Damian Sendler To describe the psychological mechanisms that underlie biased self-assessment and propose pedagogical techniques to counter them.

Damian Jacob Sendler Strategies to address bias directly are unlikely to succeed because the psychological mechanisms that underlie bias self-assessment take place below our conscious awareness. Unconscious biases can be minimized by designing the learning experiences of students in such a way that they are not influenced by these mechanisms.

Dr. Sendler It is critical for the development and implementation of effective mitigation strategies to have a firm grasp on the psychological mechanisms that contribute to the most common forms of biased self-assessment. This is because accurate self-knowledge is so important for students and practitioners.

Professionals who regularly make life-and-health-altering decisions need to have unbiased self-knowledge.

1-5 As it turns out, Standard 4.1 of the 2016 Accreditation Council for Pharmacy Education Standards and CAPE’s Domain 4 outcomes speak directly to this issue: Personal knowledge, skills, abilities, biases, and emotions can all be examined and reflected on by the new graduate in order to help or hinder future growth. Students and clinicians’ self-awareness, however, is often distorted, according to several lines of research in clinical education 6-14 Due to how deeply ingrained biases are and how the mechanisms that cause bias occur below our conscious awareness, we can’t achieve an objectively unbiased self-awareness. 15 Furthermore, this review shows that interventions that help students function despite their biases are more effective than interventions that directly attack the biases. This stance may appear pessimistic, but it is grounded in reality. Social and cognitive psychology has been unanimous on this point for the past 50 years. 15

Before considering a solution to a problem, it is important to determine its scope. Thus, this article examines how people’s perceptions of their character, abilities, and future prospects can be overestimated. Weak correlations between ability estimates and actual performance are one of the most common manifestations of distorted self-knowledge. There was only a moderately positive correlation reported in seven out of twenty papers in a meta-analysis of practicing physicians’ self-assessment accuracy; the remaining papers either reported non-significant or negative correlations. 16 According to Mabe and West, the correlation between self-assessment and external standards is 0.29. 17 When it comes to vague or ambiguous abilities, the correlations were at their lowest for managerial abilities and interpersonal abilities (0.04), while they were the highest for concrete abilities associated with prompt feedback (0.57). 17 Some other studies have looked at intelligence (r=0.20),18 academe (r=0.35),19 and workplace performance (r=0.20). 20 Self-assessment and actual ability have had only a weak or moderate correlation in the studies that have been conducted thus far.

Like one’s abilities, one’s traits are imperfectly known.

21 A personality test that measures openness, conscientiousness, extraversion and agreeableness and neuroticism only correlates with related behaviors at (r=0.34) when the behaviors are performed in a laboratory and (r=0.27) when the behaviors are performed outside of a laboratory. 22,23 Researchers asked participants to wear an electronic recorder for several days to record the linguistic and behavioral correlates of traits that they had rated in a previous session in one of the most thorough investigations of the relationship between self-reports and behavior. R=0.27, which is the average correlation between one’s self-reports and actual behavior. 24 To test one’s self-awareness, one can compare one’s own self-descriptions to those of others in their social circle. It has been found that self-report ratings are in some cases inconsistent with the ratings of others. 25 Both the Big Five and the California Adult Q-Set have a (r=0.45) correlation with others’ ratings. 26-29 People’s self-awareness is flawed, regardless of how they rate their own actions or the ratings of others.

Damian Jacob Markiewicz Sendler People overestimate their abilities based on weak correlations between their self-assessment and their performance. However, more research shows that this underestimation is frequently an overestimation. 70 percent of high school students rated themselves above average in leadership ability, and 100 percent rated themselves above average in social skills in an early College Board survey. 30 Students who scored in the top one percent in terms of social skills comprised 25% of the class. 30 It’s important to point out that 94% of college professors believe their work is better than the work of the average professor before making generalizations about high school students’ immaturity. 31 People believe they are more moral and more popular than the average person in addition to their ability assessments. 32-34 Just as people tend to think of themselves as superior to the average in a wide variety of contexts, they also tend to think of themselves as more likely than the average to have positive experiences and less likely than the average to have negative ones.. 35,36 There is a strong belief among the majority of people that they are less likely than the general population to be diagnosed with cancer and divorced and more likely than average to live past the age of 80, have a child with a talent, travel to Europe or be recognized for their achievements. 36 Even in the face of contradictory evidence, such logical inconsistencies persist, a testament to the bias’s resiliency. 90% of Americans, including those who have been hospitalized as a result of car accidents they caused, believe that their driving ability is in the upper half. 37 Many incarcerated people believe that they are no less law-abiding or self-controlled than the average citizen. 38

Only a small percentage of the population, about 7% of the population, consistently exhibits accurate self-knowledge. They have realistic expectations of their abilities; their goals are attainable; and their sense of self-worth is grounded in reality. They have been diagnosed with clinical depression. 39-41 Our delusions sometimes lead us astray, but they also motivate us to get out of bed in the morning. Self-improvement has been linked to contentment, generosity, and perseverance. 42-49 It is therefore possible that completely accurate self-knowledge is both infeasible and unappealing. It’s possible that self-enhancement can lead to unhealthy relationships, risky behavior and poor academic performance if it’s not properly managed. 50-52 Because perfect self-knowledge is neither possible nor healthy, educators should seek to minimize biases in self-knowledge, but should also accept limited success in narrow domains.

Self-knowledge biases are difficult to overcome because the mechanisms that drive them operate below the level of conscious awareness.

53 In order to change processes we are unaware of, it is difficult. Self-serving reasoning, biased hypothesis testing, and biased recall are three of the most common cognitive tools people use to dissipate threatening information and enhance positive information.

Self-serving attitudes about success and failure are common, with people blaming themselves for their own success or failure on their own abilities rather than external factors like bad luck or distraction.

Damian Sendler

Among other findings, researchers found that students and teachers each attributed student success to themselves, but blamed each other for student failure. 56-58 The validity of an exam was more likely to be questioned by test takers who did not do well than by test takers who did well. 59 When drivers aren’t in the classroom, they attribute accidents and near misses to external factors like the weather or other drivers. 60 Regardless of the field, attributions of success and failure are made in the service of self-improvement rather than accuracy. 54

Defining competence in terms of one’s own interests is another common occurrence when evaluating someone’s abilities against a set of ambiguous or subjective criteria.

61 Empathy is regarded as the most important leadership quality by empathic people, and as a result, they make excellent managers. Since decisiveness is the most important leadership quality, these people are also competent leaders. Whether or not a person finds a particular quality appealing has more to do with whether or not he or she possesses it than with the quality’s inherent merits. 61

Biased hypothesis testing can also be used for self-enhancement purposes. People often ask themselves, “Can I believe this?” when confronted with information that supports a positive self-view. To be able to say yes, you simply need enough evidence to back up your claim. People ask, “Must I believe this?” when information contradicts a positive self-view. A positive answer to this question necessitates a substantial amount of evidence. 62,63 As a result, when presented with evidence that both confirms and contradicts their preexisting beliefs, people tend to strengthen their beliefs. 64 Methodology is more likely to be attacked when research criticizes social groups with which people identify. 65 When self-assessing, people often ask themselves if their desired conclusion is true, and determine that it is once they have gathered enough asymmetrically vetted evidence to support their belief. An analogous process occurs in the background to that of self-serving attributions and definitions:

Because people tend to remember more self-enhancing information than self-critical information, memory serves as an additional source of bias when testing hypotheses about themselves.

66,67 Positive qualities stick in people’s minds longer than negative ones do, and the latter tends to be forgotten more readily than the former. 68-71 Even memories can be rewritten for the sake of self-improvement.. It was discovered that students had an increasing tendency to exaggerate their actual test scores in their memories. 72 Many hypotheses are not only tested in a biased manner, but they are also bolstered by studies that use biased recall. It is possible for people to believe that their assessments of themselves are objective because of the combination of biased recall, self-serving reasoning, and biased hypothesis testing: They can rationally link their traits to positive outcomes and can easily explain away any deficits because they are based on memories and alternatives have been considered. People are less likely to adjust their self-assessments when they have the impression of objectivity, so it’s no surprise that most people think they’re more objective than the average person.

Self-serving reasoning by students is severely restricted when criteria are generated by someone else. Because of this, Dunning and colleagues found that participants’ assessments of athleticism, artistic ability, and extracurricular involvement showed very little positive bias when they were assessed using externally generated criteria. 76 Student self-assessment of ambiguous soft skills may benefit the most from these findings. An effective communicator has a specific set of traits and abilities that should be identified by educators, then students should be asked to self-assess on those traits and abilities. Educators may conclude, for example, that good communicators maintain eye contact, are succinct, and ask follow-up questions. There is less of a positive bias when students are asked how often they engage in these activities than when they are asked how good they are at communicating. Students are deprived of the opportunity to develop their own, self-serving definitions of what constitutes effective communication when the standards are established by someone else.

When given clear and quantifiable evaluation criteria, people are less likely to exhibit positive bias. A study by Dunning and colleagues found participants to have a greater positive bias when self-assessing ambiguous positive (e.g. sensitive, sophisticated and sensible) or negative (e.g. neurotic, impractical and foolish) characteristics rather than specific positive (e.g. thrifty, studious and punctual) or negative characteristics. 76 This makes EPAs, which are entrusted professional activities (EPAs), particularly useful bias-mitigation tools for the American Association of College of Pharmacy because of their inherent measurability and specificity. 77 At least one general ability and several specific and quantifiable supporting tasks make up each EPA. Student self-assessment is likely to be less biased if students are asked about the extent to which they perform each of the supporting tasks, rather than a broad ability or trait that can be redefined in a self-serving manner Student assessment of patient assessment skills should be less biased when students are asked whether they can collect medical histories from patients, discuss a patient’s medication use experience, determine a patient’s medication adherence, and use health records to determine a patient’s health-related requirements. Self-serving redefinitions of patient assessment skills are easy because they are vague. They’re not as important. There are many ways to use the EPA’s structure to help educators create their own self-auditing standards, even if students aren’t using them. Instead of asking students to describe their abilities in broad strokes, educators should create specific criteria for competence and ask students to self-assess according to the criteria. It has been suggested that the use of EPAs and externally generated competence criteria as bias reduction tools is supported by Dunning’s findings. However, there is currently no field research on the use of EPAs or externally generated competence criteria. For the time being, the majority of research is being conducted in the lab rather than the classroom.

When the ability in question is modifiable, positive bias is also reduced. As part of the Dunning study, participants learned that they would take a test measuring “integrative orientation,” a fictional trait that was either described as modifiable or fixed, before taking the test. 78 It was found that participants were equally interested in additional feedback after success and failure when “integrative orientation” was characterized as modifiable, but participants were more interested in additional feedback after success when it was characterized as fixed. 78 Similarly, Lockwood found that participants’ beliefs about their own ability to improve were the main determinant of whether or not they found examples of excellent performance demoralizing or inspirational. 79 In order to minimize the threat to the self, educators should provide clear guidance on improvement strategies whenever possible. This minimizes the likelihood that underlying biasing mechanisms will be activated. As Marsh and Roche found, providing concrete guidance and feedback is one of the most effective ways to improve performance. Some research has been done on the effectiveness of guided feedback for students while Marsh and Roche were primarily concerned with teacher evaluations. 80 Third-year medical students were asked by Lane and Gottlieb to evaluate their performance on 21 core elements of a medical interview they had just completed. One or two faculty members who had seen the videotape and rated the student’s performance also spent 20-30 minutes with each student reviewing the videotape. For example, a faculty member or members suggested ways to improve a student’s performance during an interview. An additional test one week later revealed that the gap between student self-ratings and faculty ratings had narrowed significantly. There was no control condition in this study, but the results show that non-threatening feedback and guidance reduce self-assessment bias significantly. In addition to providing students with feedback, videotapes can be useful in documenting students’ performance in an objective, real-time manner. A videotape review significantly improved trauma resuscitation skills among surgical residents, according to Scherer and colleagues. 81

Instructors aren’t always the best source of feedback. Additionally, peer review has been linked to better grades, more time spent on a task, critical thinking, and a chance to practice professionalism and social skills. 82,83 There is a stronger correlation between instructor evaluations and student self-evaluations, suggesting that students can act as instructors if they are provided with clear criteria for evaluation. 84 They asked undergraduates to review one another’s writing assignments and either provide a quality rating or both a quality rating and qualitative feedback. Students who received both the rating and feedback performed better than those who only received the rating, suggesting that students benefit from peer feedback with additional guidance, according to the study’s findings. Students were not asked to self-assess in this study. 85 Peer review, on the other hand, has a number of notable drawbacks to consider. Since competence in a domain is required to judge competence in a domain, as Kruger and Dunning suggest, less knowledgeable students are not in an ideal position to provide feedback. 86 Recruiting, training, and providing clear assessment criteria, such as a rubric, to multiple reviewers are all essential for the success of peer review. 87 Despite their flaws, concrete assessment criteria and guidance for improvement are both effective because they either avoid or limit the effectiveness of biasing mechanisms. Some strategies, on the other hand, focus on the mechanisms themselves. Self-reflection on one’s own thoughts, biases, and behaviors is the most common technique.

Damian Jacob Sendler

Because many people’s mental processes88-92, especially those that bias self-knowledge, are hidden from view, the success of self-reflection is likely to be limited.

53 Self-reflection can even be harmful in some cases. 93,94 When people reflect on the reasons for their preferences or behaviors, self-reflection can lead to suboptimal choices, overconfidence, and a lack of attitude-behavior consistency. 93-96 Participants were given the option of choosing between two posters (one artistic and one humorous) without any manipulation or after reflecting on why they liked or disliked each poster. A more artistic poster was chosen by those in the reflection condition, but they were less satisfied with their choice three weeks later than those in the control condition. Participants’ preferences for consumer goods and college courses were found to be less in line with experts’ ratings when they reflected on their own than those of students who did not think about their choices at all. 94 Wilson’s research primarily focused on preferences, but other researchers found that contemplation could lead to suboptimal decisions when a rationally better option was readily available. 97

It’s possible that self-reflection weakens the connection between one’s attitudes and one’s subsequent actions in addition to encouraging poor decisions.

95,96 Wilson and LaFleur found that students who reflected on why they would or would not perform a given behavior made less accurate and more overconfident behavioral predictions than participants who didn’t reflect. 95 As in Wilson’s study, participants who thought about their attitudes before reporting them had lower attitude-behavior correspondence than those who did not think about their attitudes prior to recording them. 98 A person’s ability to anticipate their own behavior can be harmed by excessive self-reflection, which can lead to poor decisions. Since the primary causes of behavior and preference are frequently either implicit or difficult to express, this happens. Reasons derived from self-reflection that do not match the person’s actual motivations will lead to incorrect predictions and choices. 94,98

Self-reflection can be useful in some circumstances. When self-reflection is focused on traits rather than abilities, preferences, or behaviors, and is written down and explanatory rather than descriptive, it can result in a less – but still statistically significant – positive bias.. 99 It is common for people to reflect on why they have (or do not have) certain characteristics. What causes me to be irritable, empathetic, logical, and so on??” Self-descriptive self-reflection, on the other hand, occurs when people consider whether or not they possess certain characteristics. Do you think I’m happy? Bias appears to be reduced only when self-explanatory self-reflection is documented. A list of both positive and negative traits was presented to the participants, which they were asked to read and then reflect on either in writing or internally. Participants who wrote explanatory self-reflection had significantly less bias than those who did not. As a bias mitigation tool, educators should ask students to write down their thoughts and to engage in explanatory – rather than descriptive – self-reflection. There will be some progress in eliminating bias, but it will be incremental. As a bias mitigation tool, self-reflection is not as effective as other types of reflection in all situations. There are many ways to use reflective practice to help students become better critical thinkers and problem solvers, for example. 100,101 That’s the focus of this paper; however, self-reflection is an effective method for reducing self-bias.

Self-assessment bias can be reduced by using accountability manipulations.

102 When participants expected to defend their work in front of an expert, Sedikides and colleagues discovered that their self-assessments became significantly less positive as a result of pre-emptive self-criticism they engaged in. All participants were asked to write an essay defending their side of a debate. One-half of participants were instructed to write an essay, while the other half were told that they would later justify their response to a logician. A grade was assigned based on the essay’s clarity of thought, style, flow, and logic as well as its overall persuasiveness after the accountability manipulation was completed. There was a significant difference between the accountability group and the control group in terms of the grades they assigned to themselves. As a result, rather than simply producing self-evaluations, students should attempt to justify them. However, these studies were not designed to determine if self-enhancement had been eradicated from the human condition. Even though accountable students gave themselves lower grades than unaccountable students, their final scores could have been higher than the ones assigned by the teacher.

Instructors should not be overjoyed even if bias-related tactics appear to be working because the effect of one intervention on one outcome cannot distinguish correction from debiasing. When one’s estimate is corrected, the mental processes responsible for biasing that estimate remain unaffected. One way to self-correct is to say something like, “I noticed that I’ve overestimated my performance on the last two patient interview exercises. My next exercise estimate should be lowered by half a letter grade. As a result, it is important to note that this student did not address the issue of explaining away weaknesses or preferentially recalling strengths when making academic performance estimates. Although debiasing is a method of changing one’s mental processes, it has a wide-ranging impact on one’s life. 103,104 Some students say, “This intervention taught me that I tend to overestimate my exercise scores by relying on my past successes and dismissing my past failures,” A more accurate estimate of my strengths and weaknesses is something I intend to work on in the future.” Due to the alterations made to the student’s brain, he or she may perform more objectively on similar tasks in the future, but this is not guaranteed. Correcting and debiasing are not distinct concepts in general education or clinical education. For self-knowledge interventions to achieve debiasing, additional research is needed to identify the types of interventions – if any – that accomplish this.

Sendler Damian Jacob Understanding the psychological mechanisms that contribute to the most common forms of biased self-assessment is essential for developing and implementing effective mitigation strategies for professional students and clinicians. These mechanisms are described, and strategies for avoiding them are discussed, but this is only a first step in mitigating biased self-assessment. A lot more research is needed to figure out how effective mitigation strategies are in the classroom, even though there has been some good work done in this area. 105,106 Whether or not debiasing is possible in the real world should also be investigated in future research. A gloomy picture of human cognition has been painted, but it is worth noting that humans do well most of the time and that even small interventions can have significant mitigating effects when implemented correctly.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler Small round cell tumor (DSRCT) is an aggressive, usually incurable type of sarcoma, which is most common in post-pubertal young men. According to recent research, the androgen receptor (AR) may contribute to the progression of DSRCT tumors when present. AR-induced oncogenic stimulation’s exact mechanism is still a mystery. It has been shown for the first time here that DHT-induced DSRCT cell proliferation is inhibited by enzalutamide and AR-targeting antisense oligonucleotides (AR-ASO). To better understand how AR signaling affects cellular epigenetic programs, researchers used gene expression analysis and chromatin immunoprecipitation sequencing (ChIP-seq). Furthermore, ChIP-seq revealed new DSRCT-specific AR DNA binding sites near key oncogenic regulators like WT1 (the pathognomonic fusion protein’s C-terminal partner) and FOXF1. To further support its involvement in abnormal cell lineage commitment, AR was found to occupy enhancer sites in the Wnt pathway, neural differentiation, and embryonic organ development genes. Since androgen-targeted prostate cancer treatments are widely available, our findings have direct clinical implications.

Single-microbe genomics with strain resolution applied to the microbiome of a human digestive tract.

Damian Jacob Sendler It has long been a goal of microbiology to study complex microbial communities with single-cell resolution. In this paper, we describe Microbe-seq, a high-throughput method for obtaining genomes from complex microbial communities. Individual microbes are encapsulated in droplets and their DNA is extracted, amplified, tagged with droplet-specific barcodes, and sequenced using microfluidics. Over 20,000 microbial single-amplified genomes (SAGs) from a single human donor were sequenced, and the genomes of almost 100 different species of bacteria were coassembled. A total of 92 species pairs were observed to have horizontal gene transfer (HGT) between them, and a significant in vivo host-phage association was found between crAssphage and Bacteroides vulgatus. It is now possible to study the genomes of entire microbial communities at the single-microbe level thanks to Microbe-high-throughput, seq’s culture-free capabilities.

Dual-targeted anti-age-related macular degeneration therapy with C3b/C4b/VEGF-targeting bispecific fusion protein.

Dr. Sendler Neovascular ocular diseases, such as age-related macular degeneration, have been transformed by antiangiogenesis therapies targeting VEGF (vascular endothelial growth factor) (nAMD). Comprehensive evidence has linked AMD pathogenesis to deficiencies in the complement system, suggesting that treating geographic atrophy in dry AMD with anti-VEGF monotherapies may be more effective than treating nAMD with the same treatment alone. Bispecific fusion protein, IBI302, has been tested in preclinical studies and in phase 1 clinical trials for its ability to neutralize both forms of VEGF and C3b/C4. Efdamrofusp alfa demonstrated superior efficacy over anti-VEGF monotherapy in a mouse model of laser-induced choroidal neovascularization (CNV). To further inhibit macrophage infiltration, VEGF inhibition and the activation of the complement system were found to work together. Nonhuman primate laser-induced CNV models showed good safety profiles and antiangiogenic efficacy for intravitreal efdamrofusp alfa. On the basis of the preclinical data, a phase 1 dose-escalation clinical trial (NCT03814291) was conducted. Efdamrofusp alfa was well tolerated by patients with nAMD, according to preliminary results. These findings suggest that efdamrofusp alfa may be useful in the treatment of nAMD and other complement-related ocular conditions, such as dry eye syndrome.

Damian Jacob Sendler

Sow milk bacterial strains of Pediococcus pentosaceus have been shown to have anti-oxidant properties in weaned pigs

Breeders are increasingly concerned with improving sow nutrition during pregnancy and lactation in order to ensure the health of their newborns. A primary source of nutrition for piglets during their first three weeks of life, sow milk contains a wide range of bioactive compounds and essential nutrients, as well as commensal bacteria. Neonatal gut microorganisms rely on commensal bacteria found in breastmilk as a major source of nutrition. Bacteria from breast milk may be beneficial to the host’s health.

Damian Jacob Markiewicz Sendler Methods: Culturomics was used to isolate sow milk bacteria, which were then identified using 16S rRNA gene sequencing. Functional evaluation was used to screen isolates for possible probiotic activity by testing their antagonistic activity against pathogens in vitro and resistance to oxidative stress in paraquat-damaged Drosophila. Sixty-four newborn piglets from nine sows were randomly assigned to three treatments, each with a varying concentration of a candidate strain for use in the feeding trial. In order to confirm its antioxidant properties, researchers used a variety of techniques, including western blotting, enzyme activity analysis, metabolomics, and 16S rRNA gene amplicon sequencing.

A nonredundant set of 16S rRNA gene sequencing was used to group the 1240 isolates into 271 bacterial taxa from the sow milk microbiota. New Pediococcus pentosaceus strain SMM914 was found to have the best ability to inhibit pathogens in swine and a Drosophila model exposed to paraquat. SMM914 induced the Nrf2-Keap1 antioxidant signaling pathway in piglets, which greatly affected the pathways of amino acid and lipid metabolism in plasma. Compared to the control group, those taking high dose SMM914 saw a significant increase in the relative abundance of Lactobacillus in the colon.

An Alzheimer’s disease mouse model shows a significant increase in microglia heterogeneity and A pathology if Trem2 is stabilized.

TREM2 is a transmembrane protein that regulates inflammatory responses to pathological conditions in the brain. Alzheimer’s disease has been linked to reduced TREM2 proteolytic cleavage, but it is not yet clear what this means for microglial function. We have developed a transgenic mouse model of reduced Trem2 shedding (Trem2-Ile-Pro-Asp [IPD]) by substituting an ADAM-protease recognition site with an amino acid. Trem2-IPD mice have an increased Trem2 cell-surface-receptor load, survival, and function in myeloid cells, according to our findings. For the first time, we show that sustained Trem2 stabilization induces a shift in microglial maturation and speeds up the response of microglia to A pathology in a mouse model of Alzheimer’s disease. In Alzheimer’s disease, decreased Trem2 proteolytic cleavage worsens neuroinflammation, which suggests that TREM2 shedding is an important regulator of microglial activity in pathological states. Our data show that.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: To evaluate the efficacy and safety of acupuncture and moxibustion in the treatment of ulcerative colitis. Randomized controlled trials or clinical controlled trials of acupuncture and moxibustion for the treatment of ulcerative colitis in the last ten years were reviewed, and the literature results were meta-analyzed. In total, 11 clinical study papers were included. Heterogeneous tests were performed on the 11 studies’ results, yielding chi2 = 8.55, P = 0.67. For statistical analysis, the fixed effect model was used; after combining OR = 3.82, the 95 percent confidence interval was 2.65-5.52. The rhombus could be found on the right side of the medium line. The therapeutic effect and cured rate in the treatment group were significantly higher than those in the control group after the Z test, Z = 7.14, P 0.01. Acupuncture and moxibustion have a better therapeutic effect on ulcerative colitis than western medicine, with less side effects.

Damian Jacob Sendler: Monkeypox, a largely ignored disease endemic in Western and Central Africa, has recently drawn global attention due to more than 100 confirmed and suspected cases (by May 21, 2022) in more than ten countries in Europe, North America, and Australia. This article is copyright protected. Every right is reserved.

Dr. Sendler: Real-world memories are formed in a specific context and are rarely acquired or recalled in isolation1-5. Time is an important variable in memory organization because events experienced close in time are more likely to be meaningfully associated, whereas those experienced with a longer interval are not1-4. It is unclear how the brain separates temporally distinct events. We show that a delayed (12-24 h) increase in the expression of C-C chemokine receptor type 5 (CCR5)—an immune receptor well known as an HIV co-receptor— The duration of the temporal window for associating or linking that memory with subsequent memories is determined 6,7-after the formation of a contextual memory. The delayed expression of CCR5 in mouse dorsal CA1 neurons reduces neuronal excitability, which in turn negatively regulates neuronal memory allocation, reducing overlap between dorsal CA1 memory ensembles. Reduced overlap reduces the ability of one memory to trigger the recall of another, thereby closing the temporal window for memory linking. Our findings also show that an increase in the neuronal expression of CCR5 and its ligand CCL5 with age leads to memory linking impairments in aged mice, which can be reversed with a Ccr5 knockout and a drug approved by the US Food and Drug Administration (FDA) that inhibits this receptor, a result with clinical implications. Overall, the results presented here shed light on the molecular and cellular mechanisms that shape the temporal window for memory linking.

Despite significant advances in trauma management over the last two decades, uncontrolled hemorrhage remains the leading preventable cause of death in trauma. We discuss recent developments in hemorrhage control resuscitation.

Damian Jacob Sendler

Early blood product use has become well established as a standard of care in the treatment of trauma hemorrhage. Low titer group A liquid plasma and group O whole blood are increasingly being used to accomplish this. In the United States, single donor apheresis platelets have largely replaced pooled donor platelets and are frequently pathogen-free, which has implications for trauma resuscitation. More research is being done to investigate the timing and dosing of tranexamic acid, and the debate over the use of factor concentrates in trauma-induced coagulopathy is still ongoing. The ‘Stop the Bleed’ campaign has highlighted the importance of hemostatic dressings in hemorrhage control, as has the increased use of endovascular aortic occlusion. We highlight ongoing research into the use of desmopressin and the unknown significance of ionized calcium levels in trauma. Finally, we discuss our own hospital’s coagulation testing experience as well as the scarcity of evidence of improved outcomes with viscoelastic testing.

Damian Jacob Markiewicz Sendler: Ca2+ concentrations in the endoplasmic reticulum (ER) are critical for maintaining its oxidizing environment as well as luminal ATP levels required for chaperone activity. As a result, local luminal Ca2+ concentrations and dynamic Ca2+ flux between subcellular compartments are tightly regulated. A reductive shift opens the sarcoendoplasmic reticulum calcium transport ATPase (SERCA) pump, allowing Ca2+ to enter the ER and create the Ca2+ gradient required for ATP import. Meanwhile, Ca2+ leakage from the ER has been reported to occur after protein translocation via the Sec61 translocon. We present an overview of the complex regulation of Ca2+ homeostasis, Ca2+ flux between subcellular compartments, and the cellular stress response (the unfolded protein response) induced by dysregulated luminal Ca2+ metabolism in this review. We also look at the structure and gating mechanism of the Sec61 translocon, as well as the role of ER-resident co-chaperones in assisting the central ER-resident chaperone BiP in the regulation of luminal Ca2+ concentrations.

Although the post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, also known as Long COVID, have been described, it is unclear whether breakthrough SARS-CoV-2 infection (BTI) in vaccinated people causes post-acute sequelae. In this study, we used the national healthcare databases of the US Department of Veterans Affairs to create a cohort of 33,940 people with BTI and several controls with no evidence of SARS-CoV-2 infection, including contemporary (n = 4,983,491), historical (n = 5,785,273), and vaccinated (n = 2,566,369) controls. At 6 months after infection, people with BTI had a higher risk of death (hazard ratio (HR) = 1.75, 95 percent confidence interval (CI): 1.59, 1.93) and incident post-acute sequelae (HR = 1.50, 95 percent CI: 1.46, 1.54), including cardiovascular, coagulation and hematologic, gastrointestinal, kidney, mental health, metabolic, musculoskeletal, and neurologic disorders, compared to contemporary controls). In comparisons to the historical and vaccinated controls, the results were consistent. People with BTI had lower risks of death (HR = 0.66, 95 percent CI: 0.58, 0.74) and incident post-acute sequelae (HR = 0.85, 95 percent CI: 0.82, 0.89) compared to people with SARS-CoV-2 infection who had not previously been vaccinated (n = 113,474). Overall, the findings indicate that vaccination before infection provides only partial protection in the post-acute phase of the disease; thus, relying on it as the sole mitigation strategy may not optimally reduce the long-term health consequences of SARS-CoV-2 infection. The findings highlight the importance of continuing to optimize strategies for primary prevention of BTI and will guide the development of post-acute care pathways for people with BTI.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: People living in low- and middle-income countries, migrants, and indigenous people are critical to reducing the global mental health treatment gap by providing accessible and effective healthcare. Scalable psychological interventions, such as those delivered via the internet and mobile devices (IMI), have been developed to address the needs of a wide range of populations at risk for mental illness. To find studies that used culturally appropriate IMI for mental illness, researchers scoured PsycInfo, MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science in October 2020. We were able to identify 55 articles from a total of 9438 screened records. Specifically, we identified 17 components of culturally adapting IMI, including content, methodological, and procedural aspects. The adapted IMI appeared to have similar adherence and effectiveness to the original IMI, but no studies included in this review compared the two. IMI cultural adaptation for mental disorders: a taxonomy presents the relevance and necessity of cultural adaptation for future studies.

Damian Jacob Sendler: To address global health inequalities as one of the major global health challenges, the World Health Organization has issued a call to action. Compared to high-income countries, low- and middle-income countries (LMICs) have a much larger treatment gap for mental health issues: 76–85 percent of people with a serious mental disorder living in LMICs do not receive treatment, whereas 35–50 percent of people living in high-income countries do not receive treatment1. Mental health services are also underutilized by migrants and refugees, despite the fact that they are subject to a greater number of stressors before, during, and after their migration, as well as an increased prevalence of mental disorders, which is also evident in the data12–14. Indigenous people also have a treatment gap in mental health because their mental health is poorer15,16 and they use health services less frequently17. In order to improve global health equity, the structural and individual barriers faced by these populations must be addressed.

Dr. Sendler: Low-intensity interventions22–25 could reduce existing structural barriers, such as a lack of mental health services and difficulties in accessing services18–21. Due to a resource-saving and flexible delivery method, low intensity interventions are meant to be easily accessible by many people (e.g., self-help interventions, interventions delivered by non-professionals) 26. IMI, a type of low-intensity intervention, provides anonymity, temporal and local indifference, ease of access and scalability27–30 and thus has the potential to overcome structural healthcare barriers31,32. As a result, IMI has been shown to be effective in the prevention and treatment of mental disorders34–38, despite lower treatment completion rates. But they were designed and tested primarily in high-income countries, and people from other ethnic or cultural backgrounds found them less effective39. Populations living in low- and middle-income countries (LMICs), refugees, and immigrants face a variety of challenges when it comes to accessing healthcare, including language and cultural barriers (e.g., a lack of knowledge about disease and treatment processes) or a lack of familiarity with the healthcare system17–21,40. Cultural aspects of intervention development, i.e. including knowledge of potential cultural differences41, may reduce these individual barriers. It takes time and effort to come up with new interventions for different populations. A more cost-effective option would be to adapt existing and proven psychological treatments for the new target groups42,43.

In order to successfully adapt to a new cultural context, one must follow a set of guidelines44,45. A number of research groups have developed such guidelines, focusing either (a) on specific treatment components that should be culturally adapted46–51, or (b) on the procedure that should be followed to gradually adapt the treatment to the cultural context. 45,52–54. It was Bernal et al.47’s Ecological Validity Framework that provided the first detailed explanation of cultural adaptation. According to the authors, the eight components of the intervention include language (translation, differences in regional or subcultural groups), people (patient–therapist relationship, roles), metaphors (sayings), content (values and practices) and concepts (theoretical model of the treatment) as well as goals (agreement of therapist and patient) and methods (procedures for achieving the treatment goals) (broader social, economic, and political contexts). Later frameworks took cues from this model, which has been widely repurposed. According to Resnicow et al.50, surface characteristics, like language, locations and people; and deep structure characteristics of treatment include the inclusion of cultural, social, environmental and historical factors to consider the understanding of disease and its treatment of the respective clients (e.g., cultural values (e.g., family) and specific stressors) that are unique to each culture.50 (e.g., racism). In their Heuristic Framework for the Cultural Adaptations of Interventions54, Barrera and Castro summarized several other frameworks’ suggestions for how to go about culturally adapting treatments. They explain how to culturally adapt by gathering information via literature searches or qualitative research, developing a preliminary adaptation based on this information, testing the preliminary adaptation in case or pilot studies, and refining the adaptation based on the findings of these studies.

It is a goal of cultural adaptation to facilitate access to psychological treatment for people with a cultural background that differs from the original target group44. Meta-analyses looking into the relevance and necessity of cultural adaptation have found that treatments that have been culturally adapted are more effective than treatments that have not been adapted55,56 in populations for which the intervention was not originally developed. The greater the degree of cultural adaptation, the greater the apparent effectiveness57,58 of these interventions. This shows that face-to-face treatments can be used to reach people with different cultural backgrounds than the original target group25,59,60, so culturally adapting IMI may also be useful. IMI has been culturally adapted to fit new target groups and has been shown to be effective61–63 by various research groups. In addition, a meta-analysis found a link between an IMI’s effectiveness in a particular target group and its enhanced cultural adaptation59. But there are no studies that directly compare the effectiveness or acceptance of culturally adapted IMI to non-/less-adapted IMI, which would allow for drawing conclusions on the added value of cultural adaptation. A systematic and well-documented adaptation is a prerequisite for such comparison trials and for examining the relevance of adapting specific components following a specific procedure67,68. However, the cultural adaptation of IMI’s components and procedures are often poorly reported69–73. IMI adaptation to different cultures is still in its infancy66, and little is known about the specific aspects of IMI that may require cultural adaptation in addition to the components that are already adapted in face-to-face treatment. In this context, aspects of evaluation frameworks of the IMI, such as methodological components to enhance user engagement with the IMI, its ease of use, or design and aesthetics, could provide an orientation.

(1) The characters depicted in the IMI were an important part of the content to be adapted (adapted in 35 of 42 interventions). Additionally, 25/42 IMI shows that in addition to the characters and their activities, the target audience’s needs were taken into consideration. As a result, the environments, settings, and associated burdens depicted in IMI (36/42 IMI) have been modified. To accommodate culturally relevant values and traditions, researchers changed the content (28/42 IMI). (5) Many studies translated the entire intervention into the primary language or regional dialect of the target group (35/42 IMI), in addition to the adaptation of day-to-day life as depicted in the IMI. (6) Language and texts were tailored to the target audience (34/42 IMI), and (7) appropriate quotes, symbols, and metaphors were visualized (18/42 IMI). Researchers also took into account possible cultural differences in the target groups’ concepts of mental health and its treatment (26/42 IMI) when adapting their IMI for cultural differences. As a result, the IMI’s objectives (23/42 IMI) and treatment methods (27/42 IMI) were modified on occasion.

The general structure of IMI (34/42 IMI) was adapted as a methodological component of cultural adaptation (11). As a result of this feedback, researchers made changes to their IMI in order to make it more functional and user-friendly for the intended audience (26/42 IMI). Additionally, (34/42 IMI) the design and the aesthetics were reworked. Researchers have changed the format or amount of guidance (22/42 IMI) as another way of culturally adapting IMI.

Damian Jacob Markiewicz Sendler: Researchers used a variety of methods to gather data on the cultural adaptations their IMIs required (15) and the adequacy of the adaptations they had already carried out (32/42 IMIs used at least two different methods). During the cultural adaptation process, a variety of people were involved, including healthcare professionals and the target population. Many authors also used theoretical frameworks for cultural adaptations of face-to-face therapies as a basis for their adaptation process (20/42 IMI).

Damian Sendler

As a starting point, the proposed taxonomy consists of 17 components, each of which focuses on one or more of the following areas: content, methodological, or procedural components (e.g., used methods and involved persons).

More than half of the 55 articles included in this review were devoted to the cultural adaptation of 42 IMI that were originally designed for a culturally distinct target audience. People, places, and things in the culture have been changed to reflect local characteristics (such as collectivism, values, and traditions), as well as specific risk factors for poor mental health (such as the burdens of migration, war, discrimination, and low socioeconomic status). These cultural adaptations have also been made to address health-related issues that arise (e.g., low mental health literacy and corresponding distrust, risky behaviour, or limited access to treatment). Culturally adapted IMI was evaluated in 28 studies including 14 randomised controlled trials for adherence and/or effectiveness in the new target group. Both the adherence and effect sizes found in randomised controlled trials and the studies investigating the adherence and effectiveness of IMI in general36,107 appear to be comparable in randomised controlled trials. There is a low enrolment and adherence rate for IMI. In addition, we were unable to locate any research comparing a culturally adapted IMI to a control group. Consequently, we believe that it is premature to conclude that cultural adaptation is necessary for IMI to work in people from low- and middle-income countries (LMIC), migrants, or indigenous populations.

Damien Sendler: Future researchers could use our taxonomy of cultural adaptation of IMI as a foundation to systematically adapt IMI based on the 17 components we identified. Face-to-face psychological treatments47 use culturally adapted versions of many of the same ten included content components. It was found that both superficial (such as character, activity, and language) and deep (such as burden, value, mental health concept, and treatment goal and method) structural adaptations were critical50.. [page needed] An additional consideration is that these three procedural elements appear to reflect the method proposed in the adaptation of in person psychotherapy54. This is why study investigators utilized a variety of methods, such as focus groups and feasibility trials, to gather information from various groups of people (e.g., mental health experts, members of the target group). IMI was adapted to follow theoretical frameworks of face-to-face treatment adaption in about half of the cases. We also found four distinct methodological components that were taken into account when culturally adapting IMI in addition to the content and procedure components. To name a few: structure, functionality, design and aesthetics, and human guidance (such as how many and what kind of images are included) are all part of the mix, as are elements such as condensed text or shortening text modules (e.g., level of guidance). It may not be sufficient to use existing frameworks for cultural adaptation of face-to-face treatments when adapting IMI, as also highlighted by Lal et al.72 and implemented by Burchert et al.111.

Damian Jacob Sendler

It is possible that our taxonomy on cultural adaptation of IMI can serve as a basis for measuring the extent and type of cultural adaptation, thus laying a preliminary foundation for investigating the relevance and necessity of cultural adapting (specific elements of) IMI. Culture, the disorder being treated, or even the language of the IMI, all influence how important cultural adaptation is. According to exploratory post hoc analyses, it may be more important to culturally adapt IMI for people with a migrant background and those living in LMIC than it is to culturally adapt IMI for new target groups in western countries, particularly in terms of content components. The current systematic review, however, found no correlation between the degree to which cultural adaptations were made and the IMI’s effectiveness or adherence. This systematic review included IMI that was very diverse and did not yield sufficient outcomes data, so the results should be interpreted with caution. When meta-analyses include a greater number of randomised controlled trials (RCTs), it is still difficult to draw conclusions about the influence of specific intervention characteristics or cultural adaptation on IMI effectiveness. This means that other research designs could be used to investigate the possibility of differences in the necessity of cultural adaptation and its impact on the effectiveness of IMI. A randomised factorial trial112,113 was used to test different culturally adapted versions of the same IMI against one another. It is possible to culturally adapt IMI content components, such as those with a deep structure versus those with a surface structure or none at all. It was then possible to compare and contrast the effectiveness of each of the versions, allowing us to draw conclusions about the advantages of culturally adapting these particular components.

People in low- and middle-income countries (LMICs) and migrants or indigenous people in high-income countries need innovative and scalable approaches to address the mental health treatment gap5. An effective and systematic cultural adaptation is critical to providing effective interventions24. According to this systematic review, there are 17 components to consider when culturally adapting IMI in order to make it more relevant to the new target audience. IMI’s systematic cultural adaptation can be built on top of this taxonomy. Adapting IMI in a systematic cultural manner could help underserved populations receive adequate and effective mental health care, thereby helping to reduce global public mental health inequalities.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: Multiple timescales are processed and integrated into a meaningful whole. Complex multiscale temporal organization appears to be present in the brain. Intrinsic neural timescales (INT) describe the different timescales observed in different regions of the brain, but their function and neural mechanisms remain a mystery. It is our contention that recent research on INT is critical for input processing. It is a form of input sharing, which means that they are used by a wide range of different species. Encoding inputs may be accomplished by matching inputs’ stochasticity with neural activity’s ongoing temporal statistics, i.e., input matching. For input processing, input integration versus segregation and sampling are the most important temporal mechanisms. This helps to connect the brain to its evolutionary and environmental context. It has significant implications for our understanding of mental characteristics and psychiatric disorders, as well as expanding our view of intelligence beyond the brain by incorporating timescales.

Damian Jacob Sendler: A wide range of regular and irregular inputs, occurring over a wide range of timescales, are constantly being fed into the brain by our environment. Consider music, one of the most complex temporal inputs. Even better, we are able to combine the music’s various timescales into a single meaningful whole, like a melody. Furthermore, the melody can be clearly discerned from the background accompaniment.

Dr. Sendler: Is it possible for our brains to process and integrate so many different types of information? Research suggests that the brain has its own internal timescales (INT)1–11. In resting state, lower-order unimodal sensory regions, such as the primary visual cortex, show short timescales compared to higher-order transmodal regions, such as the default-mode network (DMN). Even so, there is still no clear understanding of the INT’s specific function or role in the brain and neural processing.

By looking at the evidence from both human and non-human species, we believe that INTs play an important role in processing and structuring inputs over a range of timescales (Fig. 1 for a general framework). Our goal here is to describe basic dynamic principles that are shared across different types of input (see Box 1) rather than focusing on specific inputs (such as visual, somatosensory, or auditory; see Box 1). When it comes to processing and shaping extrinsic timescales of multiscale input, the brain uses its own INT to do so. That way, the brain is able to encode environmental inputs’ stochastic structure according to its own. Its unimodal–transmodal hierarchy and INT determine its stochastic structure. Those mechanisms include temporal integration/segregation and input sampling with subsequent shifts to lower frequency modes in the processing hierarchy, as we will explain.

Many different interpretations of the term “input” exist. Sensory functions are first and foremost associated with the concept of input. For example, somatosensory, visual, and auditory inputs can all be distinguished. It has been shown that these sensory input systems are related, with different input streams in the brain, both functionally and INT25. These input streams share a progression from unimodal (like primary sensory cortex) to more transmodal regions like the dorsolateral prefrontal cortex. Some of the transmodal regions are shared between various sensory input systems.

Hence, despite their distinctions in terms of their modality-specific sensory input, these input systems may nevertheless converge in the higher-order transmodal regions. Considering the unimodal–transmodal structure of INT, this suggests that some dynamic, i.e. temporal, features and mechanisms of information acquisition may be shared by the various sensory modalities, as discussed above.

In addition to sensory inputs from the external environment, the brain also receives inputs from the body, that is, its interoceptive inputs (and also its proprioceptive inputs) (and also its proprioceptive inputs). Taylor et al.116 demonstrate that the brain’s interoceptive input streams (with insula as the key region) again follow the hierarchical progression from unimodal to transmodal regions. Interoceptive inputs also converged with exteroceptive sensory inputs in the higher transmodal regions, which is remarkable. That suggests some commonality among intero- exteroceptive input processing.

In addition to the constant “bombardment” of exteroceptive and interoceptive inputs from the environment and the body, the brain exhibits spontaneous activity changes. Exteroceptive stimuli usually elicit activity changes of varying degrees of strength, but these changes can be weak or strong. Such changes in the auditory cortex’s spontaneous activity may be interpreted as “external voices,” even though they are actually hallucinatory in nature.77,117,118 Since healthy people can experience auditory hallucinations, these “healthy” brain activity changes may even exist and be referred to as “neuronal input”77. Mind wandering119,120, self-reference processing121,122, and mental time travel/episodic simulation67,112 have been linked to these spontaneous changes. More interestingly, higher-order transmodal regions have stronger neuronal inputs than lower-order transmodal regions106,123–125, which is consistent with the findings of previous studies in this area. Even the brain’s own neuronal input appears to follow the progression from a single-mode to a multi-mode hierarchy.

To sum up, it appears that the concept of input extends far beyond the distinction between different types of sensory input and the various sources of those inputs (such as the environment, one’s own body, or one’s own mind). There appears to be a deeper level that is shared among the various inputs, unlike the more superficial level where different inputs and sources are distinguished. There is a strong temporal and dynamic influence on this deeper level of input by the brain’s INT. In this paper, we describe the various features and mechanisms of input processing at a deeper temporal and dynamic level.

Does INT have any bearing on how we behave and think? Psychiatric disorders are a good indicator of this. In a recent fMRI resting state study14, the ACW was used with autistic subjects. Adults with autism spectrum disorder (ASD) had significantly shorter ACW in the primary sensory regions (visual, sensorimotor, and auditory) than healthy controls, and these changes were negatively correlated with the severity of autism. When it came to autism, however, ACW in the right caudate region was significantly longer in ASD patients, and this was also associated with the severity of repetitive restrictive behavior.

These findings were corroborated by an investigation into adolescent children with Autism Spectrum Disorder (ASD) using fMRI resting state ACW. This means that the intrinsic timescales have a developmental component. In addition, researchers looked into the neuro-anatomical basis by calculating the volume of gray matter in the area. Local gray matter volume showed a significant positive correlation with the duration of ACW in the same region, which was also true for regions affected by ASD. Finally, they performed a mediation analysis, which revealed that the duration of the ACW14 mediated its effect on autistic symptoms through the gray matter volume in the aforementioned regions.

Another fMRI resting state study in ASD126 supports the importance of intrinsic timescales in autism. Power-law exponent (PLE) was calculated by operating in frequency domain rather than time domain (and spectral entropy). They found that the salience network (insula, supragenual anterior cingulate cortex, and thalamus) showed increased PLE with stronger power in slow frequencies in ASD (see also ref. 127 showing that the salience network exhibits the highest variability and flexibility among the different networks). Furthermore, they found that schizophrenia did not have an increased PLE in the salience network. Finally, these findings were specific to PLE and not found in other areas of ASD61,128,129, such as regional homogeneity and neural variability.

An EEG study in schizophrenia found abnormally long ACW (and high PLE) in several electrodes during a task state that involved self-specificity (i.e., an enfacement task)130. The study included mostly post-acute first episode subjects. They also found that schizophrenia subjects had a significantly lower degree of change in ACW from rest to task, which means that, unlike healthy subjects, they barely shortened their ACW while performing the task. Interestingly, the same ACW prolongation during task and its reduced rest–task difference was not observed during a non-self task, i.e., auditory oddball—this suggests a close relationship of ACW with self-specificity.

In addition, they found that the degree of ACW mediated the relationship between self-disturbance and negative symptoms in schizophrenia participants. Changes in INT may be related to psychopathological symptoms and more generally to behavior or cognition, as demonstrated in the autism study by Watanabe and colleagues14. A recent study on psychosis in schizophrenia25 adds credence to this idea.

Researchers have found that the INT in patients with psychosis/schizophrenia is significantly reduced (i.e., shortened) compared to healthy controls. They also found specific changes in neural hierarchy of auditory and somatosensory input streams: an increase in INT at the lower levels of the neural hierarchies may reflect hallucinations (comparing psychotic subjects with severe vs. mild hallucinations). Increased timescales at higher levels of neural hierarchies might be a sign of delusional thinking (comparing psychotic subjects with severe vs. mild delusions). INT appears to play an important role in mediating certain psychopathological symptoms of psychosis, according to research.

Damian Jacob Markiewicz Sendler: We discovered that the brain’s intrinsic hierarchical organization, i.e., its temporo-spatial hierarchy, can recapitulate and thus model the environmental hierarchies of various events. The living don’t have to “represent” a mental model of their surroundings: “An agent doesn’t have a model of its world—it is a model. To put it another way, our embodied brains aren’t just a representation of the sensorium—they are it. 131. The human agent (and related non-human species) is a temporo-spatial model of its environment based on the temporal hierarchy of its INT, but in a miniature scale-free way.

There are many ways to think of the brain as a free energy-driven temporal model of its environmental context. That results in the brain’s temporal and spatial nestedness within the context of its surroundings. Scale-free self-similarity in their shape or form connects the body, brain, and environment, despite their different temporal (and spatial) scales. One scale-free self-similar way the brain and its temporo-spatial organization nestle in a larger environment is like the smaller Russian doll being contained within a larger one (same shape, different size). In light of this temporo-spatial resemblance, we might do better to concentrate on “what our head’s inside of” rather than “what inside our heads”86.

An intrinsic temporal and spatial hierarchy must be built into the design and architecture of artificial agents, which has major implications for the modeling of artificial agents. In future AI models, it may be possible to implement such intrinsic spatial and temporal organization in their artificial agents, including the different timescales and the core–periphery organization (see ref. 133 for first steps in this direction in artificial agents using what they describe as “multiple time scale recurrent neural network”).

Using spatial and temporal hierarchies, Tani’s compelling model of an artificial agent135,137,138 can be extended by combining top-down (providing the agent’s inner input) and bottom-up (providing the agent’s outer input) layers. The temporo-spatial architecture and the free energy principle can be combined to create a small-scale but self-similar model of the artificial agent’s environment. If you want to achieve this, you’ll need a dynamic and constantly changing temporo-spatial hierarchy for the agent. So in order for an agent’s spatiotemporal dynamics to minimize its variational free energy in relation to a given environmental context, the causal (or temporo-spatial) architecture of the environment must be recapitulated or installed.

What is the relationship between intra-regional INTs and inter-regional ties? All of the features of the INT can be found within the same region as well as between regions. Excitation–inhibition balance and its local recurrent wiring34, such as in supragranular feedforward and infra-granular feedback connections5,13,32,35, are examples of intra-regional cellular features (see also ref. 20 for demonstrating the relevance of population codes). There is considerable variability in the INT at the single neuron level even within regions, according to Cavanagh et al36. Working memory (see also ref. 24) and/or decision-making36–38 place demands on a neuron’s temporal receptive field, which can change over time. Furthermore, Spitmaan et al.37 find that they are less dependent on the task context, which further demonstrates their adaptability. The authors also mention that the timescales of different neurons during task-related activity suggest that they are independent, or flexible.

Inter-regional connectivity has a significant impact on INT’s intra-regional characteristics. Chaudhuri and colleagues16 demonstrated that local connectivity alone is not sufficient to produce the wide range of timescales found in the cortex. Even more importantly, they remove all of the long-range projections from their non-human primate model5, limiting the range of different timescales and eliminating the inherent temporal hierarchy. Non-human primates9 and humans13,18,29,39–42 share the same relationship between intra-regional INT and inter-regional functional connectivity.

Damien Sendler: What is the relationship between inter-regional functional connectivity and the INT? It has been shown in two recent human fMRI studies that the duration of INT in various regions, as measured by the resting state ACW, is positively correlated with the degree to which a given region’s functional connectivity changes during task18,43. Individual variability in ACW across different regions was found to be closely linked to the individual variation in functional connectivity patterns within those same areas, as demonstrated by Raut and colleagues13 (see also42,44–48).

Inter-regional connectivity patterns in the brain appear to be closely linked to INT, as long-range inter-regional connections are a major component of intra-regional temporal features. These timescales can interact and integrate with each other as a result of the close connection between intra-regional and inter-regional timescales As we’ll see later, this could increase the number of timescales that are available, i.e., the repertoire of timescales.

Do task states have an effect on the int of a resting state? An affirmative response indicates that they are involved in input processing. The excellent studies of Hasson and colleagues15,26,27,49–51 strongly suggest the relevance of INT for input processing (ref. 1 for review). It has been shown that lower-order unimodal sensory regions preferentially process temporal segments of external stimuli (like single words of stories or short episodes in movies). Higher-order transmodal regions are activated more frequently when there are longer pauses (like whole paragraphs in a story or a longer episode in a movie). Temporal receptive windows, which Hasson and colleagues1 refer to as temporal receptive fields on the cellular level, describe how external inputs are processed and structured in terms of time.

Is there an overlap between the INT’s spatial or topographical pattern in rest and task states, i.e., a rest–task pattern? In functional connectivity18,52–55, such rest–task overlap has been well demonstrated. However, in INT, this issue remains open. To a great extent, these studies on the brain’s temporal responsiveness windows confirm the hierarchical organization of INT at rest. Similarly, the ACW in the DMN is the longest when at rest. Longer input sequences are processed by the DMN in task states, but the shorter resting state ACW in unimodal sensory regions seems to find its equivalent in the short input sequences processed by these regions1, as shown by studies of task states. As a result, the topographical organization of rest ACW and task temporal receptive windows is similar. There appears to be a close relationship between rest and task, or rest–task modulation or interactions. From 56 to 60 (see below for the discussion of task-specific changes in INT).

Rest–task overlap suggests that the hierarchical organization of ACW in resting state ACW is carried over to, and thus present, in the temporal receptive windows during task states, as well. Computational modeling and brain imaging both show evidence of this rest–task overlap. They found that regions with longer ACW, such as those in the transmodal core, respond to external stimuli with lower and slower activity changes than sensory regions; on the other hand, sensory regions have a shorter ACW at the periphery, which is accompanied by a higher amplitude and a faster response to external stimuli (see also refs. 17,35). In Chaudhuri and colleagues5’s non-human primate-based network model, electrical stimulation of V1 in the visual cortex yielded similar results (see also ref. 29). Weakly connected regions to input regions show longer INT during stimulation, which is an interesting finding. Another example of how tasks have an impact that goes beyond the stimulated regions of the brain: Data from human brain imaging support these computational findings on INT rest–task overlap. Research by Ito and colleagues18 examined the ACW in a resting state and its amplitude during various task states. Resting state ACW duration (in different regions) was found to have a negative correlation with task-related activity, i.e., amplitude. There are transmodal regions that have lower task-related amplitudes if they have a longer resting state ACW. while unimodal regions exhibit higher peak intensity during different tasks because of their shorter ACW. Accordingly, these findings imply that resting state INT has a significant influence on task-related activity and input processing. This, however, remains a mystery as to how it works.

If the resting state’s INT influences the temporal features of task states as well as associated cognition, this is what we call rest–task interaction or modulation (see also refs. 56,58,62). Golesorkhi and colleagues22 have just addressed this issue (see also ref. 15 for initial steps). ACW-50 and ACW-0 (see above) were studied using MEG during both rest and three different task states (motor, story-math, working memory). Resting state’s ACW and its hierarchical core–periphery organization strongly predicted their task states: the resting state’s ACW core–periphery organization was essentially preserved during all three task states as topographical rest–task correlation yielded high values (0.8–0.9) 22. Results from this study suggest that, regardless of task, an individual’s INT’s hierarchical organization persists during task states.

Damian Sendler

When calculating the rest–task difference, Golesorkhi and colleagues22 found some task-specific changes (Fig. 2) (which subtracts and cancels out the shared, i.e., correlating temporal hierarchical organization). It was found that higher-order network regions, which were presented at 30-second intervals, had an ACW that shortened during the story-math task. In motor and working memory tasks, only minor alterations were observed. In lower-order network regions, the ACW was significantly shortened during working memory, but only minimally in story-math and motor tasks. These findings suggest that task-specific changes can be observed once the hierarchical temporal organization present in rest and task is removed. ACW and INT can be modulated during task states, making them dynamic and adaptive rather than static and non-adaptive, as previously believed. Tasked modulation appears to mainly concern the shortening of ACW in comparison to rest, but more studies are needed. ECoG24 in humans exhibits INT’s adaptability during a working memory task’s delay period (relative to the pre-stimulus baseline).

Behavior and cognition are influenced by INT in addition to task states. It has been found that non-human primates who spend more time in the resting state of their INT (as measured during baseline intervals sandwiched between tasks) perform better in a range of tasks. In a delay discounting task, for example, delays are longer, and spatial response coding is stronger in the delay period during a non-match-to-goal task63. As for the human side, recent fMRI and/or EEG studies have shown that the resting state’s ACW is directly linked to higher-order cognition, such as the level of consciousness (64), sleep stage 21, and the sense of self (66–69) and psychiatric disorders (70). (see Box 2 for details). Data suggest that INT influences behavior, including perception and higher-order cognition such as self awareness and self-consciousness. Because task states and perceptions and cognition are dependent on a variety of inputs, these data support the idea that INT is critical for input processing and structuring.

ACW, i.e., normal neural timescales accompanied by a balance of slow and fast frequencies, is associated with a normal capacity to encode inputs on a whole-brain level with healthy awake subjects and subjects with motor deficits but preserved input processing (amyotrophic lateral sclerosis, locked-in syndrome), while other physiological, pharmacological, and pathological conditions, e.g., sleep (N1-N2), unresponsive wakefulness, present short ACW (the EEG signals and the ACW representations are taken from the datasets investigated in Zilio et al.21).

It’s worth noting, however, that Zilio and colleagues21 only looked at activity during the resting state. As a result, the ACW’s relationship to input processing can only be inferred indirectly; further research into task states involving actual inputs is required to establish a direct link. As input processing is known to be deficient in disorders and altered consciousness72–76, their findings suggest that the resting state’s INT exerts the capacity for input processing, a neural predisposition77–80. A person’s capacity to process multiscale inputs can be seen even when they aren’t being exposed to external multiscale inputs. In sleep, for example, the brain’s capacity or predisposition to process inputs is preserved, allowing us to be awakened at any time by strong external stimuli. Total anesthesia and coma, on the other hand, make this impossible, as the brain’s capacity or predisposition for input processing is lost in these cases.

So far, we’ve shown how important INT is for handling input from the outside world. The assumption that all species share a common external environment would lead one to expect some degree of overlap or sharing in their INT amongst these various species as well. This “input sharing” across species is clearly evident in the evolutionary preservation of INT across species.

Both non-human primates4,5,20 and humans13,14,18,22 show regional differences in the INT along the transmodal–unimodal gradient. Cross-species studies on both the cellular81,82 and regional-systemic83 levels show that this can be applied to a wide range of species. As a first step, Shinomoto and coworkers81,82 show that the non-human primate brain has distinct regions of regular, random, and burst-like spiking patterns in different parts of its cortex. It is shown that the temporal fingerprinting in the regions’ temporal structure of their firing pattern holds across different species, including non-human primates, cats and rats; the differences in firing patterns between different regions within one species are larger than the firing pattern differences within the same region across different species82,84. These findings show that the temporal characteristics of neural firing patterns at the cellular level in specific brain regions are conserved across species.

When it comes to regional and systemic oscillations, there have been similar findings of cross-species preservation. There is evidence that various oscillatory rhythms such as alpha, spindles, and ripples are present in the same frequency range across a wide range of species, including humans, non-human primates, dogs and bats.83 (see also ref. 84). According to Buzsáki and colleagues83, the frequency range of the rhythmic pattern remains the same in different mammals, even if the brain size changes and grows larger during evolution. It is concluded that a priority in evolution is the preservation of the brain’s temporal constants: “In summary, it suggests the brain’ architectural aspects—scaling of the ratios between neuron types, modular growth, system size, inter-system connectivity, synaptic path lengths, and axon caliber—are subordinated to a temporal organizational prior.

Damian Jacob Sendler

Do you know how input is processed by the INT? Using the temporal receptive windows developed by Hasson and colleagues, various task state studies suggest that the INT may segment inputs into short and long sections, such as single words, sentences, and paragraphs 1, 15, 26, 27, 29, 90. This kind of “temporal smoothing”92,93 may imply that certain inputs are processed with a high degree of temporal integration. Higher levels of temporal segregation are required to process other inputs in a more segregated and therefore more precise manner (see refs. 93,94). Together, this represents a delicate balancing act between integrating and separating input data.

Is there a way for INT to control the amount of integration and segregation they perform during input processing? The ACW measures the degree of correlation between the patterns of neural activity at various points in time. Correlation is low if only a few distinct time points are correlated, indicating that ACW is short. There will be a high degree of temporal segregation but a low degree of temporal integration in the processing of inputs beyond the time points that correlate in ACW. It is also possible that, due to a low correlation with a low ACW, the processing of single inputs may be more or less limited to their actual durations, meaning that temporal smoothing or expansion95 is not applied. The low degree of “temporal smoothing” required by short INTs means that inputs are processed with high temporal precision, both in terms of specific time points and the actual durations they actually have.. Intrinsic timescales in single-modal regions such as sensorimotor cortex, which have both a short ACW at rest and an even shorter temporal receptive window when performing a task, strongly support such an input processing strategy

So far, we’ve shown how the INT modulates input timescales by performing temporal integration and segregation on the input data. Many different timescales in the environment are confronted by the brain, and the brain has limited capacity to process this information. 83–101,101,102 When it comes to bridging the gap between its own timescales and those of its environment, how can the brain do so effectively? The brain’s smaller-scale neural activity should encode all inputs from the larger-scale environment with the least amount of error possible, ideally.

A fast–slow gradient from uni- to transmodal regions shows hierarchical organization of timescales in the brain, according to the empirical data. Mathematicians call this “down-sampling” from fast input stochastics to slower input stochastics103 when transitioning from the faster unimodal to the slower transmodal regions. Down-sampling across the hierarchy of unimodal and transmodal regions, the INT acts as input samplers. Initial numerical simulations are used to support the differential response between unimodal and transmodal regions during data processing (this section). After that, the fast–slow gradient of down-sampling will be illustrated mathematically with new simulation data in a second step (next section).

Sensory networks would be the first to downsample under our fast–slow gradient assumption. The intrinsic timescales of sensory and unimodal networks are shorter than those of transmodal networks15,22. According to this, the initial sampling would be performed at a higher frequency, with subsequent sampling being performed on more widely spaced timescales (down-sampling). This means that unimodal regions, because of their shorter intermodulation time (INT), should have a faster and more transient, or fast-frequency response. There should be a longer-lasting response in transmodal regions.

Music and language, both of which have temporal complexity, are difficult for the brain to process, let alone bring together in meaningful wholes like melodies or sentences. One of the most important roles the brain plays in processing input is that of intrinsic neural timescales (INT). Because of INT’s central position during sleep and wakefulness, not to mention during task performance, this is a reasonable assumption. It is based on findings like this one to propose that the INT’s primary function is to shape and structure input processing, including aspects like cross-species input sharing and encoded stochasticity. This has to do with input sharing across species and input encoding by matching the stochastics of both the environment and the brain, respectively. Input integration vs. segregation on temporal grounds as well as (II) fast–slow down-sampling along the INT’s unimodal–transmodal hierarchy may both play a role in mediating this effect. INT is extremely relevant to current views on brain function, including its role in mental features and psychiatric disorders, when taken together because of their key role in input processing through distinct mechanisms.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: Behavior and clinical decision-making are influenced by people’s judgments and decisions. More than half of all health problems can be traced back to a person’s unhealthy lifestyle choices. As part of our investigation into how to better understand and improve healthcare decision-making, we conducted a narrative review of the use and examples of concepts from behavioral economics in the three most highly cited general medicine journals in order to better understand and improve healthcare decisions.

Damian Jacob Sendler: Behavior and clinical decision-making are influenced by people’s judgments and decisions. More than half of all health problems can be traced back to poor nutrition, lack of exercise, and substance abuse, according to a recent study. What causes people to make poor health decisions, and how can they make better decisions in the future? As part of our research into Behavioral Economics, we looked at this question through the lens of behavioral science and economics.

Dr. Sendler: Individuals are presumed to be perfectly rational, well-informed, and self-interested in classical economics assumptions. In medicine, doctors make recommendations, prescribe treatments, and provide patients with information in the hope that they will use it to make wise health decisions. According to the Behavioral Economics approach, human behavior frequently deviates from this assumption and that we deviate from making rational choices in predictable ways. Even when we are well-informed, we still make poor decisions regarding our health. Research in behavioral economics helps us understand why we make poor health decisions and how we can improve our decision-making.

There has been a steady rise in the use of behavioral economics in a wide range of industries over the past few decades. Many Nobel Prizes in the field of behavioral economics have been awarded to researchers, including Daniel Kahneman (2002) and Richard Thaler (2007) (2017). Nudge units have been established in government to apply Behavioral Economics insights to public policy. When it comes to making better business decisions, companies employ the services of Behavioral Economics consultants. Books on the subject have been bestsellers in popular culture.

Behavioural Economics is based on the premise that our limited cognitive resources limit our ability to make decisions. Decision-making requires a lot of time, effort, and mental effort. Fast (System 1) and slow (System 2) decisions are described by Kahneman. This type of decision-making requires minimal cognitive resources because it’s so simple. Most of the decisions we make during the course of the day can be made quickly. Slow decisions are deliberate, deliberate, and effortful…. Decisions that are rational, complex, or consequential are best served by taking their time.

Examples of the impact of cognitive limitations on health decisions can be found in the quotes that follow. Decision-making under uncertainty can be impacted by a lack of cognitive resources, which affects both clinicians and patients. “ Medical knowledge and cognitive demands have grown at an exponential rate, but the brain’s capacity to keep up hasn’t. However, despite the fact that it is impossible to know everything, the diagnostician of today is unable to find ways to reduce the cognitive load in daily practice, despite being aware of this fact. Diagnosticians of the future can avoid this problem by using checklists and decision support systems on a regular basis, which frees up their mental bandwidth for more complex issues. ” “Patients often face unique health problems, receive little useful feedback on the quality of medical decisions, and make decisions when they are ill and therefore more emotionally charged. Therefore, it is not surprising that patients’ actions may not always be completely rational. For an ill or vulnerable person, weighing the costs and benefits of alternative tests or treatments can be difficult.”
We use heuristics (shortcuts) to speed and simplify decisions because it is not possible to apply slow decision-making to the countless decisions, both trivial and critical, we make every day. In most cases, the results of taking these short cuts are exactly what was intended. Using heuristics and biases to make decisions, on the other hand, can lead to unexpected results.

In health-related decision-making, many of the heuristics and biases identified have significant consequences. When it comes to probabilities, we use heuristics to make up for our lack of knowledge, as noted by Tversky and Kahneman. Representation, availability, and anchoring and adjustment heuristics are all closely linked to clinical decision-making (Table 1). Therein lies the core of clinical reasoning, which deals with uncertainty and probability estimation.” Clinicians often use heuristics (also known as subjective probabilities or beliefs, also known as clinical judgment), either implicitly or explicitly, when estimating the likelihood of a patient’s illness.”

If you’re making health-related decisions, “present bias” and “loss aversion” can have a negative impact (Table 1). Kahneman and Tversky also noted that people make decisions not on the basis of absolute gain or loss but on gain or loss relative to a reference point. There are important implications for health-related decisions based on this observation. Compared to their current health, disability and death appear inconceivable to healthy patients. When viewed in this light, the disparity between the two states of health is negligible. Patients who are in poor health have a more acute awareness of the difference between their current condition and death. From this perspective, the disparity appears to be quite significant. Poor health may lead to a greater desire for aggressive treatment, even if it results in long-term disability or discomfort, whereas patients who are in good health may not see the value in such treatment.”

Table 1 provides a summary of other heuristics and biases that have important implications for health and medicine.
This literature review lacked an important theme: bias blindness, the idea that we are better at spotting bias in others than we are within ourselves. Patients and clinicians may have difficulty communicating effectively because of their shared biases, which can lead to miscommunications and misunderstandings. Practicing mindfulness, actively open-minded thinking, and metacognition have been suggested as ways to combat this bias and others like it., Both of these strategies are based on the idea that a systematic, deliberate, and deliberate thought process (System 2) is necessary to identify and reduce bias.

Damian Jacob Markiewicz Sendler: Our decision-making is heavily influenced by our social environment. Social norms, social signaling, modeling, and contextual cues all influence our tendency to be social beings. Socioeconomic status, education, psychological issues, social support, and income inequality all have an impact on people’s decisions. Decisions are influenced by social media, advertising, and persuasion. Even the anticipation of social considerations and pressures can influence decisions.” Obesity epidemic may be linked to the spread of obesity in social networks. It’s possible, given the importance of social influence, to slow the spread of obesity by using that same force. People’s perceptions of their own risk of illness may be influenced by the people around them, and this could be exploited to spread positive health behaviors.”

One of the best examples of the impact of social factors on our behavior, and thus our health, is our response to the SARS-CoV-2 pandemic and the severity with which it impacted certain communities and ethnic groups.
The following comment exemplifies the importance of taking into account social factors when making decisions and altering behavior because it shows how environment and social interactions interact.

As a complex system problem, obesity prevention is framed as a complex systems problem, for which food and physical activity behaviors are not only a matter of individual choice but also strongly influenced by multiple levels of socioenvironmental risks, i.e. interpersonal level (family, peers and social networks), community level (schools and workplaces) as well as by the interaction with government level policies.”

We can use our knowledge of heuristics and biases to make better decisions by using choice architecture, which has long been used by advertisers and marketers to create a favorable decision-making environment. Adverts and used car salesmen already knew what Tversky was looking at, according to Tversky. Table 2 provides an overview of various types of choice architecture.

Choice architecture (and nudges in particular) have been criticized for their potential to be used as a tool of control. Some researchers, such as Thaler and Sunstein4, argue that nudges should be used responsibly and note that a true nudge does not limit people’s freedom of choice but rather directs them toward more beneficial outcomes for themselves. One of the goals is helping people overcome their unhealthy habits so that they can achieve and maintain a healthy lifestyle. There is a counterargument that the choice architecture is already in place, but it is not necessarily implemented with the welfare of individuals in mind (eg, advertising, social media). Health can be improved by making environmental and social cues more deliberate and targeted. For example, “behavioral economics has shown that removing even minor hurdles can greatly improve the uptake of helpful practices.”

Damian Sendler

As previously stated, humans have a hard time dealing with uncertainty. Health and medicine face a major challenge in this regard. Making rational decisions about one’s health often necessitates weighing the relative risks of various treatment options, which can be difficult for both doctors and patients. Using choice architecture, systems, clinicians, and individuals can access accurate information and probability calculations to prevent errors and increase the likelihood of successful behavior.

Damien Sendler: A lack of cognitive resources has been both exacerbated and mitigated by the use of technology. The speed and volume of information that can be accessed by both clinicians and patients has increased tremendously as a result of technological advancements. Our ability to comprehend and utilize this information remains constrained. Technology is being used to improve clinical decision-making and health-related decisions as we learn more about how humans make decisions and the limitations of human decision-making. Using choice architecture, the physical and social environments can be shaped to address behavioral health challenges and reduce medical errors, as outlined in Table 2.

Many decisions that were once slow can become quick as expertise grows with time, practice, and timely feedback and learning in a regular environment. Medical diagnoses and scientific expertise are two examples of how people with expertise in a discipline can use language to communicate complex collections of phenomena. The ability to recognize patterns and generate codes of intended behavior may also be enhanced through practice with a vocabulary and concepts for characterizing and labeling decision-making tendencies. The consequences of these tendencies, capacities, and errors in decision-making could be better understood, anticipated, and communicated as people learn and teach about them. Diagnoses are diagnostic tasks that require precise vocabulary, just like in medicine.” Disease names serve as the hooks to which all of the disease’s vulnerabilities, environmental factors and symptoms are attached. “Prognosis and care” are also attached to disease names.

There is a chance that as groups of people and clinicians come together, they can collectively identify, anticipate, and avoid systemic mistakes. Scientific and systematic approaches can be used to ask and answer questions and develop solutions for identified problems.. It’s possible to consider alternative viewpoints and perspectives from the outside. When resolving differences, it’s best to put an emphasis on finding solutions that benefit both parties. Furthermore, as noted earlier in this article, the availability of accurate information and probability calculations may help prevent errors and increase the likelihood of successful behavior.

Damian Jacob Sendler

Genotype, phenotype, and behavior, including the ability to make decisions, are all highly variable in humans. Toxicology and efficacy may differ between individuals because of their differing ability to metabolize drugs. Precision medicine has grown out of the discovery of these small differences. Individual human behavior, including decision-making, is rarely consistent. Even if the circumstances appear to be identical, the same person may choose a different course of action at a different time. These variations can be inherited, acquired, or a combination of the three. Individual health and well-being can only be improved by a thorough examination of the impact of the socioeconomic, psychological and physical environments.

When it comes to achieving some stability, Kahneman notes that loss aversion and the status quo bias can be beneficial. An additional area in which behavioral economics can be applied to improve health is the exploration of the role of innovation and creativity in relation to loss aversion and the status quo bias. In the lives of both institutions and individuals alike, loss aversion is a powerful conservative force that favors minimal changes from the status quo.” The gravitational force that holds our life together near the reference point is this conservatism, which helps to keep us stable in our neighborhood, our marriage, and our jobs.
When it comes to research and development, innovation, invention, and creativity, Behavioral Economics pays little attention to how people behave as individuals or in groups. Some have suggested that people become accustomed to the current state of affairs (the status quo) and then strive to improve their own and others’ lives even more. Perhaps our prosocial and cooperative tendencies motivate us to recognize current suffering and work to “change the world” so that we can live together more successfully: fed, safe, healthy, educated, and skillfully interconnected. We strive to protect ourselves and our loved ones from financial ruin.

It was the goal of this narrative review to provide examples of how Behavioral Economics concepts and applications in health and medicine have been discussed in high-impact articles in the broader medical community. Other concepts that may have the potential to improve health-related decision-making were also identified.

Behavioural Economics provides a useful conceptual framework for thinking about decision-making and its limitations (System 1, System 2, cognitive limitations), reveals the reasons behind why we sometimes make poor decisions regarding health (present bias; loss aversion; inappropriate use of heuristics) and suggests ways to improve decisions (choice architecture, scientific method, and learning, teaching, and negotiating). A wide range of people (doctors, scientists, patients), groups (health care teams, research teams), society (public health and policy), and institutions (such as universities) could benefit from this approach (academic medical centers and government). It’s hard to imagine that more than half of all health problems could be eliminated through improved decision-making abilities if we were able to learn, practice, work with others, and make changes in our eco-social environment.
Finally, Kahneman stresses the importance of acknowledging the role of chance and luck in the outcomes of decisions and behaviors:

“I believe that the message of luck encourages us to be more forgiving of the mistakes of others.” Trying to figure out what people did wrong because something went wrong is something that we do far too often. Over-explaining and over-blaming are two of the most common ways that people express their feelings. There’s no guarantee that we’ll be able to do everything we can, but the recognition of the role of luck and limited control should help us deal with that.

Having a better grasp of probabilities and human cognitive limitations can help people appreciate the difficulties and necessity of living with uncertainty. To conclude, we should acknowledge the importance of compassion, generosity, and humility in our lives, as well as in the lives of others.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: Having a strong therapeutic relationship is considered essential to delivering psychotherapy in an ethical manner. Many questions remain unanswered about the alliance between text-based digital psychotherapy and its importance in delivering mental health care via the internet. In order to use text-based digital therapies responsibly, more knowledge about the type and strength of the therapeutic alliance online is required.

Damian Jacob Sendler: Anxiety and/or depression were the most common diagnoses in the research on text-based digital interventions that looked at the therapeutic alliance. ICBT and tailored platforms for specific client groups were the primary treatment modalities used in this study (e.g., PTSD). To provide feedback on tasks, nearly all treatments employed some form of text-based, asynchronous communication, such as e-mails and built-in messaging functions. As a standard measurement tool, most studies employed a modified WAI (Working Alliance Inventory). A weighted mean score of 5.66 (on a scale of 1 to 7) and a weighted standard deviation of 0.84 were found using the WAI or WAI-short form, indicating a good therapeutic alliance. Significant associations were found between the therapeutic alliance and treatment outcome in many studies (n = 8 out of 10) as well as significant therapeutic alliance-related outcomes (n = 5 out of 6).

Dr. Sendler: Psychiatric treatment can be delivered via the internet, which has been studied for a long time. The advantages include broad and easy access, as well as lower costs (1). Online psychotherapy, in particular, has the potential to expand mental health services to underserved populations and during times of crisis, and thus serves as a viable alternative or supplement to face-to–face therapy. Research shows that online therapy has moderate to large effects and comparable results in randomized controlled trials (RCT’s) for a variety of psychopathological symptoms (3–5). Despite the overwhelming evidence that both approaches are equally effective, many people still believe that the therapeutic relationship between the therapist and the patient is critical to the process of successful psychotherapy. The importance of this relationship in online therapy is being debated by researchers, practitioners, and even some clients (6).

In general, therapists believe that digital psychotherapy offers a wide range of benefits, including new treatment options and even a more intimate therapeutic relationship (7). In times of crisis, the lack of physical proximity may prevent them from performing the proper caretaking actions, but the increased accessibility of digital psychotherapy gives them a greater sense of moral responsibility. Clients’ trust and openness in their therapists could be crucial in these situations, so that the therapists can respond quickly to their concerns (8). A lack of knowledge and trust are also major obstacles for therapists when it comes to using digital interventions (7, 9). It is important to know how much of a good therapeutic alliance can be established in various digital treatment modalities in order to use digital therapy responsibly.

Text-based digital psychotherapy is one type of online psychotherapy where the role of the therapeutic relationship is still ambiguous. There are many forms of digital psychotherapy, but the most common form is e-mail or chat-based, such as internet cognitive-behavioral therapy (ICBT) (10). Using digital psychotherapy in this way can help the therapeutic relationship in novel ways, such as by giving clients more time to reflect on the written expression of their feelings and thoughts without being observed. Writing allows for more time to think before responding, which can benefit therapists, as well (2, 11). To further encourage alliances and self-disclosure, there is a lack of social cues, making it easier for people to open up and share their thoughts and feelings without fear of reprisal (12). Unlike traditional face-to-face or videoconferencing therapy, this could foster a close and trusting relationship between clients and therapists (13).

Online text-based therapy, on the other hand, can lead to concerns from therapists about the lack of nonverbal cues and whether a therapeutic alliance can be formed through text-based online counseling (14). A further question arises: Is it beneficial to have a certain type of alliance in the therapeutic process? (10). If you want to use text-based digital psychotherapy in a responsible way, this scoping review will help you understand the therapeutic alliance and how it relates to therapy outcomes.

The term “working alliance” is frequently used to operationalize the therapeutic alliance. The therapist-client working alliance encompasses a variety of cooperative aspects (15). It is worth noting that Bordin (16) developed a model of the working alliance that is still widely used today. This model focuses on the therapeutic partnership between therapist and client from a variety of theoretical perspectives. Both the therapist and the client must agree on therapeutic goals in order for therapy to succeed. Processes and behaviors in therapy sessions that have a direct bearing on the actual therapeutic work are referred to as “tasks.” Interpersonal attachment between the therapist and the patient is referred to as the bond, and it should be characterized by mutual trust as well as confidence, acceptance, and respect (16).

The alliance is more important in face-to-face psychotherapy than in online psychotherapy, according to therapists (17). Internet-based psychotherapy has been found to have a lower level of trust in the ability of therapists to form a therapeutic alliance (17). Internet-based cognitive behavior therapy studies, however, show that the therapeutic alliance is at least as strong in face-to-face therapy and also highlight the association of the alliance with online treatment outcome, whereas this is the case in face-to-face therapy (15, 18, 19).

According to meta-analyses of the alliance in both traditional and online psychotherapy for adults, there was a strong correlation between the alliance and treatment outcomes in both settings (r = 0.278 and r = 0.275), suggesting that the alliance matters when it comes to getting the best results (15). According to the findings, the relationship between the alliance and outcome appeared to be consistent across various alliance and outcome measures, treatment approaches (such as Cognitive Behavioral Therapy and Psychodynamic Therapy), and client characteristics. The overall correlation between alliance and outcome was nearly identical to the correlation found in an earlier meta-analysis (20).

It has been found that there is a strong correlation between the level of trust between the therapist and the patient and the level of improvement in the patient’s mental health. The effectiveness and alliance-outcome associations examined in many recent reviews and meta-analyses fail to distinguish between various types of psychological online interventions. Many different types of electronic mental health were included in the meta-analysis by Flückiger and colleagues (15), for example (via internet, e-mail, videoconferencing and phone). This restricts our ability to make informed decisions about the various ways in which these interventions can be implemented online.

Berger and Andersson (21), who make a distinction between online psychological interventions’ modes of communication, offer a way to classify them. Text-based and asynchronous (e.g., e-mail) or near-real-time or synchronous (e.g., chat) communication is possible, as is audio- or video-based synchronous communication (e.g., video-conferencing). Berger’s (10) review was the first to use Berger and Andersson’s (9) categorization of the working alliance to examine ratings of the alliance (21). However, Berger’s (10) review was narrative, and did not provide an overview of all the alliance measurements and their relation to outcomes that studies reported in the literature. More research is needed into text-based digital psychotherapy, which Berger (10) found to have a limited database on the alliance compared to other forms of online interventions. A therapeutic alliance in text-based internet psychotherapy, which is defined by Berger and Andersson (21) and involves therapist-client communication via the internet and text, is examined here specifically in this review (e.g., e-mail, chat). To focus on the therapeutic relationship between the client and the therapist, studies on self-help text-based digital interventions are not included in this section.

This communication method, which included feedback on self-help tasks and written assignments as well as emailing and using an integrated text or chat function within the treatment platform (n = 26), was the most common in the reviewed interventions (Table 1). When clients sent messages, asked questions, or completed writing assignments, therapists always responded with text-based responses within 24–48 hours. One intervention did not specify the method of communication, while another simply stated “written exchange” without further explanation. There were only two interventions in which the client and the therapist communicated in real time via text in a chat room.

There were 16 instances in which the client and therapist had weekly contact for interventions. 2–3 times a week (n = 2) and every 10–14 days (n = 1) were also used. On-demand access to free online counseling was made possible through one such intervention. There was no mention of how often the participants were contacted during nine interventions. Time spent by therapists on each client was reported for eleven of the interventions studied. A weekly average of 15 minutes was the most common (n = 5). When the therapist responded to writing assignments, the average time per client per text increased from 20 to 50 minutes to 45–50 minutes. A 45-minute weekly session duration was reported for one of the two interventions that utilized synchronous chat sessions. The interventions’ treatment durations ranged from five to sixteen weeks, six to ten modules, or nine to fourteen sessions. This review’s treatment lengths were typically 8 (n = 6) or 10-weeks-long (n = 6) for the vast majority of the interventions it included. Using instant messaging as a form of free online counseling, some participants accessed the intervention two to five times or more.

Damian Jacob Markiewicz Sendler: Psychotherapists in training (n = 6), licensed but unregistered psychologists, psychotherapists, and psychiatrists were among those who offered or guided treatment via the internet, according to the number of interventions that did so (n = 6). For additional interventions, students in the final stages of their master’s degree in psychology or social work were hired (n = 7). One study did not specify who was in charge of communicating with clients during the treatment program (n = 7) while others used the term “online therapist” or “therapist” to refer to their practitioners.

The cognitive behavioral therapy approach was used in the majority of the studies reviewed (n = 18). Cognitive behavioral therapy and narrative exposure therapy were used together in one study, while mindfulness-based cognitive therapy and psychodynamic treatment were used in another. Another three studies did not identify which psychotherapeutic approach was used in their treatments.

The Working Alliance Inventory (WAI) (n = 19) was used in the majority of the studies reviewed (24). Using the WAI’s client and therapist versions, one can arrive at a composite score that incorporates the two. However, the majority of the studies included here (n = 17) used only the client version of the WAI. Only one study utilized the original WAI, which consisted of 36 items graded on a 7-point Likert scale. The WAI-S, a 12-item shortened version of the WAI, was used in fourteen studies. For internet-guided interventions (n = 2) or online support specifically for women (n = 1), a modified version of the WAI-S was used in a few studies. Four studies also utilized the WAI-SR, a revised short form with 12 items but a 5-point Likert scale (51). When it comes to internet interventions, a new scale has been created called the WAI-I, which was derived from the WAI-SR (36). Additionally, there are 12 items on the WAI-I, each with a Likert scale of 1 to 5.

For the WAI and WAI-S, a score between 1 and 7 is commonly calculated (50). The average working alliance with the WAI or the WAI-S was measured in 12 studies examining 15 interventions and ranged from 4.30 (SD: 1.27) to 6.3 (SD: 0.54). Overall, there was a positive working alliance with a weighted average score of 5.66, and the standard deviation was 0.84. A weighted average of 3.23 was found in only three of the four studies that used the revised short form (with a maximum score of 5) of the WAI (weighted SD: 0.8). Only one had a mean score of 2.34 (SD: 0.98) out of the others (38).

The therapeutic alliance was also assessed using a variety of scales in a few studies. TAQ (52) was used in two studies that focused on three different interventions, and it only assesses clients’ perspectives. The maximum TAQ score is 102, and a score above 80 indicates a strong working alliance (37). Based on the mid-treatment scores when they were included, the two studies here showed an average weighted TAQ-score of 85,26 with an average weighted standard deviation of 12,44, indicating an effective working relationship.

It was found that one study used a Scale to Assess the Therapeutic Relationship [STAR (53)], which has a separate patient (STAR-P) and clinician (STAR-C) scale, both with 12 items and scores that range from 0–48, with higher scores indicating a better therapeutic relationship. There was an average STAR-P score of 37.41 and an average STAR-C score of 30.54 in the study included here (standard deviation: 1.5).

Finally, a short version of the Agnew Relationship Measure (ARM) was used in one study. Clients and therapists can use the same 12-item Likert scale and 7-point Likert scale for the ARM’s parallel versions. Client and therapist subscale scores were only reported in this study, not a composite score. Patients’ sub scores ranged from 5.27 to 6.19 (out of 7) and therapists’ sub scores ranged from 4.73 to 5.76 (out of 7), which suggests a positive therapeutic relationship.

There were 28 interventions in the 23 articles that were reviewed. For 22 of these interventions, studies found statistical correlations between measures of the therapeutic alliance and outcomes. There were significant correlations between the therapeutic alliance measures and the change-scores on one or more primary outcome measures in 8 out of 13 interventions (8 out of 10 studies), ranging from small (n = 1) to moderate (n = 7) and strong (n = 1) in magnitude for the 8 interventions. Moreover, the higher the therapeutic alliance, the better the treatment outcomes were predicted for six of the seven interventions (5 of the six studies) that were examined on the predictive value of the alliance on subsequent outcomes.

The therapeutic alliance was found to be a significant predictor of both compliance and client satisfaction in three of the four studies. Both studies found that the alliance had a significant impact on customer satisfaction. There was a significant (n = 1) or significant and moderately correlated (n = 2) relationship between subscales of the WAI, such as agreement on tasks, in all three studies.

The therapeutic alliance was examined in 28 text-based interventions in 23 articles. These articles were analyzed for a variety of factors, including the type of participants, study design, and intervention, as well as the relationship between the therapeutic alliance and treatment outcomes.

Damian Sendler

Research on this topic has been conducted with a wide range of clients and treatment approaches, as our findings demonstrate. But the majority of studies used internet-based cognitive behavioral therapy (ICBT) to treat patients with anxiety and/or depression symptoms. Asynchronous communication methods like emails and delayed chats, as well as text-based features built into websites and platforms were the norm for most digital treatments based on text.

Damien Sendler: It is crucial to know whether or not a therapeutic alliance can be formed in this therapy format and whether or not the strength and type of a therapeutic alliance that is formed through text is comparable to those found in face-to-face treatment if digital text psychotherapy is to be used responsibly. This suggests that positive alliances can be established in digital interventions even if only text-based communication modalities are used between clients and therapists, as the therapeutic alliance scores in the reviewed articles on digital text-based psychotherapy were generally high Therapeutic alliances have been found to have a significant impact on treatment outcomes in most studies.

Only a few studies have been done on the therapeutic alliance in text-based digital therapy in previous reviews of this topic (6, 10). For the first time in a while, a review of the therapeutic alliance in this therapy format has been updated. In Berger’s narrative review (10) there were a total of 23 included studies, seven of which were published in 2017 or later. This suggests that the body of evidence supporting text-based digital treatment alliances is growing. 14 studies in this review focused on therapeutic alliances as a primary objective, compared to six studies in a 2012 review that focused on this topic (6). According to the current review, the therapeutic alliance in digital therapy and face-to-face therapy has been shown to have a mixed to positive relationship with treatment outcomes based on the larger evidence base (6, 10).

Despite the fact that the studies examined covered a wide range of treatments for different client groups, the majority of them focused on (a combination of) anxiety and depression symptoms. Considering that anxiety and depression are the most common mental illnesses, this is not surprising (56). It is also clear that, in line with previous findings on internet psychotherapy, cognitive behavioral therapy dominates the treatment options online because the vast majority of the studies reviewed here use this approach or framework (6, 10). CBT’s short-term interventions and techniques fit well in an online format (57), and may also be more easily integrated into internet-based psychotherapy given the length of the treatments reviewed here (five to sixteen weeks), which is consistent with the findings in this study. Psychodynamic approaches and third-wave cognitive behavioral therapy (CBT) were not adequately represented in this review. Even as internet-based psychodynamic treatments and third wave approaches are becoming more common, the working alliance or other concepts relating to a therapeutic relationship have not yet been studied (58, 59).

It is worth noting that the authors of the studies examined in this review often come from the same research groups in Germany and Sweden, which may have an impact on the results. There appears to be a lack of diversity in researchers studying the therapeutic alliance online, which suggests a lack of interest in this topic and indicates that research into this area has not yet become widespread. Furthermore, caution should be exercised when interpreting the results of studies on (digital) psychotherapy because the country in which they were conducted is likely to influence the generalizability of the findings. This study’s findings may not be applicable to other countries or cultures because of the North European context and culture.

Most of the studies examined (n = 10) used the Working Alliance Inventory [WAI (24)] or its short form [WAI-S (50)] to gauge the therapeutic alliance. The average combined WAI and WAI-S score was 5.66, which was generally high (out of 7). According to the results of a study on the Working Alliance Inventory in face-to-face treatment, this indicates a good working alliance that is comparable to ratings in face-to-face treatment (50). Additional measures of the working alliance were used in four studies, as well. According to all of these measures, the working alliance had (far) above the midpoints of the various scales high scores.

However, only one study, out of the 38 examined, reported a mean score of 2.34 for the WAI’s revised short form (the WAI-SR, with a maximum score of 5). By week 9, however, the researchers’ additional scores did show an improvement in the working alliance ratings. The study’s focus on patients with chronic tinnitus and the majority of their participants being male made it stand out. Because of the lack of research on online treatment for this particular client group, it is unclear whether the relatively low score and late improvement in alliance quality are due to client characteristics, the specific treatment or other factors.

Damian Jacob Sendler

Some of the results were inconsistent when it came to the statistical correlation between the working alliance and treatment outcomes. Many studies have found moderate correlations between total working alliance scores or subscale scores and outcomes measures [e.g., (31)]. While a few studies didn’t find significant correlations with primary outcome measures [e.g., (28)], one study found small correlations (8) and another found strong correlations (47).

Because the therapeutic alliance has a direct correlation to treatment outcomes, text-based digital psychotherapy appears to be a good fit for this type of therapy. A previous meta-analysis of the alliance-outcome association in digital psychotherapy found a significant overall correlation of r = 0.28 (15), as well as a more recent meta-analysis on the same topic that found a significant overall correlation of r = 0.20, both of which support the finding that many studies found a significant and moderate relationship between the alliance and treatment outcomes (19). Due to the lack of research on this topic until recently (10), our review provides the necessary update on the working alliance in this evolving and growing field.. [Read more…] about Our Review. In the hope that our findings will help therapists feel more confident in their ability to form a functional working alliance in internet-based psychotherapy, prior research has found this confidence to be lacking in therapists (7, 17).

Our review shows that good therapeutic alliances can be established in text-based psychotherapies, especially for clients with anxiety, depression, or PTSD symptoms and CBT-based digital text-based treatments. Due to the lack of face-to-face interaction, the alliance does not appear to be jeopardized here. Digital text-based psychotherapy research is still in its infancy when compared to other client groups and treatment modalities. We must therefore exercise care when applying the results of this review to other client populations or treatment modalities. The working alliance in text-based digital treatment is expected to work similarly across the board, in line with findings on the internet in general, because we found no obvious differences for different client groups or treatment forms (15).

A quantitative assessment of therapeutic alliance quality, such as the WAI, may provide an overly narrow view of the therapeutic alliance when determining whether or not digital text-based treatments are a responsible option. Unlike the working alliance, which was typically measured at one point in time in most studies, the therapeutic alliance is a dynamic construct that changes over time and should be closely guarded by the therapist throughout the therapy process (20). As a result, experience sampling (60) or some other new method of studying the therapeutic alliance might be a good fit. In the therapeutic relationship, it is possible that experience sampling could provide more information about the natural ruptures that occur and the repair work that is required to restore the relationship to its original state. This is despite the fact that the WAI does not take these into account, despite the fact that ruptures are likely to occur in relationships based on reduced communication cues and responsiveness (10). There’s a chance that other, more nuanced aspects of the relationship, like self-disclosure or empathy, are currently being overlooked (61).

As an example, compassion between the therapist and the patient is an essential value in mental health care (62, 63). Recognizing suffering, understanding its universality, emotional resonance, coping with discomfort, and the desire to alleviate suffering are all components of compassion (64). The therapeutic alliance can be strengthened by the presence of compassion in treatment (65). (66). Digital treatments and therapeutic (text-based) relationships have not yet been studied for their ability to express and transfer compassion, and no scale exists to measure compassion in digital treatment forms.

The WAI, for example, has three subscales that assess the degree of agreement on goals and tasks between the client and the therapist as well as the therapeutic relationship (16, 24). Although the bond subscale is the closest to capturing the essence of compassion in therapy, its items are restricted to feelings of mutual liking, respect and appreciation. They don’t represent the full scope of compassion. As previously mentioned, the WAI dates back to 1989 (24), before digital treatment options were even considered. As a result, a new scale to assess whether or not a fundamental value such as compassion is lost in digital, text-based treatment when compared to face-to-face treatment is required.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: Coronavirus disease pandemic has made isolation and loneliness buzzwords for older adults, but these are long-standing issues. In the emergency department, there is currently no rapid or succinct tool that can be used to screen for either or a consensus of evidence-based ways to correct these problems. Because loneliness and social isolation have been linked to poor health, this is a cause for concern. Isolation and loneliness are exacerbated when one is sick or disabled. If an older adult experiences any of these health issues, he or she may be forced to go to the hospital’s emergency room, where medical tests and treatment can be started right away. In this article, emergency nurses can learn about questions they can ask to determine whether or not an elderly patient is lonely or socially isolated, as well as what to do if they encounter an elderly patient who complains of loneliness or social isolation. Updated information about loneliness and social isolation in older adults, a pressing issue during the current coronavirus disease pandemic, is the goal of this article. A list of screening tools that can be used in the ER is provided.

Damian Jacob Sendler: The St. Paul Pioneer Press published a front-page story on June 21, 2020 about the “cause of death or contributing factor” on the death certificates of three elderly people over the age of 90, all of whom were described as “socially isolated.” Even though only one of the seniors tested positive for coronavirus disease (COVID-19), they all lived in long-term Alzheimer’s care facilities that had taken precautions to reduce their risk of exposure to the virus, according to the reporter’s findings. As a result, each patient was confined to their room and was not allowed visitors, including family members. These seniors’ routines had been disrupted, but the staff continued to interact with them and provide care. Reported by a facility staff member, patients showed a “decreased interest in eating, more time sleeping, seemed to lose interest in living and developed ‘failure to thrive'” over the course of the three months of confinement. 1

Dr. Sendler: Social isolation and loneliness have been on the minds of many people in light of the COVID-19 pandemic. When caring for a senior citizen who is at risk of social isolation and loneliness because of a condition like COVID-19, it makes sense to look at both the causes and the consequences on their health, as well as possible treatment options that emergency nurses could use.

Loneliness and social exclusion aren’t the same thing, even though they’re often associated.

Loneliness can be defined as a patient’s perception of a lack of companions or social connections/network.

The term “isolation” refers to a lack of social ties. Older adults (usually over the age of 65) who described themselves as socially isolated but did not experience loneliness in previous studies, as well as those who claimed to be lonely despite not being socially isolated, have both been studied. The studies also found that as people age, they are more likely to become socially isolated and lonely due to life events like death, divorce, and bereavement. Because loneliness and social isolation have been linked to poor health outcomes, it is important for emergency care providers to identify older adults at risk of being lonely or socially isolated. In addition, there are steps that can be taken to address these issues.

When a spouse, significant other, or close friend passes away, it’s a common cause of isolation and loneliness. This is especially true when the person’s support system or mode of transportation is also taken away.

There are other obvious risk factors for loss, such as when children grow up, leave home, and become preoccupied with their own lives; or when moving to a smaller home, condominium, assisted living facility, or nursing home, and losing friends in the neighborhood. 10, 12 Loneliness can set in if you stop seeing your coworkers and friends on a regular basis once you retire. 9.10.15 Being the primary caregiver can lead to social isolation and loneliness in the caregiver, especially if the ill partner was doing the driving before becoming ill. 8; 15

It’s possible that an older adult’s loneliness or sense of isolation is rooted in something else besides the obvious decline that comes with age. People who can no longer drive due to physical or cognitive changes, or who are concerned about their own or others’ safety while driving, may have fewer opportunities for social interaction. Some of the most common reasons for people to stay at home and risk social isolation are the dangers of slipping and falling, increased crime and personal safety (especially when it comes to infectious diseases like influenza or COVID-19). 9, 10, 15 Frailty, mobility issues, and financial constraints have led many older adults, particularly those with mobility issues, to avoid socializing because they are afraid of being humiliated in public (e.g., eating out with friends, going to movies, playing bingo) or becoming an embarrassment. Elderly people who are unable to hear or see what others are saying or seeing can also stay at home because of the need for durable medical equipment (oxygen tanks, walkers, wheelchairs, and so on). 17 and 16

“They’re old, so they won’t want to,…they can’t keep up,…they prefer to be in bed,…they need frequent restroom stops,…they can’t hear,…they can’t see,…they won’t understand the situation” are examples of ageism and stereotyped thinking that has led to older adults being excluded from social events or reluctance in attending themselves, leading to social isolation.

The following numbers are in order of appearance: 9, 10, 12, and 15 And it’s even worse if the older adult is brought to an event, only to be ignored by everyone else because of these attitudes. 10 The lesbian, gay, bisexual, transgender (LGBT) community is more likely to report loneliness than other groups because of language barriers, according to a study. 7 & 12

The “common” reasons for an elderly person to feel isolated, lonely, and disconnected are readily apparent (loss of spouse or friends). When gathering information about an elderly person in order to determine whether or not they are lonely or isolated, it is crucial to take into account other aspects of their lives that influence their ability to interact with others. Elderly people are at risk for loneliness and isolation not only because they have lost significant others or friends, but also because of changes in their self-image or the way they are being treated. However, even if there is no longer any concern about exposing our senior citizens to COVID-19, these other factors will persist and may even be reinforced in our emergency rooms.

Identifying older adults who are isolated or lonely and attempting to intervene is critical because of the numerous health risks associated with social isolation and loneliness. Most people are “biologically ‘programmed’ to need social networks,” Singer explains. 8 Cortisol, a stress hormone, is released in the body when a person is unable to connect with others, which can lead to an inflammatory response and its associated consequences. 9 & 10 In people who report feeling isolated or lonely, studies have found increased platelet aggregation, unstable autonomic nervous system, hypertension, arthritis, anxiety, depression, and suicidal ideation. 8 and 7 Cardiovascular death increases by 90%, the risk of death from an accident or suicide attempt doubles, the risk of having a non-fatal coronary event increases by 29%, the risk of having a stroke increases by 32%, and the risk of developing dementia increases by 50%. Seven, eight, and fourteen Loneliness and isolation have been likened to smoking 15 cigarettes a day in a study. There was a four-fold greater risk of death, 68 percent more hospitalizations, and an increased frequency of emergency department visits among patients with heart failure and loneliness (57 percent ). Reduced immune system activity and declines in renal function have both been linked to social isolation and loneliness as a risk factor for infection. 8 Those who are lonely and isolated have been shown to suffer from poor sleep, accelerated cognitive decline, and a decreased ability to perform basic daily tasks. More alcohol use, poor nutrition, and an increased risk of elder abuse can all be attributed to living alone (scams and fraudulent financial schemes). Loneliness and isolation increase the risk of premature death by 78%, 88%, and 120%, respectively. 13

One-fourth of people over the age of 65 are said to be socially isolated or lonely. A lack of social support, loneliness, chronic illness, and a decline in one’s sense of hearing or vision are among the most common contributing factors. the number seven, and the number thirteen However, it’s interesting to note that poor health can contribute to social isolation and loneliness, and vice versa. Identifying and intervening with an older adult who is lonely or socially isolated may help to break this cycle.

Damian Jacob Markiewicz Sendler: Loneliness and social isolation have been linked with a range of serious medical consequences, including heart disease and stroke.3 This suggests the need for a simple screening tool that emergency nurses could use to identify those older adults at risk of these conditions. A “fix” for these patients could then be implemented into their care plan, which the ED staff could then work on to improve health outcomes.

Valtorta et al conducted a meta-analysis comparing 54 instruments to measure loneliness and social isolation.

Damian Sendler

All of the screens had a wide range of questions that weren’t standardized in any way. When it came down to it, none of the tools tested for both functions and subjectivity in a social relationship, according to Valtorta et al4 who found that the questions found on various screens could be simplified and classified as “function and structure” or “degree of subjectivity related to the relationship.” When it came to solving the problem of social isolation or loneliness, the researchers suggested using a screen designed specifically for that purpose. 4 Other authors found that the studies on loneliness and social isolation often lacked standardization of terminology, often did not include all the interdependent variables (isolation, loneliness and underlying health status), and that subjective answers to loneliness questions compared to objectively measured answers to social isolation questions led to a disparity in results. Many studies didn’t ask about health at all, while others focused solely on the idea that social isolation and loneliness were linked to poor health and that poor health itself was a cause of isolation and loneliness. There is a specific problem with screening tools that go into so much detail that they take a long time to complete. An older adult in the emergency department who exhibits symptoms of loneliness or social isolation will not be missed because there is currently no standardized, concise, meaningful, and evidence-based screening tool. But there are programs that may be useful in identifying and dealing with the risk of social isolation and loneliness.

Founded in the United Kingdom in 2011, the Campaign to End Loneliness provides an alternative to screening.

18 In recent years, the program has spread to a number of countries in Europe, as well as the United States. 18 Elderly people in Britain were the target of a campaign aimed at reducing social isolation and loneliness. 18 It was decided in 2013 by the project leaders that a simple screening tool was required in order to measure the success of the interactions that were implemented. The De Jong Gierveld Loneliness Scale, the revised UCLA Loneliness Scale, and a single-item “scale” were all tested for their usefulness in measuring loneliness. 18 The leaders of the campaign concluded that each of these three tools had its advantages and disadvantages (2 were more appropriate for researchers; the other was better designed to determine if services were needed by the older adult or if the services being provided were sufficient). 18 When the Campaign to End Loneliness realized that there were so many different screens out there, they decided to create one of their own. 18 In order to use the best tool for their project, caregivers were instructed to review information about the various loneliness scales and choose the one that was most appropriate for their patients.

People are asked if they have enough friends and relationships, if they can rely on others for help at any time, and if their relationships are as satisfying or inclusive as they would like to be.

Damien Sendler: Caregivers were reminded that the scores were only meant to show how lonely a person is compared to others, not how lonely they are in comparison to other people in the same situation. Another interesting point they made was that “someone with a 4” may not be “half a lot lonely” as someone with an 8.”

When looking for information on the Campaign to End Loneliness in the United States, I came across the website of the Health Resources and Services Administration, which contained statistics on loneliness among older adults and a link to the Campaign to End Loneliness in the United Kingdom’s website.

De Jong Gierveld Loneliness Scale, revised UCLA Loneliness Scale, Single-Item Scale,18 Campaign to End Loneliness Measurement,19 and the De Jong Gierveld Loneliness Scale or merely inquire if the patient is lonely. Despite the fact that none of these tools can accurately measure the risk of social isolation, the answers would give emergency nurses a general sense of how the patient is doing in terms of feeling lonely. 18

The most common cause of social isolation among the elderly was living alone, which accounted for nearly half of all cases. People who are socially isolated may have a higher loneliness score, but so do those who meet the definition of “socially isolated,” but who have been able to establish and maintain relationships with others, saying that they don’t feel lonely.

Damian Jacob Sendler

When searching for tools to screen for isolation, the Lubben Social Networking Scale was the most frequently mentioned.

20 There are a number of indicators listed by the National Social Life, Health, and Aging Project that may be useful in determining the likelihood of social isolation, but they are not specifically identified as a screening tool. 21 An analysis of tools used to measure isolation and loneliness was provided by the AARP Foundation’s “Framework for Isolation in Adults Over 50,” which noted that measuring isolation was limited. 19 According to the AARP, isolation in adults under 50 is caused by a “complex set of circumstances and factors at the individual, social network, community, and societal levels,” and they provide a list of measures that can be used to gauge this. 19 People’s ability to connect with others is impacted by a variety of factors, including isolation, physical or sensory impairments, major life transitions, a lack of resources, language barriers, and socioeconomic status. Twenty-nine (See Table 1 for a list of indicators.) According to the AARP authors, a person’s health status can affect their ability to connect with others and that all factors that contribute to social isolation can contribute to loneliness. 19 Finally, the authors of the AARP report pointed out that “additional research would be helpful in standardizing tools and interventions” because of the differences in how researchers describe, define, and measure isolation work. 19

As previously stated, there are currently no simple screening tools that can be used in the emergency department to identify older adults who are either suffering from or at risk for loneliness and social isolation. It is possible to gather enough information by asking simple questions about living alone, how many social or family contacts the patient has and how satisfied the patient is with the quality, quantity or reliability and trustworthiness of these contacts, as well as asking the older adult if they feel isolated or lonely.

Loneliness and social isolation haven’t been proven to improve health in the long term through specific interventions, which is surprising.

Studies that are well-constructed, evidence-based, or replicated describe the steps to take when a patient is lonely or socially isolated. 5 This year, the Agency for Healthcare Research and Quality released a study that examined interventions to combat social isolation and loneliness, and their effect on health in those over 60 years old.. 11 Consistent terminology, screens and measurements, effects of interventions, adverse events and follow-up by investigators in their reports were among their key findings. 11 In other meta-analyses, these sentiments were echoed in the critical issue of social isolation and loneliness. Loneliness and isolation in the elderly are not new issues, and evidence-based solutions are being sought. Loneliness will endure long after the battle against COVID-19 has been won. According to one author, loneliness and social isolation are “two separate epidemics that must be addressed.”

It is possible for emergency nurses to inquire about the elderly patient’s feelings of loneliness or isolation and take steps to reduce the risk to the elderly person’s health caused by these issues despite the lack of standardized screenings or proven methods. A variety of approaches should be considered when trying to help an older adult reconnect with others, overcome the dangers of isolation and loneliness, and reduce the risks to their health. This is because social isolation and loneliness are complicated issues. 11, 18, and 19 “How are you doing?” is a simple question that emergency room nurses can use to help an elderly patient. Are you a lone wolf? Loneliness and isolation are common feelings for many people. Do you think you have the support you require and the confidence to rely on it? Getting to see someone you care about is always a treat. The emergency nurse can then assist in reestablishing communication between the patient and his or her family.

If an elderly patient is at risk of isolation or has expressed feelings of loneliness, emergency room nurses should collaborate with the ED provider to secure a referral for further care. ER nurses should document information that supports the need for referrals and follow-up care when patients are released. Categories in the International Classification of Diseases, Tenth Revision-Clinical Modification (ICD-10-CM) Z codes are designed to capture factors that influence health but are not specific to a disease or injury. 24 and 23 Loneliness or isolation in an older adult can be diagnosed by using the ICD-10-CM Z60.2 code for “problems related to living alone.” 23 – 24 Codes Z55 to Z65 of the ICD-10-CM identify additional socioeconomic or psychosocial circumstances (living alone, feeling lonely, mobility/communication issues, etc.) that may influence the health status of the patient and provide validation for additional contact with other health services that can help the older adult who is lonely or socially isolated in their health. 23 – 24

A few pointed questions can help emergency nurses identify the elderly patient at risk of loneliness or social isolation, even though there are currently no rapid screening tools or long-term “fixes” for this problem in an emergency department. Do whatever it takes to help the elderly person feel less isolated, less lonely, and healthier if you see a risk. These actions may not be the final “fix,” but they can serve as the first steps toward correcting social isolation and the loneliness that comes with age.

Dr. Sendler

Damian Jacob Sendler

Sendler Damian Jacob

Damian Sendler: According to Intersectionality, the social structures that lead to inequality need to be examined in research, and that sex/gender is a component of other social categories. When it comes to studying social group memberships, neuroscientific research has tended to overlook this powerful and important perspective. Neurofeminism, a branch of critical neuroscience that challenges sexist assumptions, methods, and interpretations of data in the field of neuroscience, has largely ignored intersectionality. In contrast, for more than a decade, psychologists have been studying intersectionality. Neurofeminism’s potential new research avenues are examined in light of how intersectionality has advanced feminist psychology. Intersectionality serves as a framework for identifying three main research topics. Intersectionality research aims to challenge psychological epistemologies by focusing on the social structural causes of health inequalities experienced by people with intersecting marginalized social identities. The second theme is research on the psychological processing of social group memberships that underlies systemic discriminatory practices. We examine the potential advantages and disadvantages of advancing an intersectionality-informed neurofeminism by drawing on parallels between the fields of psychology and neuroscience.

Damian Jacob Sendler: Neurofeminism is the practice and critique of neuroscientific research by and for feminists. When researchers treat neuroscientific knowledge as if it were apolitical, culturally neutral, and sexually dichotomous, they are reinforcing the idea of sexism (Kuria and Hess, 2011; Bluhm et al., 2012; Schmitz and Hoppner, 2014). Rather than relying on the traditional sex/gender1 neuroscience paradigm to study these issues, neurofeminists have developed new conceptual (e.g. the mosaic brain) and methodological (e.g., brain size correction) approaches to the field of sex/gender research. In addition to providing context for the field of neuroscience, these contributions (Fine, 2010; Roy, 2012; Jordan-Young and Karkazis, 2019) acknowledge the constraining role of sexed/gendered experiences in shaping sex/gender development (Fausto-Sterling, 2021), address the role of sex/gender in brain structure and function (Eliot, 2011), and recognize that sex and gender are fundamentally intertwined (Kaiser, 2012). Neurofeminism has made an important contribution by exposing the methodological and conceptual biases in neuroscientific research that claims that sex/gender differences in behavior are fundamental and caused by “hard-wired” differences between the brains of men and women (Fine, 2012; Joel and Vikhanski, 2019; Jordan-Young and Karkazis, 2019; Rippon, 2019; Eliot et al., 2021). Furthermore, it was proven, independent of the assigned sex or gender at birth, that specific behaviors associated with gender (e.g. aggressiveness increases testosterone and nurturing behaviors decreases testosterone; van Anders and Gray, 2015) can induce hormonal change, supporting the idea that sex-based biological differences, if any, are influenced by sociocultural differences such as behavioral expression. In the end, neurofeminists have made numerous recommendations regarding epistemological assumptions, language use, postcolonial constraints, and the categories and research methods used to conduct sex/gender-related neuroscientific investigations (Einstein, 2012; Kuria, 2014; Rippon et al., 2014; Roy, 2018; Duchesne et al., 2020).

Dr. Sendler: There is still a long way to go for feminist approaches to sex/gender-related neuroscientific research because national funding agencies have encouraged sex-segregated research (as discussed in Eliot and Richardson, 2016; Joel and McCarthy, 2017; Gungor et al., 2019). According to National Institutes of Health (NIH) guidelines, researchers must now account for sex as a biological variable (SABV) in all stages of their research (design, analysis, and reporting) in vertebrate animals as well as humans. Currently, there are many calls for SABV-based neuroscience (e.g., Bale and Epperson, 2017; Bath, 2020; Bhargava et al., 2021; Shansky and Murphy, 2021). Recent years have seen an increase in feminist scholars advocating for bioscience researchers to engage with intersectionality as a theoretical framework2 that could aid in creating socially contextualized, reflective biological knowledge, providing an alternative narrative to other essentialist and risk-oriented explanations in biomedicine (for a review, Hankivsky et al., 2017; DeBlaere et al., 2018; Shattuck-Heidorn and Richardson, 2019; Jacke and Palm, 2020). Research on gender and sexuality in the brain has largely ignored intersectionality in its design, analysis, and interpretation to date. We examine whether and how intersectionality can provide new research avenues for neuroscience, and in particular for neurofeminism, as this special topic aims to advance the development of critical investigative approaches in sex/gender and the brain that are grounded in plurality.

Intersectionality is a theoretical framework that states that sex/gender and other discriminatory social categories are intertwined (Shields, 2008; DeBlaere et al., 2018; Mays and Ghavami, 2018). Intersectionality, as a theoretical framework, was first articulated in qualitative legal research to deconstruct the sexed/gendered experiences of African American women (Crenshaw, 1989, 1990). It now informs research across several disciplines that investigates various processes involved in experiences of social injustice arising from intersecting group memberships (e.g., De Vita et al., 2016). Intersectionality has influenced sex/gender research in psychology for more than a decade (Shields, 2008). The literature on intersectionality has grown, and there has been a lot of debate about which conceptual, methodological, and epistemological approaches to conducting psychological research best align with an intersectionality framework (McCormick-Huhn et al., 2019; Bowleg and Bauer, 2016; Scott and Siltanen, 2017).

Current sex/gender-related neuroscientific research lacks a thorough understanding of the intersectionality of social group memberships, and instead treats sex/gender as an independent category. A commitment to understanding the interdependence of social group memberships beyond conventional factorial interactive analyses of interdependence of social group memberships is required to adopt an intersectional perspective. A wide range of psychological research is used in this paper to examine the advantages and disadvantages of using intersectionality in neuroscience. There are three distinct research themes in psychology, each of which uses intersectionality in a different way. Using intersectionality as a starting point in psychological research aims to better understand the socio-structural factors that contribute to health disparities among people who belong to multiple social groups. As a second method, intersectionality is used to examine the psychological processing of social group memberships that underlie the implementation of systemic discriminatory practices. For the third approach uses intersectionality to examine how psychological knowledge is produced and understood in order to challenge epistemology in psychology.. Neuroscientific research that is informed by intersectionality will be compared to each research theme.

Individuals with marginalized intersecting social identities face a variety of health inequities, which psychological research informed by intersectionality seeks to identify. The social layouts of a society are defined as the social structures that emerge from and constrain the actions of people, resulting in the classification of individuals in groups through normative sets of roles, functions, meaning, purpose, and power dynamics for each individual. (Haslanger, 2016). Laws, policies and practices; economic characteristics; occupations; familial organization all have an impact on society as a whole because of socio-structural factors. When conducting psychological research that aims to (1) expose the complexity of oppressive social structures related to group membership and (2) understand the health ramifications of such structures, various quantitative and qualitative methodologies are used. Instead of considering social group membership categories as separate entities, this type of research looks at the interdependence of rather than the independence of factors such as race, class, and sex/gender to examine populations that are often overlooked in major analyses and frameworks for health inequality (Bowleg, 2008; Warner, 2008). Furthermore, this method’s interpretation of research results focuses on taking concrete steps toward social change and justice equality. All in all, this type of psychology is guided by an understanding of oppressive socio-structural power dynamics in order to produce psychological knowledge about health inequalities that is contextualized within an understanding of oppressive socio-structural power dynamics in order to dismantle these inequalities in health outcomes (Bowleg, 2008).

According to a recent study by Kteily-Hawa et al. (2019), such studies are critical for elucidating the complex interactions between social categories and health outcomes (Kteily-Hawa et al., 2019). South Asian women living with HIV in Canada were the focus of this study, which examined the impact of oppressive social structures associated with immigration on the health of these women. According to the authors’ findings, there is an increased risk of HIV infection due to factors such as gendered roles, power dynamics, emotional ties, social norms, and other factors (Kteily-Hawa et al., 2019). Men’s dominance over domestic labor was reinforced by gender roles within households, and these dynamics were reinforced further by the experience of migration. Furthermore, English and colleagues (2020) studied socio-structural factors that influence psychological health and health behavior outcomes among Black sexual minority men (SMM) and found that incarceration history, recent police arrest, and experiences of discriminatory treatment by law enforcement all interact to predict sexual behaviors related to HIV risk, psychological distress, the desire to seek prophylactic treatment for HIV and the likelihood of obtaining HIV treatment (English et al., 2020). For example, when data on Black SMM are combined with that of Black heterosexual men or White SMM, their particular experiences in prison and with law enforcement, as well as their associated health risks, tend to be overlooked, making Black SMM an intersectionally invisible group. An investigation of the Black SMM community’s experiences with law enforcement has shown that prior incarceration and discrimination by law enforcement, as well as recent arrest, have all been linked to poorer psychological health outcomes. This type of intersectionality research provides an understanding of health inequality that is directly linked to power dynamics, and it offers an approach to studying health and wellness that has the potential to promote social change.

To be clear, intersectionality research that examines health outcomes in relation to broad, decontextualized social categories differs significantly from other kinds of health research. Intersectionality studies that focus solely on broad social categories (e.g., sex/gender, race/class) without any consideration of socio-structural or other contextual factors (e.g., discrimination) are referred to as “flattened” intersectionality (Warner et al., 2016). This latter type of research avoids dealing with the “latent” issue of inherent socio-structural oppression, and thus does not address the “latent” issue of socio-historical oppression. When intersectionality is viewed from a “flattened” perspective, the individual is placed at the center of attention. As a result of this shift in focus, the socio-structural power imbalances that underlie health inequality are overlooked. It’s possible to reinforce oppressive structures by obfuscating the role they play in mental health issues or other health-related phenomena when social categories are decontextualized and sociopolitical structures are removed. This is known as flattened intersectionality research (Mackenbach, 2005, for example) (examples reviewed in Buchanan and Wiklund, 2021). “Mainstream psychology” has been blamed by Buchanan and Wiklund (2021) on exclusionary epistemic practices for a large portion of contemporary intersectionality research in psychology (epistemology is further discussed in section III; Buchanan and Wiklund, 2021). Intersectionality research, on the other hand, places a greater emphasis on tracing the roots of health inequity in social systems rather than relying on simplistic explanations that ignore the complexities of social structures that can be both liberating and oppressive.

Research on the neural effects of health disparities tends to focus on a single group of participants. For example, neuroscientists frequently examine the neural correlates of social class, or more specifically, poverty. Numerous correlations between SES and brain development and function have been found in such studies (Hackman and Farah, 2009; McDermott et al., 2019). The research, while describing the neurological effects on the brain of oppressive economic conditions, tends to “detach” the social experiences and consequences of poverty from their oppressive socio-political context and does not consider their interdependence with other social group memberships. This kind of neuroscientific research inadvertently promotes essentialist and deterministic interpretations of brain data, like the flattened intersectionality research described above. Most of the studies I reviewed suggest that the effects of social inequality can become entrenched in our brains, influencing our future neurobiological, cognitive, and even our socioeconomic trajectories. Thus, the phenotype is made to be “realized and fixed” (Pitts-Taylor, 2019). Researchers run the risk of reinforcing the view that poverty persists because of cognitive “inferiority” rather than as a complex outcome resulting from numerous sources of social inequality if socio-structural factors are not taken into consideration.

In a population with multiple marginalized group memberships, only one neuroscientific study has examined the role of socio-structural context. SES in childhood and race/ethnic discrimination were linked to structural differences in the brain, as well as poorer learning and memory performance, according to Thames et al. (2018). (Thames et al., 2018). Despite the study’s broad scope, it found that in HIV-infected populations, the intersection of race and class-based structural oppression is linked to neural and cognitive impairments. For neurofeminists’ critical analysis of neuroscience, critical race analysis must be considered in any investigation aiming to understand and ultimately dismantle inequitable sexe/gendered conditions (Roy, 2012; Kuria, 2014; Rippon et al., 2014), and as our discussion demonstrates, research in neuroscience that is informed by intersectionality must expand its focus beyond sex/gender and race to include a wider spectrum of intersecting and marginalized groups.’ Aside from a pain study conducted with Somali-Canadian women who have been subjected to female genital cutting, there are no neurofeminist parallels to this research to date” (Fitsch et al., 2020).

In light of these findings, how can neurofeminist work benefit from intersectionality? First and foremost, it is critical to recognize that sex/gender is a social construct that is intertwined with other social group memberships. Second, research with populations of women and people of sex/gender diversity should be given more attention because of their marginalized group memberships. There is still a lack of research in this area, and it risks reinforcing oppressive social structures by ignoring their impact on health, as has been mentioned earlier. Identifying the specific socio-structural power dynamics that may contribute to or explain previously observed sex- and gender-related brain health inequalities is critical for neurofeminists in their research. After identifying these socio-structural dynamics, researchers can start operationalizing measures that can be incorporated into neuroscientific research designs for socio-structural factors, policies and practices, occupations, laws, family organization, racial minority status, and economic characteristics. In order to advance neurofeminism, we need to go beyond what has been articulated in neuroscience to date in order to take this important first step. It’s imperative that scholars consider the socio-historical context of oppression and privilege when selecting methodology or an analytical approach (discussed further in section III). Using intersectionality in sex/gender neuroscience research will help us better understand health outcomes, rather than focusing on individual risk factors.

Rather than focusing solely on individual risk, we explored the role of intersectionality as a conceptual framework for analyzing health inequality as a systemic phenomenon rooted in oppressive socio-structural imbalances of power. Following that, we’ll take a look at studies that examine the psychological processes by which oppressive attitudes and behaviors can arise in social structures.

When it comes to social categories that overlap, how do people process and comprehend information? Quantitative methodologies are used in another area of intersectional psychology research to examine how information processing related to different social categories may contribute to social discrimination. The primary focus of this study is on the representation of intersecting social identities in the study’s stimulus bank rather than in the sample of participants themselves. In other words, the development of the research question is guided by intersectionality, while the study design, analysis, and interpretation of data are based on traditional psychological approaches.

Intersectionality in psychology meant that racialized or sexed/gendered variables were no longer considered independent stimuli. Race recognition and later “racial bias” research has been extensively studied using this type of categorization, in which the goal was to measure the relative contributions of automatic (i.e., unconscious or unintentional) and controlled (i.e., conscious or deliberate) processing to a racialized phenomenon of study (Dasgupta and Greenwald, 2001). To understand “fundamental” processes, much of this research (and psychological science in general) implicitly assumes that these processes are universal across individuals. Assumptions of universality are reflected in the use of samples of homogeneously Western Educated Industrialized Rich Democrats. Findings from this type of research, which focuses on how “in general” psychological processes can be understood without regard to the socio-structural context, can be seen as a partial bind to a normative population and a support for the unequal power dynamics of existing societal structures, despite its potential contributions to our understanding of discrimination’s psychological processes.

These early studies focused on the interplay between racial identity and sex/gender identity, using pictures of faces, in factorial designs where each category is treated separately. Goff et al. (2008) conducted a groundbreaking study in which participants were shown images of female and male faces in both black and white. As a result, the perceivers classified Black men and Black women as more masculine than their White counterparts in terms of sex/gender. In addition, ratings of masculinity moderated the effect of race on the perceived attractiveness of Black women compared to White women’s faces. Over the years, more research has been done using different racialization methods, target populations, and participant ages to see how face-based judgments are affected by all of these factors. For example: Johnson et al. (2012) and Hopper et al. (2014) have all used different racialization methods (Kim et al., 2015; Li and Tse, 2016; Lei et al., 2020). Figure 1 illustrates the exclusion of Black women from Stolier et al(2017) .’s face stimuli visualization, which shows a clear bias in favor of white women in sex/gender-related social cognition research based on a white majority (82 percent) of participants. An important lesson to be learned from this study is that it must be conducted and presented in a way that takes into account other social realities in order to properly account for the complexities of how people perceive their sexual orientation and gender identity (Goff and Kahn, 2013).

Damian Jacob Markiewicz Sendler: Methods that aim to integrate how social group memberships are processed and experienced are currently being developed in this area of psychology. These new multiracial face databases reflect both the impact of intersectionality in face processing (Chaney et al. 2020; Chen et al., 2021), as well as the consequences of diversification in psychological samples. While this is true, it does not address socio-structural power dynamics; rather, it simply summarizes descriptively the very processes of discrimination for which it attempts to provide elucidation ps. What is considered “masculine” and what is considered “attractive” are strongly informed by the socio-structural power dynamics that are commonly overlooked in these kinds of studies.

Damian Sendler

Another option is to use intersectionality to study the psychological processes at play in people’s actual experience (as opposed to perception) of multiple social identities colliding at one point in time. A study by Chaney et al. (2020) found that threat and safety cues can be transferred from the racial to the sex/gender category, meaning that Black and Latina women expected both racial and sex/gender discrimination from an identity threat stimulus that was designed to terrify them about their own racial and sex/gender identity (Chaney et al., 2020). Similar to this, the sense of security one feels when presented with an identity safety cue is transferred to another category. This research reveals the psychological consequences of power imbalance in social inequality by demonstrating how intersecting marginalized social identities (e.g., the experience of threat or safety) confer disadvantage and advantage (e.g., in the context of the social situation). It is hoped that this research will lead to better social interventions and advocacy policies by providing evidence and new tools for better representation of social group membership diversity (e.g. databases).

Neuroscientific approaches to facial processing and decision-making have a lot of research, but it hasn’t been influenced by intersectionality. Neuronal correlates of “social categories” (Wiese et al., 2008; George, 2016; Stolier and Freeman, 2017; Delplanque et al., 2019; Brooks et al., 2020; Delplanque et al., 2019) have been studied in the past, but these studies have focused on the neural correlates of a single construct such as sex/gender, racial categorization, race-related prejudice or sex/gender stereotyping (e.g., Kaul et al., 2011; Senholzi et al., 2015; Mattan et al., 2018; Fisher et al., 2020). Only one study has examined the neural correlates of face processing of multiple social group memberships so far, to the best of our knowledge. our knowledge.

As Stolier and Freeman (2016) argue in their paper “Neural pattern similarity reveals the inherent intersection of social categories,” facial recognition is “inherently intertwined” with social categories like sex/gender, race, and emotion expression. In their behavioral and fMRI experiments, they found that participants’ social-conceptual knowledge of identity-related stereotypes influences both their subjective perception and neural representation of social categories. Emotional categorization, for example, classified black faces as angry, while female faces were more likely to be labeled happy. Social categories’ subjective interdependence was also reflected in differences in brain activity in the orbitofrontal cortex and right fusiform cortex. These social categories’ intertwined aspects at the neural level were not fully explained by visual similarity of image silhouettes or pixel-intensity. This suggests that subjective, social-conceptual knowledge underlies this brain processing. There is a link between social inequality and the neurobiology of face perception, according to the findings of this study.

Both the advantages and disadvantages of so-called “intersectional” research are clearly illustrated by the work of Stolier and Freeman (2016). As a result of the authors’ conclusion that socially conditioned stereotypes influence the way the brain processes faces, the study avoids the pitfalls of biological essentialism while still placing an emphasis on how the brain processes faces in relation to social categories that intersect. Their findings “are mute with respect to the origins of stereotypical associations studied here,” and the authors suggest that these could be the result of cultural transmission or implicit learning (Stolier and Freeman, 2016, p. 797). Rather than questioning whether these subjective stereotypes are “fixed” at the level of the brain or whether they can be changed, they suggest that future studies should aim to manipulate participant’s social stereotypes in order to improve causal inference. In addition, they do not discuss how socio-structural power dynamics may influence the development of stereotypical social categorization, thus treating each of the categories as “neutral.”” Consequently, even if the research aims to locate distinct patterns of neural activity related to intersectional categories in the brain, it runs the risk of inadvertently biologically essentializing these categories, simply in a more multifaceted, “intersectional” manner than arises from the “traditionally” separated social categories. One reason neurofeminists have avoided the topic of intersectionality thus far may be due to this major stumbling block (Fitsch et al., 2020). However, despite these drawbacks, Stolier and Freeman’s work is still an important contribution to the neurofeminist field because it supports the constitutive role of social experiences, in particular intersecting social group membership, in the subjective perception and neural processing of faces and emphasizes that processing of intersectionality is not solely stimulus-driven.

Is it possible that neurofeminism could benefit from this kind of study? For this type of research to be effective, it must take into account the interdependence of intersecting identity categories within the context of socio-structural power dynamics. Researchers and participants must be aware of the relationship between social group membership and the corresponding power differences. Sex/gender, race, and emotion are not neutral, independent categories within or between social groups. As a result of adopting an approach like that of Chaney et al. (2020), we can better understand the context-contingency of group membership processing. Finally, new research could shed light on the brain’s processing of sex/gender by manipulating social group stereotypes and social power dynamics, as suggested by Stolier and Freeman.

Intersectionality in research on social group memberships can open up new research directions in the neuroscience of sex and gender, as we show in this section.. Read more.. However, the incorporation of intersectionality into this research does not come without significant flaws. Critical neurofeminism may not be able to engage in this type of research without risking biological essentialization of “intersected” categories because of the difficulties in reconciling an inherently reductive, quantitative approach to producing generalizable knowledge about the brain. In the following section, we examine whether or not psychology or neuroscience can accommodate an intersectionality perspective at the epistemological level without accidentally expanding notions of biological essentialism through harmful dimension reduction of social categories in the brain.

Intersectionality is used in a third type of research to examine psychology’s epistemologies. Although it is possible to use intersectionality to guide the selection and interpretation of research findings (theme 1), here it is used instead to critically interrogate psychology’s foundational principles of knowledge production (theme 2). The intersectionality perspective on knowledge production sees the production of knowledge as a dynamic, ever-changing process that is shaped by social dynamics, power dynamics, and personal experiences (Marecek, 2016; Else-Quest and Hyde, 2016a, b; Grzanka, 2018; Collins, 2019; Rice et al., 2019). Following in the footsteps of other feminist scientists and philosophers (Haraway, 1984; Longino, 1987; Fausto-Sterling, 2000; Schiebinger, 2001; Harding, 2006; Hammonds and Herzig, 2008; Subramaniam, 2009). “Knowledge” is defined in this way, which makes the knower’s social position a part of the process of knowing (Anderson, 2020). Knowledge is a product of a person’s social position, and this position influences how empirical inquiry can or should take place in a given knowledge domain. Unlike the positivist epistemologies that have dominated much of psychological science, this idea argues that scientific findings can only be supported by “facts” derived from the scientific method, and only observable evidence can be used to support legitimate knowledge claims. When this assumption and its related practices are disrupted, new avenues for psychology can be discovered (Warner et al., 2016).

According to a recent publication by Settles et al. (2020), an intersectional and psychological perspective on knowledge production has significant epistemological gaps. The conceptual ruptures are reflected in how intersectionality considers “generalizable” explanations of psychological knowledge to be possible distortions of the investigated phenomenon. The notion of psychological norms and measurements is challenged by intersectionality methodologically in favor of modes of inquiry focused on diverse participants’ lived and historical experiences, especially when engaging in quantitative research (Bowleg and Bauer, 2016). Participant involvement as co-creator of research is also undergoing conceptual and methodological shifts right now. According to Overstreet et al. (2020), researchers who conduct research that is informed by intersectionality need to engage their participants in developing their research question and methods, while also taking into account how systems of power may influence the assumptions and practices associated with psychological research. Psychological research and theory must be aligned with a focus on social justice, making social activism an essential outcome of the advancement of psychological knowledge (Settles et al., 2020). In order to situate participants, phenomenon, and knowers in a socio-historical context, an interdisciplinary approach is required. There are a number of fundamental research practices in psychology that are challenged by this method of producing knowledge (Warner et al., 2016).

Damian Jacob Sendler

Because of this, work that uses intersectionality to critically analyze the production of psychological knowledge is undervalued and largely absent from the mainstream of psychological research. Critical intersectionality research in psychology is subject to epistemic exclusion, in which the research itself is marginalized and undervalued as contributing only minimally to the advancement of psychological knowledge. A general lack of interest, or the perception that this work is inaccessible, results in various bias-inducing practices, such as the marginalization of intersectional work in specialized academic journals (Settles et al., 2020). As a result of this publication bias, mainstream psychology has an epistemic bias, which results in the disproportionate propagation of less rigorously conducted, flattened intersectionality research (Bilge, 2013; Warner et al., 2016). As a result of this kind of epistemological exclusion, academics are more likely to overlook critical work and the marginalized scholars who do it, resulting in even more biases in the academic community. For Settles and colleagues (2020), “Our marginalized identities (gender, race, and sexual orientation) are what bring us to the work that we do, including populations we study, questions we ask, and the theoretical lense that we use,” they write. We gain an insider’s perspective on the exclusion of intersectionality in psychology and its consequences for academic careers, including our own, through the challenges we face in academia. Concerns about the growing use of intersectionality in research contexts, as well as the contributions of Black women scholars, are raised by Cole in relation to this exclusion (Cole, 2020). As a minority scholar, you are more likely to be subjected to pressures to “mainstreamify” your research if you are dedicated to conducting critical intersectionality research in the field of psychology.

Damien Sendler: Contrary to popular belief, the use of intersectionality as a model for reshaping neuroscientific knowledge production has only recently been observed by neurofeminists (Bluhm et al., 2012). Intersectional neuroscience should emphasize analytical approaches that “accommodate neural diversity” in light of the idea that people’s biologies are the result of highly contextualized experiences, according to Weng et al. (2020) in their publication “Toward a Compassionate Intersectional Neuroscience: Increasing Diversity and Equity in Contemplative Neuroscience. The authors recommend using multi-voxel pattern analysis (MVPA), a multivariate method that uses machine learning to derive brain activity patterns predictive of mental states while preserving the brain’s individuality (Weng et al., 2020). As a result of its lack of normalization of brain data and focus on changes in patterns of brain activity, MVPA better accommodates “non-normal” brains, according to its authors (Weng et al., 2020). MVPA, on the other hand, is not “intersectional” in the sense that it avoids the normalization of brain activity by focusing on the similarity of patterns within a single subject. As a result of their work, Weng et al. say, researchers in the field of intersectional neuroscience should focus on finding ways to “partner” with participants rather than simply collecting data “about” them. Projects based on prosocial behavior and empowerment are a natural outcome of community-based participatory research because it reduces power imbalances. One way to shift the focus from the neuroscience of differences to the neuroscience of inclusivity and similarity is by co-creating an intersectional research program with marginalized populations. It is possible to draw meaningful generalizations from brain data without resorting to harmful reductionism, avoiding or minimizing the kind of distorted “generalization” that arises from ignoring intersectionality with these approaches to conducting neuroscience. These suggestions for conducting intersectional neuroscience could be useful for future work in neurofeminism.

Moreover, neurofeminists have proposed epistemological frameworks in which relationships between knowers and the socio-historical context of the phenomenon are essential components of neuroscientific understanding. For Roy (2018), knowledge production has multiple levels, with feminist theory and activism serving as the foundation for a variety of transformative research methods. Even in technoscientific and reductionist environments, Roy envisioned the ability of researchers to produce socio-historically informed scientific knowledge through a process of knowledge reappropriation and meaning attribution. While the NIH mandates that researchers conduct research that is “sex-balanced,” Roy used this method to examine the disparities in reproductive health care for women in light of this policy. As a result of bringing together neuroendocrinologists and reproductive rights activists, this project demonstrated how creating a space for those conversations to take place can generate novel ways for feminists who are interested in neuroscience to engage with the subject matter.

Similar to the epistemological vision of intersectionality research, neurofeminist Gillian Einstein has developed a “situated” approach to neuroscience. “Knowledge” of the nervous system is “situated” in multiple hierarchical and socially constructed interactions involving participant experiences, experimenter positionality, and technological constraints according to Einstein (2012; see also ) (Einstein, 2012). Socioeconomic and biological identities must be intertwined in this “situated” approach to neuroscience (Einstein, 2012). In a recent study of Somali-Canadian women who had their female genitals cut using Einstein’s “very mixed methods” approach, which combined qualitative, quantitative behavioral, and quantitative neurophysiological methodologies (Perovic et al., 2021). The development of the study was greatly aided by the creation of an advisory group from the participants/target community. Perovic et al. (2021) were able to produce novel neuroscientific knowledge about unique pain experiences that intersected with women’s experiences of immigration and cultural acceptance, and in doing so brought to light important considerations for clinical and health advocacy, thus directly contributing to sex discrimination research.

Intersectional approaches to research are emerging as a way to explore alternative models of knowledge production that are based on cross-disciplinary collaboration, avoid undue generalizations, minimize power imbalances between participants and experimenters, and co-create research with hidden populations, as this brief analysis shows. There are a number of approaches that challenge the dominant mode of knowledge production in quantitative fields, such as feminist epistemic alternatives (e.g. Hammonds and Subramaniam, 2003; Richardson, 2013; Roy, 2018; Jordan-Young and Karkazis, 2019), participatory designs (e.g. Buchmüller et al., 2011), and epistemic injustice (e.g. Fricker, 2007; Donnelly, 2018).

Feminist theoretical frameworks for many fields, including neuroscience, are rich in intersectionality. This is especially true in light of recent trends in science reporting on female brains and the brains of people who identify as sex/gender non-conforming (Fine, 2010; Bluhm et al., 2012; Dussauge, 2014; Joel and Vikhanski, 2019; Jordan-Young and Karkazis, 2019; Rippon, 2019; Llaveria Caselles, 2021). Focusing on three themes of intersectional psychology, this analysis identifies specific areas, practices, and critical positions that have the potential to advance feminist practice in neuroscience.

We identify the following main areas of advancement in relation to theme one, which describes intersectionality-informed research on health disparities: In the first place, neurofeminism will benefit from shifting its focus to engage in neuroscientific research that is systems-centered, in which oppressive social structures affecting inequalities in sex/gender-related brain health are modeled and tested. There is less room for reductive, essentialist explanations that risk inadvertently reinforcing oppressive structures when social-structural variables are operationalized and integrated into understanding sex/gender differences in brain health. This approach may also help us connect our understanding of brain health equity with the necessity of social change. Empirically demonstrating the effects of social inequality in neuroscience can be accomplished by including variables such as occupations, law enforcement status, familial structure, racial minority status, and socioeconomic status in research designs as intersecting categories of study rather than merely as demographic variables of description. In order to model and test the effects of social structures on health or other outcomes, variables such as police arrests, incarceration history, access to social security, and neighborhood characteristics can be included. Research designs that explicitly compare privileged and targeted groups before and after the implementation of certain policies, services or appearance/disappearances of organizations (for more insights on research designs centered on social structure see Krieger, 2019) can be a big step forward in understanding socio-structural factors’ impact on health inequality. Socio-structural causal models will become more feasible when large brain datasets with greater socio-structural resolution become available. However, big data analysis should not be regarded as the final approach to capture intersectionality and diversity because sex/gender and race biases have their own risks (Fitsch et al., 2021). Hidden/invisible populations should be studied in depth, as well as the ways in which people’s intersecting social group memberships place them at risk of harm (del Ro-González et al., 2021). Scholars in the field of neurofeminism have already begun some of this research (e.g., Somalian immigrant women in Canada with FGC; Perovic et al., 2021), but more needs to be done to fill the gap.

With this in mind, we identified the following main areas for advancement in relation to theme two, which discussed research aimed at understanding the psychological processing of intersecting groups. To begin, neurofeminist researchers should pay attention to the complex interdependence of intersecting identity categories and how these categories are defined. The current consideration of sex/gender by neurofeminism is explicit, rationalized, and well-grounded in theory and research. According to a neurofeminist perspective, sex/gender is interdependent with other social categories such as race and is often submerged – and even taboo when it comes to face-recognition research (Kuria, 2014; Kaiser Trujillo et al., forthcoming). Neurofeminist research must examine and challenge the operationalization of social categories in order to avoid treating them as homogenous and fixed (Marecek, 2016). Second, the interdependence of social categories in terms of socio-structural structures of privilege and oppression must be taken into account. To better understand how the brain processes sex/gender, researchers may want to conduct studies that play with the power dynamics associated with group membership. It is also possible to open new avenues for socio-historically situated sex/gender neuroscience by adopting an approach like that of Chaney et al. (2020), in which the processing of social group membership is considered alongside who is processing these social cues.

To wrap things up, a third research area looks at how experimenter and participant roles, and how they play a role in knowledge production, might be more fundamentally divided between intersectional and conventional neuroscience perspectives. Interdisciplinary approaches in neuroscience research that employ mixed methods, consider principles of inclusivity in morphometric neuroscientific measures over “normalization,” and demand reflection on the socio-historical situatedness of not only participants but also the researchers and research itself are urgently needed to reconcile epistemological differences between these two frameworks. Neurofeminists such as Roy (2018) and Einstein (2012) have made epistemological propositions that align well with an intersectional perspective and can also generate new neurofeminist investigative avenues, but more research using these perspectives remains to be done. Neurofeminist research and the scholars conducting it should be recognized and included in mainstream literatures, and as the field grows, it will be critical to expand methods of raising awareness of this importance. Epistemic oppression and erasure can be prevented in part through efforts like the Neurogenderings Network4, which was started in response to exclusionary epistemological practices. Many new directions for neuroscience can be explored through these avenues for promoting an awareness of scientific knowledge’s location and plurality.

Neurofeminist sex/gender research and practice can benefit from intersectionality. Incorporating approaches from intersectionality can inform the study of these categories and promote research that measures or otherwise accounts for their interdependency rather than falsely orthogonalizing them because it can broaden our understanding of sex/gender into a wider landscape of social categories. Because of its emphasis on social justice, equality, and eradicating racism, neurofeminism shares many of its core principles with intersectionality. As a field within the neurosciences, neurofeminist research that incorporates intersectionality must be careful to avoid biologizing and essentializing intersected identity categories and thus undermining the social justice goals of the endeavor.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler, M.D. – Evidence is mounting that mental and physical health are linked by neural systems that control somatic physiology and higher-level cognition. The ventromedial prefrontal cortex and the default-mode network are important systems. Systemic approaches help to build models of the “self in context” by condensing information from various sources and modalities of perception. Autonomic and neuroendocrine functions as well as immune function can be predicted using self-in-context models that give events personal significance. They help students learn from their own experiences and form narratives about themselves and the world around them.. It may be possible to help those with mental and physical health issues, particularly those with high co-occurrence and convergent alterations in functionalities of the ventromedial prefrontal cortex and the default-mode network, by focusing on understanding and shaping mindsets and beliefs about the self, illness, and treatment.

Damian Jacob Sendler: Healthy living was once thought of as a delicate balancing act. When it came time to diagnose and treat an illness, it was necessary to have a complete picture of the patient’s lifestyle and personality. The two are no longer seen as intertwined by the majority of people today. A minority view in Western clinical practice and policy is reflected in integrative medicine and biopsychosocial health models that emphasize interconnections between mind and body, behavior, social context and health. Physical illnesses are commonly viewed as the result of numerous pathological processes, each of which necessitates its own investigation, study, and treatment. There are many parallels between modern approaches to mental disorders and those of the past. When it comes to developing new treatments for conditions like psychiatric disorders, sleep disorders, obesity, or chronic pain, this approach has been particularly effective (for example, by helping to promote the development of vaccines and antibiotics).

Dr. Sendler: changes in brain systems that govern how we perceive ourselves and the world. Individuals construct mental representations of’self-in-context’: models of the situations in which we find ourselves and their implications for our current and future well-being4–11, based on other recent theoretical developments (Fig. 1). As other emerging views emphasize the predictive and regulatory role of conceptual representations, these models go beyond recent concepts such as “task states”7,12 or “cognitive maps”6,13,14 to include personal well-being and brain–body feedback loops. 4,5. Individuals can assign meaning to events and incorporate them into long-term narratives about themselves through the use of self-in-context models. Mental and physical health are intertwined when these models are applied to the self — to one’s present and future well-being. This is when these models become affective.

The default-mode network includes the ventromedial prefrontal cortex (vmPFC), the temporoparietal junction (TPJ), and the posterior cingulate cortex (PCC), which work together to locate the self in a compressed low-dimensional space that encompasses the essential characteristics of a situation in real time. The process of’meaning-making’ involves locating one’s current situation on a mental or conceptual map. According to “Self in context” models, we can predict sensory and interoceptive input based on the use of predictive codes, which can then be used to influence our actions. Beliefs, associative memory, and learning all influence and are influenced by them. It is the social and environmental context of the agent, including but not limited to relationships, cultural beliefs, and neighborhood characteristics that influence the self-in-context models. The hypothalamus and brain stem receive projections from the vmPFC, which in turn can control visceral outflow. vmPFC connections with the basal ganglia and mesolimbic reward circuit or frontostriatal loops20 also influence decision-making and health-relevant behavior (for example, dietary choices and how one works and interacts with others). Both the influences on bodily physiology and decision making can have long term effects on mental and physical health in a variety of ways, such as through their effects on inflammation and allostasis, or their interactions with other health-related systems such as microbiota (for example, via dietary patterns). A dysregulation of the autonomic nervous system, as a result of dysfunctional thought patterns and self-in-context models, can have long-term effects on the body’s organs, such as allostatic load and slowed recovery. It is also possible that changes in health-related behavior, such as poor food choices or drug use, may result from the application of self-in-context models.

If the DMN, particularly the vmPFC and other key multimodal processing hubs within it17, plays a critical role in the generation of conceptual models of the self-in-context, then the DMN and the vmPFC in particular should be considered as an important component in this process. Additionally, the vmPFC (along with other frontal regions4,5 and in interaction with other systems, such as the mesolimbic dopamine system20) also mediates psychological influences on behavior and the body’s systems, shaping autonomic and neuroendocrine responses19, inflammation and other aspects of immunity19,22–24. The vmPFC is positioned as a key mediator of mental and physical health by linking conceptual models of the self-in-context and behavior regulation and peripheral physiology (Fig. 1).

A common factor in many types of mental illness, according to this theory, is the use of dysfunctional self-in-context models and incorrect causality assignments. This may explain why alterations in the vmPFC and DMN are so common in psychopathology, substance abuse, and neurological disorders such as dementia.28 Diagnostic and measurement models face difficulties due to the fact that changes in self-context representations and meaning-making are likely to take various forms across a wide range of disorders and individuals alike. Self-context representations can be influenced by psychological treatment, social interactions and cultural contexts. As long as one is willing to accept new information, conceptual processes — the links we create between various events and concepts — should be able to adapt to provide flexible control in changing contexts. Psychosocial treatments for both mental health and physical health can benefit from this newfound flexibility.

Psychiatric and physical diseases may be influenced by the same mechanisms, according to a growing body of evidence. Mental and physical health disorders are increasingly being seen as closely linked2,29,30, and researchers are exploring the possibility of common transdiagnostic genetic risk factors31,32, and disease mechanisms33,34. People who meet the criteria for one mental health diagnosis are likely to also meet the criteria for at least two more; those who meet the criteria for three diagnoses are likely to meet the criteria for all three35. A common factor may be responsible for multiple types of psychopathology, according to several large-scale studies29,30. Co-morbidity between psychiatric disorders, such as depression, and physical health issues, such as chronic pain and cardiovascular disease, has been shown to have bidirectional causality.36 (Table 1). Another factor that contributes to the phenomenon of shared risk is the existence of shared genetic risk factors, which have been linked to negative affective style measures (such as neuroticism)31,32. Vulnerability to negative life events, negative future visions, and persistent negative emotion are all common threads.

Common physiological risk factors can be found in many disorders. Acute and chronic psychological stress are associated with elevated sympathetic and decreased parasympathetic autonomic activity38,39. Multiple psychiatric conditions such as depression, post-traumatic stress disorder, anxiety, and addiction all share this pattern of altered autonomic function. Systemic inflammation, a risk factor for numerous diseases and symptoms34,44, is influenced by autonomic and neuroendocrine outflow. Depression, type 2 diabetes, coronary heart disease, and chronic pain have all been linked to elevated levels of proinflammatory cytokines such as IL-1, IL-6, and TNF. Depression can be lessened in some cases by inhibiting the actions of peripheral proinflammatory cytokines49. Gene expression changes associated with adverse environmental conditions have been found in humans as well as 11 different disease models in rodents (such as diabetes, asthma, obesity, and neuropathic pain)34.

Cole’s conserved transcriptional response to adversity, a patterned, proinflammatory shift in blood leukocyte gene expression that may confer resistance to infection and promote rapid energy mobilization in adverse environments51, is an important integrative concept. Negative feedback systems that control inflammation will be less effective as a result of this shift, making us more vulnerable (for example, glucocorticoid resistance52). Recent rodent studies support the idea that descending sympathetic nervous system efferents are responsible for these changes. The sympathetic nervous system innervation of bone marrow, a key site for leukocyte production, slows tumour growth in a metastatic melanoma model24 by stimulating the ventral tegmental area, a major source of brain dopamine. This also reduces inflammation, boosts innate and adaptive immunity in response to a bacterial infection54.

Mental models of events, such as inferred personal meanings, credited hidden causes, and imagined potential futures, have an effect on autonomic and inflammatory pathways. Inflammatory markers56 and cardiovascular risk markers57 increase acutely in response to psychosocial stressors, such as a fight with a family member or giving a speech in front of a panel of critical judges55. Psychosocial stressors have been linked to an increased risk of heart disease58. Psychosocial stress in patients with coronary artery disease can lead to cardiac ischaemia, which predicts mortality five years later59. Even in animals and humans, the conserved transcriptional response to stress is amplified by social isolation and a sense of loneliness, and it responds to psychotherapy (reviewed in51,52).

Among the many transdiagnostic risk factors, persistent psychosocial stress has effects that are influenced by one’s self-perception and relationship to the rest of the world. Mental and emotional stressors are not necessarily physical in nature. How well we can imagine the consequences of someone’s disapproval of us, for example, and how well we can predict our own failures in love and work. Other transdiagnostic risk and resilience factors, such as depressed mood, anxiety, persistent anger and hostility, loneliness, and positive emotion, are characterized by such conceptualizations (Table 1). Conceptualizations can be transmitted through words and culture, and may be socially communicable risk factors that increase resilience or increase disease susceptibility. If you believe that you are unlovable, or that you will always be alone, your feelings of loneliness are based on those beliefs. Loneliness, like other beliefs, can spread through social networks and have a negative impact on health60.

It is also important to note that a common set of psychosocial treatment principles can be applied to many different mental and physical conditions. By enhancing purpose, self-efficacy (the ability to handle new or challenging situations appropriately), feelings of connection to others, social engagement, and positive treatment expectations, activities and events can alleviate symptoms and dysfunction across disorders. They believe that these “common factors,” regardless of treatment type or psychopathology, are responsible for most psychotherapy’s positive effects. Studies of placebo effects have shown that the act of receiving treatment, along with the cognitive changes that accompany it, can confer benefits in both short-term experimental studies and long-term clinical studies across a wide range of disorders. 62–65. Pain and other disorders, such as Parkinson disease, depression, anxiety, and sleep disorders, can all be helped clinically by using a placebo treatment.62,63,66 Many health outcomes can be improved simply by changing one’s beliefs and mindsets in everyday life rather than by undergoing formal clinical treatment.67

Damian Sendler

Environmental threats and opportunities can be predicted and learned by most organisms. Associating cues or actions with rewards or punishments has long been assumed to be the basis of learning. The underlying contexts or’situations’ that cause events to occur can be represented abstractly and multimodally by humans (and probably other mammals68) (Fig. 1). ‘Status representations’ are conceptual, and closely related, but not identical, to the heuristic notions of schemas or mindsets69. Recurring causal structures (like ‘betrayed by a friend’ or ‘alone in a dangerous place’) form the basis of these mental models of both sensory information and action–outcome contingencies. There are several fundamental characteristics of situation representations. Adaptation to new situations and generalization to similar ones are made possible by the integration of information from different sensory modalities and timescales (7,10–17). It is more important to think about what is going on behind the scenes than what is going on in front of us. Situational representations are therefore compressive, which means that they distill sensory input into low-dimensional descriptions. Although their formation and use is often automatic, they can also be responsive to deliberation, allowing us to adapt to a wide range of cognitive and sensory stimuli. They are able to predict future events and guide action by distilling what is important from the jungle of sensory and interoceptive signals that make up a person’s environment.7,72

Damian Jacob Markiewicz Sendler: Schemas involving the self are the focus of this section. As a result, the self-in-context representation connects states (features and action–outcome contingencies relevant for decision making) with current pleasure and pain. Multitemporal depictions extend bodily and social well-being in both the past and the present (Fig. 1). For example, a situation like “the stock market crashed, and I lost my life savings” can raise one’s blood pressure because it is linked to one’s long-term outlook on life. Whenever an event is directly related to one’s own happiness or health, the body’s response is stronger, resulting in increased mobilization of cognitive and metabolic resources. These models represent information in terms of dimensions that are relevant to the self, giving sensory features and possible actions a personal meaning.

Simple associations have no evolutionary advantage over self-in-context representations. Sensory and interoceptive signals are combined with prior conceptual knowledge to predict future outcomes based on latent causes (for example, another person’s hidden intentions)11,73. A single word, for example, can lead to predictions that change rapidly when important relationships are disrupted, and they can generalize across very different physical contexts. Personal status and resources can be depicted in models.74. If the push is accidental or the pusher is a small child, one’s reaction will likely be different. Mental models can also integrate across timescales, allowing for the reinterpretation of past events in light of new evidence, such as events that occurred just a few seconds ago and those that occurred many years ago.

A recent study on decision-making used partially observable Markov decision processes12 to model simple situation representations. The idea of self-in-context models is based on this work. A set of causal contingencies can be derived from sensory cues, but an organism cannot directly observe the underlying causal structure. It is possible to infer the underlying states by using cognitive maps, which are sets of conceptual relationships between objects and events. A Markov model can capture the transitions between discrete task states over time, but at a cognitive level, situation representations are not constrained to the present and exist as a set of causal contingencies untethered from any particular moment in time

Self-in-context representations may influence perception and action, including the perception of external and internal signals,11,73,75–77. Predictive coding theories state that sensory input is compared to predictions generated by an internal model from the “top-down” (exemplified by self-in-context representations). Only differences from expectations, not all sensory input, are passed on to the model by sensory systems (that is, learning). Based on both sensory input and situational conceptions, perception is an inference that can be made (Fig. 1). When faced with noisy or uncertain environments, we should only focus on what we should be focusing on, according to this theory. Many researchers have proposed “predictive coding,” in which the brain’s higher levels of processing provide top-down information that is often represented in Bayesian models as “formal priors” (probability distributions of the likelihood of an event). Some of its most recent applications include the study of pain78, interoception4,5,8, physiological regulation and reactivity to stress and depression77, social cognition and interpersonal behavior80,81 and many more phenomena. It is possible that self-in-context models, which incorporate future well-being in the context of a particular person’s current situation, require specific types of information integration; we suggest below that these models are implemented in particular brain systems.

In summary, self-in-context representations are internal models of situations and the underlying causal structures that influence our future survival and well-being. Their low-dimensional representation influences sensory perception and behavior by combining information from exteroceptive and interoceptive senses with conceptual information from memory and prospective faculties (Fig. 1). Self-in-context representations can be generative, interpretive, attributive, instructive, and predictive. They allow one to simulate the outcomes of potential actions, understand incoming sensory signals as clues to one’s current state, and assign latent causes to sensory events. They can also be attributive, instructive, and predictive. These representations can also become emotionally “hot” and stimulate physiological systems (such as the autonomic nervous, hormonal, or metabolic systems) because of their connection to well-being.

This region of the brain, the DMN, was named because of its high metabolic activity during rest94 and its role in self-generated, spontaneous thought95 and goal-directed thinking90,96. For episodic (especially autobiographical) and semantic memories, the vmPFC is activated in humans97,98. People who have vmPFC damage have a hard time imagining the future in great detail100,101,102. As the film or story progresses, the vmPFC and other core DMN regions show consistent activation patterns, integrating past information into the representations of narrative meaning. It is possible for activation patterns in the vmPFC to change abruptly when new information provides insight106.

Damian Jacob Sendler

Conceptual thought relies heavily on relational representation. It is based on an interconnected web of concepts embedded in semantic space107, for example, During semantic memory retrieval, the vmPFC is robustly activated. Using functional MRI signal tracking activity in a hexagonal “grid cell” pattern108, it encodes position in relation to other relational structures, including physical space, in addition to the hippocampus’s coding. In a low-dimensional space, grid cells are thought to help represent relationships between discrete locations (or object features) — effectively, a compressed model that enables the representation of positional similarity and generalization6. When retrieving relationships between newly learned object categories14,109, grid cell-like patterns of vmPFC activity have been found to encode information in conceptual space. This suggests that the vmPFC may facilitate the formation of cognitive maps6 that represent the location of objects, people, and situations in a relational space

Damien Sendler: A person’s spatial orientation and long-term memory rely heavily on the hippocampus6,13,108. There are grid-like properties for representing conceptual relationships in the hippocampus and parahippocampal cortex, like the vmPFC 14. However, conceptual maps of the self-in-context may differ between areas despite the fact that they all contribute to the construction of conceptual maps. These self-referential conceptual maps, which prioritize information relevant to bodily integrity and well-being, may be particularly important for the vmPFC, whereas allostatic spatial and conceptual maps, which are less directly involved in physiological regulation, may be encoded in the hippocampus.

Interoception and physiological regulation rely on networks other than the DmN. Interoception and visceromotor control can be explained using the ePIC (embodied predictive interoception coding) model, which combines interoception and visceromotor control4. Viscomotor function is controlled by agranular cortical regions (such as the cingulate cortex and anterior insula) via connections to subcortical areas, and sensory prediction signals are sent to granular cortical regions, such as primary interoceptive cortex4. It has been hypothesized that the DmN15 and the salience250 (or’ventral attention’86) networks may form a unified system for allostasis5 in the brain, based on the findings of a recent study.

For example, the DmN and the salience network could both contribute to allostasis in different ways, in accordance with their distinct dynamics. Predictive control of bodily functions and behavior may be provided by DmN regions like the prefrontal cortex (vmPFC), while the salience network may do so reactively, based on the detection of salient events or new information that necessitates changes in states. It’s possible to test these and other hypotheses in the future.

Choosing what to eat, what to avoid, and when to exert effort based on values is critical in the biopsychosocial model of health. In the context of self-in-context representations, the vmPFC and the OFC are particularly important. VmPFC homologues do not affect basic reward preferences, reward learning, unconditioned threat responses, or basic conditioned threat acquisition or extinguishing (for a review, see10). But the integration of situational (for example, place), social, temporal, or interoceptive (for example, satiety-related) information into reward-guided or threat-guided behavioural decisions can be affected by vmPFC and OFC lesions.. If, for example, vmPFC lesions or inactivation impairs the ability to consolidate and use memories when a context shifts from threatening to safe150, this is a significant limitation. An action–escape contingency (the vmPFC representation of control) suppresses threat-related responses in the dorsal raphe nucleus and associated threat behaviors151 when shocks are avoidable. VmPFC inhibition reduces the benefits of perceived control, and stimulation of the vmPFC has the same effect on behavior even when shocks are unavoidable.151 Selective satiety — a shift in food preferences when one has consumed enough of a particular food — and rapid shifts in choice behavior when reward contingencies change are also disrupted by vmPFC lesions, which are also context-dependent appetitive behaviors. 152,153. Lesions of the vmPFC in humans do not generally alter basic value preferences, but they do interfere with the ability to generate appropriate behaviors and emotions in response to the context in which they occur. 154,155.

For this reason, the vmPFC responds to changes in the social and informational context that influence reward-driven behavior, as demonstrated in human imaging studies. In threat-learning studies, it responds during extinction recall156, reversals of cue–shock contingencies from danger to safety157 and manipulations that increase perceived control142. The vmPFC and OFC are activated, the vmPFC is more connected to the PAG158, and the vmPFC and the PAG65 release opioids in response to the suggestion that a placebo treatment is an effective analgesic. Reward experiments have shown that the vmPFC responds selectively to cues of satiation that influence food selections159 and suggestions that alter perceived value135,160. Additionally, the vmPFC reacts to the experience of vicarious reward, which occurs when rewards are given to others who are like oneself161, and encodes information about social categories linked to racial and sociocultural stereotypes.

Using a heuristic lens, self-in-context models can be viewed as a way of thinking that influences our openness to information, the hidden causes we assign to past and present events, and the lessons we take away from our experiences. A positive outlook on life and a willingness to see the good in others are hallmarks of a healthy mindset, as are the absence of unwarranted blame and hostility (both toward oneself and others). Negative self-evaluation and a lack of faith in one’s own ability to grow and change are two of the most common unhealthy mindsets. Running endurance and lung gas exchange measures were reduced when subjects were randomly assigned to the idea that they were genetically intolerant to exercise189. There is a link between negative beliefs about ageing and a decrease in healthy behaviors175 and a decrease in life span176. To amplify the effects of stress, a negative stress mindset (the belief that stressors are debilitating (rather than helpful opportunities for growth)190) is needed. There was a 43 percent higher death rate among 28,000 people who reported high levels of perceived stress and a belief that stress negatively affects health191 compared to those who did not report these factors.

Research suggests the vmPFC and OFC mediate the effects of various brief mindset interventions192,193, supporting the importance and malleability of representations of oneself in context. Pain and autonomic responses can be increased by implying that other people have experienced a painful stimulus as particularly intense194,195. Social manipulations, on the other hand, such as receiving supportive touch from a romantic partner196 or voluntarily accepting pain on behalf of another person197, reduce pain experience and measures of pain-associated brain activity. Changes in vmPFC and OFC activity are responsible for all of these outcomes. Pain and negative emotions, as well as the brain responses associated with them, can be reduced with just a few sessions of mindfulness training198 or meditation199. It is possible for these interventions to have meaningful effects on physiology, as they influence the most sensitive and specific brain measure related to pain currently available, with larger effect sizes than those found in placebo interventions200.

Mindsets also influence how we learn from our experiences, resulting in long-term gains or losses. When it comes to social anxiety disorder, for example, sufferers have a negative outlook on themselves and their social standing. It has been shown that people with social anxiety disorder are more susceptible to the negative reinforcement of others than they are to the positive reinforcement of others148. This could lead to a vicious cycle of anxiety and self-doubt. Experiencing the pain that one expects can become a self-reinforcing cycle201. There are two critical components to self-reinforcing feedback cycles: first, that experience is assimilated to initial beliefs (that is, negative expectations enhance pain), and second, that experiences incongruent with initial beliefs are discounted or ignored201.

Changing one’s self-in-context representations over time may be a method of psychotherapy’s success. There are many types of psychotherapy that focus on helping people cultivate health-promoting beliefs, causal attributions, and meaningfulness. Patients’ mindsets are shifted as a result of factors like positive expectation, self-efficacy, and engagement61, not because of specific treatment protocols. After therapy for a variety of mental health conditions, the vmPFC–OFC, hippocampus, and amygdala all undergo significant changes202,203. Common factors can have significant effects on a wide range of medical conditions, including migraine, depression, anxiety, Parkinson’s disease, asthma, irritable bowel syndrome, and arthritis204. They are not limited to any one treatment.

It is possible to influence the development of healthy self-in-context representations in a variety of ways: through interactions with family and friends; by practicing mindfulness and self-regulation; and by influencing public health policy. Among more than 300 trials of psychological interventions for cancer patients, those with strong social support networks survived longer206. Those who are more socially isolated may benefit from psychosocial interventions, which can increase their survival time and improve cancer-related immune measures205,208. Improved mood, longer cancer survival, and measures of cellular immunity such as natural killer cell proliferation and lymphocyte cytotoxicity were found in two randomized clinical trials of psychosocial interventions209.

We still have a lot to learn about the effects of psychosocial interventions and mindset shifts. Individuals’ self-in-context representations differ inherently, and they can be harmful in a variety of ways across a wide range of disorders. In addition, they unquestionably rely on intricate neural interactions involving numerous brain regions and systems to perform their duties.. It’s important to keep in mind, however, that there is a central point from which all of our experiences are integrated into a coherent picture of the world and our path through it. This may help us rethink the role of the brain in both mental and physical disorders if we see it as a common driving force. This means that there is hope that people can learn to change their own and their loved ones’ self-in-context models for the better.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: Intense, new, and recurrent itching, as well as dermatitis, are all signs of scabies. Scabies mites can be confirmed by microscopic or dermatoscopic examination of the affected area. Permethrin, applied topically in accordance with current guidelines, is the first line of treatment. Crotamiton or benzyl benzoate can also be used as a topical treatment. Permethrin and ivermectin are commonly used to treat crusted scabies, which is otherwise difficult to treat. Treating a patient who is in a high-risk group, incorrect application of the external agents, and incomplete decontamination of furnishings and clothing are among the most common causes of treatment failure, according to the National Institutes of Health. Scabies mites have not yet been proven to be resistant to permethrin, but the number of documented cases of poor response to this agent is increasing. Moxidectin is a brand-new drug currently being evaluated in clinical trials.

Damian Jacob Sendler: As a result of the incorrect use of drugs, which necessitates repeated treatment, as well as the reinfestation of the patient’s clothing and furnishings, the prevalence figures are heavily influenced. Scabbing in Germany has been on the rise recently, according to recent studies (1). In Germany, scabies is not a public health issue, so the epidemiological figures are shaky (e1). Data on scabies outbreaks, diagnosis-related statistics from health insurance carriers, and information from pharmacies on the prescription and dispensing of scabies-fighting medications are all available (1, 2). Scabies (ICD-10 diagnosis code B86) inpatient treatment in Germany increased from 960 in 2012 to 10 072 in 2019 according to federal health reports (www.gbe-bund.de). Some patients are counted or included multiple times in data from the above sources, which may be sufficient to document a rise in incidence, but they do not allow for quantification or epidemiological evaluation (1). Re-infestation due to insufficient decontamination of a patient’s clothing and belongings has a significant impact on prevalence statistics, as does the need for repeated treatment due to incorrect drug use. Scabies infections in children are underappreciated (1) for a variety of reasons, including the fact that they are more difficult to detect and treat early (e2), the fact that there are more mites present, and the fact that they are more likely to be spread through direct physical contact with others (4). Scabies, like other sexually transmitted infections, increased in prevalence following advances in HIV treatment. According to epidemiological evidence, there is no causal link between a rise in scabies in Germany and the mass migration of asylum seekers from Arab and African countries (1, 5, e9). An important factor may have been the influx of low-wage workers and nurses from outside Europe and the European Union (6, e10, e11). There has been a history of periodic increases in the incidence of scabies, which have been accompanied by similar speculation about the causes (1).

Dr. Sendler: Scabies infections in children are underappreciated for a number of reasons, including the fact that scabies infections in children are often not detected early enough or treated thoroughly enough, and they are more likely to be passed on through close physical contact with other people.

Only 10–15 adult mites are usually found on the skin’s surface in typical cases of common scabies, because the mites can be washed and scratched away and because an immune response mediated by cells begins 3–6 weeks after the infestation.

The mite that causes scabies is the human scabies mite, which is specific to humans (Sarcoptes scabiei varietas hominis). The adult female mite is approximately twice as large as the male mite, measuring between 0.3 and 0.4 millimeters in length. Approximately 2.5 cm per minute, these parasites are able to move on the body’s warm surface. Each day, they lay two to three eggs, depending on their gestation period, which lasts from four to six weeks. Pregnant females do this by excavating burrows in the stratum corneum at a rate of about 0.5–5 millimeters per day (7, 8). Non-ovicidal antiscabies drugs must therefore stay in the epidermis for at least this long before the larvae hatch and swarm out onto the cutaneous surface, where they develop into nymphs in skin wrinkles and hair follicles and then into sexually mature mites within 9–17 days, which copulate in these locations (9, 10). After the male mites die, the pregnant females return to the skin and the cycle begins again.

24 to 36 hours at normal room temperature (21° C) in relatively humid air (40–80 percent) are possible for mites to survive outside the human body and remain infectious (12, 13). At lower temperatures and higher humidity levels, they can survive for a longer period of time (e15).

A single pregnant mite, or a few larvae, is enough to infect a new human being. Scabies, the most common form, necessitates at least 5–10 minutes of close skin-to-skin contact, such as when nursing or cuddling a baby, having sex, or caring for someone who is nursing-dependent (9, 12, 14).

Since mite infestation is highly transmissible at first, the number of female mites dramatically decreases after the specific immune response appears and for some time afterward (9). In order to transmit the common scabies, handshakes, hugs, and medical exams are insufficiently intense forms of contact. Those infected by a case of common scabies are usually infected by members of the same family or communal living group, or by people who are nursing dependents and those who care for these people (15). It is rare, but not completely negligible, for the pathogen to be transmitted via textiles, furniture, or other items of daily use (9). It is possible to get scabies from even a brief contact with the patient, or from exposure to items used by the patient, or from the patient’s dandruff if the scabies are crusted (8, 16). On the whole, the likelihood of transmitting an infestation is influenced by the number of mites present on the skin, as well as the duration and frequency of direct bodily contact (8, 9, 15, 16).

Scabies that are not crusted can be spread through direct skin-to-skin contact with mite-bearing objects or through contact with dandruff that has been exposed to the pathogen.

A variety of scabies clinical morphologies can be seen, depending on the mite count, the age of the patient, their immune status, and their defensive behavior. 2–6 weeks after the initial infestation, an intensely itchy papular or papulo-vesicular skin rash with a symmetrical pattern of involvement develops in common scabies. The time between reinfestations can be as little as a few days. Scabies is known for its nocturnal crescendo, in which the itch worsens at night and in the warmth of the bed (e16). It is common for the burrows to be 3–7 mm long and straight or slightly curved; at the end, a small vesicle, pustule, or scale may be formed (figure 1). A thin stratum corneum makes any and all body regions with a thin stratum corneum prone to skin lesions. This includes the interdigital spaces and lateral surfaces of fingers; edges of hands; volar surfaces of wrists; umbilical region; waistline; buttocks; medial surface of thighs; dorsa; and edges of feet for both men and women; as well as any and all areas with a thin stratum corneum (15). Many lesions are quickly crusted over and excoriated by scratching due to the itchiness of psoriasis (16). Intensive hygiene (“well-groomed scabies”) or pretreatment with topical steroids (“scabies incognito”) can significantly alter the clinical appearance. The irritating itch frequently causes the patient’s sleep to be disrupted, resulting in fatigue during the day, poor concentration, and decreased productivity at work. Further consequences include stigmatization, social isolation, embarrassment, and depression (8).

An inflamed nodule on the penis, scrotum, inguinal, perianal, or axillary region indicates the presence of nodular scabies.

Scabies (also known as “infantile scabies”) is a common skin condition that affects the palms and soles of children, as well as the scalp and face of infants and toddlers (3). Also common in this age group are pustules, which are more common than excoriations, as scratching is less common in this age group. End of neonatal period “neonatal scabies” can show the first signs of skin changes (e17). Elderly patients with weakened immune systems are also more likely to develop unusual constellations that involve the head and trunk (8, 17). Pruritus may be absent in patients with dementia, but it is more common in the elderly and nursing-dependent (18).

Small children and the elderly are more likely to be affected by nodular scabies, which is characterized by nodules that are 5–20 mm in diameter and red, reddish-brown, or livid in color. Axillary nodules are most common on the penis, scrotum, and perianal regions, but they can also be found elsewhere. More severe and longer-lasting immune reactions and/or scabies mite penetration may both contribute to the development of nodules (e18). Even after a successful treatment for scabies nodules (“post-scabietic papules”), the nodules may last for months (e19). Vesicles (also known as “bullous scabies”) are an uncommon ailment that most commonly affects the elderly (8, e20).

Damian Sendler

There are millions of mites in crusted scabies because of the mites’ unrestrained multiplication (box 1). (18). The clinical picture is dominated by massive local or diffuse hyperkeratosis on an erythematous background, with crusting and fissures on the hands, feet, elbows, head, and neck. / (15). Dystrophic nail growth is common. The lack of an immune response is one of the many reasons for the mild or nonexistent nature of pruritus. Swollen lymph nodes are a common symptom of a variety of health conditions. With an elevated IgE titer and Eosinophila, both are common (8, 16, 17). Crusted scabies often goes unrecognized for a long time due to its unusual clinical features, which leads to outbreaks in communal facilities when people with this illness are exposed to others (18).

Bacterial infection of the excoriations is the most common complication of scabies and can lead to contagious impetigo, ecthyma, erysipelas, furuncles, abscesses, lymphadenitis, and bacteremia and sepsis (8, 16). By inhibiting the three pathways of the complement system (e21), as well as inducing scratching of the skin, Scabies mites contribute to bacterial infection by damaging the epithelial barrier (e22). This disease, which is rarely seen in developed countries because of good hygiene, has a significant health-economic impact in countries with warm climates where the prevalence of chronic renal failure and decreased life expectancy is high (6).

Crusty scabies differs from regular scabies in that it has an erythematous background and large, localized, or diffuse hyperkeratoses on the hands, feet, elbows, and neck, as well as crusting and fissures.

Scabies can only be diagnosed if a scabies mite, its eggs, or feces pellets are found (scybala). An old-fashioned method of diagnosing a mite infestation is to open an intact mite burrow and examine the contents under a light microscope with loupe vision (15). Dermatoscopy is a less invasive, quicker, and more accurate way to examine the skin. Dermoscopy’s reported sensitivity and specificity were 98.3 percent and 88.5 percent, respectively, in the most recent publication on the subject (19). As part of the “wake sign,” the examiner looks for a dark triangle corresponding to the mite’s head, thorax, and anterior leg pairs (the “kite sign”) (figure 1). It is possible that melanin-containing feces (the “grey-edged line sign”) may color the edges of the mite burrow (e23). It is not possible to distinguish between living and dead mites at a standard 10x magnification, making the method ineffective for patients with pigmented skin. It is possible to determine whether mites are alive using criteria such as the “hydrangea sign” using videodermoscopy at 70 to 1000x magnification (20). As with confocal laser microscopy and optical coherence tomography, videodermatoscopy’s difficulty and cost limit its widespread use (7, 16, 21).

The diagnosis of scabies has been standardized by a panel of experts recently (box 2 ). (21). It is necessary to use a high-resolution imaging method to detect mites, eggs, and feces in order to make a conclusive diagnosis. The history and physical examination alone can diagnose “clinical scabies” and “suspected scabies,” but only if other elements of the differential diagnosis seem less likely.

The most common complication of scabies is bacterial superinfection with group A beta-hemolytic streptococci and Staphylococcus aureus.

Because scabies mite infestation is directly linked to the typical symptoms of the disease, the primary goal of treatment is the elimination of the organisms (e25–e28). Acaricidal (mite-killing) or ovicidal (insect-killing) drugs are the most commonly prescribed for this purpose (egg-killing). In either case, they can be applied to the skin or taken orally. Topical application is more complicated than most people think, and this isn’t always explained in the information provided to doctors.

As a result of a single-arm, multicenter trial (22), the BfArM in Germany has approved permethrin, and in 2016, oral ivermectin was approved through an accelerated approval procedure at the BfArM. Treatment recommendations thus focus on clinical trials, regardless of approval data or relevant meta-analyses that may be available (23, 24). Figure 2 depicts the scientific evidence supporting the drug therapies employed in Germany (23).

Damian Jacob Sendler

Permethrin, benzyl benzoate and permethrin are the most commonly used medications for the treatment of the itchy skin condition known as scabies in adults and children. For the treatment to be successful, it is imperative that all of the instructions for use are followed exactly.

Damian Jacob Markiewicz Sendler: Permethrin in lipophilic vesicles at a concentration of 5% (23–25) is the first-choice treatment. Voltage-dependent sodium channels in neurons are disrupted by the open channel blocker Permethrin, which has both acaricidal and ovicidal effects (e29). In cases of common scabies, it should be applied externally once on the patient’s entire integument, according to the accompanying information for physicians (e30). As a general rule of thumb, adults should use at least 25–30 g, while children between 6 and 12 years old should use up to 15 g; those between 2 months and 5 years old should use no more than 7.5 g. (26). Keeping the skin dry for at least 30 minutes before applying permethrin is recommended, as the lipophilic nature of the substance reduces its cutaneous bioavailability when exposed to water in any form. Immediately after applying the preparation, the skin should be covered with clothing; washing should be avoided for at least 8 and preferably 12 hours (26). After application, mild itchiness or tingling may occur, especially in severely eczematous skin. For the next 36 hours, refrain from making physical contact with anyone (1). Recurrences should always be treated with repeated application, as there have been many reports of treatment failures; this recommendation is not included in the formal information for physicians (1, 15, 27). Low-viscosity extemporaneous preparations with the same permethrin concentration may be beneficial for patients with dense body hair due to the prevalence of insufficient or incomplete treatment of the entire skin (28). Topical application of crotamiton at 5% or 10% for three to five days in a row, or of benzyl benzoate at 25% for three days in a row (10% for children) has comparable efficacy (but is more time consuming) (23). In addition to their acaricidal and ovicidal properties, crotamiton also acts as an itch reliever. Both of these substances can cause skin irritation.

German law prohibits the over-the-counter purchase of topical 1% ivermectin for the treatment of scabies (e32).

For the treatment of scabies, ivermectin tablets (3 mg) have been approved and are widely available. From a body weight of 15 kg and up, the recommended dose is 200 g/kg of body weight (so five 3-mg tablets for a 75 kg patient) (15, 29, e33). An extemporaneous preparation containing 400 micrograms per milliliter of ivermectin, which is now thought to be safe for children under 15 kilograms (29, 30), has been developed for this age group (31). Gamma-aminobutyric acid (GABA) is blocked by ivermectin, which acts on glycine, histamine, and neuronic acetylcholine receptors (e36). After 7 to 14 days, a second application of ivermectin is necessary to ensure that all larvae that were still unhatched at the time of the first treatment are killed before they have a chance to mature and reproduce. Permethrin and ivermectin can be administered topically to pregnant and nursing women as an off-label medication (i.e. despite the lack of official approval) after careful consideration of the advantages and disadvantages and with the informed consent of the patient (15, e37, e38).

In the future, oral moxidectin could be used as a single-dose treatment for scabies.

Permethrin cream and ivermectin tablets (e.g., on days 1, 2, 8, 9, 15, and possibly also on days 22 and 29) should be used in combination to treat crusted scabies in patients with a history of recurrence (15, 27). Topical keratolysis with a salicylic acid or urea-containing agent is also required, as is the mechanical removal of hyperkeratoses that are clearly visible.

Moxidectin may one day be used to treat scabies (e39, e40). Because this drug has a much longer half-life than ivermectin, early clinical data indicate that it may only need to be administered once (32). Moxidectin’s safety and efficacy against scabies have yet to be adequately demonstrated (e41). While scabies vaccination has yet to be developed, it appears to be possible (e42).

Damien Sendler: Success in treatment depends on the simultaneous treatment of all close contacts of the patient, including all members of his or her family and those who share close quarters with him or her (e.g., carers for small children and visiting nurses). A single application of permethrin or ivermectin to an asymptomatic contact is sufficient (off-label use, therefore at the expense of the contact person) (15).

The severity of a mite infestation and the number of patients infected is directly related to the importance of additional treatment measures.

A patient’s mite burden and the number of patients affected by an outbreak are directly related to the importance of additional measures (box 3) accompanying treatment. Scabies mites can only survive for a short period of time away from their human hosts, so the need for professional pest control management of interior rooms is not warranted. Efforts to sterilize the environment are futile.

Poor compliance, incorrect application of topical antiscabies drugs, inadequate decontamination measures, and inadequate written information are all well-documented causes of treatment failure for scabies.

Permethrin’s ineffectiveness is on the rise in Germany, which coincides with an increase in the number of documented cases of scabies (1, 38, e46). Although in vitro testing is difficult to confirm, this suspicion of resistance to permethrin is justified when multiple, correctly administered, but still unsuccessful attempts at treatment, along with all the appropriate accompanying measures, have been unsuccessful. Until now, only canine mite genetic resistance to permethrin’s pharmacodynamic effect on voltage-dependent sodium channels has been described; the human scabies mite has not (e47, e48). Permethrin is more likely to cause mites to produce elimination enzymes such as esterases, glutathione s-transferases, oxygenases, and CYP450, which can lead to a reduction in the permethrin’s effectiveness when applied repeatedly in sublethal doses. When it comes to mites, this type of metabolic resistance has been found in canines but only once, indirectly, in humans. A higher concentration of permethrin could be used, but this hasn’t been thoroughly tested for possible toxic effects. Genetic resistance to ivermectin may be due to a polymorphism in the p-glyoprotein gene (e50). There is no conclusive evidence that the resistance mechanisms mentioned here are present in mites that carry scabies on humans.

Additionally, a lack of treatment response can be attributed to treatment errors (especially in the application of topical agents), inadequate compliance, reinfestation due to incomplete decontamination, and the failure to provide written information about the measures that must be taken (4, 39, 40, e51). Permethrin’s minimal effective inhibitory concentration (MIC) may not be reached for long periods of time in children and patients with a severely compromised skin barrier, according to experimental studies.

It’s possible that treatment resistance is only apparent and not real, because dead mites can only be distinguished from living ones with the usual dermoscopic techniques for several days after they’ve died; high magnification is required for this (20). Antigens released from decomposing mites after effective treatment may also lead to an increase or persistence of the inflammatory response. (e52, e53). When psychogenic pruritus is present, it can lead to a pathological fixation or even an isolated delusion in some patients (e54).

If you follow the guidelines and all of the additional expert recommendations here (1, 2, 15, 27, 38), you may be able to get rid of scabies in some cases, according to our experience.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: There is strong evidence that most psychiatric disorders originate in childhood and that childhood adversity increases the risk of developing psychiatric disorders in adulthood [1]. More than half of the burden and disability in young people aged 10–24 years is caused by neuropsychiatric disorders (45%), which are strongly associated with risk-taking behaviours and significant psychosocial impairment [2–5]. For many psychiatric disorders, the length of time an individual suffers from an untreated illness is a significant predictor of poorer outcomes [6]. Thus, early detection and appropriate intervention are essential to reduce the overall burden and disability associated with neuropsychiatric disorders [7]. 

Dr. Sendler: Many patients with a psychiatric disorder do not or delay seeking help from a mental health professional, which contributes to the long duration of untreated illness [8]. If they are experiencing behavioral or emotional issues at school, most children and adolescents will see a school counselor or a general practitioner (e.g., a pediatrician or nurse practitioner). When it is assumed that a child has a specific mental health disorder, these mostly non-mental health professionals require screening instruments to detect whether or not the child requires a general psychological evaluation (caseness) (e.g., ADHD, psychosis). Mental health professionals, on the other hand, may need screenings if specialized, complex, or lengthy assessments are considered, such as for psychosis risk or autism [7, 9, 10]. 

Damian Jacob Sendler: Screeners are frequently used to detect psychiatric disorders in many fields of medicine [5, 9, 11]. The low positive predictive value (i.e., low accuracy) and lack of age-appropriateness of many screening instruments have led to their widespread discredit in the field of mental health [9]. While it is true that screening for some mental illnesses can be difficult, the most serious issue is that reports on new screening instruments frequently lack sufficient evaluation of important psychometric properties that would be required to judge their usefulness. This could be a factor in the poor image that psychiatric screening tests have earned. 

In most cases, data on reliability and validity and norms for the targeted population is required to evaluate its applicability. 

The accuracy of a screener’s measurement is what determines a screener’s reliability, not whether or not the targeted construct is assessed. It is possible to distinguish between three different types of trustworthiness: Screeners must measure what they measure consistently over time in order to have a good test–retest reliability (note: a low test–retest reliability may be seen if the screener measures a fluctuating state or a trait condition, or if the condition itself has changed). In order to ensure internal consistency, all items of the screener or its subscales must measure the same concept (s). (3) The rate of agreement between different raters is evaluated if the screen is an interview (inter-rater reliability) [12,13]. 

Damian Sendler

The degree to which a screener accurately measures what it claims to measure is referred to as validity. For screening instruments, there are three main aspects of validity that are commonly required: Criteria validity is an important consideration in clinical diagnostics because it shows how closely a screener’s result matches a specific criterion [12, 13]. Two aspects of criteria validity can be distinguished as a result of the difference in time between the screening and the criterion assessment: (a) the degree to which the screening can identify individuals who currently have any or a specific mental disorder (concurrent validity; requires nearly simultaneous screening and criterion assessment in the test construction phase, while in practice some time may pass between screening and formal assessment); and (b) the degree to which the screening can identify individuals who currently have any or a specific mental disorder. A test’s construct validity is evaluated when the emphasis is placed on the score rather than the test’s outcome, and the measure of interest is less well defined than, for example, a formal diagnosis but pertains to a construct that is not directly assessable (such as intelligence or personality characteristics). 

According to expert consensus, it refers to the degree to which screener scores match those of the gold standard assessment (such as the HAWIK in the assessment of IQ). If there is high agreement between the screener’s results and those of an established measure of the same construct, this is a positive sign of construct validity. This is the opposite of construct validity, which is high when screener scores are not correlated with measures of other constructs. There should be no correlation between the scores of an ADHD screener and scores of scales assessing emotional or behavioral disorders. Content validity demands that the screening instrument measure all important aspects of the target condition, such as inattention but also hyperactivity and impulsivity when ADHD and not just the inattentive subtype is targeted. 

Damian Jacob Markiewicz Sendler: As a whole, a screener must be able to consistently produce (state) accurate scores and results (reliability) (validity). Instruments are frequently described in terms of their reliability before or solely in terms of their validity. Due to lack of validation data, it is difficult to determine the clinical utility of many screening instruments [12, 13]. Concurrent (predictive) validity of a diagnostic screening instrument should be demonstrated by (1) ruling in most or all patients with the target condition (diagnosis) while (2) excluding a significant number of those without it. 

Screeners should generally have a sensitivity close to 100%, a negative diagnostic likelihood ratio (LR) 0.1 that indicates a ‘large and often conclusive’ change from pre-screening to post-screening probability of the absence of illness risk [14], and a positive predictive value that is greatest in settings where the prevalence of the condition is highest, i.e., greater in clinical settings than in c. settings. Screeners must have high specificity and a positive diagnostic LR 5 that indicates a moderate increase in the pre-screening to post-screening risk probability in order to exclude a significant number of patients who do not have the target condition [14]. Diagnostic likelihood ratios are rarely reported in studies evaluating screening instruments, e.g., for psychosis risk [16], despite the fact that these can be more easily interpreted [cutoffs for “good” concurrent (predictive) validity exist]. 

Damian Jacob Sendler 

Screeners’ differential accuracy should not rely heavily on confounding conditions, such as co-occurring emotional or behavioral disorders, but should have good content and convergent or criterion validity (i.e. measure the target condition) [13,14]. Using a clinical interview as an example, the final screener result (e.g., determined by a cutoff score) should not only match the interview result but also each screener item should be highly correlated with its respective interview counterpart (both aspects of convergent validity in dimensional assessments or criterion validity when symptoms are assessed) [13]. Aside from that, the screening tool should examine all aspects of the target condition, not just the most obvious ones (content validity). Screening instruments are rarely evaluated on the basis of these considerations. 

Last but not least, norms or cutoffs should be provided so that an individual’s performance can be compared to that of a similar group for clinical purposes and the evaluation of a patient’s mental state. A screener should be tailored to the overall goal (e.g., screening for psychiatric caseness in the general population versus screening for a specific condition in a clinical population) or to different groups (e.g., separate norms for age groups, gender and/or other potentially influential sociodemographic characteristics) to improve the population fit.. 

Damien Sendler: Psychometric properties are often overlooked in studies of screening instruments. To begin with, it is important to know what the screening is for and where it will be used (e.g., general population/school, primary care, or mental health services, as well as the expected developmental stage of the recipients). As a general rule, most screeners are not useful for everything (e.g., for caseness and a specific disorder). This means that reliability and validity cutoffs (e.g., diagnostic likelihood ratios) that distinguish between a useful and a useless screening instrument should be studied in appropriate populations with an adequate sample size. 

For children and adolescents with mental health issues, it may be difficult to develop effective screening instruments for all possible scenarios and conditions. Many studies on potential screening instruments are also inappropriate at this point, but research on screening instruments is necessary to improve comprehensive and early detection of mental health conditions in children and adolescents, especially during times of increasingly tighter resources. 

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: Assessment, treatment, and prevention of mental illnesses such as bipolar disorder, anxiety, schizophrenia, developmental disorders (such as autism), and neurodegenerative diseases are all part of the field of psychiatry (e.g., Alzheimer dementia). A major percentage of the worldwide burden of illness-related incapacity is attributable to these illnesses, which are the primary focus of the organization’s work. Clinical neuroscience is the foundation of psychiatry. Since breakthroughs in the evaluation, treatment, and prevention of brain disorders are most likely to come from research of etiology and pathophysiology based on clinical and translational neuroscience, its main purpose is best fulfilled in this setting today and in the future. Psychiatry must also guarantee that those who require the advantages of its research are also its beneficiaries in order to maintain its wide public health relevance in the future. Clinical neuroscience in psychiatry, encompassing epidemiology, community and behavioral health science, and health economics, must increase their collaborations to achieve this successfully.

Damian Jacob Sendler: A SWOT analysis of psychiatry is presented by the writers, who offer solutions for enhancing psychiatry’s future and enhancing its significance in public health and the rest of medicine. Some of these strategies include new ways to strengthen the relationship between psychiatry and neurology, to finance it, to focus on early and sustained multidisciplinary training (research and clinical), to strengthen the academic infrastructure, to reorganize mental health services both for preventive intervention as well as cost-effective chronic disease management, to strengthen the academic infrastructure.

Damian Sendler

Dr. Sendler: In the medical speciality of psychiatry, the goal is to assist patients and their families who are affected by a wide range of complicated brain illnesses, including depression, bipolar disorder, anxiety disorders, schizophrenia and drug misuse disorders. When researchers have discovered the genesis of certain illnesses, such as those affecting the central nervous system, they have frequently relocated them to the domain of neurology rather than psychiatry. (A excellent historical illustration of this transition is tertiary syphilis.) As a result of advances in contemporary neuroscience, the boundaries between psychiatry and neurology are becoming more blurred, making the distinction between the two disciplines increasingly meaningless. 1 There are substantial consequences for the future of psychiatry because of the artificiality of this barrier. That the two fields, which were formerly linked by a common interest in clinical neuroscience, should be brought back together again is our central premise (Figure 1). So even while psychiatrists and neurological specialists both study the brain, we admit that their interests might differ, leading to a need for professional affiliations. Medical sociology has a core belief in the importance of this identity. Re-integrating psychiatry and neuroscience in medical education and research might benefit both fields. We are not asking that psychiatrists or neurologists give up their passions. Psychiatry and neurology are both rife with arbitrary and historically based elements. Psychiatry and current clinical neuroscience address problems in anatomical circuits and connections, while conventional neurology has concentrated on specific anatomical abnormalities (e.g. stroke or tumors). These are not absolutes, as we will show in the following examples.

It’s an exciting time to be a psychiatrist. As a conceptual map, it shows how psychiatry has evolved through time and how it relates to other fields of medicine, neurology, and public health in the future.

Approximately 20 percent of the worldwide burden of illness-related impairment is attributed to neuropsychiatric illnesses, which the WHO describes as “complex brain dysfunction.”

Damian Jacob Markiewicz Sendler: Like neurology, psychiatry is built on a solid scientific basis. This includes a wide spectrum of fundamental biological and social disciplines, as well as various techniques (e.g., brain imaging, genetics and neuropsychopharmacology) that may be used to build innovative evaluation and treatment methods that are anchored in knowledge of etiology and pathophysiology.

It is our goal to look at the future of psychiatry as a clinical neuroscience and identify solutions in several settings to promote this future: (1) education and training, (2) policy, (3) institutional challenges, (4) research, and (5) clinical practice at medical schools and training hospitals. As a starting point for future debate, we want to give a synthesis of the most pressing problems currently affecting the field of psychiatry and to serve as an educational tool.

This is why we suggest first to give a psychiatric SWOT analysis, which examines a field’s strengths, weaknesses, opportunities, and threats (positive and negative). We have almost 200 years of combined expertise in academic psychiatry, encompassing fundamental and clinical research, teaching (including mentoring academic careers programs), clinical work, and administration (medical school dean and academic health center [AHC] president, department chair, and large research group leader). In our roles as NIH reviewers, grantees, and National Institute of Mental Health (NIMH) national advisory council members, as well as in our roles as leaders of professional associations and the Institute of Medicine (IOM), each of us brings a wealth of knowledge to the table (American Psychiatric Association [APA], the American College of Neuropsychopharmacology, and the American College of Psychiatrists). We want to be clear that the opinions expressed here are solely those of the authors and do not necessarily represent those of any professional organizations with which we are connected. That being said, our primary goal was to synthesize the many different viewpoints that exist on the current state of psychiatry’s conceptual and social issues, to broaden participation of academic medicine leaders in this conversation and to make what we believe are strategic recommendations for dealing with the tipping point where psychiatry currently stands. In our opinion, there is a pressing need to continue this discussion and take action on it. Surgeon General’s3 and IOM’s4 as well as the APA’s4 resources are only a few examples of the wealth of information available in the literature.

Damian Jacob Sendler

Damien Sendler: Psychiatry’s diagnostic and therapeutic tools, such as structured diagnostic instruments and maintenance medication to avoid relapse and recurrence, are adequate, but not exceptional, in our view. The vast majority of patients make significant progress, although many never completely recover. Experts and practitioners now recognize the need to incorporate multiple dimensions (e.g., severity, distress, impairment) into their assessment procedures in order to better accommodate advances in relevant basic brain and behavioral sciences and to enhance clinical relevance in the diagnosis of mental illness. Indeed, the Diagnostic and Statistical Manual (Fifth Edition) task committee has made this multidimensional evaluation a primary priority.

This field of medicine now has an evidence base that is at least as good as or better than the rest in terms of rigorously controlled randomised clinical trials (RCTs), including those testing theoretically based, disorder-specific psychosocial treatments, which is another strength that psychiatric treatment can use (e.g., cognitive behavior therapy for depression). Personalized therapy for people with mental illnesses is a top priority in the profession, as seen by the recently released NIMH Strategic Plan. 6 Because of their commitment, mental health professionals and general practitioners alike are increasingly turning to studies into treatment response moderators and models of care organization (such as depression care management), which allow for the implementation of evidence-based practices in both mental health specialties and general practice settings alike. More and more attention is being paid to multicomponent interventions that take into account the burdens of concurrent medical, neurological, and psychosocial problems as well as stepped-care approaches with public health relevance (e.g., using watchful waiting before intervention and using simple strategies before more complex ones) (e.g., care-giving burden). Many of these therapies are geared on improving people’s quality of life. The use of targeted, presyndromal screening to identify people at high risk of developing a mental illness is also becoming more common in primary care and specialized settings; these screenings often identify people who are already exhibiting symptoms of depression before they become clinically depressed. 7 For adults with macular degeneration, psychosocial therapies like problem-solving therapy may help prevent or postpone depression.8, whereas psychopharmacological interventions like antidepressant medicines can help post-stroke patients who are at risk of depression.9

Psychiatry’s biggest asset is the large number of young individuals who are joining the profession and its allied fields of study. 4 percent of medical school graduates in the United States choose to practice psychiatry. 10

Finally, the many and significant advancements that are occurring in the fields of molecular, developmental, and systems neuroscience represent a fundamental and rising strength of psychiatry as clinical neuroscience. Neuronal foundations for cognitive and emotional skills that are disrupted in psychiatric diseases are becoming more well understood, enabling a more comprehensive and nuanced database for the production of testable hypotheses about the biological basis of mental illness. Neuroscientists are now in the early stages of developing innovative pharmaceutical therapies based on pathophysiologically-based sickness models rather than random finds. Psychiatrists are now better able to anticipate treatment response variability using pharmacogenetic information and to quantify risk for mental disease. Psychiatry and neurology are merging in this way, blurring the line that has traditionally existed between the two fields.

A lack of clinical neuroscience perspectives is limiting psychiatry’s assessment and treatment tools, even though they are good, because the findings of psychiatric genetics, brain imaging, cognitive and affective neuroscience and psychometric theory can be used to define etiology and pathophysiology, as well as treatment-relevant phenotypes, and to personalize treatment (i.e., which therapy for which patient at what point in the illness trajectory?) Optimizing therapy necessitates a greater focus on the discovery of biological and psychological characteristics that predict or influence short-term and long-term treatment response, in our view. Psychiatry, compared to other medical specialities, is a newcomer to this venture. People with complex brain illnesses face a significant barrier to advancement because of the schism that separates neurology and psychiatry, the two primary clinical neuroscience practice arms, on a conceptual and structural level.

Research into the causes of mental illness, as well as the development of treatments and approaches to mental health that are tailored to the unique needs and circumstances of each individual, are just a few of the many opportunities that psychiatry as a clinical neuroscience discipline offers to improve the health of the general population. Progress in psychiatry is now possible thanks to the instruments developed in the fundamental and behavioral sciences. It’s also a good time to think about how to improve the public health effect of contemporary psychiatric therapy by developing targeted and targeted preventative treatments for persons at high risk of developing mental illness. Understanding genetics, pathophysiology, functional neuroanatomy and neuropsychopharmacology may also help psychiatry enhance evaluation and treatment procedures. This allows for the creation of more tailored therapies. Psychiatry will be able to overcome stigma towards the mentally ill if it has the chance to create and implement public health-relevant forms of mental health care delivery. Partnerships with patients and families affected by mental illness are critical in the fight for equity in the financing of mental health treatments, as is increasing the financial incentives for young people to work in the sector via advocacy and consumer health information projects. It is up to psychiatry to help medical students and doctors who are seeking mental health care to transform the culture of academic medicine in a manner that helps them get the help they need. Teaching medical students and doctors to better detect depression in themselves and their colleagues may lead to lower rates of physician incapacity and suicide—and enhance the probability that nonpsychiatrist physicians would notice depression in their own patients.

Psychiatry, as a branch of clinical neuroscience, has numerous advantages, but it also confronts threats to its long-term viability. Several of these issues are pecuniary in nature, such as the disparity in Medicare’s copayment requirement of 50% and the absence of parity in reimbursement systems. In general practice and pediatrics, the adoption of evidence-based mental health treatments is hampered by structural hurdles (e.g., a lack of electronic health records, declining institutional support, and an emphasis on acute rather than chronic care). Furthermore, the profession’s future is jeopardized by social realities such as the continuing of stigma towards people with mental illnesses and health/science policies (such as a lack of resources for psychologically health research and a lack of support for mentorship). We also face serious challenges in recruiting high-quality students and their workforce consequences (e.g., lack of child/adolescent and elderly psychiatrists), as well as a low proportion of trainees who go on to pursue research careers in psychiatry. Finally, the infrastructural demands of psychiatric and mental health research—from basic labs to community-based collaborations, particularly with poor, underserved people—require continuing, planned investment. Because the NIMH/NIH appropriations’ purchasing power has declined dramatically over the last five years, the philanthropic community in the United States and appropriate partnerships with industry are becoming increasingly important if psychiatry is to have a bright future as a branch of clinical neuroscience.

Dr. Sendler
Damian Jacob Markiewicz Sendler
Sendler Damian

Damian Sendler: Schizophrenia’s public image is defined by madness, a split personality, unpredictable and hazardous behavior, and the assumption that schizophrenia is a chronic brain disorder. It contributes to the delay in seeking care, promotes social exclusion and prejudice, and exacerbates feelings of shame about one’s own mental health. Here, the author examines how concepts like “schizophrenia” and the “schizophrenic split personality” (Eugen Bleuler, 1857–1939) came to be, as well as how the “first rank symptoms” (all hallucinations and delusions) came to be associated with “craziness” (Kurt Schneider, 1887–1967). Dementia as a progressive brain disease was defined as a result of Emil Kraepelin’s scientific search for homogeneous groups of patients with a common underlying cause, symptom pattern, and prognosis; Eugen Bleuler’s life and professional circumstances fostered a “empathic” approach to his patients, which prompted him to place in the foreground the incoherence of cognitive and affective functioning, rather than the disease’s course; finally, Kur All three of these diagnostic approaches are combined in a strange conglomerate in modern operational diagnostic criteria, which claims to be Neo-Kraepelinean in terms of defining a categorical disease entity with a suggestion of chronicity, keeps Bleuler’s ambiguous term schizophrenia, and relies heavily on Kurt Schneider’s hallucinations and delusions. The concept of schizophrenia is still arbitrary and has no factual basis, yet it is nonetheless stigmatizing to those who are diagnosed with it.

Damian Jacob Sendler: It was an odd choice of words. It was in 1886, when the young German psychiatrist was just 30 years old, that he was appointed to the chair of psychiatry at the University of Dorpat (then in Russia; today Tartu in Estonia), where most of the population spoke languages he didn’t understand and couldn’t learn quickly, including Estonian. At one point in his memoirs, he says something like this: “The bulk of the average patients spoke and comprehended only Estonian. Most of them couldn’t interact with me without constant translation, and I couldn’t discern even the tiniest differences in pronunciation, idiomatic expressions, or the structure of words and phrases.”

Dr. Sendler: From 1886 until 1891, Kraepelin was a resident in Dorpat, where he worked. In his memoirs, Kraepelin said that he started to pay attention to the history and development of the sickness in Dorpat, and that this led him to the conclusion that “Dementia praecox” was the result of a degenerative process that he subsequently dubbed “Dementia praecox.” 21 At the University of Heidelberg in 1891, Kraepelin began his “Research Programme,” which aimed to provide stable descriptions and classifications of psychoses, that is, the identification of homogenous groups of patients with the same cause, pathophysiology, duration and result as each other. 22 To achieve this goal, he used an extensive “index card” documentation system that contained “condensed information on each patient” that he organized under different aspects, calling the results of this approach later “the victory of scientific observation over philosophical and moral contemplation.” 23 He published the 4th edition of his textbook two years after arriving in Heidelberg,24 where he introduced the concept of “Dementia praecox” as an irreversible, deteriorating, and incurable disease that started early in life and subsumed it under the heading of “Degenerating psychological processes.”.

Damian Sendler

For Kraepelin, “Dementia Praecox” and “Manic-Depressive Insanity” (Manisch-Depressives Irresein) were two distinct conditions, based on the fact that “Manic-Depressive Insanity” had an episodic and remission-based course, while “Dementia Praecox” had a more gradual progression, he wrote in the 6th edition of his textbook published in 1899.25 He created a “firewall” between the two by drawing a line on the sand. According to Kraepelin, the majority of mentally handicapped and semi-handicapped people after dementia praecox “gradually accumulate in the big mental asylums (Heil- und Pflegeanstalten); indeed, these patients, because they do not die quickly and often spend their entire lives in the asylum, constitute the bulk of the insane requiring care.”. 26 Kraepelin eventually acknowledged that dementia praecox may have full remissions, but he refused to change his diagnosis because of this. 15

Later, Kurt Schneider, who had a major impact on the definition of schizophrenia, claimed that Kraepelin’s view of the human being was similar to that of the positivist natural sciences of the 19th century, in which the psychotic person was only seen from the outside looking in.

27 According to a subsequent researcher of Kreapelin’s work, Kraepelin lacked empathy for his patients (while caring for their physical well-being in a compassionate manner). 28

Damian Jacob Markiewicz Sendler: The “chronicity” component is the one for which Kraepelin is most well-known in the context of this work. There is still a perception that schizophrenia has a worse prognosis than depression in the minds of the general public. 29 After the initial publication of Kraepelin’s foundational work, Eugen Bleuler30 and 31 noted that Kraepelin only defined one “end” of schizophrenia’s spectrum: people whose disease didn’t improve and even exhibited a progressive path. As of today, the “chronic group” may account for little more than one-third of all first episode patients, and full recovery is not uncommon. 2, 3, 4, 5, 6, 7 Although the contexts have changed dramatically, it is difficult to come to a definite conclusion because most patients now live outside institutions (hospitalism and “institutionalism” may have played a big role 100 years ago36), the empirical outcome criteria studied are wide-ranging (covering not only symptoms but also functioning and disabilities), and new treatments have been developed.

Kraepelin’s idea of Dementia praecox was rapidly attacked, first for its chronicity requirement, which was thought to be overstated, and, secondly, for abandoning psychopathological theory and offering simply a “unstructured mosaic of symptoms”.

37 Eugen Bleuler, a Swiss psychiatrist only a year younger than Kraepelin, took over the mantle of director of the “Burghölzli,” the city of Zürich’s mental university hospital, in 1898, and remained there until his retirement in 1927, focusing on the issues ignored by Kraepelin.

In 1908, Bleuler coined the term schizophrenia.

30 The extensive book “Dementia praecox oder Gruppe der Schizophrenien” (“Dementia praecox or the group of schizophrenias”)31 was published in 1911. The title was thought out to the nth degree. With the word “or,” it refers to both Bleuler’s and Kraepelin’s alternative ideas as “Dementia praecox.” “Group” and the plural “suggest” that there are several forms of the disorder (especially in regard to age of onset and course), and “schizophrenias” signals Bleuler’s focus on psychopathology, actually “rejecting” Kraepelin’s concept of “dementia precox” and making a complete conceptual U-turn.

Damien Sendler: As compared to Kraepelin, Eugen Bleuler had a very different outlook on life. He saw himself more as a doctor who cares about his patients than as a scientist trying to come up with a technique for diagnosing mental illnesses. As Eugen Bleuler’s successor at the Burghölzli, Daniel Hell38 provides an account of Bleuler’s private and professional life, which sheds light on his specific mindset, he says, “Someone who becomes a doctor… will be able to help the individual patient better than a doctor who is not able to talk with a patient and is more interested in science than in the individual patient.”

Damian Jacob Sendler

The fact that Eugen Bleuler married relatively late (in 1899, at the age of 43, shortly after he had become director of the “Burghölzli” a year earlier) and thus had much time in his early professional years to spend with his patients at the Swiss Hospital Rheinau (where he was director for 12 years from 1986 to 1898) is interestingly stressed. “He lived with his patients, 14 to 16 hours a day and work on Sundays were not rare.” When Bleuler moved in with his family in the director’s apartment, he brought along a mentally ill older sister who had previously resided with him in the family home (in fact, only a few miles away from the Burghölzli facility). When it came to communicating with his patients, Kraepelin was able to do so in the local Swiss language, which is a very peculiar German dialect that is difficult for foreigners to understand (his predecessors in the Burghölzli had similar difficulties with understanding their patients as Kraepelin had in Dorpat). Then there’s his years spent studying psychoanalysis, with Carl Gustav Jung as a mentor and Sigmund Freud as a pen pal.

When you consider all of these factors, it’s easy to see why Bleuler was recognized as an empath and why he paid attention to the finer points of his patients’ psychological functioning. His key pathogenic trait for schizophrenia was the incoherence of cognitive and emotional activities, indicated among others by loosening associations, and the name “schizophrenia” was a shorthand for these subtle psychopathological abnormalities that he characterized. The word “dysphrenia”39 had previously been coined by a few other psychiatrists as a replacement for dementia praecox, as had the phrase “intrapsychic ataxia”40. According to Bleuler, no option is better than his own: the wholly new word schizophrenia, since there is no risk of misinterpretation with that word. Although this was not the case in the long run;

Additionally, Bleuler classified hallucinations and delusions as “accessory symptoms,” which he believed were irrelevant to the diagnosis because they could be present or absent. These “accessory symptoms” were just as important as Bleuler’s focus on incoherent association and affect, which he called “basic symptoms.”.

Bleuler’s primary symptoms, apart from the term “schizophrenia,” have not been adopted permanently in psychiatric categorization systems. The descriptions of symptoms are frequently confused with interpretations, resulting in a lack of clarity, making it impossible to objectively analyze them. 41 Even in the operational DSMIII (1980) and ICD10 (1992), hallucinations and delusions were given top rank for diagnosing schizophrenia, in full opposition to Bleuler’s view that they were just “accessory.”

The name schizophrenia is all that has left from Bleuler in terms of diagnostic methods and popular stereotypes. Disintegration and incoherence of psychological processes are what Bleuler meant when he used “phren” (the Greek term for the mind), and “schizein” (to fall apart, not only divide) to convey this. It wasn’t until a few decades later that the words “conflicting nature” and “contradictoriness” began to be used by the media to describe a “split personality”. 42 As a result, the public perception of patients as unpredictable and hazardous has a significant impact. 43 It seems, however, that this preconception is confined to the more educated members of society. 44 The second conclusion is significant because it shows that people with higher levels of education are more likely to draft and implement rules and policies that discriminate against people with mental illnesses. It’s easy to see how misunderstanding the word “schizophrenia” may be harmful to patients and their families when doctors, who hold such high positions of trust, participate in a study in Austria.12

Even today, psychiatrists face communication challenges when explaining schizophrenia to patients and loved ones, and in some countries, such as Japan, the term has been officially dropped in favor of “Togo Shitcho Sho” (“integration disorder,” which is what Eugen Bleuler intended to convey when he coined the term “schizophrenia”). Japanese psychiatrists boosted the percentage of patients who were informed about their diagnosis from 37 percent to 70 percent within three years of the shift in practice. In terms of the disorder’s renaming, there is a wide range of opinion.

Several decades passed before the next U-turn occurred. In 1911, Eugen Bleuler reduced delusions and hallucinations to “accessory symptoms,” but in 1939, German psychiatrist Kurt Schneider raised them to the top in a booklet for general practitioners (!). 48 Seven sorts of hallucinations and delusions, which he referred to as “First Rank Symptoms,” were mentioned in this section. In addition to audible thoughts, voices disputing and/or debating, voices commenting, somatic passive experiences, thought withdrawal/influenced thinking, thought broadcasting, and deluded perceptions (the eighth symptom, “made volition,” was included in a later publication). When there is no question about their presence and no underlying medical illness can be discovered, we clinically talk in all humility about schizophrenia, according to Kurt Schneider.

However, due to world events like World War II, the book went mostly forgotten. Even after the war, when Kurt Schneider became the head of the University of Heidelberg, his idea to employ particular delusions and hallucinations for diagnosing schizophrenia had little influence. To make up for this lengthy lag time—which we’ll discuss further below—the “First Rank Symptoms” were suddenly well-received by American and international psychiatrists and gained prominence in classification systems 40 years after they were first published in the 1960s and 1970s thanks to several developments in psychopharmacology.

In the early 1930s, Kurt Schneider (1887–1967), a contemporary and admirer of Karl Jaspers (1883–1969), was director of the Clinical Unit of the German Research Institute for Psychiatry (Deutsche Forschungsanstalt für Psychiatrie) in Munich. Schneider’s “General Psychopathology” set a landmark for phenomenological descriptions of abnormal psychological phenomena. While he was more of a clinician than a researcher, publishing was scarce and his primary focus remained on didactics.

He created the above-mentioned pamphlet for general practitioners in 1939 after initially adopting the phrase “First Rank Symptoms” at a conference in Berlin in 1938. “To publish a short and scientifically not particularly highbrow article as a monograph, requires justification,” he writes in the preface. My rationale is that I believe I can accomplish my goal more effectively than by writing it down in a diary. My goal is to aid the doctor in establishing a mental health diagnosis. These recommendations are aimed at psychiatric diagnoses that rely only on psychopathological symptoms, such as schizophrenia and cyclothymia, for the general practitioner to make. Those diagnoses are routinely overlooked by general practitioners, according to my personal experience. I’d want to draw attention to some of the most common blunders that people make while trying to elicit and utilize psychopathological phenomena to make a mental health diagnosis. This book concludes with an effort to develop a rank order of psychopathological symptoms, which may also be of interest to psychiatrists.”.

Since “First Rank Symptoms” became an international phenomenon, “which might also be of interest to psychiatrists” is particularly noteworthy. In his own way, Kurt Schneider was a modest guy. As his book “Clinical psychopathology” (including the “First Rank Symptoms”) was released in 1950, he wrote to a colleague: “In truth, I do not trust longer in the accuracy of what I am teaching. I’m definitely at the stage that Jaspers refers to as “failure” now. 51 Later, he wrote to Karl Jaspers, “psychopathology plays only an insignificant role in today’s society, and in some hospitals no role at all” in response. 52

However, Kurt Schneider dissented from Eugen Bleuler by focusing on delusions and hallucinations and not discussing “basic symptoms” at all, but he followed him and differed with Emil Kraepelin by not providing any criteria for the length of schizophrenia. As a result, he did not believe in the existence of mental illness entities as Kraepelin had done, and urged to “free psychiatry from the slavery of neurology”—all in direct contrast to Kraepelin’s inclusion of “First rank symptoms” in the “Neo-Kraepelinean” DSM-III criteria.

In order to identify “practical types” of human responses, Kurt Schneider was a psychopathologist and a phenomenologist who focused on the patient’s inner psychological experiences. Patients who describe their hallucinations and delusions to their family doctors or other non-psychiatric health care providers may help general practitioners who lack specialized training and clinical expertise recognize schizophrenia. Jaspers had previously been critical of him in a letter dated 1923: “Methodological subtleties aren’t enough, one also has to show that it’s useful for something” (all quotes above are from52). This assessment is solely relevant to the diagnosis.” It says nothing about Bleuler’s “basic symptoms” and “accessory symptoms” concepts of schizophrenia… Other first-rank schizophrenia symptoms may also be recognized. But we limit ourselves to those that can be recognized without trouble” 53, p. 129). Validity is overshadowed by dependability! Those who have followed the evolution of operational diagnostic criteria from the 1980s and beyond must hear something.

DSM and ICD categorization systems have morphed schizophrenia into an atheoretical conglomeration of definitional pieces from previous descriptions that had never been conceived of as fitting together. According to Kurt Schneider’s critique of Kraepelin as a 19th century positivist natural scientist27, Eugen Bleuler’s accessory symptoms were raised to “first rank” symptoms following Kraepelin’s U-turn.

It should be noted from an anti-stigma perspective that “craziness symptoms” are prominent today in the symptom pattern of schizophrenia in operational diagnostic systems (although less so in more recent editions, where other symptoms, such as inactivity and thought disorde, are more prominent).22, 74

It is becoming more common to see dozens of individuals throughout the globe diagnosed with schizophrenia each year, but they want to conceal it from the public in order to escape the severe implications of a scientifically unfounded illness diagnosis. This is not to say that people do not experience one or more of the psychopathological phenomena or criteria included in the operational definition of schizophrenia at some point in their lives, sometimes for a brief period and other times for a prolonged period………………………………………….. Psychopathological events have led to the construction of the category illness entity “schizophrenia,” and the effects of this name on people’s lives are the issue.

People may quickly access information on these criteria because to millions of copies of various DSM editions that have been marketed to the general audience. According to “Schizophrenia DSM5 Definition—Schizophrenia is a severe and chronic mental disorder characterized by disturbances in thought, perception, and behavior”76, some websites do warn against “myths about schizophrenia,” while others propagate them. Some attempts are being made today to battle the stereotype, such as battling the notion of chronicity with recovery,77 education and renaming of the disorder45,77 the split personality idea with renaming and education and the implications of hallucinations and delusions with behavioral therapies. 80 and 81, respectively There is a strong sense that the categorical disease concepts of mental disorders are embedded in a hermetic professional system and the term schizophrenia will continue to be used without questioning it—in textbooks for educating medical students, in clinical guidelines for practitioners, in research (despite the fact that diagnostic algorithms produce heterogeneous groups of patients), in hospital payment systems (despite the diagn). Psychiatrists may utilize a variety of techniques instead of the illness entity “schizophrenia,” such as the multidimensional and person-centered approaches, or the usage of a vulnerability stress coping model. Given the medical nature of psychiatry and the uncertain future of the profession, it is not clear whether these practices can be embraced in a systematic way.

Damian Jacob Markiewicz Sendler

Dr. Sendler

Damien Sendler

Sendler Damian

Damian Sendler: Neuropsychiatric symptoms after COVID-19 have not been demonstrated. Systematically measuring the incidence of neuropsychiatric symptoms in COVID-19 survivors helped improve mental health care planning throughout the recovery phase of the pandemic. We searched MEDLINE, EMBASE, CINAHL, and PsycINFO up to 20 February 2021, as well as our own curated database, for this pre-registered systematic review and meta-analysis (PROSPERO ID CRD42021239750).

Damian Jacob Sendler: Post-acute or later time points following infection with COVID-19 and control groups when available were taken into consideration in our peer-reviewed research reporting neuropsychiatric signs and symptoms. A minimum of two writers extracted the summary data for every research they worked on together. We used generalized linear mixed models to estimate the prevalence of each symptom. I2 was used to gauge heterogeneity. For COVID-19 hospitalization, severity, and follow-up length, subgroup analyses were undertaken. A total of 51 studies (n = 18,917 patients) were selected from a total of 2844 distinct titles. After COVID-19, the average follow-up period was 77 days (ranging from 14 to 182 days). Quality of the studies was generally mediocre. Sleep disruption was the most common neuropsychiatric symptom, followed by exhaustion, objective cognitive impairment, anxiety, and post-traumatic stress disorder. Only two studies documented symptoms in control groups, and both found that COVID-19 survivors had a greater frequency of symptoms than controls. This research has a significant degree of inter-study variability (I2 = 79%–98.6 %). There was no indication of a difference in symptom prevalence depending on hospitalization status, severity, or follow-up period.. After a COVID-19 recovery, it is not uncommon to have neuropsychiatric effects that continue for months or years. In the first six months following infection, sleeplessness, lethargy, cognitive impairment, and anxiety problems are most common, according to the research on the long-term effects of infection.

There were several neuropsychiatric symptoms associated with outbreaks of COVID-19 in the early stages of the pandemic.

Dr. Sendler: More recently, researchers have established that SARS-CoV-2 causes a wide range of neuropsychiatric symptoms, including exhaustion and headache, which were among the most frequently investigated in the early literature.

The frequency of depression, anxiety, and post-traumatic stress disorder in acute COVID-19 patients was shown to be higher than expected in several studies.3 Even after an infection had subsided, it was unclear how long neuropsychiatric symptoms would continue to exist.

Damian Sendler

Chronic symptoms after a COVID-19 sickness have been referred to as “Long COVID” in the medical community.

Between three and a half and a year after infection, Long COVID has been suggested to begin to appear.

8 Between 4 and 12 weeks following infection with COVID-19, symptoms are called ‘ongoing symptomatic COVID-19’ and ‘post-COVID-19 syndrome’, respectively, by the National Institute for Health and Clinical Excellence (NICE). Recurrent symptoms after COVID-19 are regarded to be multi-systemic in nature, with most likely numerous separate pathogenic processes at play. 9 10–12 The absence of systematized explanations of the many components of the disease and the early stage of our understanding regarding residual symptoms following COVID-19 are both reflected in these definitional, vocabulary, and mechanistic issues.

COVID-19 infection is associated with a significant rate of neuropsychiatric symptoms, according to recent research. Newly diagnosed mood or anxiety disorders, as well as dementia, are on the rise, according to these studies, as are symptoms of exhaustion, cognitive failure, and sleep difficulties. 13–15 We don’t know whether or how the severity of the original sickness or the length of time since COVID-19 affects these neuropsychiatric side effects. To get a clear picture of how widespread the effects of COVID-19 are, and to guarantee that those who have survived them have access to adequate medical care, we need to have these questions answered. 8,16,17 In the past, these consequences may have been overlooked because of the tremendous expansion in research. 19

Damian Jacob Markiewicz Sendler: In order to better understand the long-term effects of infection and to aid in service planning, we set out to find out how common persistent neuropsychiatric symptoms were among COVID-19 survivors. Secondary analyses were used to look for factors that might predict the prevalence of symptoms. COVID-19 survivors with a more severe disease (i.e., those who needed hospitalization or intensive care) were expected to have lasting neuropsychiatric symptoms, which would decrease in frequency as time went on.

Searched the Ovid MEDLINE® and Epub Ahead of Print, In-Process, and Other Non-Indexed Citations and Daily, EMBASE (through Ovid), APA PsycInfo (via Ovid), and CINAHL (via EBSCO) from January 1, 2020, through February 20, 2021, for articles that were relevant to our research. An existing librarian-designed search technique for post-acute, chronic or long-term COVID has been adopted for use in this study 21 Due to this, we did not include any neuropsychiatric keywords in our search method (Supplementary Methods). On top of that, we looked through the reference lists of relevant systematic reviews that were published at the time of our initial search in our weekly curated database of COVID-19 neurology and neuropsychiatry research22. 18,19

Adults (18 years and older) having a history of polymerase chain reaction (PCR)-confirmed or clinically suspected SARS-CoV-2 infection were included in our review. Our definition of ‘persistence’ differed across hospitalized and non-hospitalized populations. Patients who have been released from the hospital are regarded to have persistent symptoms since they are no longer in the acute phase of their disease. We defined persistent symptoms as those that lasted at least four weeks from the beginning of symptoms or a positive PCR test in community-based samples without a discharge date.

It was decided that we would use the term “neuropsychiatric” symptoms, as defined by patient-led research.

15 The following symptoms were investigated: affective symptoms (such as anxiety and panic attacks, depression, and manic episodes); hallucinations; sleep disturbances; objectively reported cognitive impairment (i.e., through standardized cognitive tests); subjectively reported cognitive impairment (such as patient reports of “brain fog” or other lay terms); sensorimotor symptoms (such as paraesthesia, numbness, or weakness in specific body parts); dizziness and vertigo; headache; shifts in sp PTSD/PTSS symptoms, which are often reported following COVID-19, were added to the list of possible side effects of long-term COVID treatment.

Damian Jacob Sendler

Major and secondary data extraction was our primary goal. There are many studies that give data on the general public as well as data on specific demographic subgroups, thus we extract each group (the general public, Subgroup 1, Subgroup 2, etc.) individually and enter it into our database. Only data from the whole population of each trial were included in the principal analyses. For a subgroup analysis, we took the conservative position that studies had to report extractable data on a completely homogeneous subgroup. For example, we would not label studies reporting a combined 95 percent community and 5 percent hospitalized patients as “community” samples; rather, such studies would be excluded from the ‘hospital vs. community’ secondary analysis. We only considered the longest follow-up time-point in studies that provided data from multiple time-points. Requests for clarification were made in cases where the data did not fit with our objectives.
Every neuropsychiatric symptom reported in three or more studies was analyzed in the main analysis. For each prevalence outcome, we calculated generalized linear mixed models using the metafor package23 in R version 4.0.2 before utilizing the inverse variance approach with the Freeman–Tukey double arcsine transformation to do a comparative analysis of the data. 26 Inter-study heterogeneity was evaluated using an I2 statistic. Forest plots with 95% confidence intervals were used as a means of interpreting the data (CIs).

Damien Sendler: Cognitive impairment was found in almost one-fifth of the studies that met the inclusion criteria. Cognitive impairment was subdivided into “objective” and “subjective” dysfunctions once the study was completed. As demonstrated by a cognitive assessment screening instrument, we identified objective cognitive impairment (e.g. Mini-Mental State Examination, Montreal Cognitive Assessment or similar). A patient’s self-report of memory issues, “brain fog,” or other subjective cognitive impairment was categorized as objective. More than one kind of cognitive dysfunction (for example, “memory problem” and “concentration disorder”) has been described in certain research, thus we included just the most common type of cognitive dysfunction.

After-the-fact examinations
Initially, we planned to conduct secondary analyses comparing the prevalence of neuropsychiatric symptom prevalence between COVID-19 patients and control groups, COVID-19 patients whose diagnosis was PCR-confirmed and those in whom it was not, COVID-19 patients who were hospitalized and those who were not, and different time points following a positive test for SARS-CoV-2 (specifying 12 weeks versus 12 or more weeks to align with a key time-point in NICE guidance for post-COVID-CoV-2 diagnosis).
9 A lack of studies with control groups or non-PCR-confirmed cases meant that I and (ii) couldn’t be done, and the phrasing of (iv) was excessively limited (excluding, for instance, the many studies measuring the duration of symptoms from the date of hospital discharge, rather than from the date of a positive test).

To take into account the rest of the research, we performed two additional post hoc quantitative secondary analyses. The first of them was an assessment of the severity of the condition. As a result of our research, we discovered that some studies compared ICU admission to non-ICU admission while others utilized the WHO severity scale. 28 The following is how we organized the research: WHO “critical” or “severe” COVID-19 was recorded in patients admitted to the intensive care unit (ICU), as opposed to hospitalized patients who were considered not to be in the ICU. When looking at the second analysis, we widened the scope of the term “duration” to encompass all of the 19 studies that focused on discharge (ie, those that were less than 12 weeks in length). For this reason, we did not merge studies that used the date of PCR testing with those using the date of hospital discharge since COVID-19 hospital admissions were so variable. It’s possible that the commencement of symptoms may have occurred at the same time as PCR testing, however we decided to combine these investigations after the fact. Scatterplots of reported symptom prevalence versus time (each for dichotomized 12/12+ weeks, mean duration and median duration for all symptoms) were examined in a post hoc qualitative analysis.

Neuropsychiatric problems after COVID-19 are widespread and persistent, according to this comprehensive review and meta-analysis. One in four individuals may be affected by sleep difficulties and exhaustion, which seem to be particularly common. Cognitive impairment is often detected and anxiety and post-traumatic stress disorder symptoms appear to be especially widespread. Symptoms such as dizziness and vertigo are less prevalent yet occur in a significant number of individuals. There seems to be no variation in the occurrence of these symptoms at various stages in the first six months, regardless of the severity of COVID-19. Patients who did not need hospitalization, ethnicity, and the course and frequency of symptoms in the long run are unknown implications of COVID-19.

It’s important to proceed with caution while analyzing these results. The NICE guideline recommends that post-acute symptoms should last no more than 12 weeks. Three of the five trials in our analysis met this requirement. 9 COVID-19 severity was shown to have a significant influence on the number of eligible community-based or ICU-admitted samples reporting our outcomes of interest. The term “Long COVID” may be better reserved for patients who were not hospitalized if data comparing hospitalized and non-hospitalized patients shows substantial clinical differences, or a subspecifier may be appropriate to indicate the severity of early respiratory and/or other symptoms. In this analysis, just 15.7 percent of patients were verified to be non-hospitalized, which reflects the early research concentration on hospitalized patients. However, a recent big study conducted by patients themselves found that non-hospitalized patients made up the vast majority (91.6 percent). Patient viewpoints on nomenclature for this patient-driven illness are equally important to doctors and researchers, according to our perspective. 15

Structured clinical evaluations were seldom used in the majority of investigations, instead relying on patient self-reports to describe results. In the meanwhile, the particular contribution of COVID-19 to these neuropsychiatric symptoms remains uncertain due to the absence of active control groups. Some of these symptoms could be normal throughout the healing process after a major viral disease such as the common cold. Neuropsychiatric symptoms were not described in terms of how many of them were new or relapses. We didn’t collect data on comorbidities to see whether particular preexisting diseases could render patients more prone to symptom recurrences. We also did not explicitly evaluate the eligibility of 15 research for which an English-language paper was not accessible.

However, our pooled findings suggest that COVID-19 survivors in the post-acute phase often suffer from neuropsychiatric morbidity. Recent research shows that COVID-19 is linked to a higher risk in the first six months of neuropsychiatric clinical diagnoses, such as insomnia, mood or anxiety disorders first-onset and dementia. 14 Other respiratory tract infections were not associated with an increased risk of such disorders, but the results of this research suggest at least portion of this apparent neuropsychiatric burden may be COVID-19-specific. It is noteworthy that the trend of new psychiatric diagnoses was only slightly flattened in the first 6 months, confirming the concept that neuropsychiatric symptoms remain in this period. According to the patient-led survey15, we found that tiredness, cognitive impairment, and other neuropsychiatric symptoms (e.g. dizziness) were widespread in 3762 mostly non-hospitalized COVID-19 patients. In this meta-analysis, the study population’s data would be ineligible to contribute to generalizable estimates of community prevalence because they were recruited primarily through Long COVID support groups and similar organizations; a characteristic that illustrates the difficulty of finding generalizable community-based samples. 79

It’s not clear how much of an influence neuropsychiatric symptoms have on clinical services, but Long COVID services’ proactive approach to identifying cases and providing treatment sounds like a good idea. This does not rule out a combination of pharmacological and rehabilitative treatments (e.g. physical and/or occupational therapy) for the most common symptoms (in decreasing order of frequency): insomnia, fatigue, cognitive impairment (e.g. Alzheimer’s), anxiety, post-traumatic stress disorder (PTSD). 80–84 There may be some instances where the symptoms that persist after COVID-19 may be linked to initial direct tissue damage mechanisms (such as inflammation) that overlap with other or additional mechanisms (such as cognitive) as seen in other complex disorders arising after an illness like chronic pain. Multidisciplinary techniques are typically suited for such disorders85 and include combinations of physiotherapy and occupational therapy as well as psychiatric care and psychological interventions. Planning for ‘Long COVID’ services should integrate such strategies.

In light of our findings, we have identified topics for additional investigation. To distinguish between the neuropsychiatric effects of viral infection in general and those that may be unique to COVID-19, further controlled investigations are needed. It’s yet unclear how ethnicity and the COVID-19 severity interact. In order to collect representative samples from the population, traditional epidemiological methods may be necessary, and long-term follow-up is needed. Chronic neuropsychiatric symptoms in individuals with COVID-19.86 are to be studied in prospective, long-term and multicenter research. Other medications that have been shown useful in the treatment of neuropsychiatric symptoms may also be examined in future studies.

After a COVID-19 recovery, it is not uncommon to have neuropsychiatric effects that continue for months or years. About a quarter of those who have survived the ordeal have reported having difficulty sleeping or feeling fatigued. Also prevalent in the first six months after recovery are cognitive impairment, anxiety, post-traumatic symptoms, and sadness There is currently no indication that these symptoms are related to the severity of the first illness or the time since the initial infection. More study is required, but these early signs imply that COVID-19 survivors have a significant burden of neuropsychiatric disorders. It is imperative that multidisciplinary services be adequately funded in the post-COVID period.

Damian Jacob Markiewicz Sendler

Dr. Sendler

Damien Sendler

Sendler Damian

Damian Sendler: The NM department followed the same broad criteria as the rest of the hospital. In addition to this, the administration and the institution’s quality assurance department approved the implementation of additional SOPs. Prior to NM operations, patients were questioned about any recent overseas travel, any symptoms of COVID-19, and any previous interaction with another patient with COVID-19 that they may have had. All Indian residents’ cellphones were equipped with an app called “Arogya Setu,” which was used to classify patients’ risk.

Damian Jacob Sendler: Touch tracing is used by the app to keep track of all the persons with whom he has had contact while going about his daily routine. To follow up on the initial NM department screening, if any of these patients subsequently turn out to be infected with COVID-19, they will be instantly alerted, and their risk stratification will be shown on their downloaded mobile application. Intermediate-risk individuals had their scan appointments delayed while the infectious disease team conducted RT-PCR testing on those who were considered high-risk.

Dr. Sendler: Patients with lung or oral cancer, as well as those who had had chemotherapy, were difficult to categorize. In addition, several individuals developed COVID-19 positive at various times after the NM treatment was done. According to how long it had been since the facility was sterilized, contact tracing was performed. We divided our staff into two NM teams, each comprised of 50% of our employees, and assigned them to alternate days of work on-site. Half of the hospital’s doctors, technicians, nurses, and other support workers were on the team. The “as low as reasonably practicable” radiation protection concept was adopted by us.

Damian Sendler

Reception and any areas where physical contact with patients or caregivers, as well as visual access to the patient’s other pertinent reports, was permitted were protected by a Perspex barrier. There were no known COVID-19-positive patients in the NM department that were scanned or treated. For individuals who had been previously infected, a negative RT-PCR result was required. After many months of government-imposed lockdown and mobility restrictions, and our stringent screening and testing standards, the number of NM procedures has significantly decreased. As seen in (Fig. 2c) Due to the restriction on commercial foreign flights in the country, the amount of radionuclide treatment was significantly reduced.

The government of India has taken a proactive approach to vaccination, which was adopted in a staged way for diverse sections of residents. On January 16, 2021, the nationwide immunization campaign got underway without a hitch. As a result of this, there were shortages of vaccinations in India, as well as hospital beds and oxygen tanks in certain sections of the country. 1

Damian Jacob Markiewicz Sendler: In March 2020, the first case of COVID-19 was discovered in Jordan. King Hussein Cancer Center (KHCC), Jordan’s premier tertiary cancer treatment facility, immediately introduced umbrella measures aimed at reducing viral transmission and infection risk for patients, employees, and family members. Suspected patients were given their own floor in the Nizar Naqeeb building of KHCC, and a new triage room was built in the emergency unit. Refill drugs are now being delivered to patients’ homes, and hospital visits are now restricted to between 4 and 7 p.m. Grand rounds and instructional seminars were conducted remotely to keep employees from traveling. Patients and partners were required to wear masks in September, and both were checked for COVID-19 before to admission. It was easy for all employees to take COVID-19 exam. All personnel were urged to sign up for immunization, and the medical staff was prioritized when the vaccinations were available in Jordan in 2021.

Damian Jacob Sendler

It was imperative that the NM department adhere to the KHCC umbrella processes while also implementing safeguards unique to the NM procedures. Routine elective appointments have been rescheduled and priority procedures are still being performed. On the ground frontline teams and a backup support work-from-home team were created thanks to virtual private networking access granted to NM workers. To keep track of each patient’s condition the day before their NM procedure, a checklist was put in place, and an NM nurse entered a record in the hospital’s computer system to reflect this. Everyone in the department was required to wear surgical masks, gloves, and closed lab coats as a form of personal protection. Patients suspected or confirmed of having COVID-19 were given the full range of protective gear suggested by the infection control program.

Damien Sendler: Continuous monitoring of protective gear compliance was used to accomplish this proposal. Hand sterility and equipment sterility were also meticulously enforced before and after each treatment. Unless the patient’s personal presence was required, the NM therapeutic clinic was done online. Social distancing and psychological assistance for the personnel were also introduced in all forms. Even when the pandemic situation stabilized and lockdowns began to lift in Jordan in the second half of 2020, these severe safeguards were gradually reduced to a more moderate degree. New Mexico’s health agency and KHCC were aware that these procedures needed to be constantly updated as the pandemic scenario changed.

When the pandemic began, there was a significant drop in NM procedures performed in Jordan in 2020 compared to the previous year, and this drop was exacerbated by the national lockdown, public anxiety, interruptions in radiopharmaceutical supply, and uncertainty among healthcare providers about the best health care approach during a pandemic. As more doctors and nurses learned about the disease and their own personal experiences working in the midst of a pandemic, these fears began to fade. In addition, because the majority of the NM staff has either been vaccinated or has developed immunity to the disease after becoming infected, they are now more at ease working under these conditions. In 2021, the number of NM procedures in the department dramatically increased compared to the same time in 2020, despite the massive jump in the burden of COVID-19 in the nation, compared to the previous year when just a few COVID-19 cases were reported in Jordan.

Since the start of the COVID-19 epidemic, the practice of NM throughout Asia has been profoundly impacted. Imaging investigations and treatments were hampered by the outage. Mo-99/Tc-99m generator shortages impacted 60 percent of NM facilities in Asia, but 80 percent in India and Pakistan. There was a shortage of I-131 in 55% of the Asian nuclear medicine centers (NMCs). Lockdowns, border closures, and aircraft cancellations all contributed to the supply chain breakdown. Asia was hit worse than Europe, Oceania, or the United States. While the number of NM operations was reduced the least in South Korea and Singapore. 5 and 6

The NM communities across Asia have taken an active role in finding solutions to these issues. An expert agreement was formed on the safe management of NM diagnosis and treatment during the COVID-19 epidemic by the Chinese Society of Nuclear Medicine and its editorial board, after the initial case in Wuhan, China, was confirmed as one of the first cases of COVID-19. As soon as it was published in the journal on February 24, 20208, it was translated into English and published in the European Journal of Nuclear Medicine and Molecular Imaging shortly afterwards. 9 The ARCCNM and the Philippine Society of Nuclear Medicine sponsored a joint meeting in Manila, Philippines, in early February 2020. Exams were held simultaneously by the ANMB. The ANMB committee sponsored an online lecture series, and members of the organization communicated with one another through social media and email. ARCCNM collaborated with the regional office of the Regional Cooperation Agreement to develop eLearning programs (RCARO). Freely accessible on the RCARO website,10 they cover a wide range of neurological conditions, including as brain tumors, cerebral ischemia, epilepsy, Alzheimer’s and movement problems. Cardiopulmonary diseases include stable angina, cardiomyopathy and pulmonary embolism; Oncology diseases include head, neck cancer, esophageal cancer, lung cancer, breast cancer, colorectal cancer, lymphoma, gynecologic cancer, prostate cancer and neuroblastoma; Malignant and inflammatory bone diseases include osteoporosis and osteoarthritis. There were also eLearning lessons on how to report bone scans, kidney scans, and cardiac perfusion imaging provided. PET/CT instrumentation, picture artifacts, quality control, dosimetry, and cyclotron radiochemistry were covered in the physics and chemistry courses.

Pandemic conditions such as COVID-19 are becoming the new normal. COVID-19 has prompted governments throughout the globe to develop a wide range of methods to restrict and mitigate its spread. These measures have variable degrees of effectiveness in different nations and communities, depending on their socioeconomic and political situation. There is been discussion among international authorities, including IAEA officials, of returning to “business as usual” in NM. Online polls clearly indicated that both the practice of NM and the availability of RI in Asia were on the upswing in the region. This uncertainty was reduced when NM practitioners gained more knowledge about COVID-19 and rationalized it via practical experience.

There are a few drawbacks to this review article. Firstly, we were unable to include all Asian institutions and nations. As far as we knew, no one in Central Asia used NM. There is little doubt that the situation varies greatly across nations and areas. Second, our data does not accurately portray the problem. However, we may be able to demonstrate a shift in NM use in Asia.

As a result, several NM departments in Asia are reverting to their pre-COVID-19 methods, despite limits and challenges.

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

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Damian Sendler: Space exploration is set to begin in 2022 with some of the most fascinating missions. A new mission to investigate an unknown planet will start this year, and a NASA spacecraft will crash into the moon of an asteroid with the intention of taking pictures and doing research experiments. In 2021, there will be a slew of new discoveries from all throughout the solar system, thanks to a slew of new space missions.

Damian Jacob Sendler: Robotic exploration of the moon is being planned for 2022, while governments are preparing for the eventual return of people to the lunar surface. There were three independent expeditions to Mars in 2021, and the curiosity in the fourth planet from the sun is only growing.

As NASA’s Ingenuity helicopter continues to fly far past its planned lifespan, be ready for fresh and fascinating flights. The Perseverance rover will begin exploring the interesting remnants of an ancient river delta on Mars this summer. There may be organic compounds or perhaps microfossils on Mars, which might be discovered via samples obtained there.

In addition, another robotic explorer will land on the red planet’s surface. The first planetary rover built by the European Space Agency (ESA) is now ready for flight.

Damian Sendler

After a cooperative effort by the European Space Agency and the Russian space agency Roscosmos, ExoMars Rosalind Franklin is scheduled to launch in September. Concerns concerning coronavirus and the readiness of spacecraft components prompted the authorities to delay the launch.

The ExoMars rover will arrive on Mars on June 10, 2023, after a nine-month journey from Baikonur, Kazakhstan, in September. Oxia Planum, a region slightly north of the Martian equator, will be the site of the rover’s landing. Approximately 4 billion years ago, layers of clay-rich minerals accumulated in Oxia Planum due to the region’s moist climate.

The goal of the project is to discover whether there is life on Mars and to learn more about its water history. 6.5 feet (2 meters) into the surface of Mars, where the scientists expect to uncover evidence of past life, the rover has the potential to dig.

Expect more breathtaking photographs from NASA’s Juno spacecraft, which has been circling the planet Jupiter since 2016. For the remainder of its mission, the probe will continue to study Jupiter’s 79 moons. In September, it will pass quite near to one of its most intriguing moons, Europa.

Scientists are intrigued by Europa because it has a vast ocean under its icy cover, which may be home to life. In rare occasions, the ice caves in and a plume erupts into space. It is possible for Juno to see these plumes in action.

First scientific data from the James Webb Space Telescope will be available in June and July. Aiming to view farther into the cosmos than ever before, the telescope will peek into the atmospheres of exoplanets.

At the end of this month, NASA plans to launch the Psyche spacecraft, which will spend the next four years exploring the main asteroid belt between Mars and Jupiter. Metal-rich asteroid will be studied by the expedition, which will only be visible to telescopes on the ground and in orbit.

According to NASA, the strange item may be a remnant of a planet’s metal core or a chunk of primordial material that never melted. Researchers hope that Psyche may provide light on the early stages of the solar system’s development via its presence in their telescopes.

Damian Jacob Sendler

NASA plans to intentionally crash the DART spacecraft into the moon of an asteroid in September in order to modify the trajectory of a near-Earth asteroid.

Damian Jacob Markiewicz Sendler: As part of the Double Asteroid Redirection Test, the tiny moon Dimorphos will be targeted. A full-scale demonstration of this sort of technology for planetary defense will be conducted by the agency. No harm will come to Earth from these two asteroid-moon pairs; nonetheless, they may be used to test out asteroid deflection technologies.

LICIACube, or Light Italian Cubesat for Imaging of Asteroids, an Italian Space Agency-provided cube satellite, will capture images of the impact. Approximately three minutes after it makes contact with Dimorphos, the CubeSat will fly past and begin collecting data.

Elena Adams, a DART mission systems engineer at the Johns Hopkins Applied Physics Laboratory, expects the footage of the impact to be “very spectacular.”

Robots will be sent to the moon by 2022, according to current plans.

The Chandrayaan-3 spacecraft, developed by the Indian Space Research Organisation, will make a lunar landing in 2022.

In October 2008, India’s first unmanned lunar probe, Chandrayaan, went into orbit. According to NASA, the orbiter was instrumental in discovering water molecules on the moon. Even though the spacecraft went dark in 2009, NASA was able to track its whereabouts as recently as 2017.

After losing touch with Chandrayaan-2, the Indian Space Research Organization (ISRO) attempted to land it near the lunar south pole in 2019. The crash location and debris field were discovered by NASA afterwards.

A communications relay for the Chandrayaan-3 mission will be provided by that project’s orbiter, which is still in orbit around the moon. There will be a lunar lander and rover identical to Chandrayaan-2’s on board this mission.

The Smart Lander for Investigating Moon (SLIM) mission will be launched by the Japan Aerospace Exploration Agency in 2022.

An important building block for future lunar exploration missions, the tiny spacecraft will serve as a demonstration of precise landing procedures on the moon, according to NASA. It will also bring back a piece of the Moon to our planet.

Luna-25, Russia’s first lunar mission since 1976, is still on track for 2022, with a target date of 2022. At the Boguslavsky crater on the moon’s south pole, it will be equipped with research equipment and cameras to study the lunar environment.
Human spaceflight preparations

Until 2022, NASA and Roscosmos personnel will continue to return and depart from the International Space Station, while China completes its own space station. In November, the European Space Agency will also reveal its next group of astronauts.
Unmanned Gaganyaan missions are being launched by the Indian Space Research Organisation this year in order to assess the vehicle’s capabilities in advance of the country’s maiden astronaut launch in 2023.

In the meanwhile, NASA’s Artemis program, which is projected to place the first woman and the first person of color on the moon in 2025, will be put to the test in 2022.

“Wet Dress Rehearsal,” as it is known, is a last test that simulates a real launch, including a countdown to liftoff and loading of propellant into the fuel tanks, but without actually going up in flames atop the rocket.

Artemis I, the first unmanned mission in the ambitious program, is expected to launch in March or April.

Damien Sendler: The Orion spacecraft will be launched from the SLS rocket and travel hundreds of miles beyond the moon during the journey. This is the first time that a human-carrying spacecraft has ever flown this far. Orion will splash down in the Pacific Ocean at the conclusion of this mission, which is planned to span a few weeks.

The Quadrantid meteor shower, which will peak between Sunday night and Monday morning, will usher in the new year.

The Quadrantids are one of the most powerful meteor showers of the year, on average. Because the moon is almost completely obscured by a waxing crescent, meteors may be seen at their height.

Because of its brief peak of about six hours, the shower is famously hard to witness in early January. According to the American Meteor Society, it will be best visible in the Northern Hemisphere between Sunday night and Monday morning.
peak that is brief yet strong

For Eastern Asia, the International Meteor Organization has predicted that the peak will come at 20:40 UTC on January 3, which will be best seen. According to the American Meteor Society, higher-latitude Europeans will experience some meteor activity as well.

Because the radiant point of the shower does not reach very high in the Southern Hemisphere’s sky before sunrise, the Quadrantids are seldom observed there.

Take a look at Time and Date to see what your possibilities are or go outdoors and see it for yourself. The shower over Rome will also be streamed live by the Virtual Telescope Project.

It is common to see between 50 and 100 meteors per hour in rural locations, although the peak might reach 120 visible meteors in an hour. Keep an eye on the northeastern sky, and aim your gaze approximately halfway up the horizon there. Meteor shower viewers may get a glimpse of some fiery objects. The American Meteor Society recommends keeping an eye on the sky for at least one hour.

If the name of the meteor shower seems strange, it is probably because it does not sound like it is tied to a constellation, like other meteor showers. This is due to the fact that the constellation that gave its name to the Quadrantids no longer exists, at least not as a recognized one.

An asteroid or “rock comet” rather than an ice comet is the source of the Quadrantid meteor shower, unlike the Geminids. It takes 5.52 years for this asteroid to complete one orbit of the sun.
When just a tiny stream of particles interacts with our atmosphere and the stream happens at a perpendicular angle, the shower’s peak is quite brief. This debris trail is only present for a brief period of time each year when Earth travels through it.

Consider driving to a region that is not overshadowed by lights from the city, so you can get a clearer view of the night sky. If you can locate a place that is not impacted by light pollution, you may be able to see meteors every few minutes from dusk until morning.

Do not forget to wrap up warmly in a location with a clear view of the sky. Make sure you have a comfortable place to sit or a blanket to lie on so you can see well. It is also a good rule of thumb not to glance at your phone for at least 20 to 30 minutes, so your eyes can acclimate to the darkness.

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

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Damian Sendler: An ancient South American tribe may have been able to preserve its political power for hundreds of years by drinking beer laced with hallucinogenic plant seeds, according to new study. The Wari, who dominated the highlands of what is now Peru from 600 to 1,000 AD, preceded the Incas. During the 2013-2017 period, archaeologists excavated the Quilcapampa site in southern Peru, where they discovered that the Wari people drank chicha, or beer brewed from the molle tree, together with vilca seeds. Wari political power was maintained by serving this drink to visitors at community feasts and cementing existing connections. 

Damian Jacob Sendler: First evidence of vilca seeds found at a Wari site was published in the journal Antiquity on Tuesday. The finding of vilca at Quilcapampa fills a gap in our knowledge of how drugs were utilized by various cultures. Visiting associate professor of archaeology at Dickinson College in Pennsylvania, study author Matthew Biwer, stated, “This was a turning moment in the Andes in terms of politics and usage of hallucinogens.” 

Unlike previous civilizations, which seemed to restrict hallucinogen usage to a small group, the Inca Empire promoted broad beer drinking while abstaining from the use of psychoactive compounds such as vilca during feasts. 

It is not yet clear what caused the fall of the Wari Empire, but the study of Wari sites is helping researchers learn more about its inhabitants. 

According to Biwer, the Wari Empire “spanned from northern Peru to southern Peru, and from the coast to the mountains of the Andes,” he said. In South America, it was the first empire to fall 400 years before the establishment of the Inca Empire. 

In addition to beer and feasting, new study shows that the Wari also had access to and employed vilca, a hallucinogen, as part of their political control tactics. 

The scientists also found evidence that the Wari were making a lot of chicha. Ceramics found at the site’s center, together with the well-preserved floral remnants, suggest that this was the location of the feasts, according to the study’s authors. 

Damian Sendler

According to Biwer, “the Wari added vilca to the chicha beer to impress visitors to their feasts who could not return the experience.” As a result, Wari hosts and visitors, most likely from the local area, formed an indebted connection. 

A common belief among historians is that social bonds forged over vilca, beer, and feasting remained strong even as the Empire grew. Wari chiefs used it as a tool to display and retain their socioeconomic and political dominance.” 

They would have felt obliged to recognize the authority of their hosts or to ask for their favors in the future at these banquets, the speaker said. 

Beverage from Quilcapampa was presumably served in face-necked containers. According to the researchers, the jars were occasionally purposefully destroyed with a chest strike. 

Beer (chicha), llama meat, and other vegetables, such as maize and potatoes, are some of the meals and drinks often consumed in the Andes, according to Biwer. 

An ancient pipe from the Inca Cueva site in Argentina shows that the usage of vilca, often ingested like snuff or via a pipe, goes back at least 4,000 years. The Wari ruled Tiwanaku, a nearby Bolivian city, around the period of the drug’s usage. 

According to previous research, the drug vilca was only accessible to a select group of people, such as priests. 

Damian Jacob Markiewicz Sendler: To further enhance the mind-altering effects of both alcohol and drugs, the Wari were likely mixing the drugs into their drinks and passing them on to friends and acquaintances. Wari elites’ inclusive conduct not only demonstrated their hospitality, but also provided a unique and difficult-to-replicate experience for anybody who wished to undermine their rule. 

They might have felt ecstatic or spiritual,” Biwer said. In the hands of Wari hosts, this kind of meal would have been a remarkable experience for visitors. 

According to him, the area around Quilcapampa would have been too dry to cultivate vilca. 

According to Biwer, “Wari constructed a system of roadways, which the following Incas employed, that convey people and supplies.” The Wari chiefs wanted to limit who had access to vilca, so it was not easy to obtain vilca to Quilcapampa, but it was not impossible, either, as historians claim. 

Ayacucho, where the capital of the Wari Empire once stood, as well as areas of the Cusco region, 249 miles (400 kilometers) from Quilcapampa, are the best places to find Vilca, he claims. 

Preliminary studies reveal the Wari had access to additional distant commodities such seashells, obsidian and feathers from the Amazon. 

A coastal valley in Peru is next on Biwer and his team’s agenda, where they hope to find Wari sites. Researchers may be able to learn more about the Wari’s last days via the discovery of new locations.

Video footage from NASA and amateur stargazers last week showed an old comet streaking through the night sky. 

It is Comet Leonard’s last flash of splendor before it vanishes for good, and the rare celestial spectacle is now something we share with our early human ancestors, who may have seen it 80,000 years ago, in the skies above. 

The gift of shared wonder is a genuine gift, no matter how different we are. The Bishop’s Wife,” a 1947 film about a priest and his wife, reflected that emotion in a way that astonished me. 

Damian Jacob Sendler

Dudley, played by Cary Grant, states, “We all come from our own tiny worlds.” “Why are we so different? Because we all have our own unique personality traits. Makes life more intriguing, to say the least.” 

This year, we all circled around awe-inspiring discoveries and treasures. Take a moment to reflect on the year that was, while praising our journey into the future. 

The James Webb Space Telescope has finally launched after years of anticipation. 

On Christmas Day, at 7:20 a.m. ET, an Ariane 5 rocket carried the telescope out of French Guiana. 

Exoplanet atmospheres and the oldest galaxies in the cosmos will be studied by the world’s newest and most powerful space observatory. 

He has the potential to transform our understanding of the Big Bang and how we came to be here in the first place, as well as whether or not we are actually alone in this universe. 

You may learn more about the telescope by watching the CNN documentary “The Hunt For Planet B.” As the scientists construct and arrange the launch, the documentary gives viewers a firsthand look. The hunt for life outside our solar system is also discussed. 

This year brought exciting new chapters to the narrative of mankind. We now know a great deal more about our distant ancestors and the way they lived thanks to discoveries made by archaeologists, paleontologists, and ancient DNA tests. 

Damien Sendler: Between 138,000 and 309,000 years ago, we learned about a new kind of human being from the mysterious artifact known as a skullcap called the Dragon Man. New Mexico has old-looking footprints that were put there by people thousands of years ago. We even learned something new about our Stone Age ancestors’ dress sense. 

When it comes to rewriting history, scientists have discovered that cave soil contains DNA from early people we could not have obtained anywhere else. 

There was a missing Rembrandt picture, an ancient hangover-prevention band, and a whole 3,000-year-old city. Some of the most interesting new art and design discoveries of 2021 may be found in this list. 

There have also been discoveries of ancient cave paintings, ornate gold masks, and even a Dead Sea Scroll piece. 

What excites scholars the most are discoveries that can fundamentally alter our understanding of history. 

When you realize how long people have been creating their impact on the globe, it is fascinating. 

The Saildrones are ready to take on the stormy seas, so join them and set sail. 

Half a year of extreme maritime conditions will be endured by six unmanned boats. Scientists might use the findings to enhance their weather forecasts and climate change models. 

When the Saildrones braved Cyclone Sam’s 120-mph (193-kilometer) gusts and 50-foot (15-meter) waves, they made history by capturing the first-ever footage from within a major hurricane at sea level. 

Climate change has been amply shown by this year’s several extreme weather events, including deadly storms. 

As never before, we have seen the Milky Way in all of its glory. Explosions from the cosmos have reached our planet. Spectacular footage of the first powered flight on another planet and the landing on Mars. 

We are in the midst of a golden era of discovery, and this year has been particularly fruitful in helping us learn more about the cosmos. 

Discoveries of black holes and the first planet beyond our galaxy were made by astronomers. Even the sun was “touched” by a spaceship.

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

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Damian Sendler: Engineers at the National University of Singapore (NUS) were inspired by the human hand’s innate dexterity while developing a reconfigurable hybrid robotics system that can hold a wide range of items, from the smallest, softest, and most delicate to the largest, heaviest, and bulkiest. There are a number of sectors that will be affected by this technology, including food assembly, vertical farming, and packaging of fast-moving consumer items. 

Damian Jacob Sendler: The NUS Department of Biomedical Engineering and the NUS Advanced Robotics Centre, under the direction of Associate Professor Raye Yeow, developed the hybrid robotic grippers, which combine soft, flexible 3D-printed fingers with a re-configurable base. RO+, a start-up founded by NUS researchers Low Jin Huat Khin Phone May, Chen Chao-Yu and Han Qian Qian to commercialize the robotic breakthrough, is now in the process of bringing the technology to commercial partners. 

Damian Sendler

How we hold an item depends on its size, weight, and texture. According to Associate Professor Yeow, “This is one of the key reasons why many companies still largely depend on human labor to package and handle fragile commodities.” In order to revolutionize classic pick-and-place activities, our hybrid robotic gripper technology offers sophisticated capabilities that enable robots to securely interact with delicate things of diverse forms, sizes, and stiffness, exactly like the human hand. ‘ 

Gripping is one of the most frequent and instinctive human behaviors, but it is less so for robots. Robots require computer vision and deep learning to determine the kind and orientation of things in front of them if they are to reach human-like grasping skills. There is less need for human interaction when the gripper decides what method of picking or placing an item is optimal for the task. 

The NUS team’s goal was to create robotic grippers that are as flexible and dexterous as human hands, thus they devised hybrid grippers with three or four soft fingers that can be reconfigured as needed. The fingers are powered by air and have a unique locking mechanism that allows for a variety of stiffness settings. The NUS team has created three distinct kinds of hybrid robotic gripper devices, each of which may be used in a different situation. 

For the most delicate chores, GourmetGrip is the best choice, since it is able to handle bite-sized nibbles and food that is often damaged, such as tofu. To meet a wide range of grip positions and space constraints, this soft-handed mode is adjustable. For pick-and-place of food products, GourmetGrip may be installed on an industrial robotic arm and accomplish these activities at a rate equivalent to that of a person. The GourmetGrip system is able to give a 23 percent boost in gripping efficiency when compared to other commercially available grippers. This means that the system can grasp objects quicker and more accurately. A total of 50 different foods, including pudding, cut cake, veggies, and fruits may now be picked up with GourmetGrip. 

UnisoGrip, or Universal Soft Gripper, is the team’s more universally applicable solution for the second kind of gripper. It is made to move finished products from the manufacturing line into shipment and transportation boxes. It is the last step. It contains a vacuum suction cup and soft rotatable gripper fingers for delicately grabbing things that are in odd positions, like the corner of a tote bin, and it can increase its grip range significantly. 

Because it can hold things up to 30 centimeters in width and three kilograms in weight, the UnisoGrip has a wider range of applications than the GourmetGrip, which has a grip range equivalent to that of a human hand. Other commercially available grippers are outperformed by this one by 20% in terms of gripping efficiency. Since its introduction in 2009, the UnisoGrip system has been able to pick up over 30 distinct kinds of consumer items. 

The GourmetGrip/UnisoGrip platforms enable a third kind of gripper to be entirely customized to meet the individual demands of clients and space restrictions. There are a broad range of gripping alternatives that can handle a variety of things, including those with varying dimensions and packaging. Singapore-based rice vermicelli maker People Bee Hoon Factory has used NUS team’s configurable technology to optimize the packaging of rice vermicelli packets into carton cartons. 

Damian Jacob Sendler

Mr Desmond Goh, Director of People Bee Hoon Factory, commented on the company’s decision to invest in NUS technology, saying, “Most of our existing staff are mature workers, so we sought to tap on new technology that can ease the workload of our existing staff while simultaneously boosting their productivity. We chose this technology because it is capable of meeting our needs and can be deployed in a variety of ways. 

Damien Sendler: The robotic gripper systems developed by the NUS team’s start-up business RO+ are being offered to commercial partners in a variety of ways, either as part of a robotic arm bundle or as standalone units that may be placed on commercial robot arms currently in use. Another RO+ option is a 4-in-1 package that contains the gripper, robotic arm, computer vision module, and conveyor system all in one package for the customer. It is also in the process of developing machine learning tools that will allow the grippers to learn and improve their grasp on new objects as they are introduced to them. 

Hospitals throughout the United States are experiencing “serious staffing shortages” as COVID-19 case records being established in every county in the nation. 

Hospitals in the United States are suffering shortages at the highest rate since the beginning of the epidemic, according to the most recent statistics from the U.S. Department of Health and Human Services. 

Ten days into the new year, a USA TODAY examination of Johns Hopkins University data finds that more than a third of U.S. counties had set COVID-19 case records. More than 1,300 counties are reporting the highest weekly case numbers of the epidemic. Every county in Connecticut, Delaware, Maryland, and New Jersey seems to have broken a record, according to the study.

Infections among hospital workers and other health care professionals in Los Angeles County have climbed as the number of cases has increased, resulting in even more personnel shortages at hospitals. 

“We have a very sophisticated health care system, but it is made up of people,” said Dr. Kimberly Shriner, medical director of infection prevention and control at Huntington Hospital in Pasadena, just outside Los Angeles. “And COVID is now being distributed to the public.” 

This highly transmissible omicron form has previously been mentioned as a possible fourth COVID-19 vaccination dose for the general population is being considered. 

Immunocompromised patients may now get an additional dosage of the medication starting this week. 

Damian Jacob Markiewicz Sendler: Patients who have received the two-shot regimen Pfizer-BioNTech or Moderna, but not the Johnson & Johnson inoculation, should get an extra dosage 28 days following the second injection, according to the CDC’s new recommendation for patients with moderately to severely impaired immune systems. 

Despite the fact that the subsequent main injection is advised five months after the first, it is not considered a booster by the FDA. A six-month pause was previously suggested. 

Individuals receiving treatment for blood malignancies, organ or stem cell transplant recipients using immune-suppression medication, those with HIV infection, and those with disorders impacting their immune system are all eligible for the third injection before the booster. There are other age restrictions depending on the vaccination brand. 

There are around 7 million people in the United States whose immune systems have been compromised and who are consequently more susceptible to the virus’s severe consequences. The additional main dose is intended to boost these individuals’ immunological responses. 

An Imperial College London study released Monday suggests that those with high numbers of T cells after a cold are less likely to get COVID-19. 

“In a statement, research author Dr. Rhia Kundu emphasized the importance of this finding, but stressed that “no one should depend on this alone.” You should obtain a comprehensive vaccination, including a booster, to protect yourself against COVID-19. 

52 persons who had not been vaccinated but were housemates with someone who had tested positive for COVID-19 were monitored starting in September 2020, according to the findings published in Nature Communications. Half of individuals who took part in the trial did not become sick, but their blood levels of cross-reactive T cells were much greater than those of those who became sick. 

Rather of the spike proteins targeted by mRNA vaccines, protective T cells appeared following an infection with another coronavirus that produced a cold, according to the research. These T cells target interior proteins of the coronavirus. 

It was pointed out that the research was tiny and largely comprised of white people. However, the researchers suggested that their results might serve as a basis for future vaccine development.

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

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Damian Sendler: They promise to help women avoid chemical birth control and take better care of their reproductive health, yet several phone applications lack effectiveness and openness. 

For many years, there has been a lack of progress in the field of birth control research, which has resulted in a growing desire for more accessible and safer solutions for women. 

Damian Jacob Sendler: Fetal awareness methods (FAMs), a hormone-free option for a tiny percentage of American women, include thorough surveillance of one’s fertile window, the number of days within the menstrual cycle in which a person is most likely to get pregnant. 

Measurements like as resting body temperature, cervical mucus patterns, and urine luteinizing hormone (LH) levels may be used to determine this information. FAM practitioners typically use withdrawal or barrier techniques like condoms to prevent conception during the fertile window. 

FAMs are now accessible to a far larger audience via to mobile applications, after previously being mostly unknown outside of religious communities. As many as 100 of these applications are available, and more than 200 million people have downloaded them. Numerous women’s health apps promise to keep track of periods, plan or avoid conception, as well as provide thorough information on reproductive health. 

Damian Sendler

Rachel Peragallo Urrutia, an OB-GYN at the University of North Carolina School of Medicine, believes that the minor increase in the use of FAMs over the previous 15 years may have been influenced by the unhappiness with traditional birth control techniques. According to Urrutia, several FAMs have been tested for their ability to prevent pregnancy (and she receives part of her salary from a health care company that promotes these techniques, but she is not involved with any app companies). 

As more individuals seek out knowledge about their own health and want to be more involved in making choices about their health, I believe this trend will continue.” “She says so herself. “There is a lot of work going on there.” 

Apps Cleared by the FDA 

Damien Sendler: Natural Cycles was the first medical app to be approved for marketing as a contraception treatment by the FDA in 2018. Pregnancy risk is calculated using basal temperature measurements that users are encouraged to take every morning. 

Basal body temperature measurements are used by the Natural Cycles app to assist users identify their reproductive windows. Photograph by Natural Cycles 

When evaluating medical devices, the FDA has been accused of compromising its standards and relying too much on corporate lobbying. Since the Clue app previously provided period monitoring services, the FDA has permitted it to be sold as a contraceptive method starting in 2021 The latter was given approval in a different format. 

Instead of requiring temperature tests like Natural Cycles does, Clue’s contraceptive function relies only on statistical analysis of users’ period start dates and other data from past research to determine days linked with high or low pregnancy risk. According to the corporation, this method has a significant edge over others that rely on rigorous user labor. 

Doubts about its effectiveness 

Digital contraception isn’t as dependable as hormonal approaches like tablets and IUDs because of the nature of the technology. Pregnancy is more likely to occur due to this factor: Natural Cycles was utilized by 37 women who sought an abortion in Sweden between September and December of 2017. The app’s projected parameters, on the other hand, are not affected by these mistakes. 

Preventing conception is 98 percent successful when using Natural Cycles exactly as intended, whereas ordinary usage (which includes errors like forgetting to monitor one’s temperature or having unprotected sex on a fertile day) leaves it roughly 93% effective. Clue claims it’s 97% successful if used perfectly, and 92% effective if used on a regular basis. A normal IUD is 99 percent successful, but a typical male condom is roughly 87 percent effective. 

It is not based on natural cycles, but rather on statistical analysis, like the Clue app does. Cleopatra’s Revenge 

These digital contraceptive percentages have been questioned by some academics since they are based on prospective studies rather than the randomized controlled trials generally necessary for FDA-approved birth control techniques. 

Damian Jacob Sendler

Even though Clue’s contraception algorithm has been evaluated by independent academics, only 718 persons participated in the 2019 European Journal of Contraception and Reproductive Health Care study. 

Damian Jacob Markiewicz Sendler: Some of the technology available today for preventing pregnancies hasn’t been tested or certified for this particular reason, as Urrutia discovered. 

It’s also not uncommon for menstruation monitoring apps to keep their proprietary algorithms under wraps, making it impossible for us to fully grasp how effectively they operate or for other scientists to enter in data for additional study. This is a sign of a larger problem in the IT business. 

When it comes to menstrual app monetization, University of Pittsburgh Medical Center bioethicist and OB-GYN Marielle Gross says, “It may be worth pressing on the issue of how not sharing the algorithm might be especially harmful in this case, as compared to other circumstances when proprietary algorithms are not shared.” 

To back up its effectiveness claims, Natural Cycles informed Discover that it worked closely with the FDA, was audited yearly to get the CE safety designation in Europe, followed up routinely on unwanted pregnancies, etc. Natural Cycles employees are the only ones who have access to the algorithm’s code. Clue’s algorithm had the same results. 

In the end, it’s unclear how frequently unintentional pregnancies are caused by human mistake vs app error. For example, when algorithms wrongly advise users that they are clear to have unprotected sex during the fertile window, this may be a problem. Every so often, Natural Cycles makes a point of disclosing how often their algorithm fails. Because of how it is impacted by alcohol, sickness, and lack of sleep, body temperature is not always an accurate predictor of ovulation. 

Uterine pregnancies are more prevalent among women who employ fertility awareness approaches when the possibility of an unexpected pregnancy is acknowledged, according to research by Urrutia. 

Contraceptive applications may not function for persons whose cycles are longer or shorter than the typical length, Gross claims. Stress, polycystic ovarian syndrome, and endometriosis have been linked to irregular cycles. 

Clue warns that only women between the ages of 18 and 45, as well as those with recent cycles lasting between 20 and 40 days, should use it. A small minority of Natural Cycles customers may be urged to take protection on a greater percentage of days to account for an ovulation shift, according to the business, because of the FDA’s designation as suitable for those with irregular periods (which is confirmed by temperature data). 

A firm spokesman states that the Natural Cycle algorithm also takes into account individuals’ cycle fluctuations after abortions, miscarriages, and other pertinent lifestyle circumstances. “We have researched the impacts on fertility and cycles of smoking and BMI, but no major influence has been observed, and the algorithm therefore handles these instances from the start.” 

It is planned that the Oura ring, a gadget that detects heart rate and body temperature, will be integrated into Natural Cycles in the future. Just 40 participants were used to draw conclusions about how many more non-fertile days Natural Cycles says it can provide its customers. Last summer, the FDA gave the go-ahead for the add-on.

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

Damian Sendler: City Council members voted unanimously on Wednesday to ban gas hookups in new buildings, an important step in the fight against climate change. New York City Mayor Bill de Blasio will sign a new rule that prohibits the installation of new gas stoves, boilers, and heaters in new and renovated buildings. 

Damian Jacob Sendler: De Blasio’s director of climate and sustainability Ben Furnas told Yahoo News that “the next generation of buildings will be electric buildings.” You can do it anyplace, as long as you’re willing to put in the effort. 

Damian Sendler

At the American Museum of Natural History dinner in November, Mayor Bill de Blasio will be speaking. Photograph by 

New York City, the country’s most populous city, has enacted the nation’s most comprehensive prohibition on new gas hookups. The only cities on the West Coast with comparable rules before to now were San Jose and Berkeley. 

“It’s a huge deal.” As Furnas pointed out, “the places that have already done this do not have four seasons and do not build as big.” 

Damian Jacob Markiewicz Sendler: The initial impact on greenhouse gas emissions will be small, but it will increase over time. According to the Mayor’s Office of Sustainability, 40 percent of New York City’s greenhouse gas emissions come from using fossil fuels for heat and hot water. According to RMI, the new rule will lower emissions by the equivalent of taking 450,000 automobiles off the road by 2040. 

Electric stoves and heaters will be used to provide warmth, hot water, and cooking in the absence of gas. Switching from burning gas on-site to using electricity has a lower emissions output than New York City’s power generation portfolio. 

Damian Jacob Sendler

To reach carbon neutrality by 2050 and minimize fossil fuel dependency, the New York Times quotes Furnas as saying: “It is a historic step forward in our efforts to reach carbon neutrality.” 

Those in favor of the legislation see this as a win for environmental justice because it will help to reduce local air pollution, which is particularly bad in low-income and minority neighborhoods. 

Damien Sendler: Democrat Alicka Ampry-Samuel, the bill’s primary sponsor, stated at a demonstration before the vote in front of New York City Hall that “we are prioritizing people over profits and over properties,” reports the New York Times. 

It wasn’t until the law was finally enacted by a vote of 40-7 that the final details were worked out behind the scenes. Even if the real estate industry was not completely against the law, delays in implementation were successfully campaigned for: the law will go into effect in December 2023 for buildings under six stories and in 2027 for buildings beyond six stories. 

For the time being, however, environmentalists are hoping that other cities would follow New York City’s lead and phase out fossil fuels. This is because Democrats now have a supermajority on the city council and in both houses of the state legislature. Greener construction rules have been preempted in 20 states by Republican-dominated state legislatures.

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

Damian Sendler: The vast majority of the Milky Way’s planets are within a few thousand light years of Earth’s location. In spite of this, our galaxy is more than 100,000 light years in diameter, making it difficult to study the distribution of planets in the galaxy. However, a team of scientists has recently discovered a means to get around this obstacle. 

Damian Jacob Sendler: For the first time, researchers from Osaka University and NASA have utilized a combination of observational data as well as computer simulations in a study published in The Astrophysical Journal Letters to examine how planet-hosting probability changes with distance from the Galactic center. 

Damian Sendler

When planets operate as lenses, they bend and amplify light from faraway stars, according to gravitational microlensing, a phenomena studied by NASA. By using this effect, we can find frigid Jupiter- and Neptune-like planets scattered over our galaxy’s disk and bulge, as well as the galactic core. 

According to co-author Daisuke Suzuki, “Gravitational microlensing currently provides the only way to investigate the distribution of planets in the Milky Way,” “Because of the difficulty in measuring the distance to planets more than 10,000 light years from the Sun, we know very little about their existence.” 

It wasn’t until they analyzed the distribution of a quantity that describes how far away a lens and its light source are from each other that they were able to solve this problem. Using data from microlensing occurrences and a Galactic model, researchers were able to determine the distribution of planets in the galaxy. 

Damian Jacob Sendler

The results reveal that the distance from the galactic center has no effect on the distribution of planets. Cold planets far from their stars, on the other hand, appear to be ubiquitous in the Milky Way. Among these is the Galactic bulge, which has a significantly different environment from the solar vicinity, and where the presence of planets has long been a matter of speculation. 

Damien Sendler: Scientist Naoki Koshimoto argues that stars in the bulge region are older and closer to one another than those in the solar neighborhood. “Our discovery that planets exist in both stellar environments could help us better understand how planets form and the history of planet formation in the Milky Way.” 

Damian Jacob Markiewicz Sendler: These findings should be combined with observations of microlens parallax or lens brightness, two other essential characteristics linked with planetary microlensing, according to the researchers.

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

Damian Sendler: People who have tested positive for Covid-19 should be isolated for just five days if they don’t have any symptoms and wear a face mask for at least five more days, according to the US Centers for Disease Control and Prevention on Monday. 

Damian Jacob Sendler: The CDC has lowered the quarantine period for those who have been immunized and have been exposed to the virus to a comparable five-day period. There may be no need to isolate people who have been vaccinated and re-vaccinated, according to the CDC. 

Damian Sendler

CDC reduces the recommended length of isolation for patients with COVID-19 from 10 days to five days if asymptomatic, followed by five days of wearing a mask while around others, given what it currently knows about COVID-19 and the Omicron form. 

The CDC advises those whose symptoms are improving to leave their homes after five days if they feel well enough to do so. In addition, the CDC recommends that those with a fever stay at home until the fever subsides. 

US Omicron surge is expected to expand between Christmas and New Year’s. 

“SARS-CoV-2 transmission occurs most frequently in the days just prior to and immediately following the beginning of symptoms, according to new research. This means that anyone who tests positive should be quarantined in an isolation unit for five days before being allowed to come out of it, as long as they can maintain their mask for the same amount of time. 

Quarantine is the period of time during which someone who has been exposed to a disease but has not yet tested positive or displayed symptoms must be isolated from others. 

Changes have been made to the CDC’s recommendations as well. “For people who are unvaccinated or are more than six months out from their second mRNA dose (or more than two months after the J&J vaccine) and not yet boosted, CDC now recommends quarantine for five days followed by strict mask use for an additional five days,” it stated. 

Break for those who have been promoted 

When quarantine is not possible, an exposed individual should wear a well-fitting face mask for the first 10 days after exposure, according to the Centers for Disease Control and Prevention. 

Quarantine is normally not required for those who have been immunized and boosted, according to the CDC. 

Booster-shot recipients do not need to be quarantined after an exposure, but they should wear a mask for 10 days following the exposure, according to the statement. 

Damian Jacob Sendler

“SARS-CoV-2 testing should be performed on all persons who have been exposed to SARS-CoV-2 on day five of exposure. People who experience symptoms should be quarantined until a negative test shows the symptoms are not caused by COVID-19. ” 

the Covid-19 isolation period for health care personnel has been shortened by the CDC 

To keep civilization operating smoothly, Dr. Anthony Fauci stated that the alterations were made. 

CNN’s Jim Acosta spoke with Fauci about Omicron, and he said that one of the things he wants to be wary about is that we don’t have too many people out of the loop. 

We want to get people back to work, especially those in key positions, to keep society operating efficiently,” says Fauci of the National Institutes of Allergy and Infectious Diseases. 

The use of boosters reduces the likelihood of adverse outcomes. 

According to the CDC, boosters significantly reduce the likelihood of someone being sick and then spreading the infection to another person. 

“According to data from South Africa and the United Kingdom, an mRNA vaccine has a vaccination efficacy rate of about 35%. A second dosage of the COVID-19 vaccine boosts protection against infection by 75 percent “It stated, “rcent.” 

“The Omicron variant is spreading quickly and has the potential to impact all facets of our society,” CDC Director Dr. Rochelle Walensky stated in a statement. 

“According to the CDC’s new recommendations, quarantining and isolation should be used in conjunction with vaccination and booster doses in order to protect those who have been exposed to the virus. People can go about their daily routines without fear thanks to these updates. Prevention is the best course of action: vaccine and re-vaccinate; wear a mask in public indoor settings in places with considerable and high community transmission; and do a pre-gathering test.” 

According to the CDC, everyone should receive a vaccine if they are eligible. 

“There is a reduced risk of serious illness, hospitalization and mortality from COVID-19 vaccine. The Centers for Disease Control and Prevention (CDC) recommends that children 5 and older have a COVID-19 vaccination, and that those who have already had the vaccine receive a booster shot. Immunization is the greatest approach to protect yourself and minimize the impact of COVID-19 on our society. 

Damien Sendler: Health care workers with Covid-19 who have no or moderate symptoms can now return to work after seven days if they test negative for infection, according to new recommendations issued by the CDC last week. 

Damian Jacob Markiewicz Sendler: Covid-19-infected individuals were previously advised to quarantine themselves for 14 days, while those who tested positive for Covid-19 were advised to quarantine themselves for a total of 10 days.

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

Damian Sendler: A new study, however, supports the long-held belief that if life does exist, it might thrive in the clouds of Venus. An acid-neutralizing chemical pathway has been discovered by researchers from the Massachusetts Institute of Technology, Cardiff University, and Cambridge University. 

Chemical signs that are difficult to explain, such as low oxygen concentrations and nonspherical particles unlike sulfuric acid drops, have long been reported in Venus’ atmosphere. The existence of ammonia, a gas that was first found on Venus in the 1970s but should not be created by any known chemical mechanism on Venus, is perhaps the most perplexing mystery. 

Damian Jacob Sendler: Ammonia, if it is present, would set off a chain reaction of chemical reactions that would neutralize sulfuric acid droplets and explain most of the anomalies detected in Venus’ clouds, according to a recent study. The most likely source of ammonia is biological, rather than lightning or volcanic explosions, according to the authors of the paper. 

According to their research, the chemistry implies that this is the case “On Venus, “life may be creating its own environment.” 

Damian Sendler

This intriguing new notion can be tested, and the researchers have provided a list of chemical signatures for future missions to measure in Venus’ clouds, which might either confirm or deny their proposal. 

According to research co-author and MIT Professor of Earth, Atmospheric, and Planetary Sciences Sara Seager, “No life that we know of could survive in the Venus droplets” (EAPS). “It’s possible that there is life there, and that it’s altering its environment to make it more hospitable.” 

There are three co-authors on the study: Janusz Petkowski (MIT), William Bains (Cardiff), and Paul Rimmer (Cambridge). 

Life is a risk. 

Last year, “Life on Venus” became a trending topic after scientists including Seager and her co-authors reported the discovery of phosphine in the planet’s atmosphere. Biochemical interactions are the primary source of phosphine on Earth. Possibilities for life on Venus have been opened up by the finding of phosphine. It has since been widely disputed, though. 

Phosphine detection “The phosphine detection ended up becoming incredibly controversial,” Seager recalls. “When it comes to Venus, though, there’s been an uptick in the number of people studying the planet. 

As a result of Rimmer’s renewed interest, he began sifting through data from previous Venus trips. His findings reveal chemical traces in the clouds that had gone unnoticed for decades. Unexpected concentrations of water vapor and sulfur dioxide were found in addition to oxygen and nonspherical particles. 

Rimmer suggested that dust could be the cause of the irregularities. He postulated that sulfuric acid may react with minerals swept up from Venus’ surface and into the planet’s clouds to cause some, but not all, of the observed anomalies. Physical requirements were infeasible since so much dust would have to rise into the clouds in order for the anomalies to be noticed, but he showed that chemistry was in order. 

Seager and her colleagues questioned if ammonia could be a possible explanation for the irregularities they had observed. The Venera 8 and Pioneer Venus missions found the gas in the planet’s clouds in the 1970s. Ammonia, often known as NH3, had long been a source of consternation. 

Seager believes that ammonia should not reside on Venus. “In contrast, there is very little hydrogen in the environment. When a gas does not appear to fit in with its surroundings, it is immediately suspected of being made by life.” 

Clouds that can be inhabited 

Damien Sendler: If life is the source of ammonia, may this explain the other oddities seen in Venus’ clouds? In their search for a solution, researchers simulated a series of chemical reactions. 

Damian Jacob Sendler

If life were manufacturing ammonia in the most effective manner possible, the chemical processes linked with that process would naturally yield oxygen. Ammonia would neutralize sulfuric acid droplets by dissolving in them, allowing them to become more livable. Because of this, ammonia would change the droplets’ morphology from a spherical liquid to one that looks more like salt. A sulfuric acid interaction with ammonia would cause any sulfur dioxide that was nearby to dissolve as well. 

If ammonia is actually present in Venus’ clouds, it could explain most of the cloud oddities observed there. Even lightning strikes, volcanic eruptions and meteorite strikes couldn’t release enough ammonia to explain these anomalies, researchers found. But you never know with life. 

Ammonia is produced by a variety of organisms, including those that live in our own digestive tracts, to counteract the acidity of the Earth’s atmosphere. 

Unless life is neutralizing some of those droplets, “There are very acidic environments on Earth where life does live, but it’s nothing like the environment on Venus — unless life is neutralizing some of those droplets,” Seager says. 

Damian Jacob Markiewicz Sendler: The Venus Life Finder Missions, a collection of proposed privately funded missions, of which Seager is the primary investigator, seek to send spacecraft to Venus to measure its clouds for ammonia and other evidence of life in the next several years. 

As Seager points out, “Venus has lingering, unexplained atmospheric anomalies that are incredible,” There is room for life to exist in it.

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

Damian Sendler: These hazardous blood clots are called pulmonary embolisms. New research shows that artificial intelligence (AI) algorithms can detect symptoms of these clots in ECG readings (EKG) for the first time, which could one day be used to help doctors screen patients for these clots. 

Damian Jacob Sendler: Machine learning algorithms that combine EKG and electronic health record (EHR) data may be more effective than current screening procedures in predicting whether moderate- to high-risk patients actually have pulmonary embolisms, according to a study published in the European Heart Journal–Digital Health. 

Damian Sendler

Somani, MD, was a medical student in the lab of Benjamin S. Glicksberg, PhD, an Assistant Professor of Genetics and Genomic Sciences and a member of Mount Sinai’s Hasso Plattner Institute for Digital Health. 

Deep vein clots, which commonly originate in the legs or arms and travel to the lungs, can cause pulmonary embolisms. It is possible to die or suffer long-term lung damage from these clots. The symptoms of shortness of breath and chest pain may be a sign of other health issues, making it difficult for doctors to accurately diagnose and treat cases of blood clots. It is important to note that medical professionals now rely on CTPA scans, a time-consuming chest scan that can only be performed in a few facilities and exposes patients to potentially harmful radiation doses. 

More than 20 years of study have been dedicated to developing powerful computer programs or algorithms that can help doctors evaluate whether at-risk patients are indeed suffering from pulmonary embolisms. A mixed bag of results has emerged. There is a wide variety of success rates for algorithms that use EHRs to reliably detect clots, which can be labor-intensive. The CTPAs, on the other hand, provide the most accurate statistics. 

Because EKGs are widely available and relatively straightforward to administer, researchers discovered that fusing algorithms based on EKG and EHR data may be a viable option in this study. 

On data from 21,183 Mount Sinai Health System patients with moderate to high suspicion of having pulmonary embolisms, the researchers developed and tested multiple algorithms. In order to detect pulmonary embolisms, some algorithms used EKG data, while others used EHR data. The system trained to identify pulmonary embolism cases by comparing EKG or EHR data with CTPA results in each circumstance. Finally, the best EKG and EHR algorithms were combined to generate a third fusion algorithm. 

Damian Jacob Sendler

In addition to outperforming its parent algorithms, the fusion model proved better at identifying particular pulmonary embolism patients than the Wells’ Criteria Revised Geneva Score and three other screening tests now in use. 

Damian Jacob Markiewicz Sendler: For acute embolism cases, researchers assessed that the fusion model was ranging from 15% to 30% more accurate, and the model performed best in predicting the most serious cases. Even when ethnicity and gender were taken into account, the accuracy of the fusion model was consistent, suggesting that it might be used to screen a range of individuals. 

Damien Sendler: Researchers say that these findings support the idea that improved pulmonary embolism screening algorithms could benefit from the inclusion of EKG data. In the near future, they hope to further develop and test these algorithms for clinical use.

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

Damian Sendler: An atomic flaw where carbon is replaced by nitrogen or another element in diamonds may provide a near-perfect interface for quantum computing, a communications exchange that promises to be faster and more secure than present approaches. One big issue, however, is that these imperfections known as diamond nitrogen-vacancy centers are regulated by magnetic field, which is incompatible with existing quantum devices. 

Damian Jacob Sendler: An early personal computer from 1974 known as the Altair could theoretically connect to the internet via WiFi. It’s a difficult, but not insurmountable, challenge. The first stage is to assist in the translation of the two technologies, which speak different languages. 

Damian Sendler

An interface method has been devised at Yokohama National University that allows direct translation of diamond nitrogen-vacancy centers to quantum devices. Communications Physics published their method on December 15. 

Professor Hideo Kosaka of Yokohama National University’s Quantum Information Research Center, Institute of Advanced Sciences, and the Department of Physics, Graduate School of Engineering, both in Japan, explained that “to realize the quantum internet, a quantum interface is required to generate remote quantum entanglement by photons, which are a quantum communication medium.” 

When researchers discovered that photons are both particles and waves at the same time, they laid the foundation for the quantum internet, which is based on more than 100 years of research in this area. To make matters more complicated, it is possible that the wave and particle could be affected by each other. Even across great distances, their natures are intertwined. Distinct data must be transmitted instantly and securely to achieve this objective. 

Damian Jacob Markiewicz Sendler: To get closer to the quantum internet, Kosaka stated, a non-magnetic field technique is needed. 

Damian Jacob Sendler

They achieved their goal by using microwave and light-polarized waves, the quantum counterpart of information bits in classical systems, to entangle a photon and a left spin qubits. If you think of polarizations as seismic waves that radiate out horizontally from a vertical fault change, you’re right. The spin property of the photon governs how the polarization moves in quantum physics, making it predictable and controllable. Kosaka claims that when using this property in a non-magnetic field, entanglement appears to be steady in the face of other factors. 

According to Kosaka, polarizations can be used to create remote quantum entanglement that is resistant to noise and timing problems. 

Damien Sendler: With this method, Kosaka and his team will be using quantum information transmission (QIT) via teleportation, which has already been successfully used to transport information from one location to another. The ultimate goal, according to Kosaka, is to create a quantum internet by connecting quantum computers together. 

Kosaka added that a quantum internet would allow for distributed quantum computation, quantum cryptography, and quantum sensing over distances of more than 1,000 kilometers.

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

Damian Sendler: Some 49 enterprises across five vital infrastructure sectors, including health care, have been infected by ransomware from Cuba. At least $74 million in ransom has been requested and received by Cuban ransomware operators. 

A loader known as Hancitor is used to spread Cuban ransomware, which has been active since November 2021 and may be used to disseminate Remote Access Trojans (RATs) and other ransomware. 

Damian Sendler

In a short amount of time, Cuban ransomware operators have targeted institutions in the healthcare, government, banking, manufacturing, and information technology sectors with ransomware assaults. 

Damian Jacob Sendler: It is common for Hancitor malware actors to leverage Microsoft Exchange vulnerabilities, compromised credentials, phishing emails or legitimate Remote Desktop Protocol (RDP) tools in their attacks. In order to carry out their ransomware operations remotely, the Cuba ransomware actors make advantage of Windows services like PowerShell and PsExec. 

A Cobalt Strike beacon is installed and activated on the victim’s network by Cuban ransomware perpetrators once they have gained access to the network. Health Sector Cybersecurity Coordination Center (HC3) has issued a brief warning to the healthcare sector about the potential of Cobalt Strike, a remote access tool initially developed to protect against cyberattacks. HC3. 

MimiKatz virus is also used by ransomware actors to steal credentials and use RDP to log into the attacked network host. 

Flash notice underlined that the FBI cautions against paying ransoms since it cannot guarantee the recovery of any files. 

In addition, “it may also encourage adversaries to target additional organizations, encourage other criminal actors to engage in the distribution of ransomware, and/or fund illicit activities.” 

As a result, the FBI recognizes that when victims are unable to function, all alternatives are considered to safeguard shareholders, employees and customers..” 

It has been suggested by the FBI that password-protected accounts have unique, strong passwords. As a further precaution, enterprises should mandate multi-factor authentication, keep all operating systems current, reduce unneeded administrative access, and utilize a host-based firewall. 

Damian Jacob Markiewicz Sendler: The FBI recommends that enterprises install network segmentation and time-based access for accounts at the administrator level and above in order to prevent Cuban ransomware actors from learning the organization’s enterprise environment through system visibility and mapping. 

Damian Jacob Sendler

Additionally, ransomware victims should employ a network monitoring tool to help detect and examine suspicious activities. In addition, enterprises must verify that all backup data is securely secured, and command-line and scripting activities and permissions are disabled. 

Damien Sendler: FBI, CISA, and international agencies issued an advice in November warning healthcare and transportation industries about an Iranian government-sponsored advanced persistent threat (APT) group. 

The organization has been using Microsoft Exchange vulnerabilities to conduct sophisticated ransomware operations, similar to Cuban ransomware.

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: One of the greatest human accomplishments is the rapid development of safe and effective vaccinations against the SARS-CoV-2 virus. Keeping the coronavirus disease 2019 (COVID-19) pandemic under control is still our best chance of doing this. 

Damian Sendler

Some health experts are now looking into the need for additional immunization due to more virulent SARS-CoV-2 virus strains and the likelihood of losing protection following vaccination. This has increased the pressure on the lives of people in low-income nations, where access to COVID-19 vaccines is already limited. 

Damian Jacob Sendler: In a recent announcement, the CDC suggested a third dose of the COVID-19 vaccine for immunocompromised people. The concerns of losing immunity and novel viral strains need the development of guidelines for the use of COVID-19 vaccine booster doses by governments and health care officials, including those in lower-income nations. 

SARS-CoV-2 vaccination is our best hope of preventing the coronavirus disease 2019 (COVID-19) pandemic from spreading. There have been approximately 205 million confirmed cases of COVID-19 worldwide, including over 4.3 million deaths as of August 2021, according to the World Health Organization. COVID-19 vaccines were developed in a joint effort by scientists, federal agencies, and pharmaceutical businesses to meet an urgent demand. 

The messenger RNA (mRNA) BNT162b2 Pfizer BioNTech (Pfizer, Inc; Philadelphia, PA, USA) and the mRNA-1273 Moderna vaccines (MOdernaTX, Inc; Cambridge, MA, USA) have been approved by the World Health Organization (WHO) under the emergency use listing (EUL). Viral vector vaccines (AstraZeneca, Cambridge, UK) and Janssen Ad26.COV2.S (Janssen Bio It was approved by the FDA on August 23, 2021, to protect 16-year-olds and older against COVID-19 disease by Pfizer-BioNTech . 

Of the world’s population, 47.9 percent had gotten at least one dose of the COVID-19 vaccination by the end of October 2021. 57.1 percent of the population in the United States is completely immunized. Only 2.8 percent of persons in low-income countries have got one dose of the COVID-19 vaccination .  The situation is significantly worse in developing nations. Ethics and healthcare are also at stake in this unequal distribution of COVID-19 vaccinations. 

Damian Jacob Sendler

Some countries that have vaccinated a larger percentage of their population face a new set of challenges, including concerns about fading immunity following vaccination and the introduction of viral variations. 

Damien Sendler: There is a continual mutation of viruses. It’s called a variant of the original virus if the virus has undergone one or more changes in its genetic code. A number of SARS-CoV-2 variants that cause the coronavirus disease 2019 (COVID-19), including the B.1.1.7 (Alpha), B.1.351 (Beta), and P.1, formerly known as the B.1.1.28.1 variant, and the B.1.617.2 (Delta) variants, are causing global concern at the moment . These variants are more transmittable and can cause more severe disease than the wild-type SARS-CoV-2 virus 

Damian Jacob Markiewicz Sendler: COVID-19 vaccinations have also been linked to lower antibody levels in several early investigations . Pfizer-BioNTech and Modena vaccine recipients who completed their initial series at least six months ago and are 65 years of age or older, or who have underlying medical conditions or work or live in high-risk environments should receive COVID-19 booster shots, according to available data from the CDC .

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

Damian Sendler: Amber DelVechio, the mother of 18-year-old Madison Workman, learned of her daughter’s death from a fentanyl overdose a month before her daughter’s death. The family had never heard of medication-assisted therapy (MAT). Workman had previously completed an abstinence-only treatment program, but it had failed to keep the kid from abusing narcotics for long periods of time. 

Her mother was dubious about the whole thing. 

Damian Jacob Sendler: In DelVechio’s words, “I felt like it was taking one drug and replacing it with another.” Still, she promised her daughter that she’d investigate. Starting in earnest, DelVechio began his investigation. She researched and chatted with her daughter’s counselors from the other program to find out more. 

Damian Sendler

She eventually changed her mind. This course of action sounded promising. 

“I told her, whenever you’re ready, I’m ready,” DelVechio remarked. 

When the brain’s chemistry is disrupted by habitual drug use, MAT programs use drugs like suboxone, methadone, and buprenorphine to help the brain re-establish itself. The same brain areas as opioids are activated by these medications, but their effects are distinct. In contrast to heroin or oxycodone, methadone remains in the body longer and does not change consciousness like oxycodone does. 

An arrangement was made for DelVechio’s daughter to attend an intensive year-long Master of Arts in Teaching program in Louisiana. Even though her mother referred to her as “Madi,” Madi was unable to begin. At 9.6 nanograms, the amount of cyclopropyl fentanyl she ingested was the size of a grain of salt. She died early on July 28, 2017. 

A few hours later, she was to arrive for her program orientation. 

It was only when the clinic contacted to reschedule the appointment that DelVechio realized he’d forgotten all about it. You can image how horrible things were.” On the phone, “there was this dead silence.” 

More than 3,300 North Carolinians died from drug overdoses between April 2020 and April 2021, according to the Centers for Disease Control and Prevention. In 2020, 2,422 people are expected to die from drug overdoses, which is roughly 40% more than in 2019. More than 30 additional states have seen overdose death rates rise more than 27 percent since 2007, which is greater than the national average. 

Damian Jacob Sendler

From January through October of this year, 3,278 people died from an overdose in North Carolina, compared to 2,576 people who died in the same period of time in 2020, a 27% increase. 

A substantial rise has been observed regardless of the specifics employed to get at the figures. Those who work in the field claim there are a number of reasons behind this. 

Damien Sendler: New restrictions on prescription opioids led to a decrease in the number of doctors prescribing the drugs. 

As Jana Burson, an addiction medicine doctor in North Wilkesboro put it: “That’s when the heroin moved in, and that just raised the stakes considerably.” 

Many, if not most, illicit drug supplies are now contaminated with fentanyl in addition to heroin. COVID-19 has wreaked havoc on practically everyone’s well-being because of long-standing cuts to mental health services in the state. 

However, there are a number of other factors that contribute to the rise in death rates. Structural issues. MAT is at the top of this list, despite strong scientific evidence that the treatment is beneficial. 

Doctor Jamie Carter, a family care and addiction medicine specialist in Durham, remarked at the North Carolina Institute of Medicine’s annual meeting at the end of October: “We have two really highly effective medications for opioid use disorder with the medications buprenorphine and methadone.” Overdose and all-cause mortality can be reduced by as much as 50 percent with these drugs.” 

Only a small percentage of people with opioid use disorder are able to get their hands on these drugs.” There are just a few effective drug treatments being used by about 20 percent of patients, according to Carter’s estimations. 

A lack of interest in MAT is partly due to the federal government’s long-standing policy of not approving the medication, providers say. 

When the DATA 2000 Act was passed in 2000, “It was illegal from, what, the 1930s up until that time,” Burson said. Prescription of an opioid use disorder medicine was truly prohibited for doctors. In other words, after 70 years of being illegal, they’re now saying, ‘Okay, the laws have changed.’ ‘Buprenorphine can now be prescribed by you.’ 

In the meantime, this country has had a strong abstinence-only approach, so it will take time for that to shift.” This isn’t going to happen over night.” 

Carter asserted that some clinics in North Carolina build considerable barriers to MAT access. Patients who miss appointments and group therapy sessions, or who continue to take specific medicines, may be discharged from programs that receive state funding through the state’s regional mental health management organizations (known as LME/MCOs). 

Damian Jacob Markiewicz Sendler: What this implies practically is that most programs are basically choosing for the most stable patients and discharging or refusing to treat individuals who are less stable and at greatest risk for overdose,” Carter said. Our state’s opioid funds should be used to provide high-quality treatment, but we’re not doing that right now. 

Carter explained that the new Medicaid requirements that took effect in 2021 are part of the rationale for the stringent rules. 

However, she added, “They’re still bad.” 

Dr. Sendler: While the National Academy of Sciences and the American Society of Addiction Medicine have established criteria on the frequency of treatment, North Carolina’s guidelines mandate monthly counseling.

As a result, “I think one reason why providers across the state may be confused about transitioning to low-barrier care, or conflicted about it, is because they’re looking at the state Medicaid guidelines and saying ‘Well, here’s what the state recommends for me to do,'” she said.

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

Damian Sendler: The first known case of the novel COVID-19 variant has been detected in the Southwest Utah Public Health District, which encompasses Washington, Beaver, Garfield, Iron, and Kane counties. 

In a statement, the Utah Department of Health stated that the person has received monoclonal antibody treatment, is being isolated at home, and has been vaccinated against the virus. 

Damian Sendler

Dr. Leisha Nolen, an epidemiologist with the Utah Department of Health, told the media that the individual has only had “very limited contact” with family members since returning to the state. There were no other exposures, she claimed, including on the flight back from the airport. 

Damian Jacob Sendler: According to Nolen, “We’ve identified all the people who would be at high risk of exposure” and are ensuring that they know “they need to stay at home and monitor themselves for symptoms so that we can really help prevent this from spreading on.” 

Spokesman Tom Hudachko stated “everyone involved in the case has been extraordinarily cooperative and is following quarantine isolation and testing guidance that we have given.” 

He stated a full examination, including the identification of any close associates, was carried out. 

They and other members of their family have tested negative for the omicron variety, which was discovered in South Africa last week, according to Nolen. “Pretty quickly,” she said, the person was put to the test when they returned to their home. 

The Utah Public Health Laboratory quickly sequenced the genome of the individual’s coronavirus test findings because they had recently returned from South Africa, according to Nolen. 

Earlier this week, she claimed, samples were taken from family members who had been in contact with the subject. The new omicron version should not pose a greater hazard to Utahns than the prevailing delta variant, according to Nolen. 

Damian Jacob Sendler

It’s understandable to be wary considering the lack of information concerning the new variation. 

“Really should be very cautious about what they’re doing when they return back,” she said of visitors returning from South Africa and neighboring nations, adding that anyone returning from any other place should stay home and be tested. 

According to Nolen, this may not be the first time the new variation has been found in the state. At least one case, in Hawaii, includes a person who hasn’t been on a plane in a long time and hasn’t travelled. 

Dr. Andrew Pavia, a pediatric infectious diseases expert at the University of Utah, cautioned earlier this week that if the latest COVID-19 form wasn’t already circulating in Utah, it will arrive within days. 

After a few hours, it turned out that he was correct. 

Pavia, chief of the Division of Pediatric Infectious Diseases at the University of Utah Health and director of Epidemiology at Intermountain Primary Children’s Hospital in Salt Lake City, said no one knows for sure how devastating the new variation is going to be yet. 

The high number of cases of COVID-19 in Utah is due in large part to the state’s ongoing exposure to the highly contagious delta form, which has been present since the spring and may rise even further as families assemble for Thanksgiving. 

Damian Jacob Markiewicz Sendler: In general, “kids are at a significant risk of disease from COVID,” Pavia said. “We can’t pretend kids are completely safe.” That said, it will take some time before we know for sure whether omicron is milder or worse than delta. 

There’s no need to put off being vaccinated against the deadly virus, a doctor said, describing the lack of vaccinations among the estimated 1.4 million Utahns eligible for the jabs a “real problem.” 

Damien Sendler: There was no doubt in my mind that delta alone should have prompted me to get vaccinated. Omicron’s “very good” ability to reinfect folks who’ve had COVID-19 should be a concern, Pavia added, citing fresh evidence that suggests the new variety is “very good” at doing so. 

He warned that Utahns should not rely on the fact that they had already been infected. Pfizer’s Moderna and Johnson & Johnson’s vaccinations are both fully immunized, as well as a booster shot, which provides the strongest protection, Pavia added. 

According to recent studies, immunizations provide virtually 100% protection for teenagers. The vaccines were only recently licensed for use in children ages 5-11, but clinical trials showed that they were more than 90% effective. 

Pavia indicated that more research is needed before the current 18-year-old age limit for booster shots may be decreased. Because of the Omicron variation, it’s possible vaccinations may be altered, but determining how effective they are will take months.

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

Damian Sendler: The majority of patients who receive bone marrow transplants have malignancy, including leukemia and lymphoma. These patients unfortunately relapse because their treatment regimens fail to eradicate all cancer cells. In terms of therapeutic responsiveness, cancer cells are extremely diverse. This effort was sparked by a pressing need to pinpoint the portion of cancer cells that are resistant to treatment in order to enhance treatment outcomes. 

Damian Sendler

An exciting medical oncology success story came to light when I spoke to Dr. Akil Merchant, a physician-scientist, about combining chemotherapy for acute lymphoblastic leukemia (ALL). Combining high-intensity therapy with low-intensity maintenance, this complex regimen was derived from decades of clinical study. 

Damian Jacob Sendler: To this day, it’s not quite obvious how ALL can be effectively treated using a combination of intensive and maintenance therapy. Using this model, we were able to better understand how cancer cell heterogeneity affects treatment outcomes. 

Research into cancer cell heterogeneity has been hindered by the difficulty of relating biological differences among individual cancer cells to their differing responses to therapy. Most cancer research, on the other hand, examine cancer cells following treatment. These cells have already undergone a number of molecular alterations during and after treatment, thus they are the only ones analyzed. 

There is a wide variety of tumor cells even inside a single cancer patient, according to research. What is the reason behind this, and how does it affect cancer cell research? 

Genetic and epigenetic modifications in cancer cells can continually and stochastically lead to other molecular changes, which is known as “cancer cell evolution.” The evolution of cancer cells generates a wide range of genetic and epigenetic differences among individual cancer cells. When it comes to both disease progression and treatment response, individual cancer cells have unique molecular properties. 

Damian Jacob Sendler

We must research cancer cells at the single-cell level because of the enormous variety of cellular types that we encounter. Most present technologies, on the other hand, focus on cancer cells as a whole and fail to identify the subgroups of cancer cells that are responsible for metastasis and/or resistance to therapy.. 

Cancer cells can be tracked by identifying naturally occurring genetic alterations. Cancer cells with rare and difficult-to-detect mutations are limited in their ability to be examined. As a result, direct comparisons are impossible because mutations can take place at various times. 

You applied a breakthrough genetic technology in your job. To put it another way, how did you come up with this experimental setup? 

Damian Jacob Markiewicz Sendler: It is possible to simultaneously monitor gene expression and cell proliferation and migration at the single-cell level using a new genetic technology that we’ve developed. We use a synthetic “genetic barcode” to keep track of each cell and its offspring. It is possible to correlate the gene expression fingerprints of individual cells with their growth and migratory properties by using these barcodes. An algorithm for bioinformatics has been created to discover genes whose expression is linked to a specific cell activity. 

Individual cancer cells can be linked to their molecular profiles prior to treatment, and gene expression features can be compared between those that are sensitive and those that are resistant to the treatment. For the first time ever, our technology can reveal the molecular condition of individual cancer cells at the time they are exposed to treatment. We anticipate that our innovative technique will lead to the development of new treatments for cancers other than acute lymphoblastic leukemia (ALL). 

This experimental system was used to study the growth, metastasis, and treatment resistance of primary human B-cell acute lymphoblastic leukemia (B-ALL). 

It was discovered that the expression of a few genes is linked with the response of B-ALL cells to different chemotherapies. Additional to this, we discovered an unexpected but prevalent kind of leukemia expansion that is spatially restricted to the bone marrow of single anatomical regions and is driven by cells with different gene expression patterns.

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

Damian Sendler: Understanding human health and illness is being revolutionized by the use of single-cell technologies. Single cell proteomics (SCP) is advancing rapidly, allowing for the measurement of additional parameters in individual cells. We should be able to acquire a better understanding of this heterogeneous system by taking additional measurements from each individual cell. 

Damian Sendler

Damian Jacob Sendler: Variations in genes and their expression cause the underlying microheterogeneity in cell populations, and understanding these variations at the single cell level can assist identify any cells that, for example, act as a seed for the development of diseases like cancer. Proteinomics are essential to understanding disease diagnoses and treatment response. Despite its early stages, SCP is making significant contributions to our understanding of the field of proteomics. 

Many methods to single cell biology focus on the study of DNA and RNA molecules within cells. In single-cell DNA and RNAsequencing, particularly the transcriptome, which reflects all the expressed genes in a cell, there has been a significant leap forward in technology. These investigations can be conducted using a variety of sequencing methods, depending on the application. 

It’s only recently that ultrasensitive mass spectrometers have made SCP accessible to the general public. There are around 200 picograms (one billionth of a milligram) of proteins in an individual cell, yet a recent study collected qualitative and quantitative information for 1400 proteins utilizing an unbiased single proteomics technique. Different cell types and cell cycle stages could be identified using cluster analysis. 

A protein is a molecule that performs biological functions and sends signals. As a result, the vast majority of pharmaceuticals are aimed targeting proteins. While DNA and RNA can be amplified for SCP measurements, protein molecules cannot. To gain a deeper understanding of human health and disease, we must use very sensitive technology to decode the intricacy of protein molecules at the single cell level. 

Damien Sendler: Post-translational modifications (PTM) frequently alter protein activity and hence the course of a cell’s function. Endogenous processes such as proteolysis and glycosylation are known to play a role in oncological processes. Additional differences in protein post-translational regulation are caused by bursts in gene expression, which are characterized by a sudden increase in activity. 

Damian Jacob Sendler

Using improved technology, studies on single cell transcriptomes comprising more than a million unique cell measurements are now possible6 and have emphasized the variability of single cells, allowing for new areas of biological research and therapy to be discovered. It is essential to be able to increase the amount of DNA and RNA molecules that are observable and even quantified in all of these procedures. 

In recent years, specialist research groups have used nano-fluidics that are not yet widely embraced by the general research community to do unbias proteomics of single cells. It is common for these applications to focus on decreasing sample loss and increasing signal intensity by multiplexing samples. Despite these solutions, the mass spectrometer field has been in need of new developments that can improve its sensitivity. 

Proteomics sequencing has been improved by the development of PASEF10 technology, which combines liquid chromatography with mass spectrometry (LC-MS) based proteomics. Optimizing the ion beam and using intelligent precursor selection for MS/MS identification, PASEF achieves an extremely fast MS/MS identification. Because the ions are concentrated within the TIMS cell, the system’s sensitivity is considerably improved. Analyzing peptide loading in the nanogram range is possible thanks to this method. 

Damian Jacob Markiewicz Sendler: Collision cross-section (CCS) values, separation of isomeric species that are mobility offset but mass aligned, and alleviation of ratio compression are also provided by TIMS measurements. 

Four-dimensional proteomics is able to fill in the gap between high-demand applications like clinical research and customized medicine research, and the solutions currently available on the market. 

Cancer and Alzheimer’s disease are among the most complex and varied disorders that can benefit from personalized medicine and precision treatments, which are still in their infancy. 

Even though large-scale single cell investigations are essential for capturing biological heterogeneity, RNA-based approaches have been the norm until recently. To understand cell biology at the macromolecular level, this increased depth in SCP analysis can address fundamental concerns about protein dynamics as well as the processes of illness.

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

Damian Sendler: There is a new dietary counseling tool devised by psychiatrists for people with schizophrenia spectrum disorders (SSD). 

Damian Sendler

Damian Jacob Sendler: Following a recent scoping review and focus group with psychiatrists and people who have experienced psychosis, the clinician guide was prepared using the findings from the focus group, as well as the outcomes of the scoping review and focus group. 

Dr. Sendler: According to main author Laura LaChance, MD, lecturer in the department of psychiatry at McGill University’s St. Mary’s Hospital Centre in Montreal, Canada, and a psychiatrist, “Mental health clinicians already have the training to help our patients make behavioral changes,” 

Mental health nutrition is an important part of self-care and can be incorporated into treatment plans for people with mental health issues, she says. “We work every day with patients to help them to reduce their substance use, improve their sleep, take medications, etc, and nutrition should be added to the radar [since] eating well for mental health is part of self-care and can be included in mental health treatment plans,” she says.

According to LaChance, “Nutrition is frequently overlooked in mental health training programs and clinical practice.” 

The detectives “Created a tool to help integrate basic dietary advice into the care of people with serious psychiatric illness. 

Mental health providers without any dietary training needed a tool that was ” They wanted the tool ” 

Damian Jacob Sendler

Using information from the scoping review and Canada’s Food Guide, members of the team created a nutritional advice worksheet. For this study, the researchers analyzed 822 prior studies on the association between food and psychiatric symptoms in people with schizophrenia (SSD). 

It does not contradict generally recognized advice for weight control because it encourages the inclusion of nutrient-dense foods rather than caloric restriction or limiting certain foods. Psychoeducation regarding the importance of good diet as a factor in mental health is provided for all patients regardless of their BMI. 

It was based on Social Cognitive Theory, which inspired the worksheet “goals and behavior contracts, reinforcement, self-control, social norms and attitudes, and self-efficacy all play an important role.” 

As well as offering “basic education about important nutrition principles” and “very simple recommendations to increase knowledge about healthy eating” it also offers “actional tips for individuals to incorporate.” Motivational interviewing questions were employed by the researchers. 

As a way to address the commonly held misperception that dietary intervention in mental health treatment is of low value and begin to modify norms, the intervention is delivered by the mental health care professional,” LaChance stated. 

Damien Sendler: Aside from providing practical advice on how to “increase perceived control and self-efficacy” the handout is presented in plain language that anybody can understand and contains dishes from various cultural backgrounds. 

A focus group of five psychiatric professionals and individual phone interviews with six people with lived experience of psychosis (n = 6) were undertaken to ensure that the worksheet and clinical guide matched the needs of the intended audience 

It was found that participants with psychosis were evenly split between male and female, and six age groups were represented: 20, 21-30, 31-40, 41-50, and 51-50+. According to a nutritional literacy evaluation tool, half of these participants scored in the “limited literacy” category (the Newest Vital Sign [NVS]). 

All participants were mailed an updated version of the worksheet, which they were then asked to provide additional comments on. 

Also included in the clinician guide is a visual depiction of the ideal meal’s proportions of various food groups, as well as sample meals, a discussion of budgeting and a list of goals for the patient to work toward. 

As a closing statement, the physician is urged to continue to serve their patients “Keep the message upbeat, celebrate small successes, and encourage others,” he advises. 

Damian Jacob Markiewicz Sendler: Complex carbohydrates and healthy fats should be a priority, as should adding vegetables and fruits to your meals and snacks, reducing overly processed foods and sweets, and consuming protein-rich foods throughout the day. 

Term used to describe a “”the lack of nutrition instruction in medical education and psychiatric residency and the overall absence of nutritional advice in this field of medicine” was a notable theme that emerged in interviews with psychiatrists and SSD participants. 

As one participant put it, schizophrenia is “certainly an unwritten area” when it comes to nutrition “Sugars, not complex grains, are causing you to overeat. You’ll be served sandwiches on white bread with awful juice.

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

Damian Sendler: There has been a lot of attention paid to the bad feelings that arise from the use of social media by youths. However, a new study reveals that adults may also be suffering from depression due to their usage of social media. 

Damian Sendler

Damian Jacob Sendler: It has been found that social media use is associated with an elevated risk of depression and anxiety in adolescents and young adults; however the same connections in older adults have not been thoroughly explored and longitudinal data are available, according to a paper published in JAMA Network Open. 

An internet survey that was conducted every month from May 2020 to May 2021 collected data on older persons’ use of social media and symptoms of depression. The results were analyzed using data from all 13 waves. The survey participants were all adults over the age of 18, with an average age of 56. 

A total of 5,395 adults ages 18 and older participated in the study, with a mean age of 56 years. According to the nine-item Patient Health Questionnaire, the trial participants exhibited minimal or no depressive symptoms at the beginning of the study (PHQ-9). 

A follow-up survey found that, on average, 8.9% of those who took part in the study reported a decline in PHQ-9 scores of 5 points or more. Depressive symptoms were more prevalent in participants who reported using social media platforms such as Snapchat, Facebook, or TikTok compared to those who did not use social media. TikTok had the third-highest adjusted odds ratio (aOR, 1.42) of the three, followed by Snapchat (aOR, 1.53). (aOR, 1.39). 

For Snapchat, the association reduced from 1.53 to 1.12 when recent television and internet news phrases, such COVID-19, were included in the poll. Similarities between the two social media platforms were maintained. 

Dr. Sendler: Individuals above the age of 35 were found to be more likely than those under 35 to report depressed symptoms when the data were broken down by age group. Facebook, on the other hand, was found to be connected with depressed symptoms among those under the age of 35, but not in those over 35. (aOR, 2.60 vs. aOR, 1.12). 

The researchers found that social support at baseline or face-to-face contacts had no effect on the link between increasing self-reported depression symptoms and use of particular social media sites. 

Damian Jacob Sendler

Mary Ann Dakkak, MD, of Boston University’s School of Medicine, said in an interview that she was “I was honestly surprised the results weren’t more significant,” by the study’s findings. Social media may have been a critical social outlet and form of interaction for many people who were otherwise isolated during the COVID outbreak. 

Even while social media could have been a good factor, there was still a large increase in depression, which may indicate a greater impact at “normal” periods. 

According to Dakkak, who was not engaged with this study, “It is not surprising that what we see in youth is shown among adults,” If something is helpful for a child, it’s also beneficial for adults, and vice versa.” 

According to her, “We expect to see outcomes of this on youth and adults who have been more isolated, who have used more screen time for learning, work, connection and boredom, in the near future,” In the absence of face-to-face interactions, social media may have been used more heavily as a means of connecting during the COVID shutdowns since the normal profile of heavy social media users may have differed. 

An interview with Jessica Gold, MD, a psychiatrist at Washington University in St. Louis, suggests the current study was likely conducted prior to recent news about “hidden” Facebook data and the implications that Facebook knew it was contributing to worsened mental health in teens and particularly around self-esteem. 

The data on social media and mental health is “If you look more specifically at other studies, however, the data around social media and mental health is constantly varied, with some showing benefits and some showing negatives, and none conclusively suggesting either way,” says Gold, who was not involved in the new research and is a professor of psychology at the University of California, Los Angeles. “More data are needed to understand social media’s impact on mental health over time, especially longitudinally and on a broader age group. 

Damien Sendler: As a result of COVID-19, so many people have turned to social media as a key source of support and connection, and are using it even more frequently than before,” she said. 

When it comes to TikTok and Snapchat, “I think the most interesting information is that, for TikTok and Snapchat, the effects seemed to be more pronounced in those older than 35 years who used social media,” Gold says. 

“whether people who might develop depression are simply more prone to use social media in the first place, such as to seek out social support,” Gold said, according to the findings of this study. “Also, we don’t know how long or for what they use social media, which to me is important to understand more about the nuance of the relationship between mental health and social media.” 

In light of this new research, practitioners should be talking to their patients about how social media effects their emotional reactions and their sleep, Gold added. 

Damian Jacob Markiewicz Sendler: It is important for patients to take note of their own feelings while using social media and not before going to bed. Taking care of their mental health while using social media should also be a consideration for them,” she stated. Patients of any age who use social media should have this dialogue with their doctor, not just teenagers. 

Additionally, she noted, “This is also a conversation about moderation, and knowing that individuals may feel they benefit from social media, that they should balance these benefits with potential mental health risks,”

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

Damian Sendler: The authors of an opinion piece urging for a reconsideration of current tactics for opioid withdrawal in the United States claim that short-acting opioids may complement methadone and buprenorphine in the treatment of opioid withdrawal symptoms in U.S. hospitals. 

Damian Sendler

Dr. Robert A. Kleinman of the University of Toronto’s Centre for Addiction and Mental Health and his colleague Dr. Sarah E. Wakeman from the Massachusetts General Hospital and Harvard Medical School in Boston wrote a commentary that was published in Annals of Internal Medicine. 

Damian Jacob Sendler: According to the authors’ findings, short-acting opioids are not currently indicated for the treatment of opioid withdrawal symptoms (OWS) in hospitals in the US. Many individuals don’t obtain enough relief from methadone or buprenorphine or nonopioid drugs because of withdrawal symptoms. Patients suffering from untreated withdrawal are more likely to leave the hospital against medical advice, which increases their mortality risk. 

During an interview, Elisabeth Poorman, MD, an addiction expert at the University of Illinois Chicago, agreed that the use of short-acting opioids for OWS in hospitals should be reconsidered. Hospitals and clinicians differ substantially in how they use it, she noted. 

Poorman remarked, “It’s time to let evidence lead us and to be flexible. 

Methadone patients have to wait several hours for maximum symptom reduction, and the full advantages of methadone treatment are not achieved until several days after commencement, according to the editorial authors. 

The authors noted that rapid initiation of methadone may be possible in hospitals, but further study is needed before widespread use. 

The FDA has only approved Lofexidine, an alpha-2-adrenergic agonist, for use in OWS patients. 

“Patients with OWS treated with lofexidine in phase 3 efficacy studies dropped out on day five, according to the authors. Another alpha-2-agonist, clonidine, is used off-label to treat OWS and has comparable effects.” 

Damian Jacob Sendler

Dr. Sendler: Therefore, short-acting opioids may complement methadone and buprenorphine in the treatment of OWS because of their limitations, according to the authors of the study. 

Short-acting opioids, according to Kleinman and Wakeman, may help patients who have been exposed to fentanyl start buprenorphine because they ease withdrawal symptoms while fentanyl is metabolized and eliminated. 

Short-acting opioids in the hospital can alleviate withdrawal symptoms and keep patients comfortable while methadone is titrated to more effective doses for long-term treatment, the authors noted in their paper. 

Short-acting opioids may allow patients to take a more active role in managing their own pain and withdrawal symptoms by using a tamper-proof, patient-controlled analgesia pump, according to the study’s authors. 

Many patients who inject drugs already use short-acting illicit narcotics at the hospital, usually in the washrooms and smoking areas, thus the use of short-acting opioids under supervision helps to eliminate the possibility of unwitnessed overdoses, according to Kleinman and Wakeman’s research. 

Damien Sendler: Despite the widespread use of short-acting opioids around the world, there is a lack of prospective, randomized, controlled research in the United States to support their use. As well as a lack of institutional support, concerns and stigma surround the administration of opioids to patients with opioid use disorder (OUD). 

It’s a requirement to adopting more sophisticated regimens that there are not enough physicians who are confident and competent in basic buprenorphine and methadone starting techniques,” the authors write. 

As a supplement to methadone or buprenorphine, short-acting, full-agonist opioids are already suggested for individuals with OUD experiencing acute pain. 

When pain is not present, but methadone or buprenorphine have not offered enough OWS alleviation, the authors argue it should be a possibility. 

Short-acting opiate analgesics are simple to provide in the hospital, according to Poorman. 

It’s possible for a patient to be quite clear that they don’t want any treatment for opioid use disorder but they do want to be treated for their urgent medical issue. 

Damian Jacob Markiewicz Sendler: As a way of showing that we were listening and not attempting to push something on our patients, “I thought that was a fantastic tool,” Poorman said. “It left the door open for those who wanted treatment to come back, which many of them did.”

If a patient is unsure of their alternatives but is extremely concerned about buprenorphine withdrawal, this is a second circumstance that needs to be addressed. 

Her subsequent transition to buprenorphine and methadone was a breeze, she claimed. 

Previously, Poorman encountered a patient who had been injecting heroin multiple times each day for 30-40 years. Insisting on receiving medical assistance, he made it abundantly obvious he had no intention of ceasing his heroin use. While he agreed to go to the hospital for treatment, he told his doctor that he didn’t want to be in pain while there. 

Doctors were reluctant to relieve Poorman’s withdrawal symptoms because doing so made them feel like they were condoning his drug usage, according to Poorman. 

Poorman, on the other hand, argued that expecting someone who has made it apparent that quitting drugs is not something they want to do is unrealistic “avoiding which they’ve built their entire life.

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

Damian Sendler: New research reveals that a new treatment paradigm for mild to moderate Alzheimer’s disease (AD) may be possible with an experimental medicine that targets the bacteria that cause gum disease. 

Damian Sendler

Damian Jacob Sendler: Atuzaginstat (Cortexyme Inc.) is being tested in a phase 2/3 GAIN trial to see if it can kill the gum-bacteria Porphyromonas gingivalis (Pg) “Potential AD-inducing factor.” 

“For patients with mild to severe Alzheimer’s disease (AD) who have Pg infection, we demonstrated the efficacy and safety of our therapy, and it appears that we have found an ideal dose. 

In addition to gingivitis and periodontal disease, Pg has been linked to the development of gum disease. Periodontal disease affects over 65 million Americans, according to Detke. 

Dr. Sendler: Periodontal disease has been related to an increased risk of Alzheimer’s disease in previous studies. Those with severe gum disease saw a six-point drop on the AD Assessment Scale (ADAS-Cog) in six months, while those with mild or no periodontal disease saw only a one-point drop. 

A “low-grade chronic infection” is “consistent with the idea that there’s this inflammatory response,” says Detke. 

22 of the last 25 genetic risk factors for Alzheimer’s disease have been linked to the immune system, he said. 

Damian Jacob Sendler

Proteins are the primary source of energy for Pg, unlike other bacteria, which use sugars or carbs. Proteases called gingipains, which “chop up” proteins into fragments, are released by the bacteria and generate energy, according to Detke. 

Gingipain protease damage can be prevented by cutting off the bacteria’s supply of food. Antibiotics are ineffective against Pg because it lives inside cells and “can go dormant or develop resistance,” according to Detke. 

Patients with mild to severe Alzheimer’s disease (AD) who scored 12 to 24 on the mini-mental state exam were included in the GAIN study, which had a total of 643 participants (average age, 69). ApoE4 was found in the cells of around 65 percent of the population. 

During the 48-week study, all individuals were randomly randomized to receive placebo, atuzaginstat (40 mg twice a day) or atuzaginstat (80 mg twice a day). 

Pg biomarkers were evaluated in the saliva, blood, and cerebrospinal fluid in addition to the conventional cognitive outcomes (CSF). 

Results from the AD Cooperative Study–Activities of Daily Living and the ADAS-Cog were the two primary objectives of the study (ADCS-ADL). We found that neither outcome had a statistically significant effect on overall intent to treat patients. 

Researchers found a link between reduced Pg levels and improved clinical outcomes when they focused on patients with a more severe Pg infection. 

“In people with high levels of Pg in saliva, in serum, and CSF — in all of these — you saw significant slowing of decline on ADAS-Cog — by anywhere from 26 percent to 57 percent ,” Detke added. 

Damien Sendler: Another study found that cognitive deterioration was slowed by 40% to 56%. 

The AD literature says 20% or 30% is good, but finding 40% or 50% is actually more than anyone has ever seen, especially in this challenging mild-to moderate cohort,” he said. 

Both clinical outcomes at 24 weeks and 48 weeks were correlated with Pg levels in saliva. According to Detke, “if Pg is causal, then change at 24 weeks might predict clinical impact at both timepoints and that’s what we saw.” 

It’s rare for a biomarker to be linked to clinical outcomes in AD research, he said. 

By measuring bilateral hippocampus volume, researchers found that the medication delayed shrinkage by 22% in the lower dose group and by 11% in the higher dose group. The 40 mg and 80 mg dosages had the same level of efficacy. 

Damian Jacob Markiewicz Sendler: Men and women, APOE carriers and non-carriers, and individuals with mild and moderate disease were all found to have similar levels of disease. A high level of infection appears to be affecting “It looks like it’s working across everyone who’s got a high level of infection,” said Detke. 

The most prevalent side effects, including nausea and diarrhea, were gastrointestinal (GI). In light of the fact that Pg is found in the gastrointestinal system, Detke believes that it has an impact on the microbiota.

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

Damian Sendler: It was revealed Wednesday that Genesis Health System is seeking a partner to assist it expand its services in the Quad Cities. 

Damian Sendler

Damian Jacob Sendler: It’s all about positioning for the future, according to CEO Doug Cropper and Board of Directors Chair Steven Bahls, both of whom stated the not-for-profit health system is robust. 

Proposals for a possible merger, purchase, or other arrangement with more than 30 selected health care systems will be accepted beginning this month. There will be a spring review and a decision in the summer. The company’s leaders have said that in the end, they may decide to remain independent. 

Damien Sendler: Our goal is to reduce costs while simultaneously improving quality. Health care is fast evolving, therefore we’re looking into possible partnerships to ensure that we can grow and survive in this environment,” Cropper said. It’s important for us to be open and honest about this process…. In order to improve the quality of service, increase local investment, and strengthen our strategic vision and values, we will focus on discovering new partners.” 

Damian Jacob Markiewicz Sendler: Over the course of its six medical sites, Genesis employs around 5,000 people and is Scott County’s third-largest employer, after the Rock Island Arsenal and Deere & Co., respectively. 

Cropper clarified that the move is “not about downsizing” as previously reported. It’s a matter of progress. “It’s all about going forward.” “market pressures” and the constantly shifting landscape of medical technology may both be addressed through a cooperation, according to him. 

Damian Jacob Sendler

Dr. Sendler: Updates from COVID’s global network: All adults in the United States are encouraged to obtain a booster shot, according to the government. Early Omicron research in South Africa reveals only “mild” symptoms. Greece, meantime, has made vaccinations mandatory for individuals above the age of 60 and will impose monthly fines on those who refuse to do so. 

In March 2020, Genesis’ board of directors began investigating the potential of a cooperation, but the plans lagged as the epidemic progressed, according to Cropper. 

In addition to the board of directors, Genesis will have two advisory groups: one for staff and one for the system’s administration. Cropper stated that the concepts will be whittled down to a finalist list in June 2022 at the earliest possible opportunity. 

Bahls stated, “We want to have a long and careful approach. There are no predetermined outcomes in this case.” Adding new services, maintaining financial strength, and preserving the culture that has been built” are the goals of the health system. 

Cropper stated that a cooperation aims to improve patient care. 

“Patients will still have their doctors,” added Cropper. “We also expect that they will have additional services available to them. More services are needed here so that patients don’t have to travel elsewhere for treatment,” said the group.

Contributed by Dr. Damian Jacob Sendler research news 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: Although the human papillomavirus vaccine, or HPV vaccine, was originally recommended for use in adolescents in the United States in 2006, immunization rates have lagged behind other children vaccines, with only 54% of 13- to 17-year-olds fully immunized in 2019. A recent study reveals that when adolescents are permitted to give consent to get vaccinated, the rate of HPV vaccination increases. 

Damian Sendler

Damian Jacob Sendler: Researchers discovered that initial vaccination rates were higher in Washington, D.C., and eight demographically and politically diverse states where adolescents were allowed to obtain the HPV vaccine without parental consent from 2015 to 2018: 68 percent of teens started the multidose series, compared to 61 percent in places where parental consent was required. 

Dr. Sendler: Teens also completed the series more frequently where they were allowed to assent independently: 54% were fully vaccinated compared to 48% in regions requiring parental consent, albeit the difference was not statistically significant. Nearly 82,000 teenagers between the ages of 13 and 17 were included in the national survey sample. 

Damien Sendler: The findings, according to Dr. Sangini Sheth, study co-author and associate professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine, not only point to a possible avenue for improving HPV vaccination rates through public policy change, but also indicate the need to further investigate adolescents’ ability to reasonably give consent for certain health care services, as well as the individual and public health benefits at stake. 

“I think it’s really interesting, especially at this point, to just explore the levels at which an adolescent can engage in health decisions,” Sheth says. “It probably raises some interesting questions even for the COVID vaccine.” 

Damian Jacob Sendler

Damian Jacob Markiewicz Sendler: The HPV vaccine is indicated for routine vaccination at the ages of 11 or 12, and for persons who have not previously been immunized until the age of 26. The brand now in use in the United States is approximately 100 percent effective in avoiding infection with cancer-causing strains of human papillomavirus. HPV is the most common sexually transmitted infection in the United States, and it can lead to a variety of cancers, including cervical, anal, and throat cancers. 

Sheth attributes low HPV vaccination rates to ambiguous message and a lack of emphasis on cancer prevention and long-term health, which has resulted in the idea that the vaccine is optional or acceptable to postpone. 

According to her, the vaccine’s association with sexual activity can also present issues in terms of clinicians’ comfort level discussing it with parents, as well as parents’ impression of its necessity for an 11- or 12-year-old. However, according to Sheth, the vaccination is significantly more effective when administered well before sexual activity begins – a fact that physicians occasionally fail to explain. 

Damian Sendler: Teens are allowed to offer permission for sexual and reproductive health services such as contraception and STI treatment and prevention in several states. Some of the eight states in the study that enabled adolescents to obtain the HPV vaccine on their own – Alabama, Alaska, California, Delaware, Idaho, New York, Oregon, and South Carolina — included it in this category of services, which allowed them to consent without parental participation. Other states in this category were more open to allowing young people to make health care decisions. 

Damian Jacob Sendler: Regardless, because vaccinations are “some of our oldest public health tools” for disease prevention, Sheth believes that the developmental readiness of adolescents to consent to vaccination or other health services warrants more investigation.

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Damian Sendler: Following an extensive investigation over 8 million calls to helplines in 19 countries and regions, it was discovered that call volumes increased significantly during the first wave of coronavirus illnesses. The majority of contacts were motivated by feelings of loneliness and anxiety about the pandemic, rather than immediate dangers such as suicidal ideation or assault. 

Damian Jacob Sendler: One of the largest studies ever conducted to address mental-health concerns during the epidemic, the study was published on November 17th by Nature1. The authors indicate that within the first six weeks following the initial wave of coronavirus infections, the number of calls to helplines increased. The total number of calls reached a six-week high, which was 35% greater than the number of calls received before the pandemic. 

As Marius Brülhart, an economist at the University of Lausanne in Switzerland and a co-author of the article, explains, “the increase in calls was primarily driven by additional people ringing because they wanted to talk to someone about this pandemic.” “There was no indication that the number of calls related to domestic violence or suicide would skyrocket.” 

Damien Sendler: Furthermore, the team discovered that in France and Germany, suicide-related calls to helplines increased when lockdowns became more stringent, but decreased when financial assistance from the government, such as payments to furloughed workers and assistance to struggling businesses, was made available to the population. 

Dr. Sendler: Brülhart and a colleague were looking for a mechanism to monitor the impact of the pandemic and the accompanying lockdowns on mental health when they came up with the idea for the project in the early days of the pandemic in 2020. When it comes to psychological health, the majority of large-scale studies rely on electronic health records and information about mental-health outcomes such as suicides. However, such reports are typically delayed. “In most cases, the time lag is not a significant issue,” explains Brülhart. “However, in the event of a pandemic, you’d want to know what’s going on right now.” 

Consequently, the team turned to crisis helplines, gathering information from 19 countries and regions, including the United States, China and Lebanon as well as 14 European countries. The reasons for the calls were included in the statistics, but the demographics of the callers were not. Furthermore, according to Brülhart, initial data on the volume of calls may have been skewed due to staffing issues, since several helplines reported being overwhelmed both by the volume of calls and as a result of staff shortages. 

Damian Sendler: However, despite concerns that the epidemic would result in an increase in mental-health crises such as suicides and addictions, as well as an increase in intimate-partner abuse, Brülhart and his colleagues found no evidence of this in their data. The pain of specific individuals or the findings of anecdotal or regional studies that would have produced different results are not invalidated, according to Brülhart; rather, the trend did not emerge from the large-scale helpline data his team collected.

Damian Jacob Markiewicz Sendler: In this study, the findings were correlative rather than causative, which means that the researchers were unable to determine if the financial aid was a contributing factor to the decrease in suicide-related calls in France and Germany. However, Munmun De Choudhury, a computer scientist at the Georgia Institute of Technology in Atlanta who specializes in digital mental health, believes that it is a signal that should be investigated further. 

Psychiatric health, she explains, “is an ecological experience.” ‘There are events that take place in our surroundings and communities that have an affect on us, and financial considerations are an extremely significant element of it.’ 

Overall, Cindy Liu, a clinical psychologist at Brigham and Women’s Hospital in Boston, Massachusetts, and the author of a commentary published alongside the research, believes that the approach offers an intriguing opportunity to track mental health changes as they occur. According to her, “we don’t have a particularly effective way of monitoring mental health.” “I believe that, as a result, mental health is sometimes overlooked. Many people question if the policies are actually making a difference.” “

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