a resident quality improvement initiative [20, 23].

It is possible to learn about the importance of understanding the institutions that affect health in residency programs, such as housing and zoning rules [29]. Patients facing homelessness may benefit from increased financing for evidence-based supportive housing or community-academic collaborations if they have a structural competence approach to homelessness. Yale, UCLA, NYU, Columbia, and the University of California-Davis are among the institutions offering psychiatric training programs that include systems-based practice and structural competence curriculum.

Damian Jacob Markiewicz Sendler: As an initial step in resident training, it is important to assess patients, especially those with special needs, for their housing situation and pertinent socioeconomic determinants of their health. Health care providers that are sensitive, collaborative, and competent in caring for homeless patients would benefit from an understanding of the socioeconomic determinants of health. As a major social factor of health, homelessness has a significant impact. Estimated life expectancy for persons who are homeless is between 43 and 47 years of age [36]. A primary care doctor may not be able to treat people who are homeless because they may not be able to attend appointments or prove their insurance status, or they may have had unpleasant experiences with health care [38]. There are times when persons experiencing homelessness sacrifice health care services in favor of basic requirements like food and shelter, which may lead to delays in receiving preventative treatment and an overuse of emergency rooms. Prior to beginning psychiatric therapy, residents may need to build trust and rapport with their patients by helping them find accommodation or a job.

Damian Jacob Sendler

Residents should be aware of the particular socioeconomic characteristics of certain patient groupings. Housing instability, parental drug abuse and mental health issues, poverty, and exposure to violence have a substantial influence on children. Adverse childhood experiences (ACEs) are a term used to describe a wide range of negative life events that occurred during a child’s formative years. Academic difficulties, mental health issues, developmental delays, cognitive outcomes as well as homelessness are all possible in the future for these children [41, 42].

Additionally, residents should be aware of the socioeconomic determinants of health among homeless women. For women, domestic violence is the greatest cause of homelessness [43], and a study of moms who were homeless revealed that 93 percent had been traumatized. Their sexual abuse may persist because they may engage in “survival sex” to meet basic necessities; they are also at risk for sexually transmitted illnesses.

As a final point, veterans who are homeless have distinct social factors and resources. Veterans are more likely to be homeless than the general population for a variety of reasons, including, but not limited to, military service-related trauma, traumatic brain injury, and difficulties transitioning to civilian life [48]. Veterans who suffer from PTSD or sexual trauma in the military may be more likely to become homeless [49, 50]. Women who have been in the military are four times more likely to become homeless than women who have not served in the military [49, 51].

Re-traumatization in health care settings may occur because of the high occurrence of trauma during times of homelessness, particularly for vulnerable groups including women, children, and veterans. This group of patients may benefit from a trauma-informed approach to treatment when people assess their living situation, enquire about socioeconomic determinants of health, and address mental health problems One of the guiding concepts of trauma-informed care (TIC) is that therapy should prevent discomfort and re-traumatization by adhering to values such as trust, empowerment, and safety. Residents may help patients regain control of their health and well-being by providing chances for them to do so during clinical encounters, as well as by ensuring the safety of both the physical environment and their own emotions.

Patients who are homeless need to be referred to evidence-based health care models, and this is where resident education comes in. Patients with a history of homelessness benefit from specialized medical attention. By learning about these models, community members will get a better understanding of the fundamental components and advantages of these programs, allowing them to make more effective recommendations to other services in their area. If evidence-based services are not accessible in their areas, residents may be inspired to advocate for such programs via education on these models. HCHP (Health Care for the Homeless Program in the United States) is one example of a delivery model that offers primary care, drug abuse treatment, and other supporting services all under one umbrella. More than two-thirds of the country’s 285 HCHPs are situated outside of California. Thousands of Boston’s homeless population are served through the Boston Health Care for Homeless Program (BHCHP). Its outreach workers visit patients in shelters and on the streets in an effort to overcome stigma, transportation, and property hurdles in the clinic [54]. I

Patient-centered medical homes (PCMH), which are physician-directed care settings that offer coordinated and continuous care for patients who are homeless, are another delivery paradigm that is well-suited for this population [55]. With the Homeless Patient-Aligned Care Team (HPACT), the VA provides social assistance, primary care, and mental health treatment to homeless veterans. Using an empathetic approach to patients who are aware of their obstacles to treatment is a key component of the HPACT model. Among other things, HPACT aims to accommodate walk-ins wherever feasible, for example. HPACT reduced emergency department visits by 19% and hospitalizations by 34% in the first six months [28].

Damien Sendler: People with severe mental illness may also benefit from ACT programs, which have been shown to improve symptoms and housing status in the homeless population [56]. In addition to mental health care, these programs offer extensive case management and social work assistance to those who are homeless. ACT has been extensively researched and has been linked to decreased rates of mental hospitalization and improved housing stability [56].

For the third and final purpose of resident education, it is to examine the mechanisms that influence housing and advocate for the health of individuals who are homeless Psychologists would benefit from learning more about the various factors that contribute to homelessness, such as racial bias and the criminal justice system. This knowledge can be found in economic policy and historical practices like redlining as well as current issues such as the lack of rent stabilization or other tenant protections. Advocate on behalf of patients suffering homelessness: Psychiatrists When it comes to preventing homelessness, psychiatrists may play a key role as gatekeepers who can help patients get access to resources such as financial assistance (such as disability payments) and alternatives to jail. New York City’s NY/NY III Housing system requires that psychiatric examinations be conducted as part of a patient’s application for permanent supportive housing (HRA 2010e). It has been established as part of the core curriculum for UCLA’s residency in psychiatry to teach residents about local legislation on homelessness and the role of a psychiatrist [58]. The instructor is a member of the local government.

Cities are experimenting with new ways to combat homelessness. As part of Measure H in Los Angeles County, $40 million has been designated for such help; monies may be used to pay rent or relocation fees for those who would otherwise be homeless. There are a number of programs that can help low-income families in their area, including Housing First, Housing Opportunities for People with AIDS (HOPWA), Public Housing, the Low-Income Housing Tax Credit program, and other housing options for special populations like the elderly or those with disabilities. Those who are interested in learning more about these programs can visit the Housing First website.

This relationship between HUD and VA Supportive Housing (HUD-VASH) is critical to ending veteran homelessness for those who have served in the military [62]. Housing Choice Vouchers (HCV) for civilians are part of this initiative. In the same way that all other HCV vouchers are, HUD-VASH vouchers are also exchanged for private rents and distributed exclusively to veterans [62]. In 2018, the government allocated $40 million particularly for new HUD-VASH vouchers, in addition to renewing current housing vouchers [65]. In most cases, homeless veterans may be screened by the VA and then directed to local housing organizations for assistance.

In combination with local medical-legal partnerships, where legal specialists and health care professionals work together to help patients who are homeless, or local legal aid groups that specialize in housing and eviction defense, residents may learn to recommend and advocate for their patients [66]. Residents may learn to advise patients who are being evicted to seek legal aid via this cross-sector partnership.

Humanism is the fourth aim of resident education while working with homeless patients. A research by Braslow and Messac [14] shows that patients suffering homelessness might be stigmatized by locals, which can lead to hurdles to treatment. As a result of rude or dismissive personnel, patients who are homeless may not be able to establish treatment in outpatient clinics [67]. A few of training facilities have implemented instructional programs aimed at raising provider awareness of the plight of patients who are homeless. Storywork and reflective techniques in an interprofessional healthcare curriculum improved trainee empathy and helper behavior towards homeless patients [68].

We designed and use “Humanism Pocket Tool (HPT)” to promote humanism and minimize stigma in Veterans Affairs Greater Los Angeles Healthcare System’s Homeless Aligned Patient Care Team (HPACT). Patients’ objectives and obstacles to reaching them may be conveyed via the use of “vivid vignettes” in this tool. [69] When residents and other team members talk about their patients, they are encouraged to utilize humanistic language. Research is required to better understand the attitudes of residents and the reasons for their reluctance to treat those who are homeless, including probable worries about available resources, lack of knowledge, or lack of support. As a starting point, we propose a didactic on humanistic clinical encounters with patients facing homelessness, which would involve instruction on obtaining a narrative history and how to evaluate personal subjective responses to patients, such as prejudice or cynicism.

Damian Jacob Markiewicz Sendler

Dr. Sendler

Damien Sendler

Sendler Damian

Damian Sendler: The principal activator of the coagulation cascade is tissue factor (TF). Endothelial cells (ECs) and blood cells, such as monocytes, do not express TF under normal circumstances. During endotoxemia and sepsis, however, bacterial lipopolysaccharide (LPS) promotes TF expression in monocytes, resulting in disseminated intravascular coagulation. TF expression is induced by a number of stimuli in ECs in vitro, but it is unknown how much TF is expressed by the endothelium in vivo. Various intracellular signaling pathways including the transcription factors NF-B, AP-1, and Egr-1 are involved in LPS-induced TF gene expression in monocytic cells and ECs. VEGF, on the other hand, stimulates the expression of TF genes in ECs through the transcription factors NFAT and Egr-1. Similarly, via NFAT and Egr-1, oxidized phospholipids (oxPAPC) promote TF expression in ECs and potentially monocytes. Thromboxane (TX) A2 has now been added to the list of stimuli that cause TF gene expression in monocytes and endothelial cells. Inhibition of the TX-prostanoid (TP) receptor lowers TF expression in ECs triggered with TNF and monocytes activated with LPS, suggesting that a TP receptor antagonist could be effective in lowering pathogenic TF expression in the vasculature.

Damian Jacob Sendler: The primary starter of the coagulation cascade is TF, which is a transmembrane protein1. When the vasculature is damaged, the TF that surrounds it comes into contact with blood. This causes the development of the TF:FVIIa complex, which activates both FX and FIX, resulting in the production of thrombin, fibrin deposition, and platelet activation1. Pericytes and adventitial fibroblasts, which are found within and around the blood vessel wall, express TF on a constant basis2,3. It’s been suggested that TF produced by various cell types produces a hemostatic membrane that prevents bleeding following a vascular injury2. TF is also expressed by vascular cells like monocytes and ECs in pathologic situations like sepsis4. Disseminated intravascular coagulation (DIC) and thrombosis can result from this expression. TF expression by monocytes could be part of the innate immune response, and it’s likely that the host is trying to stop harmful organisms from spreading. TF is expressed by various cell types within atherosclerotic plaques, including macrophage-derived foam cells 5, in atherosclerosis. After a plaque ruptures, TF is thought to have a role in the formation of a thrombus.

Damian Sendler

Dr. Sendler: TF is not expressed by circulating blood cells in normal circumstances2. However, TF expression was observed to be low in a few CD14-positive monocytes in one study6. In vitro and in vivo, LPS stimulation of monocytes and monocytic cells promotes TF expression2,6–9. In endotoxemic mice, we and others have shown that TF expression by hematopoietic cells leads to coagulation activation10,11. Several agonists, including LPS, IL-1, TNF-, thrombin, and VEGF, have been shown to stimulate TF expression on ECs12–26 in vitro. TF expression by ECs in vivo, on the other hand, has only been reported in a few publications. TF and the EC marker von Willebrand factor were reported to be co-localized in the splenic microvasculature of septic baboons in one investigation, but not in the ECs of pulmonary vessels4. TF protein was also detected on ECs in LPS-treated mice and rabbits27,28. TF protein was recently discovered on ECs at branch sites of the aorta in septic baboons29. The TF protein was found to be functional when it co-localized with fibrin deposition29. The presence of TF on ECs, however, was limited to granular aggregates, some of which were also positive for the leukocyte marker P-selectin glycoprotein ligand-1 (PSGL-1)29. This shows that TF could be delivered to activated ECs in vivo via leukocyte-derived microparticles. We and others, in contrast to previous findings, did not detect TF expression by ECs in LPS-treated mice, rats, or rabbits30–33, which could be due to the relative sensitivity of the various techniques employed to detect TF expression. Furthermore, TF expression on ECs could have a role in signaling rather than coagulation activation. In mice models of endotoxemia and sickle cell disease, the effect of EC-specific deletion of the TF gene on coagulation activation was investigated. We discovered that a lack of TF in ECs had no effect on coagulation activation in either model34,35. However, we discovered a decrease in IL-6 expression in the sickle cell disease model35. In non-hematopoietic cells, an FXa inhibitor or a defect in the protease-activated receptor (PAR)-2 suggested that TF on ECs contributes to the stimulation of IL-6 production via FXa activation of PAR-2.

By studying a series of plasmids with varying lengths of the promoter cloned upstream of the luciferase reporter gene, an LPS response element (LRE) in the human TF promoter was discovered. This element contains an NF-B site and two AP-1 sites36 and spans 56 bp (227 to 172). The NF-B site is required for the LRE36 to function properly. The NF-B site, which has a C instead of a G at position 139, does not match the B consensus sequence and binds c-Rel-p65 heterodimers rather than prototypic p50-p65 heterodimers40. Functional interactions between c-fos/c-jun and c-Rel-p65 heterodimers14 were discovered to be involved in transcriptional activation of the TF gene14. Furthermore, nucleotide gap between the proximal AP-1 and B sites affected LPS induction of the TF gene. Physical interaction between c-fos/c-jun and c-Rel/p65 heterodimers may need this 15-bp spacing in the human, murine, and porcine promoters41. Alternatively, the conserved spacing and specified DNA bending between the AP-1 and B sites may be critical for c-fos/c-jun and c-Rel/p65 interaction with TATA box binding protein and transcription factor IIB within the basal transcriptional machinery41. Egr-1 is necessary for optimal LPS activation of the TF promoter42, according to another research. LPS stimulation of TF gene expression was reduced when the Egr-1 sites in the TF promoter were mutated or the ERK 1/2 pathway, which stimulates Egr-1 gene expression, was inhibited42.

Damian Jacob Markiewicz Sendler: TXA2 is an eicosanoid that plays a role in inflammation. By binding to the TP receptor55, it stimulates a range of cell types, including monocytes and ECs. A TP receptor agonist (U46619) enhanced TF expression in ECs25, according to a study published in this issue of Vascular Pharmacology. U46619 promotes MCP-1 expression in ECs56, according to a prior study. The TP receptor triggers the activation of AP-1 and NF-B56 via a PKC-dependent mechanism. TNF-induced leukocyte adhesion was dramatically reduced by injection of a TXA2 synthase inhibitor (OKY-046) and in TP receptor knockout mice in a mouse model of microcirculatory dysfunction in the liver, showing that TP receptor signaling may increase hepatic damage produced by TNF-57. The phenotype of TP deficient mice was more severe than that of TX synthase deficient mice, implying that ligands other than TXA2 may activate the TP receptor55. TXA2 activation of the TP receptor adds to the effects of TNF- in vivo, according to this study. Del Turco and colleagues discovered that inhibiting the TP receptor decreased TNF-induced TF expression in ECs25. Importantly, TNF or platelet-activating factor (PAF) activation increases TXA2 synthesis in HUVECs58–60. Del Turco and colleagues, on the other hand, concluded that the reduction of TNF-induced TF expression by inhibiting the TP receptor was not attributable to ECs producing TXA2 or prostanoids because they saw no effect after treating the cells with ASA or indomethacin25. One source of worry is that TXA2 metabolic product TXB2 levels were only tested for 24 hours. Other ligands that activate the TP receptor55 may also be expressed by the cells.

Damian Jacob Sendler

TF is a blood coagulation-initiating cellular receptor. It is expressed constitutively in various extravascular cell types and inducible in several vascular cell types, including monocytes and endothelial cells (ECs). More research is needed to determine the specific mechanism of TNF-induced TP receptor activation, as well as to examine the impact of this activation in various cell types and in vivo in various pathologic scenarios. The discovery that the TP receptor is a key inducer of TF expression in ECs is exciting since antagonizing the TP receptor could lead to new treatments for inflammatory disorders involving TF expression, such as sepsis and atherosclerosis. Del Turco and colleagues utilized terutroban, a TP receptor antagonist, which was compared to ASA in a randomized controlled trial (PERFORM)64 on patients with recent ischemic stroke or transient ischemic episodes.

Damien Sendler: The primary outcome, which was a composite of fatal or non-fatal ischemic stroke, fatal or non-fatal myocardial infarction, or other vascular mortality, revealed no significant differences. With the assumption that a key function of the medicine is the inhibition of TF expression, one possible explanation for the negative result is that there is little benefit to be gained after the ischemia event. However, it would be fascinating to see TP receptor antagonists tested in the prevention of stroke and coronary artery disease, as well as in the treatment of DIC and other thrombotic disorders linked to monocyte TF expression.

Damian Jacob Markiewicz Sendler

Dr. Sendler

Damien Sendler

Sendler Damian

Damian Sendler: It is estimated that conventional nuclear medicine studies would decline by 54 percent in April 2020, then rise back up to 56 percent of pre-pandemic volume by October 2020, according to two worldwide surveys by the International Atomic Energy Agency (IAEA). In 2020, the number of PET tests declined by 36 percent in April, 66 percent in June, and remained 40 percent lower than the norm in October. When it comes to radionuclide therapy, there was a 46% decline in April, a 69% decrease in June, and a 48% decrease in October. There was an approximately 50% decline in procedures compared to the pre-COVID-19 norm, even though the data from October were identical to those from April.

Damian Jacob Sendler: Technetium generators and Iodine-131 were reported to be short in 46% of the centers polled and in 47% of the centers that had them. Lutetium and samarium resources were scarce in 48% and 50% of cases, respectively, for treatments. Only 21% of the facilities have gallium-68 and [18F]FDG deficits. I-131 and technetium generators were unavailable in Latin American (LAC) cities to the greatest extent among the world’s regions. LAC had a more than 80% availability of [18F]FDG; yet, there was a 60% drop of PET operations in the city, despite this. The patients’ choice to postpone their investigations owing to COVID anxiety, as well as the closure of certain clinics or the deferral of non-urgent treatments, might explain the findings above. 17

As part of its evaluation of the effect of COVID-19 on cardiac disease diagnosis, IAEA conducted a worldwide poll.

Damian Sendler

Dr. Sendler: Over 900 sites in 108 countries participated in the study, which found that diagnostic procedure volumes declined by 42 percent in March 2020 compared to the March 2019 baseline and by 64 percent from March 2019 to April 2020. Transthoracic echocardiography fell by 59%, transoesophageal echocardiography by 76%, and stress testing by 78%. ECG, echocardiography, single photon emission computed tomography (SPECT), PET, and cardiac magnetic resonance were the stress modalities investigated in this study. Cardiac SPECT and PET scans revealed decreases of 72% and 67%, respectively. Invasive or computed tomography coronary angiography fell by 55% at the same time. Lower- and lower-middle-income nations had the greatest declines in cardiac imaging, whereas higher- and higher-income countries saw smaller drops. This is likely due to a lack of access to personal protective equipment (PPE) and telemedicine.

Pandemic dynamics

Damien Sendler: One must have a thorough grasp of pandemic dynamics if one is to effectively implement strategies to avoid and control infectious illnesses. The WHO created pandemic stages in 1999 and amended them in 2009 during the H1N1.23 pandemic to achieve this goal. These serve as a worldwide foundation for preparing for and responding to pandemics.

Indeed, the WHO has used this six-phase technique throughout the reaction to COV[[D-19. Phases 1 through 3 are mostly dominated by animal diseases, with limited human transmission. Preparation, capacity building, and early reaction planning are all part of this phase. However, human-to-human transmission is present in stages 4, 5, and 6, which indicates a pressing need for rapid reaction and mitigation measures. Taking into consideration the likelihood of recurrences or new waves after the first peak of the pandemic, this graphic method also depicts the time after the first wave to help with a more organized post-pandemic recovery23 (Fig. 1).

There must be a pre-defined time frame for implementing restriction measures in accordance with specified local objectives when an area is in a transitional period. Restrictive methods aim to interrupt or reduce transmission. Any global, regional, national or local initiatives must include support for health workers and the availability of the required protective components.

Nuclear medicine recommendations that are in sync

Organizations like the IAEA produced particular rules and suggestions as part of their assistance for the NM community as a whole.

It was recommended that NM departments adjust their SOPs to reduce infection risk to their employees, patients, and family members early on during the COVID-19 pandemic, for example. A series of recommendations based on the WHO Minimum Requirements for infection prevention and control recommendations were implemented.

Damian Jacob Sendler

In addition, WHO6’s “Coronavirus disease (COVID-19) technical guidance: Maintaining Essential Health Services and Systems” recommended implementing and adjusting six operational procedures (Table 1 ). Some of the suggestions made here might become normal operating procedures for the NM department, allowing it to operate more smoothly in the event of another emergency or disaster. Some of the things you can do to prepare for crises include selecting a designated point person to manage the operation, creating contingency and business continuity plans, and developing an effective patient flow (screenings, triage, referrals, etc.).

Damian Jacob Markiewicz Sendler: SARS-features, COV-2’s transmission methods, and multi-organ illness symptoms were quickly discovered by the scientific community working together. Maintaining and improving basic services while implementing additional safeguards was the primary goal of the recommendations. 13.14 On the other hand, which ideas do you think should be kept in place? For both COVID-19, which may fluctuate between low and high levels of contagiousness, as well as for any future epidemics of infectious diseases? When dealing with infectious illnesses, it is important to keep in mind that a situation-based strategy should be used.

In order to restore non-emergency treatment in nuclear cardiology, the ASNC, IAEA, and SNMMI have suggested a priority-based system that would allow for four clinically-driven categories: urgent, higher, lower, and elective ( Fig. 3).

14 Non-cardiac imaging and therapeutic treatments, on the other hand, are more difficult to categorize. For investigations that have been postponed owing to the pandemic, clearer methods are needed to determine which trials should be prioritized. As part of a team effort, referring doctors should be involved in prioritizing operations. Color-coded schemes depending on the condition of COVID-19 in the surrounding environment were presented as part of the 2020 proposals for the progressive reopening of NM facilities. 13 This plan has the potential to last much longer than the current epidemic.

Continuing to educate and research

Medical education is a continuous process that begins on the first day of medical school and continues until the conclusion of our careers in the field.

There is little question that research and development in nuclear medicine is a driving factor. There is a constant stream of new technology, applications, and medical evidence that must be disseminated. For the medical community to deliver the best possible patient care, within a framework of safe and quality clinical practices and foster professional progress, new standards of best practices should be stressed not just as a part of training programs but in all activities.

Recent pedagogical research has begun with the goal of eliminating interruptions in medical education and training. Virtual clinical experiences and augmented reality modules, for example, have been further developed and implemented to an unprecedented degree in the last several years. However, some of these techniques may continue to be used as a supplement for standard medical education even after the end of a pandemic. An further benefit may be that these teaching modules and platforms are now more readily available in low-resource areas, where telemedicine is still being developed. It is now possible to provide and share medical information worldwide through modern technologies, from remote imaging to the planning and guiding of radiation. The Union Européenne des Médecins Spécialistes has termed a new field of general telemedicine “tele-nuclear medicine.” 31

Since the isolation of SARS-CoV-2, we have lived in a world of ambiguity, with numerous interesting issues and a wide range of differing perspectives. Repeatedly, the same questions are posed. What’s the story behind it? How does it spread? Which groups of patients are more likely to suffer serious health consequences or die as a result of their illness? What are the short- and long-term side effects of this? Which therapies have been shown to be effective, ineffective, or in the process of being tested? Even though we’ve learnt a lot from this epidemic, we still have a lot more to learn. Is SARS-CoV-2 likely to become a worldwide pandemic? Those who have received COVID-19 will have a long-lasting immunological memory. Could COVID vaccinations be harmed by cold virus-type mutations?

At a time when there are so many unknowns, what is clear is that we must learn to live with this new coronavirus and be prepared for outbreaks or pandemics from new viruses. Many of the procedures put in place during the pandemic by nuclear medicine departments must be maintained continuously if they are to continue delivering vital services while also avoiding the virus’s spread.

A wide range of uses, from healthcare to education, will continue to benefit from communications technology.

COVID-19’s demonstrable influence on nuclear medical practices throughout the globe, as well as definitions of a pandemic and its stages, are examined in this article. nuclear medicine-specific recommendations that are up-to-date or newly produced Results of hybrid nuclear medicine investigations, which were conducted mostly for oncologic purposes, were discovered by COVID-19, as were new pedagogical approaches to medical education and research in an increasingly virtual environment. Many of the procedures put in place during this pandemic will be continued continuously by NM experts in order to maintain necessary services while while limiting the spread of the virus. Which ones are you referring to? COVID-19’s raging contagiousness must be kept in mind, as well as the prospective advent of other diseases that might lead to future pandemics.

A wide range of applications, such as healthcare and education, will make use of communications technology in the future, but how best? Departments of NM must work together to keep up with these changes, taking into account how they can best adapt to a more virtual professional setting. As a starting point for further constructive conversation, the article provides current history and analysis. NM must continue to learn from this disaster and bring fresh questions, facts, ideas, and appropriate systemic upgrades to the metaphorical table in order to effectively manage the future of the state.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

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Damian Sendler: NASA astronauts Thomas Marshburn and Kayla Barron completed several “get ahead” tasks during a six-and-a-half-hour spacewalk on Thursday. Spacewalk planned for Tuesday was postponed until Thursday due to a space debris alert for the International Space Station. The agency tweeted only hours before the scheduled November 30 spacewalk that “due to the lack of opportunity to fully analyze the risk,” it had chosen to postpone the mission until further notice.

Damian Jacob Sendler: The space station was alerted about a piece of debris by NASA. Spacewalk teams have chosen to postpone the Nov. 30 spacewalk until they have more time to examine the danger it may cause to the astronauts. It was not immediately obvious whether the warning had anything to do with the space debris left behind by a Russian anti-satellite test two weeks earlier, which caused station staff members to flee to the safety of their ship.

“NASA determined that the orbit of the debris does not pose a risk to a scheduled spacewalk by Thomas Marshburn and Kayla Barron or to International Space Station operations after receiving additional information about a late notification debris event on Monday,” the agency posted on its website Tuesday night. A delay in the spacewalk allowed NASA to assess the risk posed by the debris alert.

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Thursday morning’s departure from the hatch was sooner than planned since the astronauts were able to complete all of their responsibilities ahead of schedule.

A spare S-band Antenna Subassembly installed outside the space station was used to repair the damaged one. According to NASA, the space station uses S-band radio frequencies to provide low-rate audio and data to ground-based flight controllers at distances of up to 220 miles (354 kilometers).

NASA’s Tracking and Data Relay Satellite System (TDRS) has ceased transmitting signals to Earth after 21 years in operation. The problem was detected in September, according to NASA spacewalk flight director Vincent LaCourt.

Tom and Kayla were able to practice their spacewalk in a neutral buoyancy laboratory, or a large pool, because of the timing, LaCourt said.

The absence of this antenna has a minimal effect on the day-to-day operations of the space station. Redundancy in communications may be achieved by maintaining antennas like this one. The system of backups will continue if the spare, which has been outside the station since 2010, is installed. Other video transmission methods, such as low-rate S-band and high-rate KU-band, are available at the station.

Matthias Maurer, of the European Space Agency, handled the Canadarm2 robotic arm, which Marshburn used for her first spacewalk.

For extravehicular crew member 1, Marshburn wore the spacesuit with red stripes, while Barron wore the unmarked suit. Barron was doing his first spacewalk, which he described as “amazing,” while Marshburn was making his sixth.

On November 11, Marshburn, Barron, and Maurer boarded a SpaceX Crew Dragon spacecraft with NASA astronaut Raja Chari and arrived at the International Space Station.

A total of 245 spacewalks have been performed on the International Space Station (ISS) since it was first sent into orbit in 1997.

Using a direct-ascent missile, or DA-ASAT, Russia hit a Russian satellite and created a debris field in low-Earth orbit of 1,700 pieces of trackable debris that is also expected to produce tens of thousands of pieces of smaller orbital debris, according to US Space Command. All of the additional waste that is generated by the experiment will take months to sort through.

Damian Jacob Markiewicz Sendler: In a statement, NASA Administrator Bill Nelson said he was “very concerned.” “outraged by this ill-advised and disruptive activity. It seems inconceivable that Russia would put at risk not only the American and international astronauts on the International Space Station (ISS), but also their own cosmonauts, given the country’s long and distinguished history in human spaceflight. The Chinese space station is in danger as a result of their irresponsible and risky acts.”

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On Monday, Dana Weigel, NASA’s deputy manager of the International Space Station Program, noted that although the debris field was initially concentrated, it has since scattered. Models and forecasts were run by the planning team to get a sense of the spacewalk’s environment.

By Weigel’s estimation, it only increased danger by 7%, which is “not much more than what we observe with regular atmospheric variations” and “well within what we find with a typical quantity of debris that goes through.” Extravehicular activity has always been dangerous, as this study shows.

Debris that has the ability to enter the space suits or the space station itself is a possible threat to astronauts’ safety. Spacesuit-piercing fragments are significantly tiny than anything they can detect, Weigel said in an interview.

“It does indicate penetration, but it does not mean it is a disastrous penetration,” added Weigel. “Only a certain depth of penetration may be tolerated. The suit has an emergency oxygen supply that may keep it going for some time. The probability of having a large penetration during the six-and-a-half-hour EVA is around 1 in 2,700, so that is what we are referring to when we discuss EVA risk.”

As a result of the newly discovered debris, “we did not want to keep the team out longer for stuff that we did not think vital,” according to Weigel.

Damien Sendler: Researchers believe this footprint, found at Laetoli site A, belongs to a previously undiscovered species of hominid. A cast of an Australopithecus afarensis footprint may be seen on the right.

It is commonly accepted that the earliest indisputable evidence of upright walking in the human family tree was found in Tanzania in 1978 and dated to 3.66 million years ago.

Known as Laetoli site G, they belong to Australopithecus afarensis, a species that includes “Lucy,” one of the best-known fossils in the world.

However, the Gfootprints from the Laetoli site were not the only ones discovered at the time by academics. Because they were so distinct from Australopithecus afarensis’s tracks, a mile away at Laetoli site A, a pair of footprints were ascribed to a baby bear walking erect on its hind legs.

Currently, scientists assume that the Laetoli location Rewriting this chapter of human history might be made possible by the discovery of a footprint that belongs to a different early human ancestor that also had two legs.

A Dartmouth College anthropology professor and collaborator of the study, Jeremy DeSilva, stated, “These footprints suggest that the development of upright walking was more intricate and intriguing than we previously assumed.” The findings were published in Nature on Wednesday.

In our evolutionary past, there were at least two hominins that walked in distinct ways and on separate feet, demonstrating that the acquisition of human-like walking was less linear than many people believe.”

Striding bipedalism, the human form of two-legged walking, is unique among animals, and the common view was that it had a single evolutionary origin.

There are acacia trees all over the terrain at Laetoli, a grassland area northwest of the Ngorongoro Crater in northern Tanzania, where you may see giraffes and zebras roaming freely. A 3.66 million-year-old layer of hardened volcanic ash, which DeSilva claimed retains hundreds of footprints from ancient antelopes, elephants, huge cats, birds, and insects, as well as our early human predecessors, has been exposed by seasonal rains in certain areas.

A paleoanthropologist and postdoctoral researcher at the Max Plank Institute for Evolutionary Anthropology, in Leipzig, Germany, said the tracks had an unusual shape and suggested an upright walking movement that had a peculiar cross-stepping manner, in which each foot moved over the body’s midline to touch down in front of the other foot. She was not a part of the study.

Although Leakey had speculated that a hominid with an uneven stride may have created the puzzling tracks, one theory at the time was that a bear had been walking on two feet.

“Researchers were not satisfied by any of the explanations that were put up by the scientists. A print from Site A ended up being forgotten rather than explained, “”Said Melillo’s comments on the Nature study,” as per the aforementioned research.

“The footprint locations were meticulously mapped out by Mary Leakey. We were able to get an idea of where the tracks should go based on her map. We started digging, hoping for the best but worried that the periodic rains of the previous forty years would have washed them away “In an email, DeSilva said.

“We had to use a hammer and chisel to get to the footprint layer, which we then had to gently dig using a hard-bristled brush and tongue depressor. For the most part, the imprints remained intact.”

After cataloging the original prints, scientists compared them with those of black bears (Ursus americanus), chimps (Pan troglodytes), and contemporary humans (Homo sapiens).

More than 50 hours of footage of wild black bears were also gathered by the team. Less than 1% of the time, the bears walked on their hind legs. The researchers concluded that a bear could not have left the tracks at Laetoli, given the lack of footprints from a person travelling on all fours.

Non-human animals, according to DeSilva, are incapable of balancing on a single leg when they walk on two legs. As a result of their erratic forward motion, they leave behind a trail of widely spread imprints.

Our predecessors’ hip and knee positions changed early in human development, allowing upright hominins to walk in a straight line without the side-to-side motion.

There were “a mix of traits typical of hominins,” Melillo concurred.

There is a lot of continuity in the imprints formed by the toes and heel, and the big toe and second toe are of comparable length, she said. “A lot more impact is made on the ground by the big toe than the second toe,” she added.

“Still, it is a good resource. The footprints of a human are unique. The footprints are curiously broad and short, suggesting that the feet that made them had a large toe that could grip with a thumb-like grasp, like the big toe of an ape.”

DeSilva noted that in order to learn more about the look of this hominid, fossils would have to be found. According to him, the individual’s feet revealed that he or she was just slightly higher than 3 feet tall (0.9 meter).

Dr. Damian Jacob Sendler and his media team provided the content for this article.

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Damian Sendler: Neanderthals congregated in a cave 3,000 feet above present-day Spain’s Atapuerca Mountains a hundred thousand years ago. They smeared the floor with DNA from discarded skin, spit, and other body fluids while they cooked and watched kids wrestle. 

Damian Jacob Sendler: Over the course of millennia, even when people and animals sought refuge under the dirt, the genetic material collected and was conserved. Archaeologists have discovered several stone tools and animal bones at the Estatuas site since 2008. Because of its Swiss cheese-like firmness, the only Neanderthal bone discovered — a toe tip — seemed too valuable to smash for DNA analysis to be used. As a result, the genetic characteristics of the residents and their connections to other Neanderthal tribes could not be determined by the researchers. 

In the absence of a DNA sample, they scoured the ground for it. Sediment from strata that developed between 70,000 and 113,000 years ago was gathered by researchers in excavations at Estatuas in 2018. Over 800 silt samples were taken from Chagyrskaya and Denisova caves in southern Siberia that contained DNA-bearing relics of Neanderthal and Denisovan ancestors in 2017. 

Damian Sendler

Benjamin Vernot and his colleagues at the Max Planck Institute in Germany were able to isolate human DNA from that of animals, plants, and microorganisms. They found that a treasure mine of genetic information may be found in soil that is free of artifacts and fossils. More than 220 silt samples from Denisova Cave yielded bits of human DNA, as opposed to the nine fossils that had genetic material before. At various moments in time, the soil revealed that Neanderthals, Denisovans, and Homo sapiens were all present there. 

Observations of ancient feces suggest that early humans had significantly more diversified gut microbiomes than do modern humans today. In Karl Reinhard’s (Credit) words: 

Estatuas, which lacks DNA data from fossils, was able to benefit from these methodologies based on these findings. New Neanderthals arrived roughly 100,000 years ago and genetically varied from the Neanderthals who had lived there for the previous millennia. 

An major precedent has been created with these disgusting discoveries. Stone tools and other man-made artifacts are quite ubiquitous, but fossils, especially those with preserved DNA, are not. DNA from soil has been retrieved, however this piece of the genome only represents one maternal branch of evolution. It has been “difficult to link the genetics with the highly comprehensive work that archaeologists perform” when evaluating artifacts at locations where DNA has not been recovered, according to Vernot. 

Damian Jacob Markiewicz Sendler: Until now, that is: Vernot’s team was able to collect nuclear DNA from certain samples and gather significantly more mtDNA than previous research had been able to collect. 

Researchers in Georgia and Mexico dug through cave soil in 2021 and recovered genome-spanning DNA from Ice Age humans, wolves, bison, and bears. Meanwhile, researchers at Harvard University and the Joslin Diabetes Center combed through ancient excrement for clues. Turds unearthed decades ago in rock shelters in Utah and Mexico contained food, including maize and grasshoppers, that had been digested. DNA from the microorganisms that formerly made up people’s microbiomes was extracted by Meradeth Snow from samples of sediment at the University of Montana. 

They recreated 181 ancient genomes and tested them against hundreds of current stool samples from eight nations. There are fewer varied microbiomes now, presumably owing to the use of antibiotics, processed foods and better cleanliness. This study was published in Nature in May. 

“When you start to grasp how much [gut flora] we no longer have,” adds Snow, “it is sort of astonishing.” This discovery has the potential to enhance health in the present day, since a lack of variety in the microbiome may lead to obesity, diabetes, and autoimmune illnesses. 

In a letter from 1794, George Washington said, “I know of no occupation in which more enthusiasm & vital service may be offered to any nation than by developing its agriculture. Since Washington’s day, there has been a decline in frontier farmers, but agricultural advancements have laid the foundation for civilization and allowed the human population to grow enormously. 

Although farming is a human enterprise, it is not the only human endeavor. It is no surprise that leaf-cutter ants, who each have a brain the size of a pinhead, have evolved from hunter-gatherers to farmers. 

Damien Sendler: Ants, along with a few other species, produce their own food for consumption in order to be considered farmers. A deep-seated atavistic impulse drives the ants of the Western Hemisphere to go into the jungle and collect plant debris, which they bring back with them to the nest to feed the ants’ fungal crops, which are then eaten by the ants. 

In the South American jungle, ants have been cultivating diverse fungus for 60 million years, according to a Smithsonian research published in 2017. The research discovered that agricultural ant lineages diverged 30 million years ago as a consequence of certain ant species shifting to drier conditions, resulting in a split. 

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Farming ants cultivate both higher and lower levels of farming. Fungal crops may escape ant colonies and return to the wild in lower agriculture, which is common in humid rainforests. Ants have been known to collect wild mushrooms and transport them back to their colonies. As a consequence, the lesser ants have less control over the genetics and development of their crops since the gene pools of wild and cultivated fungus might mingle. Because the fungus is able to thrive without them, it is less reliant on them. 

Neither ants nor mushrooms are able to survive on their own in modern agriculture. As the temperature in South America began to change 30 million years ago toward colder, drier grassland, some ants migrated from the forest to the new environment. Due to the fungus’ need on ants for survival, it has evolved into a distinct species that is unable to live in the desert without the help of those insects. In order to cultivate their crops, the ants excavate chambers up to 12 feet underground and manipulate moisture and air movement. 

In a dry environment, your destiny will be determined by the fate of the colony you have been placed in. According to entomologist and primary author Ted Schultz, “you are then linked to this connection with these ants that you were not bound to while you were in the damp forest. 

This cultivated fungus, which was formerly incapable of surviving in arid regions, evolved through time. Even while human breeders have altered certain crops to the point that they can no longer reproduce and survive in the wild, some fungal species have grown so reliant on their interaction with farming ants that they are never discovered without them,” Schultz stated in a press statement. 

Dr. Sendler: Insect-fungus interactions, on the other hand, have several levels of complexity. An amino acid, arginine, was lost when ants became farmers. As a result, they had to rely on the fungus to provide that amino acid. To keep the fungus alive, the ants provide water, cleaning, and nourishment in return for food. Now we have to ask, who is the real puppeteer? What do we know for sure about the relationship between the ants and the fungus: are they in control of the fungus or are they being controlled? Neither, is the answer. It is a mutualistic interaction in which both species benefit from a harmonic sync. 

Fungus output may be increased without jeopardizing the crop’s ability to withstand environmental hazards because to the ant farmers’ use of complex, climate-controlled subterranean labyrinths and selected nutrients. In order to inhibit the development of fungus-threatening pathogens, they produce antibiotics that adapt with the local ecology. In terms of size and efficiency, their agriculture approaches that of human agriculture in providing all of the food required for their society. They are able to maintain a steady supply of food without causing environmental harm. 

Contrast this with some of the current agricultural techniques that have resulted in the loss of biodiversity and environmental health as a result of clearing forests, using steel tractors, and using chemical pesticides. Aside from copying ant farming designs, humans can learn to cohabit with other species and implement more sustainable agriculture techniques. This planet’s rapidly expanding human population necessitates that we avoid a path of degraded ecosystems and deforested wastelands.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

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Damian Sendler: Keep an ear open for useful information, even from other species, all around the animal world. 

Damian Jacob Sendler: The next time you overhear your neighbor’s talk, you may be surprised to learn that it isn’t a characteristic that is unique to humans. Even though we’ve mastered the skill of eavesdropping from enormous distances, humans aren’t the only creatures who keep a vigilant ear out for threats. 

For a long time, scientists have been fascinated about how animals interact with one other. However, they’ve begun to pay more attention to the nuanced ways in which different species communicate with one another. 

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If you’re a bird, you’re probably familiar with the “foreign language” that other birds use to communicate in order to keep themselves safe. It is possible for certain birds to determine that an unusual sound is a warning sign even before they see the source of the call or its originator. 

Wild magnificent fairywrens, which are sedentary and territorial, can be learned to run from strange noises in only a few days by researchers from the Australian National University. Simply transmitting these sounds together with warning cries from other bird species, such as fairywrens, was all that was necessary. 

Climate change and invasive species, as well as alarm call identification, “are likely to assist populations deal with shifting community composition,” according to the authors’ conclusions. As a result of our research, it seems that not only predators but even captive-bred individuals might be taught to perceive heterospecific signals of danger as well. 

Even land-dwelling animals may take advantage of birds’ tendency to chatter when they feel comfortable. 

PLoS One released a research in 2019 on the Eastern gray squirrels that live in Ohio’s parks and neighborhoods. Squirrels’ reactions to recordings of the red-tailed hawk were studied by experts who wanted to see whether they reacted differently to sounds such as songbird chatter or nothing at all. Researchers observed that when squirrels were exposed to the calming sounds of songbirds, they spent far less time freezing, gazing up, or running. 

To their surprise, researchers discovered that squirrels listen in on birds’ non-alarm noises as well, as stated in the authors’ news release, “we knew that squirrels eavesdrop on alarm cries of several bird species.” Signals of security may be equally essential as cues of danger in particular situations, according to this theory. 

Listening may also help prevent animals from going to bed hungry, in addition to protecting them from dangers. 

More than a dozen species in Panama’s jungles depend on almond trees as a key food source from December to March. Those chained to the forest floor must wait until fruit falls to the ground on its own or is dropped by monkeys as food scraps before they may eat it. 

Damian Jacob Markiewicz Sendler: Researchers from the Natural History Museum of Denmark spent nine months on an island rainforest in the Panama Canal, where they observed monkeys’ wasteful tendency to drop fruit after just a few bites, as well as other scavengers, such as coatis (raccoon-like mammals), agoutis (giant yet lovable rodents), and other predators. A study released in Biotropica last year shows that grounded animals listen in on capuchin and spider monkeys to know out what time and where they feed. 

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When the lunch bell rings, it’s as if their ears are telescoped, allowing them to hear it from wherever it is. In a news release, Rasmus Havmller, a postdoctoral researcher at the Natural History Museum of Denmark, states, “This provides them access to food that would otherwise be unavailable at the moment.” 

A small number of the animals were fitted with GPS collars so that the researchers could keep tabs on their whereabouts. Camera-equipped traps were set up to capture and record any passing coati or agouti, as well as speakers that played monkey noises in trees. Unfortunately, the fruit that did not fall into these traps was quickly devoured by ravenous scavenging monkeys, who left bite marks or were already half-way through eating it. 

Damien Sendler: Due to poaching or deforestation, however, the whole ecosystem’s food chain may soon be in peril as a result of the loss of monkeys. In addition, “I believe we’ve underestimated how much animals communicate with each other and how many ways they’re genuinely related,” Havmller said. As a new chapter in the behavioral biology of mammals, eavesdropping across species offers crucial insights into how the absence of one species affects a whole ecosystem.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: Even though climate change has been a difficult subject to get to the attention of the general public, a film that attempts to bring it to life has taken the world by storm. When “Don’t Look Up,” a dark comedy about a looming comet, debuted on Netflix last week, it topped the streaming service’s most-watched list in 88 of the 89 countries in which it was accessible. 

Damian Jacob Sendler: Most climate scientists are quite impressed by how well the film portrays their battle to explain the gravity of the climate catastrophe to policymakers and members of the public. This movie contains major plot spoilers. It depicts politicians, including the president, and tech industry elites preferring profit over humanity’s survival in the face of an existential threat. As the film progresses, astronomy naysayers believe that the comet can simply be ignored until it fades into obscurity. 

According to Lisa Graumlich, incoming president of the American Geophysical Union and professor at the University of Washington School of Environmental and Forest Sciences, “I actually stayed up until midnight to watch it as soon as it was available to me on the West Coast.” As a result, “I went between laughing and feeling like I was about to burst into tears because it sounded so familiar.” 

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For some scientists, one of the most moving aspects of the film is the superficial, even dismissive, coverage of their warnings in the media. As a result of the New York Times-esque media exposé, the scientists who discovered the comet are asked to lighten up and make the news more appealing on a morning TV chat show. Graumlich recognizes the wrath and misery felt by the young researcher, represented by Jennifer Lawrence. 

It was “very evocative of what we’ve experienced,” she added, “for many of us” to be taken seriously, at times ridiculed by the press, and to have politicians pay attention for a period but then lose focus. 

Graumlich’s early work experience is strikingly identical to Lawrence’s character’s in “Don’t Look Up,” a PhD student. 

As a tree-ring expert, Graumlich studies how climate has evolved through time, in part to determine if what we’re experiencing is natural or human-caused. When I was a young scientist, I turned 30…. My research into tree rings and previous climatic variability was featured in the New York Times a week later. You are proud to send this to your mum. Later that day, Rush Limbaugh’s radio show picked up on the subject. His jokes were directed at everything from myself (my name), to my name, to the absurdity of the idea that one could understand global warming by studying tree rings.”

In “Don’t Look Up,” some climate scientists believe that the media’s treatment of the comet in the film is a metaphor for how the American public has responded to climate change. A UCLA climate scientist tells Yahoo News that “there’s obviously some criticism of the media in the film—I don’t think it’s a media problem, per se, it’s a societal problem.” As he pointed out on the morning program appearance by the scientists, “there are some sequences which were humorous in the movie but on further reflection not all that funny. “In essence, they’re advised to lighten up, loosen up, and stop being so depressed. When it comes to climate change and extreme [weather] occurrences, I’ve heard the same thing from people in comparable positions nearly verbatim. 

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“The criticism about the broader media landscape and the way society interprets bad news rings very true,” Swain said. “My interactions with journalists are usually very positive and constructive.”

However, the hazard posed by climate change differs greatly from that of a comet that will strike Earth in less than seven months. Even while its impacts began in the late 19th century, they have only recently become noticeable to the casual spectator. Scientifically speaking, the video does depict the political and economic hurdles that must be overcome in order to mobilize the people against any future threat. 

Damian Jacob Markiewicz Sendler: MIT atmospheric science professor Kerry Emanuel tells Yahoo News that the new film was a “kind of parody that revealed an underlying truth” about climate change. As a parody, it was evident that it was exaggerated. Science is becoming increasingly irritated that it’s not being taken seriously by the media and politicians, who are essentially ignoring it.” 

Field, head of Stanford Woods Institute for the Environment and professor of multidisciplinary environmental studies at Stanford University, said he “enjoyed” the movie. “It makes you think about a lot of different things. A parable about climate change, it’s not about what we actually expect to happen. When scientists discuss critical issues, I find it difficult to avoid the frustrations and temptations that come with that. Remember that climate change is not Earth-ending in six months and 14 days, or whatsoever timetable there is in “Don’t Look Up.”” Keeping this in mind is crucial. 

As Swain put it, “Climate change is not like a physical object falling towards Earth that may suddenly wipe out humanity. “It’s not an appropriate parallel for climate change in the physical scientific sense. However, I believe it was done on purpose because we’ve been doing a pretty excellent job of collectively covering our eyes, plugging our ears, and burying our heads in the sand about some really alarming things going on in the global climate system. It appears that some of the climatic catastrophes are too subtle to be detected. As a result, I believe that the decision to make it a physical object impacting Earth and bringing an end to humanity was a necessary one. 

Michael E. Mann, a Penn State atmospheric science professor, told Yahoo News, “My own view is that it’s an imperfect analogy by design.” When Leonardo DiCaprio portrays the role “Don’t Look Up” in “Don’t Look Up,” he was inspired by the way Mann conducts his many media appearances. 

He may have wanted to focus our attention on an issue that isn’t burdened with ideological baggage, like climate change has become because of a fossil-fuel-funded disinformation effort,” Mann says. When faced with an oncoming catastrophe where entrenched interests could profit from inaction, he decided to build a politically neutral vehicle for investigating the constraints of our politics and media environment. To wit, McKay underscores one of my main points in my new book, “The New Climate War,” concerning the dangers of letting techno-billionaires to determine how we respond.” 

It also highlights the fact that we’ve been putting off action on climate change for so long that it now requires larger, faster, and more aggressive response than it would have if we’d taken action sooner. 

As Emanuel pointed out, “no metaphor is perfect,” but two features allow for a connection to the climate change issue. “One is that it’s something that’s going to happen in the future but isn’t making much of an impact right now. The longer you wait to take action, the more difficult and expensive it will be. This is true in both the climate change and the long-term effects cases. 

Damien Sendler: A meteor or asteroid can be deflected by a small amount of energy if caught early enough, according to Emanuel. There will be enormous forces required if one waits until the very last minute. Eventually, you will run out of energy and be unable to do anything about it. And the weather is also comparable in this regard. We wouldn’t have to spend nearly as much money today if we had begun [climate action] 40 years ago. You put it off and put it off, expecting that the next generation would have to deal with it instead of us, and it’s becoming more and more expensive. In the end, you will be powerless to stop it. 

Climate scientists have even used the analogy of an item from outer space in the past themselves to explain their findings. “Put yourself in the shoes of a massive asteroid on a collision course with the planet. When James Hansen, former NASA Goddard Institute for Space Studies director, spoke at TED in 2012, he said: “That’s what we face right now,” he said. On his website at Columbia University, where he is currently an adjunct professor in the Earth Institute’s program on climate science, awareness, and solutions, Hansen remarked how “Don’t Look Up” echoed his own discovery. 

There are many parallels between this film and climate change, according to Hansen in his blog post. When scientists try to convey the urgency of both the asteroid tale and the real-world climate story, they are discouraged, Hansen says. These villains include greedy industry, incompetent and corrupt government; media that abandon responsibility for ratings; and an uninterested people. Is there any hope for the asteroid’s story, given the challenges it faces? And that’s just the beginning of what the true climate story has to deal with. As a result of intergenerational conflict, today’s adult leaders fail to take necessary actions, yet today’s young people and kids pay the repercussions. ” 

The COVID-19 pandemic and other hazards to public health and safety tend to frustrate experts in other disciplines, according to several climate scientists who expressed their frustration with political denialism and inactivity on climate change. “It could well have been” about COVID, Emanuel remarked, despite the fact that the producers had climate change in mind when filming the video. “It is frustrating for climate scientists, as it is for the entire medical profession trying to get people to wear masks and get vaccines” to be disregarded by politicians and members of the public who are hesitant to embrace an unpleasant truth, he added.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: Volcanic eruptions may have sparked a spike in the population of marine microbes, which in turn produced the first puffs of oxygen into the atmosphere 2.5 billion years ago. Existing theories on Earth’s early atmosphere presume that most of the changes were caused by geological or chemical processes. This new theory suggests otherwise. 

Damian Jacob Sendler: Researchers’ findings, which are centered on the origins of our planet, could also shed light on the possibility of alien life and climate change. University of Washington, University of Michigan, and other schools led a study that was published in the journal PNAS earlier this year. 

Damian Sendler

A lot of links between the solid, nonliving Earth and the evolution of life have begun to emerge in the last few decades as the study’s first author Jana Meixnerová, a doctorate student in Earth and space sciences, explained. “But what are the specific connections that allowed for the evolution of life as we know it to take place?” 

Few, if any, oxygen-breathing lifeforms existed on Earth in its early days. About 2.4 billion years ago, the Earth’s atmosphere became permanently oxygen-rich, perhaps as a result of a proliferation of photosynthesising living forms that convert carbon dioxide and water into oxygen.

Researchers at Arizona State University studied rocks from the Mount McRae Shale in Western Australia and found that oxygen appeared in the atmosphere roughly 50 to 100 million years earlier than previously thought. Another short-term oxygen increase has been validated by more recent study, although the cause of its occurrence is still a mystery. 

Study co-author Joel Blum of the University of Michigan studied the same ancient rocks for their mercury concentration and amount of neutrons emitted by volcanic eruptions in the new study. During large volcanic eruptions, mercury gas is released into the upper atmosphere, where it circulates for a year or two before showering down on the Earth’s surface.. New research indicates that mercury levels peaked millions of years before the brief increase in oxygen. 

Professor Roger Buick of Earth and Space Sciences at the University of Washington said that the discovery that the abundance and isotopes of mercury in the rock below the temporary surge in oxygen can only be explained by volcanic eruptions in the atmosphere. 

Damian Jacob Sendler

The authors hypothesize that lava and volcanic ash fields were present in areas where volcanic emissions occurred. That rock’s nutrients would have been released into adjacent rivers via weathering, allowing oxygen-producing single-celled lifeforms such as cyanobacteria to grow. 

“There are other nutrients that modulate biological activity on short timescales, but phosphorus is the one that is most important on long timescales,” Meixnerová stated. 

Biodegradable material and agricultural fertilizer contain phosphorus, which is readily available in today’s society. However, weathering of volcanic rocks was the primary source of this limited material in ancient times. 

“Fresh basaltic rock would have slowly disintegrated, releasing the macronutrient Phosphorus into the rivers during the Archaean atmosphere’s weathering process. Those microorganisms would have been nourished, triggering an increase in biological productivity, which would have resulted in an oxygen spike, as a result “It was Meixnerová’s opinion. 

These volcanoes and lava fields are unknown, but enormous lava fields of the right age can be found in modern-day India, Canada, and other places. 

Damien Sendler: That the immediate trigger for these transitory smells of oxygen was a rise in oxygen generation, rather than a decrease in oxygen consumption by rocks or other dead processes, Buick concluded. “It’s crucial because oxygen is the most significant factor in the evolution of huge, complex life. 

Damian Jacob Markiewicz Sendler: When it comes to exoplanets, experts claim this study provides insight into how a planet’s geology affects life on its surface, which aids in the search for life in the universe.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: This month has seen a fivefold rise in pediatric admissions in New York City. Nearly double the amount of people accepted in Washington, DC. In addition, pediatric hospitalizations have increased by 48 percent in the last week on average across the country. 

The highly transmissible Omicron variant is combining with the busy holiday season to infect more children in the United States than ever before, and children’s hospitals are ready for an even bigger outbreak. 

“I think we are going to see more numbers now than we have ever seen,” said Dr. Stanley Spinner, chief medical officer and vice president of Texas Children’s Pediatrics & Urgent Care in Houston. 

“Cases are continuing to rise between Christmas gatherings and we’re going to continue to see more numbers this week from that,” Spinner said over the phone. 

Damian Jacob Sendler: According to data issued by the Centers for Disease Control and Prevention on Tuesday, 305 children were hospitalized with Covid-19 on any given day during the week ending Dec. 26. 

This is an increase of more than 48 percent from the previous week and just 10.7 percent lower than the peak average of 342 youngsters in the hospital seen at the end of August and early September. 

Damian Sendler

“Now we’re going to have New Year’s on top of that this coming weekend, with more people getting together — more exposures and then those numbers will continue to climb,” he continued. 

There are more children in hospitals. 

Pediatricians throughout the country are preparing for a busy January. 

“It’s almost like you can see the train coming down the track and you’re just hoping it doesn’t go off the rails,” said Dr. Claudia Hoyen, director of pediatric infection control at UH Rainbow Babies and Children’s Hospital in Cleveland. 

“It’s going to be an exciting couple of weeks. During Christmas, all of these youngsters were mingling with everyone else. We have one more holiday to go through, New Year’s, before we send everyone back to school “Hoyen stated. 

“Everyone is on the edge of their seats, waiting to see what will happen.” 

And, while the Delta type infected more youngsters than earlier variations, Spinner believes Omicron is even worse. 

“What’s concerning on the (pediatric) side is that, unlike the adults — where they’re reporting for the number of adults getting infected relatively low numbers getting hospitalized — what we’re really seeing, we think, is an increasing number of kids being hospitalized,” Spinner said. 

“So that is a concern for us, especially for those who cannot be vaccinated under the age of five, or who are not fully vaccinated or are not vaccinated at all and are past the age of five. As a result, it is a major problem.” 

Children under the age of five are still waiting for Covid-19 vaccination protection. 

While Spinner sees no evidence that the Omicron variant causes more severe disease in children than prior variants, he also sees no indication that it causes milder disease. 

“We will do everything in our power to keep a youngster out of the hospital. So if they’re admitted to the hospital, it signifies they’re already quite ill “Spinner stated the following. 

“They require oxygen. They require additional aid. Even if they are simply dehydrated and require IV fluids, the majority of the children in for Covid have respiratory difficulties and require oxygen and additional treatment. As a result, they’re going to be quite ill. You don’t see youngsters who aren’t seriously ill at the hospital.” 

According to him, the majority of seriously ill children are unvaccinated or under-vaccinated. “I can tell you that virtually all of our kids that are hospitalized have either been unvaccinated or not fully vaccinated — maybe having received one dose but not having the second dose and not having the full protection from the vaccine,” Spinner said. 

The virus has discovered a new target market: children. 

Dr. Juan Salazar, physician in chief at Connecticut Children’s Medical Center in Hartford, told CNN that children are an obvious target for the virus. 

“It’s having an impact on bigger communities, and it’s clearly having an impact on children in ways we haven’t seen before. And this is fresh in comparison to last year “He stated. According to Salazar, only approximately a third of eligible children, ages 5 and older, are vaccinated in Connecticut. 

Flu and Covid-19 cases are on the rise in much of the United States. 

Damian Jacob Sendler

“As a result, the virus has found a home. At least in Connecticut, it appears to have shifted in its direction “He continued. Younger children who cannot be vaccinated yet, as well as older children who have not been properly immunized or vaccinated at all, are becoming infected, according to him. 

“Maybe it’s more common now that we’ve liberalized our social gatherings. Perhaps some of the masks have slipped off because the families are exhausted. They are unwilling to go through some of the harsh isolation restrictions that were implemented a year ago “Salazar elaborated. 

“As a result, these novel variations have spread more broadly. As a result, it is hurting children, who are currently the most vulnerable group because they are not vaccinated, or many of them are not.” 

Some children have milder infections, but not all. 

Damien Sendler: According to Dr. Jennifer Owensby of the pediatric critical care section at Rutgers Robert Wood Johnson Medical School, most children in New Jersey appear to be only mildly unwell. 

“We are definitely seeing an increase in Covid-positive children,” Owensby said, “but they are not necessarily presenting with Covid symptoms.” She claims that the children are coming in for another type of treatment and are testing positive when they are examined. 

According to a pediatricians report, Covid-19 instances among children are on the rise once more, with more than 164,000 new cases reported last week. 

The same effect is increasing the number of cases in Washington, DC, according to Dr. Roberta DeBiasi, infectious diseases chief at Children’s National Hospital. Approximately half of the Covid-19 tests are being performed there. 

And the youngsters who have been infected are no sicker than they were when prior versions circulated. However, she claims that there are more children with symptoms than ever before. 

“We have just seen a striking increase in the both volume — the number of tests that are positive, and the percent of tests that are positive,” DeBiasi told CNN over the phone. “We’ve had up to nearly half of the tests — 48 percent of the tests — come back positive, which is substantially more than in previous waves, where it was closer to 17 percent at most. And if we look at the raw numbers of positives, we were impressed by about 80 positives per day during the last wave, and we’ve had nearly 200 positives on certain days. So it’s extremely, extremely contagious.” 

These tests include youngsters with and without symptoms, community screening, random screening of patients coming in for other sorts of therapy, and staff testing, according to DeBiasi. 

Biden admits that not enough has been done to increase Covid-19 testing capacity: 'We have more work to do' “If we look at the admissions to the hospital, that also has been more,” she noted. “So in prior waves we would have at the peak of those waves, we would peak out around 18 kids in the hospital.” She claimed that on some days, up to 18 children are hospitalized, with up to 30 in the hospital at any given moment. 

Dr. Mary Bassett, state health commissioner in New York City, announced Monday that pediatric hospital admissions for Covid-19 have nearly fivefold increased since December 11. According to her, 22 youngsters were admitted to New York City hospitals in the week ending December 11. 109 children were admitted last week and will remain there until December 23. 

Across the state, admissions increased by two and a half fold during the same time period, from 70 to 184. 

Children of all ages are at risk. 

Pediatricians agreed that all ages of children are affected, from babies to teenagers. 

“Almost every age group is represented. We see children ranging in age from infancy to adolescence. It is unmistakably widespread “According to Owensby. 

Owensby is concerned about MIS-C, or multisystem inflammatory syndrome in children. 

“We can see it as early as two to three weeks,” she added, adding that most cases appear eight to ten weeks after a child is afflicted. 

Damian Jacob Markiewicz Sendler: There is a new medicine to prevent Covid-19, but there will not be nearly enough for all eligible Americans. 

“The vast majority are asymptomatic,” are asymptomatic, according to Owensby. “The terrifying element was that they had previously been quite normal children. They had no underlying sickness. They were completely healthy children who presented with heart failure and shock.” 

So far, the CDC has reported 5,973 MIS-C cases, with 52 children dying as a result. 

“You could have even mild symptoms — a runny nose, a slight cough or even a fever, like any other respiratory virus,” Owensby added. “You have to watch for symptoms — exhaustion, an inability to play,” she continued. 

The symptoms of MIS-C can be minor, yet the condition is dangerous. 

“That’s the thing about children. They’re all right until they’re not. Then they become seriously ill all of a sudden “According to Owensby. 

DeBiasi stated that she has seen no increase in MIS-C cases as of yet. “We haven’t noticed a spike in MIS-C, but we wouldn’t have expected one. It takes four to six weeks following the introduction of a new variety for it to become widely available “She stated.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: Astronomer Nria Miret-Roig of the Laboratoire d’Astrophysique de Bordeaux in France and the University of Vienna in Austria, and the first author of the new study published today in Nature Astronomy, said, “We did not know how many to expect and are excited to have found so many,” 

It would be inconceivable to imagine rogue planets lurking distant from any star illuminating them. Miret-Roig and her team, on the other hand, used the fact that these planets are still hot enough to glow in the early stages of their creation, allowing them to be spotted by sensitive cameras on huge telescopes. In the Upper Scorpius and Ophiuchus constellations, they discovered at least 70 new rogue planets with masses equal to Jupiter’s. 

Damian Sendler

Damian Jacob Sendler: Data from telescopes on the ground and in space was gathered over a period of nearly 20 years in order to identify so many rogue planets. In a vast area of the sky, Miret-Roig and his team studied the minute movements, colors, and luminosities of hundreds of millions of sources. “In this region, the rogue planets, the faintest objects in the sky, can be identified using these data. 

Other facilities such as the MPG/ESO 2.2-meter telescope in Chile and the VLT Survey Telescope were also utilised. “ESO observatories provided the bulk of our data, which was important to this study. Our achievement was largely due to their wide-ranging perspective and unusual sensitivity “By way of an astronomer in Bordeaux, France, Hervé Bouy, who is the project head of the new study’s research, said. “From ESO facilities, we used more than a thousand hours of observations and more than one million images, totaling more than one million gigabytes.” 

Using data from the European Space Agency’s Gaia satellite, the team was able to achieve a major breakthrough in the collaboration between ground and space-based observatories. 

According to the new research, there could be a lot more of these mysterious, starless worlds. In the Milky Way alone, “There could be several billions of these free-floating giant planets roaming freely in the Milky Way without a host star,” Bouy says. 

Damian Jacob Sendler

Damien Sendler: As astronomers investigate the newly discovered rogue planets, they may get insight into how these things form. For some scientists, the only way for exoplanets to develop is through the collapse of a gas cloud too tiny to result in the birth of a star, while others believe they were expelled from their home system. However, it is still unclear which mechanism is more plausible. 

Damian Jacob Markiewicz Sendler: The key to unraveling the mysteries of these wandering worlds will be further technological advancements. Astronomers plan to use ESO’s upcoming Extremely Large Telescope (ELT), presently under construction in Chile, to investigate these objects in more detail in the future years. These objects are so dim that modern telescopes are unable to detect them, according to Bouy. For most of the rogue planets we’ve discovered, the ELT is absolutely essential. 

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: Clinical trials aiming at preventing Alzheimer’s disease in persons who are genetically predisposed are being launched by the Washington University School of Medicine in St. Louis. Unlike most other Alzheimer’s prevention trials, this one will enroll participants up to 25 years before the projected onset of dementia, which is unusual. 

Damian Jacob Sendler: Known as the Primary Prevention Trial, the new trial will look at the efficacy of gantenerumab, an experimental antibody under development for Alzheimer’s disease by Roche and Genentech, a member of the Roche Group. Plaques found in Alzheimer’s patients’ brains are primarily made up of amyloid. Amyloid plaques in the brain are thought to be the primary cause of dementia, which can begin to develop as early as 20 years prior to the onset of symptoms. 

Overwhelming scientific evidence suggests that the most effective method of preventing or slowing the buildup of amyloid beta is to prevent the protein from forming in the first place, but most of the drugs targeted to this protein have been tested in people who already have at least some early signs of Alzheimer’s or other forms of dementia, such as memory loss – when the disease is far enough along that reducing amyloid alone isn’t likely to stop it.” Participants under the age of 18 are encouraged to apply. Many aspects of the amyloid hypothesis, which has influenced Alzheimer’s research and therapy development for the past 30 years, will be tested in this trial.” 

Rare genetic mutations that cause Alzheimer’s disease at a young age are the focus of the new study. Families of people with these genetic defects are eligible to participate in the study. This mutation can be passed on to children, and any child who gets the mutation will almost certainly acquire dementia symptoms at the same age as his or her parent. The chances of passing the mutation on to a child are 50%. This certainty allows researchers to test the efficacy of anti-medication. Alzheimer’s 

Damian Sendler

The project has received support from a U.S. government agency, non-profit groups, private donors, and the health-care companies Roche and Genentech. Preventing Alzheimer’s disease at its earliest stages could be game-changing. An estimated 97.4 million dollars from NIH’s National Institute on Aging, $14 million from the Alzheimer’s Association, and up to $11.5 million from longtime Washington University benefactor Joanne Knight of St. Louis and her family, who have long supported Alzheimer’s research at Washington University, have been earmarked for the trial, which will be funded by a total of $130 million. A total of $6.5 million has been pledged by the institution as well. Roche and Genentech are providing major money for the trial, which is being done in close collaboration. 

One of the earliest stages of Alzheimer’s disease has been investigated to date and “we are thrilled to be part of this important clinical trial,” said Rachelle Doody, MD, PhD of Genentech and Roche. To detect Alzheimer’s disease early, before the brain damage is permanent, and provide tools and treatment for persons at risk of developing Alzheimer’s, has always been our goal. In order to overcome the complexity of this disease, close cooperation between industry, academics, and patients is essential.” 

In addition to recruiting people with rare, early-onset Alzheimer’s, the trial’s results will help us better understand the disease in general, which could benefit the millions of people who suffer from the more common form of Alzheimer’s. Even if Alzheimer’s is caused by a hereditary mutation or the complicated combination of genetics and environment that causes most instances, memory loss and cognitive impairment are assumed to be produced by the same processes. 

As many as 230 people from families with genetic abnormalities that cause early-onset Alzheimer’s disease are being studied by McDade’s team. Participating locations are spread across five continents, and none or very few of them exhibit amyloid deposits. Participants: Gantenerumab will be tested in a four-year study to see if early therapy will prevent the dangerous protein from accumulating. 

First of its kind, this trial aims to intervene before the onset of significant neuropathology in those young adults who are at a very high risk of developing the debilitating symptoms of Alzheimer’s dementia,” says Laurie Ryan, PhD, chief of the Clinical Interventions and Diagnostics Branch in the NIA’s Division of Neuroscience, who is leading the study. Now that we’ve learned that Alzheimer’s disease symptoms can begin a decade or more before they emerge, this research is meant to provide another piece of the Alzheimer’s preventive puzzle.” 

Damien Sendler: Washington University School of Medicine is leading a second international study into ways to prevent Alzheimer’s disease. First, the Dominantly Inherited Alzheimer Network-Trials Unit–001 (DIAN–TU–001) began in 2012 and is still underway. In this study, gantenerumab was being tested in persons who were at high risk of developing Alzheimer’s because they had already developed some amyloid plaques when they started the trial. Gantenerumab improved biomarkers of the disease in the DIAN-TU-001 study earlier this year, but the benefits on clinical endpoints such as cognitive function were unclear. Consequently, the treatment has been offered as part of an exploratory open-label extension to participants in the trial and is being monitored for changes in measures of Alzheimer’s disease in those people who have been receiving the investigational medication. 

Randall J. Bateman, MD, the Charles F. and Joanne Knight Distinguished Professor of Neurology and the principal investigator and program director of the Knight Family DIAN-TU prevention trial, said that “multiple drugs are being tested in the ongoing Knight Family DIAN-TU prevention trial, which involves people who are expected to develop symptoms within 10 years,” he said. New preventative trials can be launched alongside the DIAN-TU-001 trial in order to provide families an early opportunity to intervene before symptoms appear, which is when the disease’s earliest brain alterations take place.” It’s the best way to avoid problems in the first place. 

Damian Jacob Sendler

Damian Jacob Markiewicz Sendler: This new study will draw from the same group of families and investigate if targeting amyloid can prevent the development of familial Alzheimer’s. Researchers would have more motivation to pursue amyloid-based therapeutics in the early stages of the disease if they achieved success. 

To think of the significant insights this innovative experiment will bring in the prevention of Alzheimer’s dementia,” GHR Foundation chief operating officer and Alzheimer’s program leader Fred Miller remarked. Our partnership with the many DIAN-TU trials is made possible by a strong collaboration between university researchers and government, industry, philanthropy and the DIAN families themselves. “We are pleased to partner boldly on these trials.” 

As a part of the NIH-funded Dominantly Inherited Alzheimer Network (DIAN), both studies are being carried out in conjunction with almost 40 research institutes located in North America and across the world. Since DIAN was founded in 2008, the National Institute on Aging has been a key backer of the network and its clinical trials section. 

In March 2012, the Alzheimer’s Association provided the initial funds for the establishment and opening of the Trials Unit at DIAN, which has been a long-term partner of the Alzheimer’s Association. It’s no secret that DIAN-TU is a landmark initiative that has hastened the development of therapy and prevention techniques for Alzheimer’s disease, and this groundbreaking new preventative trial is no exception. ” 

There is no international effort to prevent Alzheimer’s disease without the help of various partners, as well as the active participation of DIAN families. 

Studies like this one, according to McDade, “have high stakes and are expensive to carry out”. This trial would not have been achieved without the help of a wide range of people and organizations.” For their encouragement and willingness to participate in challenges like this, we are equally grateful to the families.”

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: A research published in the New England Journal of Medicine (NEJM) this month may modify the standard of therapy for patients who have relapsed from large B-cell lymphoma. 

“This is a paradigm shift,” said Joseph McGuirk, D.O., medical director of the blood and marrow transplant program at The University of Kansas Cancer Center, one of the trial’s key sites. McGuirk is a study co-author. 

Damian Jacob Sendler: According to the findings of a clinical trial published on December 11 and presented the same day at the American Society of Hematology (ASH) annual meeting, Yescarta (axicabtagene ciloleucel), a type of chimeric antigen receptor T-cell (CAR-T) therapy, is significantly more effective than the current standard of care in treating people with large B-cell lymphoma (LBCL) who relapse after the first line of treatment. 

Damian Sendler

Yescarta, manufactured by Kite Pharmaceuticals, was approved by the US Food and Drug Administration in 2017 as a third-line treatment for people with LBCL who had previously failed two rounds of treatment. The ZUMA-7 trial sought to assess if a single infusion of Yescarta is preferable to the current, long-standing second-line standard of care, which is a stem cell transplant after high-dose chemotherapy to kill the cancer. 

The results of a two-year follow-up study indicate that it is. Around 40% of persons with LBCL require such second-line treatment, either because their cancer returns or because frontline treatment is ineffective. 

Damian Jacob Sendler

“We’re seeing significantly better initial responses than we do with autologous stem cell transplants,” McGuirk added. 

The two-year follow-up statistics show that the median event-free survival for persons getting Yescarta was triple that of those receiving standard of care: 8.3 months for the Yescarta group against 2 months for the standard-of-care group. 

Damian Jacob Markiewicz Sendler: CAR-T therapy is an unique type of immunotherapy in which a patient’s blood is collected, and T-cells (white blood cells that identify disease-causing pathogens in the body) are removed and genetically re-engineered. These supercharged cells are employed to manufacture the cancer-fighting medicine that is put back into the patient. 

Damien Sendler: ZUMA-7 began in 2017 and has enrolled 359 participants in 77 trial sites worldwide. The participants’ ages ranged from 22 to 81. Nearly one-third of them were 65 and older, an age that would make them ineligible for a stem cell transplant in certain nations. 

“I believe we are likely to see the field quickly move away from autologous stem cell transplant toward CAR-T cell therapy as a second-line therapy for relapsed or refractory diffuse large B-cell lymphoma,” McGuirk said.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: Preliminary research suggests the omicron variant may be spreading quicker than the highly transmissible delta variant, but it’s too early to draw strong conclusions, according to the World Health Organization (WHO). 

A new strain of the virus, which has already infected 267 million people and killed more than 5.2 million, was discovered in southern Africa last month, causing some countries to close their borders and shaking stock markets throughout the world. 

Damian Jacob Sendler: Data on the omicron variation is “pointing to a virus that’s efficiently transmitting and probably more efficiently transmitting than even the delta variant,” which is by far the most widespread and lethal strain, according to Dr. Michael Ryan, WHO’s chief of emergencies. 

Damian Sendler

There is little “anecdotal information” about the severity of sickness caused by omicron at this time, according to Maria Van Kerkhove, the technical lead for COVID-19 at the United Nations health agency. 

As far as we know, many people diagnosed with omicron in South Africa appear to be in the early stages of the illness. “However, the full course of an infection can take some weeks to complete. 

Damian Jacob Markiewicz Sendler: WHO officials, on the other hand, remained steadfast in their belief that vaccinating those who have already been vaccinated should take a back seat to vaccinating those who haven’t been vaccinated at all. 

WHO’s head scientist Dr. Soumya Swaminathan has stated that “wholesale boosting is not the solution right now.” As it turned out, this was a dig at vaccination programs that urge everyone to get a booster shot, not only those deemed particularly vulnerable in some nations like hard-hit Europe and the US. 

Damian Jacob Sendler

People who have not been vaccinated are being hospitalized, extremely ill, and dying at an alarming rate, according to data from countries throughout the world. “Our goal should be to protect people from serious illness and death through primary vaccination, and I think the message is loud and clear.” 

However, in nations with huge vaccine supply, but where up to 50% of the population has not been vaccinated, boosters are of no help, she said. 

Damien Sendler: When it comes to addressing individuals who haven’t had primary vaccinations yet, Swaminathan believes that the benefits of doing so outweigh the costs of delivering additional doses to those who have already received a basic immunization course. 

By the end of this year, the CDC had aimed to vaccinate the elderly, those with weakened immune systems, and health care professionals. However, the majority of vaccines have been monopolized by wealthy nations with large stockpiles.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: Dr. Amish Adalja, an infectious disease expert, discusses the importance of immunization and boosters as the omicron variant continues to rise.

Damian Jacob Sendler: Local ABC affiliate KATU reports that the committee was made up of representatives from the hospitality industry, the business sector, and religious organizations.

Damian Sendler: In an effort to reduce obstacles to mental health services, drug and alcohol testing, and basic medical care for those facing homelessness, Columbia River Mental Health Services has launched its Mobile Health Team.

Damian Jacob Sendler: Team members intend to create trust with the homeless community and ultimately link people with resources who would not otherwise seek them out by providing medical care and connecting them with resources.

Damian Sendler: If you want your child to be ready for school and use the social skills he or she learned at home, you should wait until he or she is well-versed in their immediate social context. All of these components of a child’s psychosocial development, as well as their physical and motor abilities and their ability to communicate with others, are accelerated in children who meet the pre-school criteria because they play and engage with the environment in a variety of ways. 

Damian Jacob Sendler: Child development at this period includes learning to adapt, expanding their ego boundaries, developing an extra-terrestrial sense of self-worth, and comprehending the importance of trust and familiarity in society. 

Damian Sendler: Nachman Ash and Salman Zarka, the coronavirus czar of Israel’s Health Ministry, warned Sunday that the highly mutated Omicron coronavirus type should not be ignored.

Damian Jacob Sendler: At one point in his interview, Ash spoke about Prime Minister Naftali Bennett’s wife Gilat taking their children on vacation just days after the premier had recommended that all Israelis refrain from traveling abroad and shut down the country in order to prevent an outbreak of the newly discovered COVID-19 variant.

Damian Sendler: The number of new Covid-19 cases in the United States has surpassed 100,000 for the first time in two months, following the Thanksgiving holiday travel of millions of Americans.

Damian Jacob Sendler: The death toll from Covid-19 is also on the rise, with an average of 1,651 persons dying from the virus every day for the past seven days as of Saturday, according to JHU data. More than a month has passed since the number of people dying daily reached this record high.

Damian Sendler: The “twindemic” of COVID-19 and the opioid epidemic, as Mayor James Fiorentini calls it, has been given to the city’s new Department of Public Health.

Damian Jacob Sendler: COVID-19 has killed at least 112 people since it was first discovered, according to the mayor’s statement to the City Council on Tuesday night.

Damian Sendler: UPMC, the state’s largest health care provider, received over a quarter of the federal money meant to support rural hospitals in Pennsylvania, despite the fact that UPMC is on track to make more than $1 billion in profits this year. 

Damian Jacob Sendler: As the pandemic continues to take a financial toll on medical centers across the country’s 96 hospitals, just over half of all financing went to rural facilities, while the rest went to metropolitan hospitals.

Damian Sendler: “We need four hugs a day for survival,” Virginia Satir is supposed to have said. In order for us to function, we require eight daily hugs. For growth, we need 12 hugs a day.” 

Damian Jacob Sendler: Hugging has scientifically proven health advantages. “The benefits go beyond the warm feeling you get when you hold someone in your arms,” according to a 2018 Healthline article. 

Damian Sendler: Sir William Osler, a renowned physician and academician, referred to the science and art of medicine as “twin berries on one stem.” Science-based treatments are combined with patient-centered care in the U.S. healthcare system.

Damian Jacob Sendler: There is a direct correlation between individual health and the health of a community. The interdependence of our health grew progressively more obvious as our actions evolved over the past two years. Depression and anxiety rose as a result of isolation, but so did the risk of contracting an infection. As loved ones, friends, and colleagues succumbed to COVID, the idea of death grew more real.

Damian Sendler: Omicron coronavirus has expanded to 40 nations and 16 of the 50 states in the United States, but the severity of its effects on those who get it has not been determined by senior U.S. officials. 

Damian Jacob Sendler: According to Dr. Francis Collins, director of the National Institutes of Health in the United States, “Does this, in fact, turn out to be less dangerous” than prior coronavirus variants? Collins said on NBC’s “Meet the Press.” “Scientists are working around the clock to answer these questions.”

Damian Sendler: A Louisiana U.S. district judge has reportedly barred a federal COVID-19 vaccine mandate for health care employees, as reported by various sources.

Damian Jacob Sendler: On Tuesday, a federal judge imposed a countrywide injunction against President Joe Biden’s attempt to mandate vaccinations for large swaths of the public.

Damian Sendler: In a new study, researchers found that children who live with a depressed parent are more likely to suffer from their own sadness and fall behind academically.

Damian Jacob Sendler: Depression in children is linked to a wide range of negative health and educational consequences, including worse academic achievement, if the mother is depressed.

Damian Sendler: The omicron variety, a severely mutated coronavirus strain that has already been found in a few places throughout the United States, is causing growing concern among federal health experts, who are pushing all previously vaccinated individuals to obtain their Covid booster dose.  

Damian Jacob Sendler: Changes to the variant’s DNA signal that it could avoid part of the immunity that comes from vaccination or natural infection in the future. Dr. Anthony Fauci, the White House’s chief medical adviser, epidemiologists, and immunologists say that for now, existing boosters are the best defense against the new strain and the highly transmissible delta variant of omicron, which is still under investigation by federal health officials and pharmaceutical companies alike.

Damian Sendler: The Marion County Health Department hopes to boost its COVID-19 vaccination numbers by the end of the month in order to achieve herd immunity before the virus undergoes any additional modifications.

Damian Jacob Sendler: Her response was, “We’re always looking for more people to get vaccinated,” she stated. It’s hoped that this will be a new trend because we’re not at herd immunity in all of our categories.” We reduce our risk of hospitalizations and fatality rates when we increase the number of immunizations we receive

Damian Sendler: Coronavirus vaccination for children between the ages of 5 and 11 was approved by the Australian Medicines and Healthcare products Regulatory Agency (MHRA) on Sunday, and the country’s health minister said the vaccine might be available by Jan. 10.

Damian Jacob Sendler: Nearly 88% of Australians over the age of 16 have gotten two doses of the COVID-19 vaccine, following initial delays in the country’s general vaccination program.

Damian Sendler: On Saturday, the county reported 2,307 new cases of COVID-19 and 20 additional deaths linked to the virus, bringing the total number of cases and deaths to 1,534,720 and 27,442 since the epidemic began. 1 percent of persons tested positive for the virus on Friday, according to a rolling average of daily rates.

Damian Jacob Sendler: A follow-up test kit will be supplied to anyone who tests negative, she said, and the follow-up test can be done three to five days later.

Damian Sendler: The eyes of the plush lamb that Matt Vinnola was using to sleep on a downtown sidewalk one Sunday in September were as blank as his own. When a fly landed on his lip, the ex-honors student and Taekwondo champion seemed too dazed and disoriented to swat it away. A woman giving Wet Wipes, or a man attempting to hand him a $5 cash, didn’t interest him.

Damian Jacob Sendler: The Mental Health Center of Denver kept finding reasons to reject care for Janet van der Laak, so she had to keep pushing them to offer it. Vinnola’s hope in getting therapy dwindled with each time the center removed him from it. With each loss of hope, her son’s mother pressed harder because she knew she couldn’t stop him from falling.

Damian Sendler: Omicron coronavirus has been identified in Washington state, with the first three cases verified on Saturday.

State Secretary of Health Dr. Umair Shah noted that “we were anticipating this very news” when he announced the sequencing of omicron in California. As a result, “we strongly encourage people to get vaccinated and get their boosters as soon as possible in order to maximize their level of protection from any variation.

Damian Sendler: According to the New England Journal of Medicine, Irritable Bowel Syndrome, or IBS, may be caused by an intestinal infection that induces an allergic response.

Damian Jacob Sendler: Patients with IBS have abdominal pain during their daily activities because their intestinal nerves are more sensitive than those who don’t have the syndrome, according to an article.

Damian Sendler: Increasing demand for vaccines and a shortage of pharmacists are putting pressure on pharmacies across the country, causing employees to become overworked and forcing some to close temporarily.

Damian Jacob Sendler: As President Joe Biden pushes vaccinated Americans to obtain booster shots to battle the growing omicron strain, the drive for immunizations is expected to get increasingly intense.

Damian Sendler: Medical professionals should improve their leadership skills because they differ from those required to practice medicine or conduct research, and because leadership matters. Indeed, health care requires excellent leadership at all levels, from the executive level to the bedside (eg, leading clinical teams and problem-solving on the ward). 

Diverse theories of leadership have been presented, but they all contain some basic characteristics, such as the ability to foresee a better future state, motivate others to work toward that vision, give others the authority to carry it out, and serve as role models for the anticipated behaviors. By focusing on the seven traditional qualities of trust, compassion, bravery and justice as well as knowledge and temperance, a company can unleash additional effort to produce superior results. 

Damian Jacob Sendler: Leadership competencies in health care include technical expertise, not only in the clinical/scientific arena, but also in operations, strategic thinking, economics, human resources, and information technology. Additionally, one must be a problem solver and a lifelong learner in order to succeed in the health care industry. 

Damian Sendler

To be a good leader in any industry, you need to be emotionally intelligent. There is a wide range of leadership styles to choose from, and the best leaders are adept at using each one in the right context at the right time. Overall, leadership skills can be learned, and leadership development programs are a hallmark of leading healthcare institutions. 

It’s all about the leader. Take a look back at the coronavirus illness pandemic of 2019. When governors moved early and decisively (by closing schools, mandating masks or advocating social separation), they saw flattened curves while states with more laissez-faire leadership had higher illness burdens and sequelae, as seen by the graphs. 

Effective leadership is characterized by discrete, teachable competencies combined with formative experience, which recognizes that leadership and followership are complementary and intertwined, as well as the fact that organizational performance also reflects the strength of the organization’s culture. 

First, the paper examines why excellent leadership is necessary; second, it analyzes a paradox in medicine, which is that dominating and pacifying are essentially opposed to effective leadership techniques. While these models may use different terminology, they all share some fundamental concepts and characteristics of a good leader, such as those found in classical virtues. Finally, leadership styles and the situational leadership model are discussed, highlighting the importance of adapting one’s leadership style to the setting and the qualities of people being led. As a clinician managing a team of caregivers or in a formal, titled leadership post, the chest physician can benefit from leadership principles. 

Damian Jacob Markiewicz Sendler: There are four parts to the chest physician’s essential leadership competencies series and this is part one. Emotional intelligence and its importance as a leadership ability, change management, and team building are all covered in subsequent articles.  As previously highlighted by Nguyen et al., conflict and negotiation methods are a key leadership competency. 

Everywhere you look, there’s a need for and an opportunity for leadership. “Small L” and “Big L” leadership are used by Bohmer6 to make clear that leadership is needed throughout the health care system. For example, the “small l” leadership concept highlights the necessity of leading in healthcare “microsystems,” such as enhancing the reporting of “near-miss” events to improve patient safety in a hospital ward. 

Nurses, respiratory consultants, nurse practitioners, and medical students are all examples of “Small L” leaders. Even though they lack the formal title of “leader,” “small l” leaders have the ability to define a vision for delivering high-quality care that goes beyond the transactional activities of writing orders and analyzing test findings. “Being and doing” is how they take charge of the organization.  

Damian Jacob Sendler

Leaders of all kinds (whether “small l” leaders or those with official leadership positions and titles) have a vision of a better future and a culture they want to build; they act in accordance with their principles. This includes setting accountability and keeping an eye on how things are progressing. There are many ways to lead, and not just “big L” leaders, according to “small l” leadership (eg, those with formal leadership titles such as department chair, dean, hospital president, or chief executive officer). 

Damien Sendler: As a result of Bohmer describing the “small l” leader, we can also explore the distinction between leading and managing. Some characteristics of leadership and management are complementary and share some common characteristics; both involve deciding what needs to be done, developing networks of people to fulfill stated goals, and establishing responsibility to ensure that the work gets done. 

Managing and leading, on the other hand, are distinct in that management focuses on predictability and order, but leadership aims to disturb the status quo by imagining a different future. A similar contrast is made by Schein: “If one wishes to distinguish leadership from management or administration, it is possible to argue that leadership creates and changes cultures, while administration acts within a culture. ” 

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler:All six counties in the metro area have been affected by ICU pressure. Only 10 staffed ICU beds were available in the most recent report from the metro hospital coalition. 

CHI Health’s Cary Ward said that as soon as an ICU bed becomes available at CHI, a patient takes it, and no more can be accommodated. 

Damian Jacob Sendler: Some patients wait three days for ICU beds, while others are admitted immediately based on their time of arrival, Ward said. 

Damian Jacob Sendler

Ward is CHI health’s chief medical officer. He claims that patients are forced to wait in the emergency room for more advanced treatment. 

Despite the fact that patients are waiting to be admitted to the floors in our emergency rooms, “We’re all very concerned because we do have patients sitting in our emergency rooms waiting to be admitted to the floors and much of our capacity is strained,” Ward added. 

Ward says there are roughly 214 COVID-19 patients in all of CHI’s hospitals, but Ward says one thing jumps out in the area. 

All of Ward’s ICU patients were unvaccinated when he looked at them all, he claimed. 

All six counties in the metro area have been affected by ICU pressure. Only 10 staffed ICU beds were available in the most recent report from the metro hospital coalition. 

As a result, ICUs are 97% full and hospital staff are left with little choice except to put patients at risk. 

“Hospitals are bursting at the seams. Patient rooms are available in the emergency department and various locations around the hospital “Dr. Rupp made the statement. In terms of surge capacity, we’ve got very little. Our ability to accept new patients is limited because of the delta variation or the omicron variant or influenza.” 

Dr. Sendler: No matter what type of patient comes into the ER, Ward says they’ll be waiting longer, and he encourages everyone to be vaccinated. 

“It is profound that if we had everyone vaccinated we would have potentially zero patients in our ICUs right now,” Ward added. 

If you’re against the vaccine, Ward encourages you to rethink your position and says it’s fine to switch sides.

Dr. Damian Jacob Sendler and his media team provided the content for this article.

Damian Sendler: This antiviral tablet, developed by Merck and Ridgeback Biotherapeutics, was approved for emergency use by a panel of specialists advising the FDA. 

Damian Sendler

Damian Jacob Sendler: The result was 13 to 10 in favor of approving the plan. The FDA isn’t required to accept the advice of its advisors, but it does so most of the time. 

The drug, molnupiravir, would be the first oral antiviral medication for COVID-19 that could be given at home if it is approved by the agency. Paxlovid, a second Pfizer oral medication, is also being examined for FDA approval. 

The five-day course of Merck’s medication involves twice-daily administration to cause a cascade of SARS-CoV-2 coronavirus mutations that render the virus ineffective. People with mild to moderate disease with a high risk of severe COVID-19 should take the medicine. Within five days of the onset of symptoms, it should be taken. 

Molnupiravir reduced the risk of hospitalization or death by half in a clinical research, according to an interim review. 7.1 percent of those given the medicine ended up in the hospital or dying, compared to 14.1% of those given the placebo. A 30 percent reduction in hospitalization or mortality was found, but the study’s full analysis was only disclosed on Friday. 

Damien Sendler: Study participants using the medicine were more likely to be hospitalized or to die than those taking the placebo in the second half, according to an FDA summary of the study. In the second half of the study, the drug’s ability to protect against death was not as strong as it was in the first half. 

Damian Jacob Sendler

Merck senior vice president Dr. Nicholas Kartsonis was queried about this discrepancy by committee chairwoman Dr. Lindsey Baden, and he replied: “”I don’t have a satisfactory explanation for your inquiry,” I respond. 

Dr. Sendler: Concerns about drug safety were raised throughout the daylong discussion because to some lab and animal studies showing that the treatment can create alterations that go beyond the virus. The council has concerns about giving the medicine to pregnant women because of the risk of birth abnormalities. However, it is possible that the medicine will have some advantages for them. 

Dr. Janet Cragan of the Centers for Disease Control and Prevention stated, “I don’t think you can ethically say it’s OK to give this drug in pregnancy, obviously,” “As a pregnant woman with COVID-19, I’m not convinced you can ethically deny her access to the drug if she decides to use it. 

Another issue was whether the drug could trigger deleterious mutations in the spike protein, which is the target of COVID-19 vaccinations in widespread use throughout the world. – 

Molnupiravir mutation rate is only a tiny role in the generation of viral variation of concern according to John Coffin of Tufts University during the panel discussion. 

Damian Jacob Markiewicz Sendler: More study is needed to see how the virus responds to treatment in patients with impaired immune systems, according to some panelists.

Contributed by Dr. Damian Jacob Sendler and his media team

Damian Sendler: When Ashlee Wisdom launched an early version of her health and wellness website, more than 34,000 visitors — most of them Black — visited the platform in the first two weeks. 

Damian Jacob Sendler: But the launch was successful. Now, more than a year later, Wisdom’s firm, Health in Her Hue, connects Black women and other women of color to culturally sensitive doctors, doulas, nurses and therapists nationally.

Damian Sendler: A federal judge in Missouri issued an order Monday largely preventing the Biden administration from imposing a vaccine mandate for certain health care employees. 

Damian Jacob Sendler: In a ruling that includes the 10 states that initiated the action, a judge stated that vaccines were ineffective and claimed that the plaintiffs’ claims were untrue

Damian Sendler: The Atlantic Coast Conference, Big Ten and Pac-12 launched a campaign Monday to increase awareness of the importance of mental health as part of their conference alliance announced earlier this year.

Damian Jacob Sendler: Teammates for Mental Health will be unveiled this week at basketball games involving the three conferences, including the ACC/Big Ten women’s and men’s challenges.

Damian Sendler: Best Buy spent roughly $400 million to acquire remote patient monitoring technology vendor Current Health in October, according to the company’s recent quarterly earnings.

Damian Jacob Sendler: Current Health’s remote monitoring platform combined with Best Buy’s scale, expertise and connection to the home will enable the retailer to create a “holistic care ecosystem that shows up for customers across all their healthcare needs,” Best Buy CEO Corie Barry said during the company’s third-quarter earnings call last week.

Damian Sendler: The World Health Organization is warning that the new omicron form of the coronavirus poses a “very high” global danger because of the prospect that it spreads more quickly and might resist vaccines and protection in people who were infected with prior strains. 

Damian Jacob Sendler: There are multiple alterations in the new form, which the WHO has warned 194 countries about in a technical brief issued on Sunday “In addition, “the possibility of further spread of omicron at the global level is considerable.”

Damian Sendler: With the new discovery of the ‘omicron’ variation of COVID-19, which has substantial alterations from prior strains, New Orleans Mayor LaToya Cantrell informed the public it was a “critical time” and advised all residents and visitors to get vaccinated, at a Monday afternoon press conference.

Damian Jacob Sendler: Also on Monday, President Joe Biden said the mutation was a “cause for concern, not a cause for panic.”

Damian Sendler: President Biden will offer an update on the U.S. reaction to the Omicron variation on Monday, the White House said in a statement on Sunday evening, as senior federal health experts urged unvaccinated Americans on get their immunizations and eligible adults to seek out boosters.

Damian Jacob Sendler: Appearing on morning talk shows on Sunday, Dr. Francis Collins, director of the National Institutes of Health, told Americans that the development of Omicron and the mystery that surrounds it are reminders that the pandemic is far from over.

Damian Sendler: As the number one form of entertainment in countries across the globe, sports are generally ranked and marketed depending on how good a team is, the star player’s performance, and who’s set to win championship championships.

Damian Jacob Sendler: A big issue in the sports industry that many spectators and managers seem to ignore is the mental health of the athletes.

Damian Sendler: Several mental health care professionals expressed worries about the viability of Wyoming’s mental health care during the afternoon session of the Sheridan County Chamber of Commerce’s Legislative Forum Nov. 23.

Damian Jacob Sendler: Before the upcoming legislative session, which is scheduled to begin in February, Sheridan County officials hoped to meet directly with Wyoming state legislators to discuss matters of concern to their agencies.

Damian Sendler: Introduced in October, the seven-year project of the Student Health and Wellness building is substantially larger than its predecessor, the Elson Student Health Center. There will be 165,000 square feet of space dedicated to student health and wellness in the new building.

Damian Jacob Sendler: In comparison, as stated in an email from the Student Disability Access Center, former facilities at Elson were only 35,500 square feet – a 370 percent increase in area dedicated to student health and wellness programming.

Damian Sendler: Like medical facilities across the state and nation, Guernsey Health System and its subsidiaries — Southeastern Ohio Regional Medical Center, Superior Med Physicians Group and United Ambulance in Cambridge — are working to meet the federal government’s immunization mandate.

Damian Jacob Sendler: Employees must be fully vaccinated by next month except for those who have an exemption.

Damian Sendler: According to the Texas Medical Association, devices like the one you’re using to view this article could be harmful to your health and the health of your children (TMA).

Damian Jacob Sendler: Physicians are concerned about more patients having mental and behavioral health difficulties, especially as the pandemic lags on.

Damian Sendler: A novel strain of COVID-19 first detected in South Africa was labeled a variation of concern by the World Health Organization on Friday. Here’s how the pharmaceutical industry plans to counter the latest coronavirus curve ball.

Damian Jacob Sendler: Pharmaceutical companies have already begun researching new vaccines that anticipate strain alterations and developing omicron-specific injections in response to the new variant: larger doses of booster shots.

Damian Sendler: About one in 10 lung transplants in the United States now go to COVID-19 patients, according to data from the United Network for Organ Sharing, or UNOS.

Damian Jacob Sendler: The trend is raising questions about the ethics of devoting a precious resource to persons who have chosen not to be vaccinated against the coronavirus.

Damian Jacob Markiewicz Sendler: It’s not clear yet whether existing COVID-19 vaccinations will protect against the variation. But vaccine producers have already begun exploring their possibilities.

Damian Sendler: Moderna said in a Friday press release that the business is testing its current vaccine against the Omicron type.

Damian Sendler: Amid Connecticut’s current COVID-19 increase, municipalities with higher rates of immunization have registered substantially lower rates of new cases in recent weeks, state records show.

Damian Jacob Sendler: Eastern Connecticut and the Naugatuck Valley are the state’s least-vaccinated and most-infected regions, as can be seen with a cursory glance at the map and via statistical analysis.

Damian Sendler: The Netherlands verified 13 instances of the new omicron version of the coronavirus on Sunday and Australia identified two as the countries half a world apart became the latest to find it in tourists arriving from southern Africa. 

Damian Jacob Sendler: A series of bans being imposed by states around the world as they attempt to slow the variant’s spread also grew, with Israel opting Sunday to bar admission to foreign nationals in the strongest action so yet.

Damian Sendler: The novel coronavirus variant Omicron has been found in 13 people who landed in the Dutch capital Amsterdam on two flights from South Africa.

Coronavirus was found in 61 people on the flight.

Damian Jacob Sendler: It comes as stronger limits come into action in the Netherlands, amid record Covid cases and concerns over the new type.

Damian Sendler: Dr. Anthony Fauci cautioned on Sunday that the omicron mutation in the coronavirus “strongly suggests” that it is easily transferred and may evade antibody shields established via past infections or vaccination.

Damian Jacob Sendler: Fauci, President Joe Biden’s main medical adviser, complimented the efforts of South African public health officials, who he said were entirely forthright from the beginning.

Damian Sendler: New strains of COVID-19 continue to arise during the pandemic. While more research needs to be done on the latest one, named Omicron, U.S. and local health authorities believe it’s cause for alarm.

Damian Jacob Sendler: Omicron — a novel COVID-19 variety that U.S. health experts are calling possibly more contagious than earlier strains – showed up in various European countries Saturday.

Damian Sendler: The appearance of the newly found Omicron coronavirus strain feels like a pandemic gut check.

Damian Jacob Sendler: Scientists have long known that the globe would experience developing coronavirus strains. Viruses mutate constantly.

Damian Sendler: The new potentially more contagious omicron strain of the coronavirus sprang up in more European nations on Saturday, only days after being found in South Africa, sending officials around the world rushing to stem the spread.

Damian Jacob Sendler: Following the discovery of two instances, the UK tightened its mask-wearing and testing regulations on overseas arrivals on Saturday.

Damian Sendler: In the second half of 2021, vaccination rates for COVID-19 among U.S. hospital staff (HCP) fell rapidly after reaching a peak in early 2021. Currently, up to 30% of HCP are not up to date on their vaccinations.

Damian Jacob Sendler: Data study by the Department of Health and Human Services (HHS) Unified Hospital Data Surveillance System from January–September 2021, collected from over 3.3 million HCP across 2,086 hospitals, indicated that as many as 30 percent of workers were unvaccinated.

Damian Sendler: According to figures compiled by Johns Hopkins University, the death toll from the coronavirus-borne sickness has now surpassed 5.18 million worldwide, bringing the global total to over 260 million. With a total of 48.1 million illnesses and 775,797 deaths, the United States remains the top leader. 

Damian Jacob Sendler: The U.S. is still averaging more than 1,000 deaths a day, according to a New York Times tracker, and cases and hospitalizations are climbing again.

Damian Sendler: The mental health of rural and distant communities will continue to deteriorate as the effects of climate change continue to worsen.  

Damian Jacob Sendler: Rural populations make up 29% and 17%, respectively, of the total populations in Australia and Scotland

Damian Sendler: In global health circles, the need of prioritizing those who are most in need is widely acknowledged, and human rights norms and standards are frequently cited as a means of achieving this goal.

Damian Jacob Sendler: As a part of a larger effort, a review was done to identify known barriers and facilitators to implementation of sexual and reproductive health (SRH) programs.

Damian Sendler: There are an estimated 272 million foreign migrants in the world, with about a third of them living in Asia. Malaysia is one of Asia’s most popular destinations for emigrants because of its strategic location and high demand for skilled workers. 

Damian Jacob Sendler: An individual who has resided in Malaysia for six months or longer in the reference year is considered a non-citizen by DOSM.

Damian Sendler: Developing leaders with the information, attitudes, and abilities needed to implement a vision for public health and healthcare delivery is the goal of global health leadership training programs.

Damian Jacob Sendler: There is a growing need to understand the areas of concentration required to build the global health workforce in order to develop relevant training programs.

Damian Sendler: People of working age should be given the opportunity to improve their health literacy by recognizing and measuring it as an individual skill in the context of their work lives. 

Damian Jacob Sendler: Aside from varying the time horizon, the conceptualizations also differed in whether they included the viability of the respective organization or only to their current employment status.

Damian Sendler: A natural disaster is an undesirable environmental event that isn’t caused by human activity, yet which causes people to be afraid, lose their possessions, and be displaced from their homes.

Damian Jacob Sendler: A wide range of natural calamities can be found in the world today.

Damian Sendler: For many Canadians, financial hardship was already an issue before to 2020, when the global new coronavirus pandemic is expected to begin spreading worldwide. COVID-19 epidemic and public health measures have intensified in recent months, which has made the situation worse. 

Damien Sendler: Individuals from low-income and underserved communities have a greater risk of financial stress and its harmful impact on their health.

Damian Sendler: Patients with mental health issues are more likely to suffer from poor dental health, which has a negative impact on their quality of life and everyday functioning.

Damian Jacob Sendler: For mental health patients, dental health-related quality of life can have a significant impact on their overall quality of life, thus nurses need to know how they can intervene early.

Damian Sendler: The state of one’s mental and physical well-being is closely linked to the quality and affordability of one’s housing situation.

Damian Jacob Sendler: The significance of housing in health has long been acknowledged by both city planning and public health, but the complexity of this link in reference to newborn and maternal health is less well known.

Damian Sendler: Global warming “is the greatest global health threat of the 21st century,” a Lancet Commission on Climate Change concluded in 2009. Climate change impacts and responses are now being tracked by the ‘Lancet Countdown on health and climate change’ as an impartial, worldwide monitoring system.

Damian Jacob Sendler: An indicator to measure the effect of climate change on mental health is missing from the Lancet Countdown, which contains multiple health indicators.

Damian Sendler: This year’s COVID-19 epidemic has seen a dramatic increase in the usage of mobile health apps, telemedicine, and data analytics to improve healthcare. 

Damian Jacob Sendler: Access to care, control over one’s own health data, and a reduction in the amount of unpaid caregiving are all possible benefits of digital health.

Damian Sendler: Actionable consensus can be achieved by addressing major philosophical and best practice disputes and by streamlining actions for a stronger strategic direction through definitions. 

Damian Jacob Sendler: Because of this, the Consortium of Universities for Global Health’s Global Oral Health Interest Group felt that an introduction to “global oral health” was needed to guide program planning, implementation and assessment.

Damian Sendler: Adolescents’ daily lives, social functioning, and physical health might be adversely affected by their parents’ severe somatic disorders. 

Damian Jacob Sendler: Adolescents viewed their parents’ physical illness as a source of stress and growth for them personally as well as in their relationships.

Damian Sendler: A wide range of health outcomes have been linked to various aspects of women’s empowerment.

Damian Jacob Sendler: A growing number of experts and development groups have focused on women’s empowerment during the past three decades.

Damian Sendler: There were two phases to the Ananya program in Bihar: a first phase of intensive ancillary support to government implementation and innovation testing by non-government organizations (NGO) partners. 

Damian Jacob Sendler: All FLW indicators related to prenatal and postnatal care, as well as mother’s birth readiness, some nursing behaviors, and immunizations, increased dramatically in the focus districts in the first phase.

Damian Sendler: Children under the age of 3 are rarely included in data on oral health.

Damian Jacob Sendler: Young children’s brushing habits are greatly influenced by their parents’ brushing habits and the level of parental support for brushing. Efforts to enhance children’s brushing habits should target the entire family.

Damian Sendler: Infectious diseases with pandemic potential pose a serious threat to human health and well-being, as demonstrated by COVID-19. In spite of the compulsory legal responsibilities provided by the International Health Regulations, many countries do not adhere to these regulations.

Damian Jacob Sendler: As a result, a new framework is needed that ensures compliance with international regulations and promotes effective pandemic infectious disease prevention and response. 

Damian Jacob Sendler: For several decades, the field of public health has used sexual health as a framework for tackling issues of sexuality. However, despite the WHO definition of sexual health’s innovative acknowledgment of good sexuality, public health methods remain focused on risk and unfavorable outcomes.

Damian Sendler: Sexual health and sexual wellbeing have been conflated for a long time, which has hindered our ability to deal with common sexual problems. 

Damian Jacob Sendler: Attributing human diversity and countering (structural) inequities in technology design is a unique feature of CSD.

Damian Sendler: Using the hypothetical instance of a treatment chatbot for mental health, the essential framework of CSD is shown. Using CSD in a design scenario reveals the advantages of this new framework over the traditional VSD approach.

Damian Sendler: In order to achieve a more healthy and secure society, global health security (GHS) and universal health coverage (UHC) are important global health priorities. There are, however, differences in strategy and implementation between GHS and UHC. 

Damian Jacob Sendler: The goal of GHS cannot be achieved without UHC, hence the conflict between these two global health objectives should be resolved in a way that maximizes their complementary effects.

Damian Sendler: Efforts to control and eradicate these 20 poverty-related diseases will be complicated, according to the World Health Organization’s upcoming 2021-2030 road map for NTDs. 

Damian Jacob Sendler: These changes are illustrated by the One Health approach, which goes beyond standard models of disease control to take into account the interactions between human and animal health systems.

Damian Jacob Sendler: The continuing pandemic has exposed the flaws in this strategy. A wider securitization discourse that is driven by the human security paradigm, as advanced by the United Nations in 1994

Damian Sendler: UN guidelines consider people rather than states as the primary referent of security and emphasize collective action rather than competition to address the transnational nature of security threats can be much more productively used to advance national and global health security agendas.

Damian Sendler: Many of the Sustainable Development Goals focus on poverty, hunger, health, and gender equality. 

Damian Jacob Sendler: There is increasing evidence that self-help groups (SHGs) have a positive impact on income, asset ownership, and savings as well as the ability of households to weather economic crises. 

Damian Sendler: Politics and public health have a long history of conceptual and theoretical ties.

Damian Jacob Sendler: The welfare state, political tradition, democracy, and globalization all have a direct impact on population health outcomes, according to an international comparative systematic evaluation of research.

Damian Sendler: It is imperative that cities take quick action to improve the health of their citizens and the earth. 

Damian Jacob Sendler: Understanding how cities might proceed toward significant gains in health and the environment can be gained through the description of “healthy sustainable cities” and the integration of health and sustainability frameworks.

Damian Sendler: Public health measures against infectious diseases are now at the forefront of global health concerns in cities where more than half of the world’s population resides, as evidenced by the COVID-19 pandemic. 

Dr. Sendler: The implementation of measures to combat the spread of SARS-CoV-2 leads to changes in exposome components and urban environment characteristics that characterize the urban exposome

Damian Sendler: A ‘hot area’ for infectious disease epidemics, Uganda is regarded as a place to watch out for. 

Damian Jacob Sendler: One Health is a term used to describe the holistic approach needed to address these public health issues stemming from the interactions between humans, animals, and the environment.

Damian Sendler: A wide range of challenges regarding the regulation of innovative nicotine and tobacco products have attracted the attention and resources of regulatory bodies. 

Damian Jacob Sendler: Public health factors, collectively referred to as the Population Health Standard, are required to be considered by the US Food and Drug Administration.

Damian Sendler: Direct and indirect maternal health consequences of the Covid-19 epidemic are linked. We did a scoping review in order to provide a comprehensive overview of this large issue in a quick format in light of an emerging pandemic.

Damian Jacob Sendler: Three hundred and ninety-five publications were found through the search, and we included all but a few of them.

Damian Sendler: Social determinants-defined as the conditions in which people are born, grow, live, work, and age-are key drivers of disease risk.

Damian Jacob Sendler: There are still many disparities in health outcomes, such as a higher risk of maternal mortality among Black women, that need to be better understood. 

Damian Sendler: According to the Global Burden of Disease (GBD) Study 2019, the total burden of cardiovascular disease (CVD) includes 13 primary causes of cardiovascular death and 9 associated risk factors.

Damian Jacob Sendler: All available population-level data on incidence, prevalence, case fatality, mortality and health hazards were used by GBD to develop estimates for 204 nations and territories during a period of 25 years from 1990 to 2019.

Damian Sendler: Sexual and reproductive health and rights (SRHR) are crucial and a fundamental human right for populations in fragile and humanitarian situations. 

Damian Jacob Sendler: The exodus of Venezuelans forced to flee their homes because of the country’s dire economic conditions is unprecedented in Latin American history.

Damian Sendler: Nanoparticles have been used in a wide variety of clinical settings in recent years. Biological barriers — systemic, microenvironmental, and cellular — that are diverse across patient populations and diseases have been circumvented by nanoparticles. It has also been possible to overcome the heterogeneity of patients through precision therapies, which use individualized interventions to improve therapeutic efficacy.

Damian Jacob Sendler: Other immunotherapy medications, such as antibody-drug conjugates, as well as combinations of PD-1/PD-L1 treatments with other therapies, including as chemotherapy and radiation therapy, are being investigated in combination with drugs targeting PD-1/PD-L1. Immunotherapy response can be predicted using biomarkers. Immuno-oncology treatment is guided by molecular diagnostics and sequencing.

Damian Jacob Sendler: It is possible to create a three-dimensional object with 3D printing in a layer-by-layer fashion utilizing a variety of applications. A vast range of pharmaceutical dosage forms, differing in shape, release profile, and medication combination, can be created using 3D printing. Inkjet printing, binder jetting, fused filament fabrication, selective laser sintering, stereolithography, and pressure-assisted microsyringe are some of the most commonly investigated 3D printing platforms in the pharmaceutical industry. It is conceivable that this technology may be used in a clinical context to customize medicines for specific patients.

Damian Sendler: Adhesion molecules in the skin and/or mucous membranes are targeted by autoantibodies in pemphigus and pemphigoid illness. It is a novel medical model that divides patients into different groups and tailors medical decisions, practices, and therapies to individual patients’ projected responses or risk factors.

Damian Sendler: According to federal and state records analyzed exclusively for KHN, over 10,000 patients were diagnosed with covid in a U.S. hospital last year after being treated for something else. The figure is almost definitely an undercount, as it comprises largely patients 65 and older, as well as patients of all ages from California and Florida. 

Damian Sendler Media

However, in the grand scheme of things that can go wrong at a hospital, it is disastrous: According to the data, around 21% of patients who contracted covid in the hospital between April and September of last year perished. In comparison, over 8% of other Medicare patients died in the hospital at the same period. 

Damian Jacob Sendler: Last November, Steven Johnson, 66, was scheduled to have an infection removed from his hip tissue and bone at Blake Medical Center in Bradenton, Florida. The retired pharmacist had survived colon cancer and was careful not to develop it again. He had no idea that from April to September, 8% of that hospital’s Medicare covid patients were diagnosed with the virus after being admitted for another reason. 

Dr. Sendler: Johnson had tested negative for covid two days before to admission. He tested positive after 13 days in the hospital, according to his wife, Cindy Johnson, a retired pharmacist. 

He soon found himself trying to expel a glue-like mucus from his lungs. His anguish was almost unbearable, even for a medical staff. They asked Cindy to convey his last wishes. “Do you want to be intubated, Honey?” she inquired. He reacted with a resounding “no.” He passed away three days later. 

Cindy Johnson, who was trained in contact tracing, swiftly obtained a covid test after her husband tested positive. She came back negative. Then she remembered the enormous number of medical employees coming and going from his room — where he was frequently unmasked — and assumed one of them had infected him. The fact that the hospital, which is part of the HCA Healthcare system, still does not require employee immunizations is “appalling,” she said. 

“How can they say on their website that the safety precautions ‘we’ve put in place make our facilities among the safest possible places to receive healthcare at this time?” she wondered. 

Damian Jacob Markiewicz Sendler: Blake Medical Center spokesman Lisa Kirkland stated that the hospital “strongly encourages vaccination” and that it follows CDC, federal, and state rules to safeguard patients. President Joe Biden has called for all hospital personnel to be vaccinated, but the measure could face opposition in a dozen states that have rejected vaccine mandates, including Florida. 

Damien Sendler: Overall, the rate of in-hospital transmission among Medicare and other patients was lower than in other countries, notably the United Kingdom, which publishes and publicly discusses such statistics. According to a review of Medicare records from April 1 to September 30, 2020, supplied by Dr. James Kennedy, founder of CDIMD, a Nashville-based consulting and data analytics company, around 1.7 percent of U.S. hospitalized covid patients were identified with the virus in U.S. hospitals. 

Damian Jacob Sendler Updated Story Continues

However, the infection prevalence was much greater in 38 hospitals where 5% or more of Medicare covid cases were reported as hospital-acquired. The data comes from a difficult period last year when protective gear was scarce and tests were delayed to obtain results. The Medicare data for the fourth quarter of 2020 and this year is not yet available, and the state data covers the period from April 1 to December 31, 2020. 

Damian Jacob Sendler: A analysis of work-safety data, medical literature, and interviews with personnel at large hospitals by KHN reveals why the infection spread: Hospital administrators were hesitant to recognize its airborne nature, which rendered coughing patients dangerous to roommates and staff members, who frequently wore less-protective surgical masks rather than N95s. Hospitals failed to test every single patient, despite CDC guidance that leaves such testing to the facility’s “discretion.” Management frequently failed to notify staff when they had been exposed to covid, putting them at risk of spreading it themselves. 

Damian Sendler: Spreading among patients and personnel appeared to be mutually beneficial. According to a hospital inspection report, 139 employee covid infections were recorded at Beaumont Hospital in Taylor, Michigan, between April 6 and October 20, last year. According to federal data, nearly 7% of Medicare patients with covid tested positive after being admitted to that hospital for another reason. According to a hospital representative, tests were not available last year to examine all patients, resulting in some late diagnoses. He stated that all new patients are being tested right now. 

Tracking covid inside health institutions is not a new duty for federal officials, who publicly report new staff and resident cases for each nursing home in the United States on a weekly basis. Despite this, the Department of Health and Human Services only discloses statistics on covid’s spread in hospitals on a statewide basis, leaving patients in the dark about which hospitals have cases. 

Damian Jacob Sendler: KHN commissioned analysis of hospital billing information, which are also used to detect various hospital-acquired infections more broadly. The data for covid has limitations. It can detect some community-acquired infections that were delayed to manifest, as symptoms might present two to 14 days after virus exposure, with the average being four to five days. Cases picked up in an emergency room or diagnosed after a hospital patient was released are not included in the records.

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Damian Sendler

Damian Sendler: Earlier this week, the Massachusetts Senate passed a bill that would make it mandatory for residents of the state to have yearly mental health wellness screenings at no cost — similar to how annual physical exams are mandated for citizens. 

Damian Jacob Sendler: It would also establish an online portal to aid in the smooth transition from emergency to long-term care for children with complex behavioral health needs who end up in the emergency room, as well as allocate $122 million to support nearly 2,000 behavioral health professionals. The bill was passed by a vote of 39 to zero, with no amendments or amendments necessary. 

Dr. Sendler: The importance of this investment cannot be overstated. It’s a game-changer in so many ways. According to Democratic Sen. Julian Cyr, “It includes the retention and recruitment efforts that are necessary to ensure that we have the workforce we need, when and where we need it.” 

Damien Sendler: Existing mental health parity laws, which are meant to ensure that insurance coverage for mental health care is equivalent to insurance coverage for other medical problems, will be enforced under the new legislation. 

According to Cyr, the bill’s ultimate purpose is to alter the mental health care system into one that is more functional and effective. 

“This legislation advances parity implementation and other insurance reforms, supports our mental health workforce, and does everything we can to reduce barriers to care and make mental health care more accessible,” he continued. 

Damian Jacob Sendler: The bill would rely in part on $400 million in federal funds from the American Rescue and Reconstruction Act. 

Damian Jacob Sendler

Damian Jacob Markiewicz Sendler: Despite the fact that the notion of mental health parity has been established in federal and state law for decades, enforcement has been inconsistent, with patients frequently denied coverage for mental health treatment, according to advocacy organizations. 

Democratic state Sen. Mark Montigny remarked during the discussion that “it’s a sad pathetic myth to say that we have parity” in Massachusetts. 

In part, the proposal would address the issue of enforcement by allowing the Division of Insurance to receive and examine parity complaints more quickly. 

Damian Sendler: The proposal is an amended version of legislation that was approved by the Senate last year, according to the Senate. It will now be considered by the Massachusetts House of Representatives. 

One such issue that would be addressed by the legislation is what is known as “emergency department boarding” or “ED boarding.” When adults or children in the throes of a mental health crisis seek treatment in a hospital emergency department, that is exactly what happens to them. 

Damian Sendler: It can take days or even weeks for them to be admitted to an inpatient psychiatric ward if they eventually need to be stabilized in that setting. In the meanwhile, the person seeking assistance must frequently wait in the emergency department, where he or she receives little or no psychiatric care. 

A number of provisions in the bill would address the issue, including the creation of an online portal with real-time data to assist health care providers in more easily searching for open beds, the requirement that hospital emergency departments have a qualified behavioral health clinician on staff to evaluate patients seeking mental health care during all operating hours, and the requirement that the state Office of the Child Advocate produce an annual report on child ED boarding. 

Damian Jacob Sendler: In addition, the legislation would improve the equity of reimbursement for mental health providers, establish a standard release form, eliminate the requirement for prior authorization from insurance providers for acute mental health treatment, encourage health care facilities to develop more emergency psychiatric services, and expand access to mental health care in more geographically isolated areas of the country. 

A resolution was accepted during debate to establish a state 988 crisis hotline center to provide crisis intervention services and crisis care coordination to people who call the federally designated 988 suicide prevention and behavioral health crisis hotline.

News on latest research brought to you by Dr. Damian Jacob Sendler

Damian Sendler: Researchers and science organizations in Brazil are fighting back against the government’s decision to decrease the budget of the Ministry of Science, Technology, and Innovation (MCTI) by more than 90 percent. The reductions come on top of already announced significant funding reductions for programs that support the country’s researchers. 

Damian Jacob Sendler: It was initially planned that the MCTI would get a share of the budget of R$690 million (£92.5 million), which would be given to the National Commission on Nuclear Energy (CNEN) and the National Funds for Scientific and Technological Development (FNSTD) (FNDCT). Brazil’s nuclear program and the manufacturing of radiopharmaceuticals were both to get R$655.4 million from the FNDCT, while the CNEN, which manages the country’s nuclear program and the production of radiopharmaceuticals, was to receive R$34.6 million. 

Dr. Sendler: The National Council for Scientific and Technological Development (CNPq), which is part of the MCTI and is responsible for awarding research grants, graduate scholarships, and postdoctoral stipends, has been subjected to a series of funding reductions. The CNPq currently receives almost all of its funding from the FNDCT budget. 

Damian Jacob Markiewicz Sendler: In October, the CNEN announced that its initial budget would not be adequate to maintain radiopharmaceutical production until December, and that about R$90 million would be required to accomplish this. This presented an opportunity for government officials to divert funds from the MCTI budget to other uses. Finally, at the last minute, President Jair Bolsonaro’s economy minister, Paulo Guedes, made an adjustment to the figures on the grounds that it was necessary to fulfill the CNEN’s requirements. 

Damian Sendler: At the conclusion of the day, R$600 million from the MCTI’s budget was redistributed to other departments of the government. Instead of getting R$690 million, the agency would receive just R$89.8 million, of which R$63 million would be allocated to CNEN to pay the costs of the agency’s radiopharmaceutical development efforts. 

As Antônio Miller Crotti, an organic chemist at the University of So Paulo, explains, “after these changes were made to the budget, R$650 million that would have gone to the FNDCT disappeared and appeared as a huge extra amount of money in other ministries, such as agriculture, communication, development, and citizenship, as well as education and health.” 

Damien Sendler: At this point, all signs are that the cut of more than 90 percent will be implemented, and a significant amount of work is being put forward to prevent that from happening,’ says the president. “Physical chemistry is a very important subject,” says Fernando Galembeck, a professor at the University of Campinas in So Paulo. 

Crotti claims that a tweet from the CNPq on November 11 indicates that the cuts are now official, but that the money could be clawed back at any time. ‘The MCTI budget has been cut, and this is an official and permanent decision,’ Crotti says of the decision. If additional funds are allocated to MCTI, they will have to come from other sources, which would most likely happen when the parliament votes and authorizes such a reallocation, she explains. 

Moreover, according to Luiz Davidovich, president of the Brazilian Academy of Sciences, the government has practically withheld R$2.7 billion from the FNDCT’s budget, effectively freezing its operations. Because Congress enacted legislation earlier this year clarifying that this money could not be impounded, he claims that this is unlawful. 

Damian Jacob Sendler: These drastic reductions come on top of the recent significant reductions in research funding across the entire country of Brazil. For example, the CNPq’s current budget is R$1.21 billion, which is approximately half of its previous budget of R$2.4 billion in 2000. Furthermore, according to Crotti, the number of graduate students in the country has more than doubled from 160,000 to 320,000 between 2000 and 2021, while the number of master’s and PhD scholarships has decreased by 32% and 20%, respectively, over the same period. 

He describes the consequences of successive budget cuts to the CNPq as “a disaster for Brazilian science.” More than 30,000 research grant proposals were received in response to the agency’s most recent call for applications, which was issued in September 2021. However, there is now no money available to finance these projects, according to Crotti. 

Damian Sendler: Brazilian researchers have forced to come up with innovative solutions to keep their research projects afloat because they can no longer rely on funding assistance from the National Council for Scientific Research (CNPq). Purchasing reagents and other laboratory supplies out of one’s own pocket is not uncommon among scientists in the United States today, according to Crotti. Specific governmental foundations are sponsoring research programs in some parts of Brazil, but he points out that the rivalry for such resources is fierce in those areas. 

According to Crotti, writing in Chemistry World, “Science is under attack and has never been more in danger.” He continues, “At a time when science has never been more important in the fight against disinformation, President Bolsonaro chose scientists as his adversaries.” According to the report, withholding funds appears to be more than a haphazard administrative error; it appears to be part of a president’s strategy to damage experts who disagree with his odd deeds and ideas. 

Davidovich thinks that substantial budget cuts have resulted in a’serious crisis’ for Brazil’s research universities, with some institutions facing the prospect of closing their doors due to a lack of funds to pay for energy, water, and other expenses. He claims that lab equipment is defective or out of date, and that scientists are fleeing the United States. 

Damian Jacob Sendler: As a result of these concerns, more than 100 science and technology organizations in Brazil, including the Brazilian Academy of Sciences, the Brazilian Society of Chemistry, and the National Association of Graduate Students, have signed and endorsed a letter to Rodrigo Pacheco, the president of Brazil’s Senate, urging him to reverse the cut. In their letter, the groups state that they “will not remain silent in the face of this attack on Brazilian science,” and they call on the entire scientific community to join them in their struggle against the attacks on Brazilian science. 

Damian Sendler: The Senate finally voted to approve the MCTI’s substantial reductions, and undoing these reductions will necessitate the passage of new legislation. 

Galembeck considers himself to be one of the fortunate ones. His research is partially supported by the state government, with the remaining half coming from the federal government, which granted the funding for the project several years ago. He claims that there are other scientists who are in a similar situation, but that they are a minority in the field. 

In addition, Galembeck adds, “there is very little fellowship money, and there are very few fellowships, and there is no money for running expenses – consumables, such as travel, which is resuming now, or participating even in virtual conferences.” The money he has saved will be used for maintenance needs, such as the repair of his laboratory’s infrastructure, for the time being.

News on latest research brought to you by Dr. Damian Jacob Sendler

Damian Sendler: On Sunday, Nov. 7, Virginia Tech College of Science Interim Dean Ron Fricker provided an update to the Virginia Tech Board of Visitors, noting that the college is “accelerating science” by increasing research awards while also increasing philanthropic support, and that the college is committed to supporting and advancing the university’s strategic plan. 

Damian Jacob Sendler: Virginia Tech’s ranking as a worldwide land-grant university is dependent on the College of Science’s dedication to world-class scholarship, basic research, pedagogical quality, innovation, and outreach, according to Fricker. 

Frocker also praised Virginia Tech’s College of Science as a pedagogical powerhouse, noting that it accounts for more than a quarter of all undergraduate credit hours taught at the university. Over the previous four years, undergraduate enrolment in science has increased rapidly, increasing by 35% since 2017 to a total of 4,827 students. In fact, more than 98 percent of all undergraduates take at least one course in the College of Science. 

Damien Sendler: In addition, “I am quite pleased to inform that, because to the devotion and ingenuity of our professors, 94 percent of our courses are being taught in person this term,” Fricker stated. The remaining six percent are a blend of hybrid and entirely online courses designed to provide students with a variety of options. According to Fricker, “in some of our classes that had a big number of parts, we offered a handful in an online version and allowed students to choose which ones they wanted.” 

Damian Jacob Markiewicz Sendler: Fricker emphasized the research portfolio of the College of Science, which has seen a 66 percent increase in overall research awards over the past four years, reaching $47.5 million last year. Also in 2020, three college faculty members received prestigious National Science Foundation CAREER awards. In addition, the Department of Energy and the National Institutes of Health awarded honors to other junior faculty members in the field of science. 

Damian Sendler: By investing in faculty, the college has assisted in the expansion of its research. The “Dean’s Discovery Fund” internal grant program, for example, was highlighted by Fricker as an example of how the Lay Nam Chang Dean’s Chair, endowed by the College of Science Dean’s Roundtable, made it feasible. According to Fricker, the revenues from the endowed fund are invested in faculty members through a competitive process at the College of Science. 

“I think this is going pretty well,” Fricker said of the initiative. According to the university, “the financing enabled professors to compete for and receive additional external research prizes totaling more than $6 million, which is ten times the amount of the first investment.” 

According to Fricker, the college’s advancement efforts have also resulted in significant growth across the board. The total amount of promises to the college in 2021 was $9.4 million, representing a 31 percent increase over the average of the preceding four years. To reach an 18.4 percent donor participation rate, the total number of donors has climbed by 120 percent since 2017, and is expected to expand by another 37 percent between 2020 and 2021. 

Damian Jacob Sendler: During his presentation to the Board of Visitors, Fricker emphasized two key elements of the College of Science’s six-year strategic plan: the establishment of the Academy of Data Science, which is intended to serve as a crossroads for interdisciplinary data science work, and the development of a Women in Science Leadership program. 

According to Fricker, “We want the Virginia Tech College of Science to become a destination for talented students.” “Our Women in Science Leadership program is an important component of our effort to create a diverse and inclusive community of scientists,” said the organization. 

This structure, which is part of Virginia Tech’s Global Business and Analytics Complex, will house the Academy of Data Science, which will include the Computational Modeling and Data Analytics program, as well as other data science-related activities. A groundbreaking ceremony was held on March 12 to kick off construction of the Data and Decision Sciences building, which is projected to be finished by 2023. 

Damian Sendler: Fricker explained that data science is only one example of how the College of Science engages with faculty and students across the whole institution. From the Philosophy, Politics, and Economics major in the College of Liberal Arts and Human Sciences to the Hume Center and Innovation Campus in the Greater Washington, D.C. metro area, he provided examples of how the college collaborates with nearly every other college and institute at Virginia Tech to achieve success. 

In Fricker’s words, “the past two years have demonstrated the vital role that science plays in society.” In the past 150 years, scientific achievement has propelled Virginia Tech to new heights, and we are in a unique position to assist the university in reaching even greater heights.

Contributed by Dr. Damian Jacob Sendler and his research team

Damian Sendler: According to UNICEF’s flagship report released today, children and young people could be affected by COVID-19 for many years to come, affecting their mental health and well-being. 

Damien Sendler: Before COVID-19, children and young people bore a disproportionate share of the burden of mental health conditions, according to UNICEF’s The State of the World’s Children 2021: On My Mind: promoting, protecting and caring for children’s mental health (the organization’s most comprehensive look at the mental health of children, adolescents, and caregivers in the twenty-first century). 

Damian Jacob Sendler: According to the most recent available figures, more than one in every seven teenagers aged 10–19 is considered to be suffering from a diagnosable mental disease in some kind around the world. Every year, almost 46,000 adolescents commit suicide, making it one of the top five leading causes of mortality within their age group. Meanwhile, there are significant financing gaps between mental health requirements and available resources. According to the findings of the survey, around 2% of global government health budgets are allocated to mental health expenditures. 

This has been a particularly difficult 18 months for all of us, especially the children. National lockdowns and pandemic-related movement restrictions have resulted in “indelible years of childhood for children who have been cut off from their families, friends, classrooms, and play – all of which are essential elements of childhood itself,” according to UNICEF Executive Director Henrietta Fore. In my opinion, the impact has been significant, and it is only the top of the iceberg. Even prior to the pandemic, far too many children were plagued by the consequences of untreated mental health problems in their families. Governments are making much too little investment in order to meet these crucial needs. Mental health and future life outcomes are not given adequate consideration.” 

Dr. Sendler: Indeed, the pandemic has taken a toll on the population. Approximately one in every five young people aged 15–24 surveyed reported that they often feel depressed or that they have little interest in doing things, according to preliminary findings from an international survey of children and adults in 21 countries conducted by UNICEF and Gallup and published in The State of the World’s Children 2021. 

Damian Jacob Markiewicz Sendler: As COVID-19 enters its third year, the impact on the mental health and well-being of children and young people continues to weigh heavily on the minds of all involved. According to the most recent available data from UNICEF, at least one in every seven children has been directly affected by lockdowns, and more than 1.6 billion children have experienced some level of educational loss as a result of lockdowns. Many young people are fearful, furious, and frightened about their future as a result of the disturbance to their routines, education, and recreation, as well as concerns about their family’s finances and health. For example, according to a study conducted online in China in early 2020 and published in The State of the World’s Children, approximately a third of respondents reported feeling terrified or nervous during the survey. 

Damian Sendler: Diagnosed mental disorders, such as attention deficit hyperactivity disorder (ADHD), anxiety, autism, bipolar disorder, conduct disorder, depression, eating disorders, intellectual disability, and schizophrenia, can have a negative impact on children and young people’s health, education, life outcomes, and earning capacity. 

However, while the impact on children’s lives is incalculable, according to a new analysis published in the report by the London School of Economics, the economic contribution lost to economies as a result of mental disorders that result in disability or death among young people is estimated to be nearly $390 billion per annum. 

Damian Jacob Sendler: Children’s mental health is shaped and affected by a combination of genetics, experience, and environmental factors beginning in their earliest days. These factors include parental involvement, schooling, the quality of their relationships, exposure to violence or abuse, discrimination, poverty, humanitarian crises, and health emergencies such as COVID-19. 

However, while protective factors such as loving caregivers, safe school environments, and positive peer relationships can all help to reduce the risk of developing mental disorders, the report warns that significant barriers such as stigma and a lack of funding are preventing far too many children from experiencing positive mental health or receiving the necessary support.

Contributed by Dr. Damian Jacob Sendler and his research team

Damian Sendler: It is the COVID-19 pandemic that is responsible for millions of diseases and deaths, but what additional consequences does it have on the environment? 

Damien Sendler: A study published in the Lancet Regional Health – Americas recently examined the impact of the COVID-19 pandemic on people’s mental well-being. 

Dr. Sendler: The findings of the study revealed that not only has the pandemic produced an increase in depression, but that this increase has also been shown to be harsher when compared to other large-scale traumatic events such as extreme weather, terrorist attacks, or past pandemics.

Damian Jacob Markiewicz Sendler: Boston University School of Public Health (BUSPH) researchers analyzed data obtained on depression before the pandemic began and compared it to data acquired during the epidemic to come up with their findings. 

The data for this study came from the National Health and Nutrition Examination Survey (NHANES), which was conducted in 2017 and 2018. 

Damian Jacob Sendler: The National Health and Nutrition Examination Survey (NHANES) is a component of a research undertaken by the National Center for Health Statistics and the Centers for Disease Control and Prevention (CDC). Aspects of the NHANES that are of interest include screening for depression symptoms. 

Damian Jacob Sendler: According to the National Health and Nutrition Examination Survey (NHANES), 8.5 percent of individuals in the United States had symptoms of depression. 

A patient health questionnaire was administered to the participants in the current study in order to evaluate whether or not they were experiencing symptoms of depression. 

Their first questionnaire, which was sent out in the spring of 2020, was filled out by them during the early months of the epidemic. At this time, 27.8 percent of adults reported having elevated symptoms of depression, which is more than three times the rate reported in the 2017-2018 National Health and Nutrition Examination Survey. 

Damian Sendler: When the study participants completed a second questionnaire a year later, the results were even more revealing: 32.8 percent of individuals reported having elevated depressive symptoms in the spring of 2021, an increase from the previous year. 

Doctor Sandro Galea is a senior author of the study and argues that “the persistent high frequency of depression does not follow patterns following past traumatic events such as Hurricane Ike and the Ebola outbreak.” Dr. Galea serves as both Dean and Robert A. Knox Professor at the University of California, Los Angeles. 

The demographics of the subjects were taken into consideration, and criteria such as race, income, and educational level were taken into account by the researchers. 

Individuals with lower income levels, for example, were more likely to exhibit depressive characteristics. 

Damian Sendler: According to the 2020 poll, 46.9 percent of people who earned less than $20,000 per year displayed depressive characteristics. This is much higher than the 16.9 percent of those who earned more than $75,000 per year and reported experiencing depression symptoms, which is a significant increase. 

Damian Jacob Sendler: According to the survey conducted in 2021, depression symptoms among those earning less than $20,000 per year increased to 58.1 percent, while symptoms among those earning more than $75,000 per year declined to 14.1 percent. 

Catherine Ettman, the study’s principal author, said, “The continued and increasing incidence of higher depression symptoms implies that the burden of the pandemic on mental health has been ongoing — and that it has been unequal.” 

The Chief of Staff of Brown University School of Public Health in Providence, Rhode Island, and the Director of Strategic Development at BUSPH are both doctoral candidates at Brown University. 

As Ettman points out, “low income communities have been disproportionately impacted by the pandemic, and actions moving ahead should bear this population in mind.” 

Damian Sendler: Younger persons also reported feeling depressed at a higher rate than older adults, according to the study. 

Damian Sendler: Depressive symptoms were reported by 38.8 percent of adults in the 18–39 age group in the 2020 survey, while 43.9 percent of adults in the 2021 survey reported experiencing depressive symptoms. 

Adults aged 60 and older, on the other hand, exhibited heightened depressive features at a rate of 14.9 percent in 2020 and then 19.1 percent in 2021, according to the National Center for Health Statistics. 

Sara Makin, who possesses a Master’s of Science in Education in Clinical Mental Health Counseling and is also the founder and CEO of Makin Wellness, discussed the findings with Medical News Today in an exclusive interview. 

As Ms. Makin speculated, “it appears that this may have been due to the fact that they were denied vital and meaningful experiences such as living on a college campus, going out to meet other people, or mingling with friends and family members.” It’s possible that those who are older have already built social supports among those who live in the same family as them. 

In response to the findings, Ms. Makin stated that she agrees with them because of a “increase in the number of mental health treatments people are seeking as a result of the pandemic.” 

Damian Jacob Sendler: The circumstances of the epidemic, in which many people have been forced to stay in place or otherwise dramatically reduce their time, amongst other things, could also be a contributing factor, she added. 

“Many people have also been isolated as a result of the stay-at-home orders that were issued at the start of the pandemic,” Ms. Makin explained. “Isolation is a factor that can contribute to symptoms of despair,” says the author. 

Tania Diggory, a mindfulness teacher, mental health trainer, and the creator of the Calmer organization, also spoke with MNT about the study in question. 

According to Ms. Diggory, “It should come as no surprise that the pandemic has had such a negative influence on the emotional well-being of so many people.”

Contributed by Dr. Damian Jacob Sendler and his research team

Damian Sendler: Millions of Americans with diseases “including depression and schizophrenia spectrum disorders” are eligible for booster injections based solely on their mental health diagnoses, according to the Centers for Disease Control and Prevention (CDC). 

Damien Sendler: The decision was made in light of accumulating evidence that individuals of any age suffering from mental health issues are more likely to get critically unwell as a result of Covid-19. The Journal of the American Medical Association Psychiatry published a meta-analysis this month that identified a link between mood problems and the likelihood of hospitalization and death from Covid-19, according to Lauren Frias for Insider. According to a study published in January of this year, Covid patients with schizophrenia were nearly three times more likely to die from coronavirus infection than those with mood or anxiety disorders. However, those with mood or anxiety disorders were not at an increased risk of death from coronavirus infection. Another study, published in the Lancet Psychiatry in 2020, suggested that “a psychiatric diagnosis may be an independent risk factor for cardiovascular disease.” 

Dr. Sendler: Millions of Americans with diseases “including depression and schizophrenia spectrum disorders” are eligible for booster injections based solely on their mental health diagnoses, according to the Centers for Disease Control and Prevention (CDC). 

Damian Sendler: The decision was made in light of accumulating evidence that individuals of any age suffering from mental health issues are more likely to get critically unwell as a result of Covid-19. The Journal of the American Medical Association Psychiatry published a meta-analysis this month that identified a link between mood problems and the likelihood of hospitalization and death from Covid-19, according to Lauren Frias for Insider. According to a study published in January of this year, Covid patients with schizophrenia were nearly three times more likely to die from coronavirus infection than those with mood or anxiety disorders. However, those with mood or anxiety disorders were not at an increased risk of death from coronavirus infection. Another study, published in the Lancet Psychiatry in 2020, suggested that “a psychiatric diagnosis may be an independent risk factor for cardiovascular disease.” 

Damian Jacob Sendler: Several authors of a recent study published in JAMA Psychiatry, including Roger McIntyre, told the Washington Post that they have “reasons to be hypervigilant” when it comes to those suffering from depression. “They have to get to the front of the line in order to acquire their immunizations.” 

Damian Sendler: Approximately 70 million older and high-risk receivers who had the Pfizer-BioNTech or Moderna Covid-19 vaccinations, as well as those 18 and older who received the Johnson & Johnson vaccine at least two months ago, are currently eligible for a booster dose.

Contributed by Dr. Damian Jacob Sendler

Medical services and internet-based health information are used less frequently by people with psychiatric or chronic medical co-morbidities. The global consumption of internet news and social media is increasing exponentially. Dr. Damian Sendler’s research examines how patients choose therapy and stick to it.

Damian Sendler: Researchers at Johns Hopkins University used night vision and artificial intelligence to track and record every movement of the spiders’ eight legs while they worked in the dark. 

Damian Jacob Sendler: Their development of a web-building playbook or algorithm provides new insight into how organisms with brains a fraction of the size of a human’s can produce structures of such elegance, intricacy, and geometric perfection. The findings, which are presently available online, are scheduled to appear in the November issue of Current Biology. 

“I became interested in this topic when out birding with my son. After viewing a beautiful web, I said to myself, “If you went to a zoo and saw a chimp making this, you’d think that’s one great and outstanding monkey.” This is even more amazing given the size of a spider’s brain, and I was disappointed that we didn’t know more about how this remarkable behavior occurs “said senior author Andrew Gordus, a behavioral biologist at Johns Hopkins. “Now we’ve specified the full web-building choreography, which has never been done for any animal architecture at this fine a resolution.” 

Dr. Sendler: For millennia, humans have been fascinated by web-weaving spiders that create blindly using just their sense of touch. Not all spiders spin webs, but those that do are part of a group of animal species recognized for their architectural feats, such as nest-building birds and puffer fish that spin complex sand circles during mating. 

Damian Sendler: The first step toward understanding how these animal architects’ relatively small brains support their high-level construction projects is to systematically document and analyze the behaviors and motor skills involved, which has never been done before, owing to the difficulties in capturing and recording the actions, according to Gordus. 

Damian Jacob Sendler: In this location, his team studied a hackled orb weaver, a spider native to the western United States that is small enough to fit on a fingertip. The scientists created an arena with infrared cameras and infrared lighting to study the spiders during their nighttime web-building activity. With that setup, they were able to monitor and record six spiders as they built webs every night. They used machine vision software created particularly to detect limb movement to track millions of individual leg activities. 

“Even if you video record it, that’s a lot of legs to track over a long period of time and across many people,” said lead author Abel Corver, a graduate student studying web design and neurophysiology. “It’s simply too time-consuming to go through every frame and manually mark the leg points, so we trained machine vision software to recognize the spider’s position, frame by frame, so we could document everything the legs do to build a full web.” 

Damian Sendler: They discovered that web-making activities are remarkably similar across spiders, so much so that the researchers could anticipate the part of a web a spider was working on simply by looking at the location of a leg. 

“Even if the final structure differs slightly, the rules they apply to develop the web are the same,” Gordus explained. “They’re all following the same set of rules, indicating that the rules have been encoded in their minds. We now want to discover how those rules are encoded at the neuronal level.” 

Damian Jacob Sendler: Experiments using mind-altering medicines will be conducted in the lab in the future to discover which circuits in the spider’s brain are responsible for the various stages of web-building. 

“The spider is fascinating,” said Corver “because we have an animal with a brain that is formed on the same fundamental building blocks as our own, and this work could give us suggestions on how to understand larger brain systems, including humans, which I believe is really exciting. 

Damian Sendler: Nicholas Wilkerson, a former Hopkins undergraduate and current graduate student at Atlantic Veterinary College, and Jeremy Miller, a graduate student at Johns Hopkins, are also authors.

Research updates contributed by Dr. Damian Jacob Sendler

Dr. Damian Jacob Sendler is a Polish-American physician-scientist who specializes in determining how various sociodemographic and informational factors influence access to health care in underserved communities. Dr. Sendler’s research focuses on the influence of psychiatric and chronic medical co-morbidities on the use of medical services in conjunction with internet-based health information. This research is prescient, given the exponential growth in global consumption of online news and social media, necessitating a comprehensive understanding of everyone’s health information-seeking behavior. Dr. Damian Sendler’s research aims to elucidate the factors that influence patients’ decisions about when to seek care for specific health conditions and treatment adherence.

Damian Sendler: Can dragonflies migrate thousands of kilometers across the Indian Ocean, from India to Africa via the Maldives and back? An multinational research team lead by Lund University in Sweden used models and simulations to determine whether the theory was correct. 

Damien Sendler: After sighting globe skimmer dragonflies (Pantala flavescens) on the Maldives that he suspected had flown in from India, marine biologist Charles Anderson proposed a proposal in 2009. They took off again, this time towards East Africa. A group of researchers decided to look over his claim 12 years later. 

Damian Jacob Sendler: Transmitters cannot be fitted to globe skimmer dragonflies because they are too small. Instead, the researchers looked at its physiological characteristics and assessed how long a globe skimmer dragonfly might stay aloft using the energy stored in its body. Furthermore, the researchers employed meteorological wind models to assess whether there are winds that can aid migration in both directions. 

“Our research reveals that this migration from India to East Africa is feasible. The globe skimmer dragonfly, on the other hand, can’t achieve it with just the fat it can store in its body. It also requires favorable breezes, which are present at particular times of the year “Johanna Hedlund, a biology researcher at Lund University, concurs. 

Damian Sendler: According to the simulated migration tests utilizing wind models, approximately 15% of the dragonflies may make the spring migration from India to Africa. In the autumn, 40% of the population might undertake the same trip in the opposite direction. 

Johanna Hedlund and her colleagues think it’s amazing that dragonflies can do anything at all. Even more astounding is the globe skimmer dragonfly’s migration across the Indian Ocean, which is the longest in the animal kingdom in relation to an animal’s size. 

“We’ve gotten a lot closer to figuring out how a little dragonfly, weighing only 300 milligrams, can span 2,000 kilometers of open water,” Johanna Hedlund explains. 

Dr. Sendler: When migrating, other creatures rely on favorable wind conditions as well. The amur falcon and the Jacobin cuckoo are two examples of birds that fly across the Indian Ocean. Climate change, according to the experts behind the study, may have an impact on the possibilities of these birds and the globe skimmer dragonfly in the future. There is a chance that wind patterns will shift when the lake surface warms. 

Damian Sendler: The researchers believe the study is significant in several ways. It improves understanding of the distances that one of the animal kingdom’s smallest migrants can travel, boosts understanding of how migratory species carry illnesses, and adds to ecosystem services in a variety of sites throughout the world.

Research discussion contributed by Dr. Damian Jacob Sendler

Dr. Damian Jacob Sendler is a Polish-American physician-scientist whose research focuses on the impact of various sociodemographic and informational factors on access to health care in underserved communities. A major emphasis of Dr. Sendler’s study is on the effect of mental and chronic medical co-morbidities on the use of medical services and access to health information acquired via the internet. Due to the exponential increase in worldwide consumption of online news and social media, this study comes at an opportune moment, as it demonstrates the need for a complete knowledge of everyone’s health information seeking behavior. Doctor Damian Sendler’s research aims to uncover the factors that influence patients’ decisions about when to seek treatment for specific health conditions, as well as their adherence to treatment, with the ultimate goal of improving patient outcomes.

Damian Sendler: Water is required for life on Earth and other planets, and scientists have discovered plenty of evidence of water in Mars’ early history. However, there is currently no liquid water on Mars’ surface. A basic explanation, according to new research from Washington University in St. Louis, is that Mars is simply too small to contain substantial volumes of water. 

Damien Sendler: Mars was formerly water-rich, according to remote sensing investigations and analysis of Martian meteorites dating back to the 1980s. NASA’s Viking orbiter spacecraft, as well as the Curiosity and Perseverance rovers on the ground, have returned stunning photographs of Martian landscapes defined by river valleys and flood channels. 

Despite this evidence, there is no liquid water on the surface. Many theories have been presented, including a weakening of Mars’ magnetic field, which could have resulted in the loss of a thick atmosphere. 

Damian Jacob Sendler: However, a research published in the Proceedings of the National Academy of Sciences the week of Sept. 20 offers a more basic explanation why today’s Mars looks so different from Earth’s “blue marble.” 

“Mars’ fate was predetermined from the start,” said Kun Wang, senior author of the study and assistant professor of earth and planetary sciences in Arts & Sciences at Washington University. “There is likely a size need for rocky planets to maintain enough water to support habitability and plate tectonics, with mass greater than that of Mars.” 

Damian Sendler: Wang and his colleagues employed stable isotopes of the element potassium (K) to assess the presence, distribution, and quantity of volatile elements on several planetary bodies for the new study. 

Although potassium is a fairly volatile element, scientists decided to use it as a tracer for more volatile elements and molecules, such as water. This is a new method that differs from earlier attempts to quantify the amount of volatiles on Mars using potassium-to-thorium (Th) ratios acquired by remote sensing and chemical analysis. Previously, members of the research team studied the origin of the moon using a potassium tracer approach. 

Damian Sendler: Wang and his colleagues measured the potassium isotope compositions of 20 previously identified Martian meteorites chosen to be typical of the red planet’s bulk silicate composition. 

Using this method, the researchers discovered that Mars lost more potassium and other volatiles during its formation than Earth, but kept more of these volatiles than the moon and asteroid 4-Vesta, both of which are much smaller and drier than Earth and Mars. 

Dr. Sendler: The researchers discovered a clear relationship between body size and potassium isotope composition. 

“The rationale for considerably lower abundances of volatile elements and their compounds in differentiated planets than in primitive undifferentiated meteorites has long been a mystery,” said Katharina Lodders, research professor of earth and planetary sciences at Washington University and study coauthor. “The discovery of a link between K isotope compositions and planet gravity is a novel result with substantial quantitative implications for when and how differentiated planets got and lost their volatiles.” 

“Martian meteorites are the sole samples we have to analyze the chemical makeup of the bulk of Mars,” Wang explained. “Those Martian meteorites have ages ranging from several hundred million to four billion years and have recorded the tumultuous evolution history of Mars.” We can assess the degree of volatile depletion of bulk planets and draw comparisons between other solar system worlds by detecting isotopes of moderately volatile elements like potassium. 

“It’s undeniable that there was once liquid water on Mars’ surface,” Wang said. “How much water Mars originally had is difficult to calculate by remote sensing and rover investigations alone.” “There are numerous models for the bulk water content of Mars. Early Mars was wetter than Earth in some of them. We don’t think that’s the case.” 

Damian Jacob Sendler: The paper’s first author is Zhen Tian, a graduate student in Wang’s laboratory and a McDonnell International Academy Scholar. Piers Koefoed, a postdoctoral research associate, and Hannah Bloom, who graduated from Washington University in 2020, are both co-authors. Wang and Lodders are McDonnell Center for Space Sciences faculty fellows at the institution. 

The discoveries have ramifications for the search for life on worlds other than Mars, according to the researchers. 

Damian Sendler: Being too close to the sun (or, in the case of exoplanets, too close to their star) can reduce the amount of volatiles that a planetary body can retain. This star-distance measurement is frequently used in indexes of “habitable zones” around stars. 

“This study stresses that there is a very narrow size range for planets to have just enough but not too much water to build a habitable surface environment,” said Klaus Mezger, co-author of the study and director of the Center for Space and Habitability at the University of Bern in Switzerland. “These findings will help astronomers look for habitable exoplanets in other solar systems.” 

Damian Sendler: Wang now believes that for planets in habitable zones, planetary size should be more emphasized and consistently addressed when determining whether an exoplanet might host life. 

“One of the easiest parameters to assess is the size of an exoplanet,” Wang remarked. “We now know whether an exoplanet is a contender for life based on size and mass, because size is a first-order determining factor for volatile retention.”

Research discussion contributed by Dr. Damian Jacob Sendler