Damian Jacob Sendler: Have you ever experienced “hanger,” the state of being so hungry that you become angry? Adam Rosenthal, PhD, an assistant professor in the Department of Microbiology and Immunology, has discovered that when certain nutrients are lacking, some bacterial cells become “hangry,” releasing harmful toxins into our bodies.

Damian Sendler: New technology developed by Rosenthal and his colleagues at Harvard, Princeton, and Danisco Animal Nutrition revealed that genetically identical cells within a bacterial community have different functions, with some members behaving more docilely and others producing the very toxins that make us feel ill.

According to Rosenthal, “bacteria behave much more differently than we traditionally thought.” Researchers have found that even when studying a population of genetically identical bacteria, the bacteria do not exhibit uniform behavior. To what end, we sought to discover.

Damian Sendler: These results, which were published in Nature Microbiology, are significant because they shed light on the reasons and mechanisms by which bacterial communities assign specific tasks to individual cells and, potentially, point the way toward future strategies for combating antibiotic resistance.

Rosenthal decided to investigate the distinction between “good actors” whose job it is to release toxins into the environment and “well-behaved citizens” who do not. For his research, he settled on Clostridium perfringens, a rod-shaped bacterium that lives in the digestive systems of humans and other vertebrates, as well as insects and soil.

They used a tool called a microfluidic droplet generator to partition single bacterial cells into droplets, which allowed them to read the genetic information of each individual cell.

They determined that C. perfringens cells not involved in toxin production were well nourished. However, C. toxinogenes are a different story. It would appear that those vital nutrients are absent in perfringens cells.

Damian Jacob Sendler: The researchers then put acetate in contact with the bad cells. Their theory made a lot of sense. The community as a whole experienced a decrease in both toxic levels and the number of undesirables. However, more questions have arisen as a result of these remarkable findings.

Rosenthal wonders if this new finding is unique to C., given the importance of nutrients in toxicity, or if there are other environmental factors that may be ‘turning on’ toxin production in other types of infections. perfringens.

Rosenthal hypothesizes that feeding bacteria a new set of nutrients could result in a novel therapeutic approach that could be used on both animals and humans.

Damian Sendler: The model organism Clostridium perfringens, for instance, is a dangerous predator in the hen house. Poultry have no protection against the deadly disease as the food industry moves away from using antibiotics. Recent research from Rosenthal et al. suggests that antibiotics may not be necessary for farmers to use this method of reducing pathogenic bacteria.

Damian Sendler: There is still more to be done by us humans. In order to put his recent findings into action against antibiotic resistance, Rosenthal is currently forming partnerships with colleagues across UNC. Tolerance to antibiotics develops when some bacteria are able to avoid the drug’s target, even if the community as a whole has not developed mutations that render all cells resistant to the antibiotic in question. The mechanisms regulating tolerance are poorly understood, which can lead to less effective treatment.

The work of Adam Rosenthal and his colleagues has far-reaching implications for our knowledge of bacterial behavior, antibiotic tolerance, and the development of new therapies for treating bacterial infections.

First, this research improves our knowledge of how bacteria act in groups. The idea that cells within a bacterial community can be genetically identical but serve distinct roles is challenging long-held beliefs about bacterial uniformity. Understanding the diversity of bacterial populations, wherein some cells are well-behaved while others release toxins, provides new perspective on the complexity of bacterial communities and the interactions they have with their surroundings.

Damian Jacob Sendler: Antibiotic resistance is a growing medical concern, and this study sheds light on the topic. When some bacterial cells are able to avoid drug targets without becoming fully resistant, this is called antibiotic tolerance and it can lead to less effective treatments and increased infection persistence. This study expands our understanding of the factors that regulate bacterial tolerance, providing new opportunities to combat antibiotic resistance and provide better care to patients.

The possibility of developing novel approaches to treating bacterial infections is another important facet of this study. Adding nutrients like acetate to bacteria may decrease toxin production and the overall number of “bad actor” cells, according to the study. This discovery opens up exciting new avenues for non-antibiotic treatment of infections. In the food industry, for instance, this could give farmers an alternative to using antibiotics, which have been linked to antibiotic resistance in humans, for the purpose of reducing pathogenic bacteria in poultry.

Environmental factors that may affect bacterial behavior and toxin production are also an area where this study raises pertinent questions. Scientists may be able to reduce toxicity and improve patient outcomes by focusing their attention on these factors by studying their role in other types of infections.

Significant implications for public health can be drawn from the work of Adam Rosenthal and coworkers in the areas of infection control, antibiotic resistance, and the creation of new treatment methods.

Damian Sendler: Infection control is one of the most important areas where this study could be used to improve public health. Interventions to prevent and manage bacterial infections can be better targeted and more effective if we have a better understanding of the factors that influence bacterial behavior and toxin production. The risk of infectious disease spreading within communities can be reduced, for example, if public health officials are aware of the environmental factors that promote toxin production in different types of infections.

Damian Sendler: The study’s results also have major bearing on how we approach the pressing problem of antibiotic resistance. Antibiotic-resistant bacteria are a serious threat to public health around the world because of their proliferation due to careless use of these drugs. This study can aid in the fight against antibiotic resistance by shedding light on the mechanisms by which bacteria develop tolerance to treatment and by identifying potential non-antibiotic treatment options. Antibiotic resistance can be slowed and existing antibiotics preserved for use against more severe or life-threatening infections if alternative treatments, such as nutrient supplementation, are used instead.

The study’s findings could also be used to inform public health initiatives aimed at preventing disease. The findings of this study raise the possibility that feeding certain bacterial communities could reduce the incidence or severity of infections in humans and other animals. This has the potential to increase food safety and decrease the prevalence of food-related illnesses in the food industry. To prevent pathogenic bacteria from entering the food supply and infecting humans, nutrient supplementation can be used, for instance.

Finally, the findings have the potential to influence public health policy and the allocation of resources. In order to develop effective public health interventions and inform policymakers on the best ways to manage bacterial infections, a thorough understanding of the complex interactions within bacterial communities and the factors that influence their behavior is essential. This information can also help researchers decide where to focus their efforts to find new solutions to the growing problem of antibiotic resistance.

Adam Rosenthal’s and team’s study has important implications for the study of microbiology and infectious diseases in medical schools. The study’s results show the complexity of bacterial communities and cast doubt on some long-held beliefs about bacterial behavior. As a result, it has the potential to enrich medical education and training by contributing to a deeper comprehension of infectious diseases.

First, this study emphasizes the significance of healthcare providers keeping abreast of recent developments in the fields of microbiology and infectious diseases. In order to ensure that medical professionals have the most up-to-date knowledge and skills to diagnose, treat, and manage bacterial infections, medical education and training should incorporate the latest research findings into their curriculum. The results of this study could be used in a variety of ways, such as incorporating discussions of bacterial heterogeneity and behavior into microbiology curricula and investigating how this information can be applied in clinical settings.

Second, this study has the potential to improve future doctors’ familiarity with antibiotic resistance and the significance of using these drugs sparingly. Antibiotic resistance is a major public health concern worldwide, so medical schools must train the next generation of doctors to use antibiotics sparingly and encourage them to research possible alternatives. The study’s findings on nutrient supplementation as an alternative treatment strategy highlight the necessity of incorporating a broader understanding of bacterial behavior and exploring alternative therapies into medical education to reduce the risks associated with antibiotic use.

Damian Jacob Sendler: The findings can also be used to shape new approaches to education that promote student engagement and critical thinking. Students in the medical field would benefit from learning more about the interconnectedness of bacteria, the impact of context on bacterial behavior, and the mechanisms of bacterial tolerance. Methods that achieve this goal include using the most recent research findings in interactive classroom activities, laboratory experiments, and case-based learning.

Finally, the study has the potential to inspire new investigations into microbial behavior, infectious diseases, and potential therapies. In order to combat the rising problem of antibiotic resistance, medical schools should encourage their students to conduct groundbreaking research in the fields of microbiology and infectious diseases. The next generation of healthcare providers will need to be able to recognize new threats, investigate potential solutions, and expand the boundaries of medical knowledge, all of which can be facilitated by incorporating research opportunities into medical education.

The work of Adam Rosenthal and his colleagues in the fields of infection control, antibiotic resistance, and alternative treatment strategies is highly relevant to the promotion of health. Health promotion initiatives that seek to curb the spread of bacterial infections and encourage more prudent antibiotic use can benefit from the study’s findings.

To begin, the study shows how critical it is to encourage people to adopt practices that lower their risk of contracting bacteria. Some examples of such measures are stressing the importance of washing one’s hands before eating and recommending balanced diets. Pathogenic bacteria can cause infections, so it is important to keep your gut microbiome in good shape through health promotion efforts.

Second, health promotion campaigns that encourage prudent antibiotic use can benefit from the study’s findings on antibiotic resistance. The public needs to be made aware of the dangers of antibiotic overuse and misuse, such as the rise of drug-resistant bacteria, through health promotion campaigns. They should also advocate for the use of nutrient supplementation and other non-antibiotic methods of infection prevention in order to cut down on antibiotic prescriptions.

In addition, the findings can be used to formulate new approaches to treatment, which in turn can help lessen reliance on antibiotics and advance more environmentally friendly medical procedures. Innovative solutions, such as bacteriophage therapy, probiotics, and other alternative therapies that can treat infections without relying on antibiotics, can be investigated as part of health promotion initiatives. Health promotion campaigns can help in the fight against antibiotic resistance and encourage sustainable healthcare practices by promoting and incentivizing the development of alternative treatment strategies.

In the end, this study has policy implications for limiting the spread of bacteria and encouraging prudent antibiotic use. Infection control measures, responsible antibiotic use, and funding for the development of alternative treatment strategies can all be promoted through health promotion initiatives. Additionally, they can work together with policymakers, healthcare providers, and researchers to spot new risks, encourage innovation, and put scientific findings into practice.

Infection prevention, antibiotic resistance, and the creation of new forms of treatment are just some of the areas that stand to benefit greatly from Adam Rosenthal and company’s findings.

Damian Sendler: The results of this study may one day be used to create targeted interventions that protect against bacterial infections. Based on the results of this study, public health officials may be able to develop strategies to mitigate environmental factors that stimulate toxin production in various types of infections, thereby reducing the risk of infections spreading within communities. Infectious disease rates and the spread of pathogenic bacteria could both be lowered with the help of targeted interventions based on the findings of this study.

Alternative treatment strategies that can combat the spread of antibiotic resistance could also benefit from this study. The results of this study on the use of dietary supplements as a treatment strategy highlight the need to investigate other therapies that can lessen the negative effects of antibiotics. This study has the potential to pave the way for novel treatments of infections that make use of natural substances and target specific bacterial communities. Antibiotics are losing their effectiveness because of antibiotic resistance, but these new approaches to treatment show promise.

Damian Jacob Sendler: The findings can also be used to improve methods for detecting and treating bacterial infections. To better meet the needs of each individual patient, healthcare providers will need to be able to identify and differentiate between different bacterial populations within communities. To lessen the likelihood of bacteria developing resistance to antibiotics, this technology could be used to create more effective targeted therapies for treating bacterial infections.

Finally, the study has the potential to inspire researchers to dig deeper into the mechanisms that regulate bacterial tolerance and antibiotic resistance. Further study is needed to develop new treatments and prevention strategies for antibiotic resistance, which is a growing global threat. Research into the mechanisms that regulate bacterial behavior and the creation of new treatments that reduce the risks associated with antibiotic use can benefit from the study’s findings on bacterial heterogeneity and nutrient supplementation.

Damian Sendler Diagnosis labels may influence treatment plans. We looked at the impact of labeling low back pain (LBP) on beliefs about imaging, second opinions, surgery, seriousness, recovery, work and physical activities. We found that labeling LBP had a significant impact.

Damian Jacob Sendler Using a six-arm, online, blinded experiment, participants with and without low back pain were randomized. Labels like “disc bulge” were given to participants, as well as the more specific ones like “arthritis” and “lumbar sprain,” which were given to those who didn’t fit the other categories. The most important result was a shift in attitudes toward imaging.

Dr. Sendler Results: There were 1375 participants (mean [SD] age, 41.7 years [18.4 years]; 54.4 percent women) in total. When compared to the labels “episode of back pain” (6.0 [2.9]), “lumbar sprain”, and “non-specific LBP” the need for imaging was rated lower with the labels “arthritis” (4.2 [2.9]), “degeneration” and “disc bulge” (5.7 [3.1]). In comparison to “disc bulge” “degeneration” and “arthritis” these labels led to higher recovery expectations and lower ratings of the need for a second opinion, surgery, and perceived seriousness. LBP sufferers with a history of seeking medical attention were more likely to be affected by the study results. There were no differences in the six labels’ beliefs about physical activity and work.

“Episode of back pain,” “lumbar sprain,” and “non-specific LBP” reduced the need for imaging, surgery, and a second opinion among the public and patients with LBP, as well as reducing the perceived severity of LBP and increasing recovery expectations, according to the findings. Labels appear to have the greatest impact on those who are most likely to have a negative outcome (participants with current LBP who had a history of seeking care).

Activation of AAC and UCP1 by mitochondrial uncouplers causes proton leakage.

H+ leakage (IH) through the inner membrane of mitochondria generates heat. Long-chain fatty acids act on uncoupling protein 1 (UCP1) in brown fat2-6 and on ADP/ATP carrier (AAC) in other tissues1,7-9 to cause IH, but the mechanism by which this occurs is still not fully elucidated1. IH is induced by protonophores such as 2,4-dinitrophenol (DNP) and cyanide-4-(trifluoromethoxy) phenylhydrazone (FCCP)10,11, as evidence for pharmacological activators of IH through UCP1 and AAC is lacking. The clinical potential of protonophores for treating human disease is limited due to their indiscriminately increasing H+ conductance across all biological membranes10,11 and adverse side effects15, despite their success in animal models in combating obesity, diabetes, and fatty liver. IH induced by DNP, FCCP, and other common protonophores can be directly measured, and we found that it depends on AAC and UCP1. The binding sites for protonophores and long-chain fatty acids are found to overlap with the putative ADP/ATP-binding site by performing a computational analysis on the molecular structures of AAC. Mathematically, we propose an uncoupler-dependent IH mechanism via AAC. AAC and UCP1 can be activated by protonophoric uncouplers, paving the way for the development of new and more specific mitochondrial bioenergetics activaters.

Barrier function and the skin’s microbiota

Damian Jacob Markiewicz Sendler Our skin serves as a first line of defense against toxins, radiation, and pathogens. Besides protecting our internal organs and tissues, defining our appearance, and providing a sensory interface, our skin also acts as a barrier against dehydration. Protecting the skin from disease-causing microorganisms, tuning the immune system, and enhancing the epithelium are all functions of the colonizing microbiota that reside on and in the skin. To better understand how the microbiota affects multiple aspects of skin barrier function, we have highlighted recent advances in our knowledge. We discuss recent findings in the field of pathological host-microbiota interactions and their implications for skin and other systemic diseases. Last but not least, we look at how microbiota-based mechanisms can be targeted in order to prevent or manage skin disorders and impaired wound recovery.

Cellular roles and applications of circular RNAs are discussed in this article

Damian Jacob Sendler

Back-splicing of exons from precursor mRNAs is the most common method for producing circular RNAs. Circular conformation and sequence overlap with linear cognate mRNAs have been overcome by recent technological advances, allowing better understanding of their cellular roles. A variety of biological and pathological processes can be affected by circular RNAs, depending on their location and specific interactions with DNA, RNA, and proteins. Circular RNAs can also influence transcription and splicing, cytoplasmic mRNA stability and translation, signaling pathways, and act as translation templates. New biomedical research applications of RNA circles, such as interfering with cellular processes, modulating immune responses, and directing translation into proteins, are emerging. Here, we present an overview of the current understanding of the regulatory roles of circular RNAs and discuss their future potential applications.

Cancer survival analysis platform Survival Genie, a web-based tool.

Damien Sendler It has become common practice to use genomics data to identify gene signatures and pathways in order to make predictions about cancer survival and treatment choices. Despite the development of a large number of packages and tools, the ability to perform such analysis based on pathways, gene sets, and gene ratios is lacking. In addition, cluster markers from cancer single-cell transcriptomics studies remain an underutilized prognostic option in this era of single-cell omics.. There is a lack of online bioinformatics tools that can assess whether the enrichment of canonical cell types in cancers correlates with survival. As a result, we have created Survival Genie, a web-based tool that can perform survival analysis on RNA-Seq data as well as a variety of other molecular inputs, including gene sets and ratios of tumor-infiltrating immune cells. There are 53 datasets of 27 distinct malignancies from 11 cancer programs in Survival Genie for a comprehensive analysis of adult and pediatric cancers. Gene expression partitioning can be done using any of several methods, including scRNA-seq data or entire gene sets, and the impact of expression levels on survival outcomes can be assessed using a variety of methods. Box plots of low and high-risk groups, Kaplan-Meier plots with univariate Cox proportional hazards model, and correlation of immune cell enrichment and molecular profile are provided by the tool.

Systemic lupus erythematosus can be studied using a transcriptome-wide association study of immune cell transcripts.

These genetic discoveries are hindered by the fact that the disease genes at most of the risk loci have not been identified by genome-wide association studies [GWAS], which have identified more than 100 risk factors for SLE. It was our goal to prioritize the 110 SLE loci identified in the most recent East Asian GWAS meta-analysis of SLE genes.

A total of 105 Japanese individuals were studied to build gene expression predictive models in blood B cells, CD4+ and CD8+ T cells, monocytes, natural killer cells, and peripheral blood cells. The latest genome-wide association meta-analysis of 208 370 East Asians was used to conduct a transcriptome-wide association study (TWAS) and three data-driven computational approaches were used to look for potential candidate genes.

Analysis of GWAS data revealed 127 (74.3 percent) SLE loci to contain 171 significant SLE genes (p1.010-5). Out of these, 114 (66.7 percent) showed significance only in a single cell type. An association between CD83 and SLE was found by TWAS with a p-value of 7.710-8. A new single-variant association was found at rs72836542 (OR=1.11, p=4.510-9) around CD83 in a meta-analysis of genetic associations in the existing 208 370 East Asian and additional 1498 cases and 3330 controls. Among the 110 SLE loci, 276 gene candidates were identified, including 104 genes at newly discovered SLE novel loci. rs61759532 showed an allele-specific effect on ACAP1 expression, and the presence of the SLE risk allele reduced ACAP1 expression in vitro.

SLE gene discovery was enhanced and novel genetic associations were discovered using cell-level TWAS in six different immune cell types. SLE genetic associations can now be explained biologically thanks to gene findings.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler It has been shown that monkeypox can be transmitted from animal to human via direct contact with secretions or rodent secretions contaminated by the monkeypox virus. It is mentioned in this letter that two cases of monkeypox have been found in Lahore Jinnah hospital, Pakistan. In developing countries like Pakistan, where healthcare facilities are scarce, it is imperative that this disease be closely monitored and the general public made aware of the danger it poses. It is possible that the combination of all of these measures will aid in the acquisition of new information and the reduction of outbreaks in developing countries like Pakistan.

Damian Jacob Sendler An investigation into the role of the NLRP3 Inflammasome and its Regulator miR-223-3p in multiple sclerosis and experimental demyelination

Dr. Sendler After damage to the myelin sheath, inflammation and repair are mediated by innate immune pathways. Although the regulation and contributions of inflammasome activation in the demyelinated central nervous system (CNS) are not fully understood, activation of inflammasomes has recently been implicated as a driver of myelin injury in multiple sclerosis (MS) and its animal models. The NLRP3 (NBD-, LRR-, and pyrin domain-containing protein 3) inflammasome and its endogenous regulator microRNA-223-3p were studied in both MS and an animal model of focal demyelinating disease (FMD) in this study. In activated macrophages and microglia, we found increased expression of NLRP3 inflammasome components and microRNA-223-3p. Activation of the inflammasome was suppressed in macrophages and microglia by microRNA-223-3p and MCC950, small-molecule NLRP3 inhibitors; macrophages were more prone to inflammasome activation than microglia. After lysolecithin-induced demyelination, systemic administration of MCC950 to mice reduced axonal injury in demyelinated lesions significantly. Following demyelination, macrophages and microglia produce NLRP3 inflammatory mediators, which could be used as therapeutic targets for MS and other inflammatory-mediated demyelinating diseases, such as Parkinson’s disease.

Leukocytes are regulated by the brain’s motor and fear circuits during acute stress

The immune system and the nervous system are intertwined1. It is well-documented that stress affects immunity, but the mechanisms by which stress networks in the brain influence peripheral leukocytes are still poorly understood2. During acute stress in mice, we found that distinct brain regions influenced leukocyte distribution and function. In a study using optogenetics and chemogenetics, we found that skeletal muscle-derived neutrophil-attracting chemokines trigger rapid neutrophil mobilization from bone marrow to peripheral tissues via motor circuits. Direct cell-intrinsic glucocorticoid signaling in the paraventricular hypothalamus, on the other hand, controls monocyte and lymphocyte exit from secondary lymphoid organs and blood to the bone marrow. People who experience stress-induced, counter-directional, population-wide leukocyte shifts are more susceptible to disease. Acute stress, on the other hand, modifies innate immunity by reprogramming neutrophils and directing their recruitment to injury sites. Conversely, leukocyte shifts mediated by corticotropin releasing hormone (CRH) neuron protect against the acquisition of autoimmunity but impair immunity to SARS-CoV-2 and influenza infection. As a whole, these findings show that the immune system’s ability to respond to physical threats is regulated by the brain’s ability to rapidly alter the landscape of leukocytes in response to psychological stress.

Glioblastoma tumor progression is revealed by single-cell RNA sequencing.

Damian Jacob Sendler

Malignant glioblastoma (GBM) is a primary brain cancer that is inherently protumorigenic and therefore incurable. Only a few studies have examined the GBM immune microenvironment during tumor progression and current therapies. An epidermal growth factor receptor-driven genetic mouse GBM model’s immune cell composition changed in a large-scale, comprehensive longitudinal manner during tumor progression, as revealed by single-cell transcriptomics and flow cytometry. As the blood-brain barrier breaks down and the growth of epidermal growth factor receptor+ GBM cells expands, we found that proinflammatory microglia and antiinflammatory macrophages and protumorigenic myeloid-derived suppressors cells become more prevalent in end-stage tumors. In low-grade glioma and GBM patient biopsies, a similar relationship between microglia and macrophages was discovered. However, concurrent treatment with temozolomide irradiation increased intratumoral GranzymeB+ CD8+ T cells but also increased the number of CD4 regulatory T cells. Using these findings, researchers have been able to map the entire immune cellular landscape and its evolution as GBM progresses.

Treatment targets can be identified using chromotin profiles, which classify castration-resistant prostate cancers.

Damian Jacob Markiewicz Sendler The loss of androgen receptor (AR) dependence in castration-resistant prostate cancer (CRPC) results in clinically aggressive tumors with limited therapeutic options. Organoids, six xenograft cells, and 12 cell lines were studied using ATAC-seq (asay for transposase-accessible chromatin sequencing), RNA sequencing, and DNA sequencing. While the well-known AR-dependent and neuroendocrine variants were already known to exist, we also discovered two new variants that were AR negative/low: one based on Wnt signaling, the other on activator protein-1 (AP-1) transcription factors. We classified 366 patients based on their transcriptomic signatures, and SCL was found to be the second most common CRPC subtype after AR-dependent. For example, our findings show how this group’s transcriptional landscape is maintained by AP-1 and YAP/TAZ and TEAD protein interactions. To put it another way, this molecular classification can help doctors identify potential drug targets and help them make treatment decisions.

Prostate cancer lineage plasticity and castration resistance are controlled by the FGFR1 ligand Gremlin1, which can be therapeutically targeted.

The development of castration-resistant prostate cancer (CRPC), which can be fatal, and the lack of effective targeted therapies for more advanced disease are two of the most significant challenges in the clinical management of prostate cancer (PCa). By binding to FGFR1, we’ve found that Gremlin1 promotes lineage plasticity and increases castration resistance. Anti-Gremlin1 antibody and androgen deprivation therapy (ADT) in CRPC have been shown to have a synergistic effect. Androgen receptor (AR) inhibits GREM1 transcription, which is then unlocked by ADT. Gremlin1 binds to FGFR1 and activates MAPK signaling downstream, as demonstrated here. Gremlin1 has a unique interaction with FGFR1 compared to FGF1’s canonical ligand FGF1, as demonstrated by docking and mutagenesis. Gremlin1 appears to be a promising therapeutic target for CRPC, according to our research findings.

Those who recover from infectious mononucleosis have different pre-illness metabolite and metabolic pathway profiles than those who do not.

Damien Sendler Methylamines, lipids, amino acids and neurotransmitters may all contribute to the pathophysiology of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). A prospective, long-term study at Northwestern University enrolled 4501 students. As part of our investigation into infectious mononucleosis (IM), we conducted a 6-month follow-up for those who recovered (N = 18) and those who developed ME/CFS (N = 18). We found significant detectable metabolite differences in pre-illness blood samples between participants destined to develop severe ME/CFS following IM and recovered controls, which were compared to recovered controls. There are several potential dysregulated pathways that we identified, including glutathione, nucleotide, and the TCA cycle. During an inflammatory immune response, the pathways that differed between cases and controls are critical for cell proliferation. Using a leave-one-out cross-validation (LOOCV), our models correctly classified the severe ME/CFS group and recovered controls with 97.2 percent accuracy, 94.4 percent sensitivity, and 100.0 percent specificity. These alterations are in line with the increases in pro-inflammatory cytokines found in patients who went on to develop severe ME/CFS six months after IM, as previously described.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler Health care workers’ preparedness is essential to a successful response to an emergency situation. For this study, the primary goal was an overview of relevant studies on the willingness to work in emergency and disaster situations, a description and classification of the most important challenges and solutions, identification of knowledge gaps in the literature which could inform future research.

Damian Jacob Sendler The inclusion criteria were met by 26 articles out of 2902 that were found during the search. Aims, study design, and reporting details were all different in the studies. Nearly three-quarters of the studies were conducted in high- and middle-income countries. Due to the COVID-19 pandemic, most of the studies were published in 2020. Emerging and re-emerging infectious diseases were the most commonly reported types of crises in the studies that were included. The majority of the issues were related to mental and psychological issues, health concerns for employees, and the management-employee relationship.

Dr. Sendler One of the most important factors affecting system efficiency is human resource allocation, which plays a significant role in healthcare systems. Because of this, it is a critical component of the hospital’s overall infrastructure. Disruption of hospital operations is inevitable in the absence of adequately trained and qualified staff [1]. Patient care will suffer if human resources are under-utilized and under-motivated, which will lead to lower levels of efficiency and motivation. Because determining a hospital’s human resource requirements is a common issue, human resource management should play an important role in healthcare system planning [2].

According to popular academic usage, “emergency situations” have a wide range of definitions. Change from the usual to the unusual is generally dangerous and can lead to an emergency [3, 4]. Unpredictable causes of crises are extremely rare [5]. A disaster occurs when a natural or man-made emergency exceeds the society’s or system’s ability and capacity. There will be an impact on every facet of human life, from death to physical injuries to damage to assets and infrastructures to social and economic costs, if a disaster occurs.

Throughout history, disasters have posed a constant threat to human life. It’s been found that the number of disasters is steadily rising; for example, in 2019, there were 409 worldwide disasters. As a result of each disaster, the healthcare system is impacted both directly and indirectly. It will be up to government and crisis committees at healthcare facilities to decide where patients will be treated and who will provide services if the crisis continues[6].

Continuity of care for a large number of patients requires meticulous planning on the part of healthcare officials and policymakers across the country during an emergency. Planned responses to emergencies and disasters should focus on increasing the motivation of workers and encouraging them to provide high-quality services. Health care workers’ time and workloads can be kept under control with the help of these parts of the system. Patients and coworkers who die in the line of duty put health care workers at risk of infection, exhaustion, separation from their loved ones, and other forms of mental and emotional stress.

The following are the main factors that influence the absence of personnel during a disaster: a) the willingness of the staff to accept the risk of their duties. In addition, their willingness to demonstrate their skills at work. During pandemics and terrorist incidents like CBRN [chemical, biological, radiological] or a nuclear holocaust, hospitals and public health centers report substantial absences of staff [4, 6]. Also, some studies have shown that absenteeism and job satisfaction decrease significantly following natural disasters [7].

According to some studies, employees’ willingness to work can be boosted by a well-thought-out plan that supports patients, their families, and the substructures of hospitals. Increasing the hospital’s capacity prior to an emergency is one of the basic measures of service delivery systems. Providing adequate space, equipment, and human resources is essential. Increased capacity and human resources in healthcare systems are needed to deal with these challenges [9, 10].

In hospital disasters and emergencies, a lack of personnel has not been sufficiently discussed [11]. Because of the high rate of nurse absenteeism (20%), researchers believe that implementing plans to safeguard patients, employees’ families, and hospital infrastructure can increase employee motivation to work [12].

Iran’s hospitals are plagued by a lack of and inefficient use of human resources, according to a number of studies. When disaster strikes and time is of the essence, these issues take on a new urgency. There needs to be more research into the importance of human resources in hospitals, given their critical role in the quality and quantity of services provided.

The management of human resources during emergencies and disasters should also be considered in emergency planning, according to studies. Having a better understanding of the factors that influence the ability and willingness to care in the aftermath of a disaster is critical for health care administrators and policymakers. This study’s goal is to find ways to increase the willingness of healthcare workers to show up for work in the event of an emergency or disaster and to cut down on their absence.

Out of 26 studies, 24 were conducted in nine countries (the United States, Japan, China, Taiwan, the Commonwealth of Guinea and the Republic of Sierra Leone, along with New Zealand and Singapore), while only two studies involved researchers from more than one country. Eleven studies were conducted in the United States, making it the country with the most findings. More studies were conducted in countries with a high level of income and stable economies than those with less developed economies.

Damian Jacob Markiewicz Sendler According to the findings of the study, interventions and strategies for retaining health professionals differ depending on the country’s level of income, such as in the United States, Japan, Singapore, Australia, and New Zealand, which are considered high-income countries. China, a country with an upper and middle-income status, relies heavily on the psychological support of its health workers to keep them going. As the Ebola epidemic has shown in low-income countries like Africa, particularly New Guinea and Sierra Leone, health systems and policies are a major source of concern. However, reforms focused on human resource management could significantly improve the long-term viability of the healthcare industry.

Due to the study’s global scope and expert advice, it was decided to use the World Health Organization’s 6BB classification system after extracting data from studies on both barriers and solutions (Six building blocks). To achieve the Sustainable Development Goals (SDGs), the WHO framework serves as a powerful tool for strengthening the health system. Most of the findings from the study were incorporated into this framework, which includes providing service; human resources; information; medical products/vaccines and technology; finance and leadership; and leadership. This goal can be achieved by providing appropriate services in a safe and effective manner, along with qualified health interventions at the required time and location, with the least amount of resource waste for the individual, the community, and those in need.

Damian Sendler

As a general rule, 114 of the original code were found to be barriers and challenges to manpower retention in the study of barriers and challenges. The number of codes was reduced to 24 in the next step by eliminating duplicate codes and merging similar and homogeneous items. Six main categories (24 subcategories) were grouped into by the researchers based on a 6bb framework. In terms of challenge recurrence, poor leadership communication and emotional support, as well as worries about family, were the most common causes, while a lack of funding for training, salaries, and other forms of compensation were the least common.

The research team identified 133 primary codes from the articles included in the study relating to solutions and interventions for the maintenance of manpower in emergencies and disasters. The number of codes was reduced to 27 after duplicates were removed and homogeneous items were merged. The extracted items were divided into six main categories (27 subcategories) based on the framework’s six building blocks after the researchers classified the codes. Seven subcategories of management, mainly positive communication with staff and outside the organization; the least repetition in the financial class, which includes support programs and resource development for hiring and retention.

Damien Sendler There are many challenges that medical staff face in times of emergency and disaster, and this study uses a systematic mapping review method to investigate these issues. A total of 26 articles from 11 different countries were included in this investigation. There have been 11 articles published in this field in the United States in the last few years, which is more than any other country. In addition, the most pressing issues and crises in these countries have been those related to diseases.

Damian Jacob Sendler

Poor relationships between managers and employees, family concerns, job security after returning to work, fatigue and stress among staff members, moral dilemmas and patient care concomitant with fear were some of the most significant challenges that countries identified. There were also solutions based on studies, including good communication between managers and workers, the implementation of maintenance regulations and health instructions as well as updates to those instructions, the development of the organization’s morale as well as the public’s support of and appreciation for it; the use of volunteers and localization; enhancing the sense of responsibility; providing medicine; increasing the capacity of the hospital

Human resources disaster research is largely confined to wealthy and semi-wealthy countries, according to the findings of this study. Low-income countries must conduct additional research into this topic due to the prevalence of epidemics like Ebola and the severe consequences of a lack of medical personnel. As a result of their high incidence of natural disasters, countries like the United States and Japan place greater emphasis on disaster preparedness that includes having adequate human resources readily available. Financial difficulties and the possibility of contracting infectious diseases are two additional factors that limit the availability of human resources in low-income countries [17, 19, 24, 31]. In addition, the study’s findings show that the approaches taken by high- and low-income countries to disaster preparedness differ due to different priorities. As an example, in high-income countries, the first priority is to ensure the physical and mental well-being of emergency responders, whereas in low-income countries, the focus is on raising funds [14, 18, 32].

Disasters, epidemics, and pandemics, according to this study, lead to a shortage of workers in the short term. Compared to natural and man-made disasters, the shortage of workforce has occurred more frequently during the outbreak of new and recurring diseases in the last 20 years. Because of the repeated nature of these crises and the associated health, family, and society concerns that accompany them, it may be possible to link it to this phenomenon These worries will lead to an increase in absenteeism among employees. Rather, the challenges faced by workers during natural and man-made disasters are the safety of their families and the safety of the path between their homes and workplaces. In order to benefit from the presence of dedicated and experienced personnel during a disaster, health systems must consider and solve these challenges in advance [15, 16, 20, 32–34]. Even more importantly, countries can prepare themselves by enacting mandatory laws and regulations regarding their healthcare systems. A joint committee has been established in the United States to evaluate the state of healthcare facilities and to increase the capacity of hospitals in case of a natural disaster.

According to the findings of this study, a majority of the research has been conducted in hospital environments, which indicates that hospitals are the primary centers and front lines in dealing with disasters. In order to support them, officials need to give them the resources and equipment they need. Hospitals must increase their preparedness in order to reduce their risks. The World Health Organization’s Hospital Safety Index can also be helpful, as it assesses hospitals’ preparedness based on structural, non-structural, and practical criteria. Building and developing smart hospitals with the help of technology can also reduce waste and staff shortages, which can be beneficial to the healthcare systems of countries.

As a result, it is difficult to maintain human resources if managers are not aware of employees’ emotional needs and have a poor relationship with them, according to the findings of this study. Mental exhaustion from family separation can put employees in a quandary and cause them to miss work [22, 37, 38]. An effective solution in such circumstances is to hire sufficient human resources and to adjust their shifts in a way that prevents staff burnout due to long hours and time away from home. These measures ensure that the necessary personnel are always available.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler When the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus infects a person, human genetics can shed light on the biology and epidemiology of coronavirus disease 2019 (COVID-19) by identifying causal mechanisms that explain why some people are more severely affected by the disease. Multiple disease phenotype definitions and different study designs have been used to identify several genomic regions associated with COVID-19 in large-scale genetic studies. As a result of these findings and a slew of subsequent research, we now have a better grasp on what causes COVID-19 and how to treat it. SARS-CoV-2 infection has long-term consequences, and the ability to translate genetic risk prediction into clinical practice is an important emerging opportunity. This includes the clinical translatability of genetic risk prediction and the repurposing of existing drugs. These transferrable opportunities are likely to have a significant impact on the study of a wide range of infectious diseases.

Aiming to dispel myths and misconceptions about the treatment of acute hyperkalemia.

Damian Jacob Sendler It is estimated that millions of people are affected by hyperkalemia at some point in their lives. Despite the fact that hyperkalemia is common and dangerous, there are no accepted treatment guidelines or even a common understanding of what it is. An overview of common misunderstandings about hyperkalemia emergency care is presented here, as well as a review of the most recent research on the subject, as well as some practical advice on various treatment options. Additionally, we discuss the pathophysiology of hyperkalemia’s electrocardiographic effects and how intravenous calcium preparations can counteract these effects. At the end of each section, we offer suggestions to help emergency physicians treat acute hyperkalemia in a safe and effective manner.

Omicron strain of SARS-CoV-2

Dr. Sendler The Omicron variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic (B.1.1.529). Global health officials are concerned about the high transmissibility and immune evasion of the Omicron variant, the most common SARS-CoV-2 mutation. Omicron has quickly supplanted Delta as the dominant variant in several regions due to its improved transmissibility. Studies have shown that the Omicron variant is less pathogenic because it has a different cell tropism. While vaccines and convalescent serum can neutralize Omicron, most antibody therapies have little effect. New findings on Omicron variant’s molecular and clinical characteristics were summarized in this review, and potential therapeutic applications in response to Omicron infection were also discussed. To that end, we’ve outlined possible responses to upcoming waves and strategies for putting an end to the pandemic.

Post-COVID-19 patients are being hit by a deadly storm of an uncommon opportunistic mucormycosis.

Damian Jacob Sendler

Zygomycetes of the order Mucorales produce Mucormycosis, an opportunistic fungal infection that is rare but life-threatening. Soil, decaying vegetation, and organic matter all contain these fungi. There are many ways in which sporangiospores can enter the human body, including through inhalation or direct skin inoculation by trauma or ingestion, which can lead to mucormycosis in immunocompromised individuals. There is a high risk of developing mucormycosis in patients with uncontrolled diabetes, hematological malignancies, high-dose glucocorticoid therapy, iron overload, or organ transplantation. Among all other countries, India was hit the hardest by the second wave of SARS-CoV-2, with the highest number of cases and deaths. Mucormycosis, a rare but deadly disease, also emerged in the country. Many patients with underlying risk factors like uncontrolled diabetes, high-dose steroid therapy, and mechanical ventilation have developed mucormycosis as a result of coronavirus disease 2019 at present. The most common mode of transmission for sporangiospores in the nose is through inhalation. sporangiospores germinate and grow into hyphae in an immunocompromised host. Tissue infarction, necrosis, and thrombosis are all the result of these hyphae invading tissues. Rhino-orbital-cerebral mucormycosis is the end result of angioinvasion-induced hematogenous dissemination to numerous organs, with the brain being the most frequently affected. The primary diagnostic methods are clinical characteristics, radiology, fungus culture, histopathology, and molecular techniques. The most common treatment options are a surgical procedure and a course of antifungal medication. While posaconazole and isavuconazole are commonly used as step-down therapy and salvage therapy for mucormycosis, amphotericin B is the drug of choice for treatment of the disease.

Ferroptosis and macrophages interact

Damian Jacob Markiewicz Sendler Ferroptosis, a newly discovered iron-dependent cell death pathway, is characterized by lipid peroxidation and GSH depletion mediated by iron metabolism and is morphologically, biologically, and genetically distinct from other programmed cell death mechanisms. For additional reasons, ferroptosis is frequently accompanied by inflammation. It has been implicated in the onset of a wide range of illnesses thus far. Among the many immune cells found in the human body, macrophages play a critical role in tissue homeostasis by mediating inflammation and regulating iron, lipid, and amino acid metabolisms through their unique functions such as phagocytosis and efferocytosis, as well as the secretion of cytokines and the production of ROS under various polarizations. In light of these similarities between ferroptosis characteristics and macrophage functions, it is clear that macrophages and ferroptosis are linked in some way. Therefore, our review aims to shed light on the relationship between macrophages and ferroptosis in terms of three metabolic pathways and the application of this relationship in the treatment of diseases, particularly cancer. Final thoughts: by regulating ferroptosis in specific tissue-resident macrophages, we provide ideas for future research into the treatment of certain disease states. FACTS: An iron-dependent hydroperoxide in the lipid hydroperoxide of ferroptosis is a newly discovered form that is non-apoptotic and iron-dependent. Ferroptosis has been implicated in a slew of diseases, including hepatitis, neurological disorders, and cancer, to name just a few. Immune cells that phagocytose and efferocytose, as well as secrete cytokines and produce reactive oxygen species (ROS), are known as macrophages. Our bodies’ metabolic and immune systems depend on macrophages, which have been shown to play a role in both. Changing the polarization of macrophages, which damages the tumor microenvironment and causes ferroptosis in cancer cells, has been studied as a treatment for cancer recently. HOW MAY I HELP YOU? How do macrophages control the ferroptosis of other tissue cells? Are there any other diseases that could benefit from the interaction between macrophages and ferroptosis, besides cancer? What can we do to target macrophages to treat ferroptosis-related diseases? Using macrophages and ferroptosis as a treatment for disease is it more effective than other therapies?

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Basic research and clinical applications of human organoids

Damian Sendler: Organoids are three-dimensional (3D) miniature structures cultured in vitro that mimic the cellular heterogeneity, structure, and functions of human organs. They are made from either human pluripotent stem cells (hPSCs) or adult stem cells (AdSCs) derived from healthy individuals or patients. With the advent of human 3D organoid systems, it is now possible to observe stem cell morphogens, maintenance, and differentiation in a manner similar to primary tissues, enhancing the potential to study both human physiology and developmental stage. Organoids derived from patients hold great promise for biomedical research and preclinical drug testing because they are similar to their original organs and contain human genetic information. They are currently used for personalized, regenerative medicine, gene repair, and transplantation therapy. Researchers have succeeded in creating various types of organoids that mimic in vivo organs in recent decades. We present an update on current in vitro differentiation technologies for brain, retinal, kidney, liver, lung, gastrointestinal, cardiac, vascularized, and multi-lineage organoids, discuss the differences between PSC- and AdSC-derived organoids, summarize the potential applications of stem cell-derived organoids systems in the laboratory and clinic, and outline the current challenges for the application of organoids, which would deepen our understanding of mechanis

Killer cells in the body

Damian Jacob Sendler: Natural killer cells (NK) have recently gained attention as an important type of innate immune regulatory cell as a promising alternative platform for cellular immunotherapy. Through non-MHC-restrictive effects, NK cells can rapidly kill multiple adjacent cancer cells. Although tumors may develop multiple resistance mechanisms to endogenous NK cell attack, in vitro activation, expansion, and genetic modification of NK cells can significantly improve anti-tumor activity and give them the ability to overcome drug resistance. Some of these approaches have been translated into clinical applications, and clinical trials of NK cell infusion in patients with hematological malignancies and solid tumors have yielded a number of promising clinical results. CAR-T cells have shown great promise in the treatment of hematological malignancies, but they have a number of drawbacks, including high manufacturing costs and potentially fatal toxicity, such as cytokine release syndrome. To address these issues, CAR-NK cells were created through genetic engineering and demonstrated significant clinical responses while having fewer side effects than CAR-T cell therapy. We summarize recent advances in NK cell immunotherapy in this review, focusing on NK cell biology and function, NK cell therapy types, clinical trials, and future perspectives on NK cell therapy.

Following SARS-Cov-2 vaccination, patients developed autoimmune mucocutaneous blistering diseases.

Cases of severe autoimmune blistering diseases (AIBDs) have recently been reported in association with the SARS-CoV-2 vaccination.

Dr. Sendler: Seven days after receiving a second dose of the mRNABNT162b2 vaccine (Comirnaty®/ Pfizer/BioNtech), a 60-year-old female patient developed oropharyngeal and nasal bullous lesions. A diagnosis of oropharyngeal Pemphigus Vulgaris was made based on histology and direct immunofluorescence findings of supra-basal blister and intercellular staining of IgG antibodies, as well as the presence of a high level of anti-Dsg-3 antibodies (80 U/ml; normal 7 U/ml) in the patients’ serum.

A total of 35 AIBD cases were discovered as a result of the SARS-CoV-2 vaccination (including our report). 26 (74.3%) were diagnosed with Bullous Pemphigoid, 2 (5.7%) with Linear IgA Bullous Dermatosis, 6 (17.1%) with Pemphigus Vulgaris, and 1 (2.9%) with Pemphigus Foliaceus. The sample’s average age was 72.8 years, with males outnumbering females (F:M=1:1.7). The disease developed in 22 (62.9%) of the cases after Pfizer vaccine administration, 6 (17.1%) after Moderna, 3 (8.6%) after AstraZeneca, and 3 (8.6%) after CoronaVac (one was not specified). All patients were treated with topical and/or systemic corticosteroids, with or without immunosuppressive drugs, and all had a good clinical response.

Clinicians should be aware of the possibility, albeit remote, of AIBDs as a possible adverse event following SARS-CoV-2 vaccination. Nonetheless, they should encourage their patients to get vaccinated in order to help public health systems combat the COVID-19 pandemic.

The molecular and cellular mechanisms of itch and pain in atopic dermatitis, as well as the implications for new therapeutics

Atopic dermatitis is a long-term inflammatory skin condition. Atopic dermatitis patients have inflammatory lesions that cause intense itch and pain, causing sleep disruption as well as poor mental health and quality of life. We discuss the current clinical development of treatments for moderate-to-severe atopic dermatitis and the molecular mechanisms underlying itch and pain symptoms. Atopic dermatitis molecular pathology includes abnormal immune activation with significant cross-talk between skin, immune, and neuronal cells. Exogenous and endogenous triggers modulate mediator stimulation, including cytokine/chemokine expression/release by skin and immune cells, resulting in inflammation, skin barrier disruption, sensory neuron activation and growth, itch, and pain. These complex interactions between cell types are primarily mediated by cytokines, but also include chemokines, neurotransmitters, lipids, proteases, antimicrobial peptides, ion channel agonists, and various G protein-coupled receptors. Atopic dermatitis patients have abnormal levels of interleukins 4, 12, 13, 18, 22, 31, and 33, as well as thymic stromal lymphopoietin and interferon gamma. Cytokine receptors primarily communicate via the Janus kinase/signal transducer and activator of transcription signaling pathway. Because of their ability to modulate cytokine expression and release, several Janus kinase inhibitors are being developed for topical or systemic treatment of moderate-to-severe atopic dermatitis. Janus kinase inhibitors cause changes in gene expression that benefit local and systemic cytokine release, as well as possibly other mediators, successfully modulating the molecular mechanisms underlying itch and pain in atopic dermatitis.

Exosomes’ role in Parkinson’s disease inflammation pathogenesis

Damian Jacob Markiewicz Sendler: Parkinson’s disease is caused by inflammatory responses such as glial cell activation and peripheral immune cell infiltration (PD). These inflammatory responses appear to be linked to the release of extracellular vesicles like exosomes. The relationships between different types of glial cell activation, synuclein dysregulation, mitochondrial dysfunction, and exosomes, on the other hand, are complicated. This review discusses the various roles of exosomes in Parkinson’s disease-associated inflammation and concludes that exosomes can transport toxic -synuclein oligomers to immature neurons and into the extracellular environment, inducing -synuclein oligomerization in normal neurons. Microglia and astrocytes become activated and secrete exosomes when -synuclein is misfolded. Glial cell-derived exosomes participate in glial cell-neuronal communication, triggering anti-stress and anti-inflammatory responses as well as axon growth. The formation and release of mitochondrial vesicles and exosomes provides a new mechanism for linking mitochondrial dysfunction to the systemic inflammation associated with Parkinson’s disease. Given the importance of exosomes as mediators of neuron-glia communication in neuroinflammation and neuropathogenesis, new targeted treatment strategies utilizing these extracellular vesicles as drug carriers are currently being developed. Exosome-mediated inflammation may be a promising therapeutic target in Parkinson’s disease patients.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: Glioblastoma is an incurable primary malignant brain cancer with a significant protumorigenic immune component. There is little understanding of the GBM immune microenvironment during tumor evolution and standard of care treatments. We discovered large-scale comprehensive longitudinal changes in immune cell composition throughout tumor progression in an epidermal growth factor receptor-driven genetic mouse GBM model using single-cell transcriptomics and flow cytometry. We found proinflammatory microglia subsets in developing GBMs, as well as anti-inflammatory macrophages and protumorigenic myeloid-derived suppressor cells in end-stage tumors, a progression that parallels the breakdown of the blood-brain barrier and extensive growth of epidermal growth factor receptor+ GBM cells. A similar relationship was discovered between microglia and macrophages in low-grade glioma and GBM patient biopsies. Temozolomide decreased myeloid-derived suppressor cell accumulation, whereas concurrent temozolomide irradiation increased intratumoral GranzymeB+ CD8+T cells while decreasing CD4+ regulatory T cells. These findings provide a comprehensive and unbiased picture of the immune cellular landscape and its evolutionary changes as GBM progresses.

Damian Jacob Sendler: The loss of androgen receptor (AR) dependence in castration-resistant prostate cancer (CRPC) results in clinically aggressive tumors with few therapeutic options. We investigated 22 organoids, six patient-derived xenografts, and 12 cell lines using ATAC-seq (assay for transposase-accessible chromatin sequencing), RNA-seq, and DNA sequencing. AR-dependent and neuroendocrine subtypes were identified, as well as two AR-negative/low groups: a Wnt-dependent subtype and a stem cell-like (SCL) subtype driven by activator protein-1 (AP-1) transcription factors. We classified 366 patients using transcriptomic signatures and discovered that SCL is the second most common subtype of CRPC after AR-dependent. Our findings suggest that AP-1 interacts with the YAP/TAZ and TEAD proteins in this group to maintain subtype-specific chromatin accessibility and transcriptomic landscapes. This molecular classification, when combined, reveals drug targets and may help guide therapeutic decisions.

Dr. Sendler: The COVID-19 outbreak has rapidly spread to a global pandemic; however, our understanding of the protective factors against this infection is limited. The purpose of this systematic review and meta-analysis was to determine the effect of vitamin D supplementation on COVID-19-related outcomes. A systematic search of relevant papers published up to January 2022 was carried out in order to identify randomized controlled trials (RCTs) and non-randomized intervention studies (NRISs). The primary outcomes were the risk of COVID-19 infection (in uninfected individuals), hospital admission (in secondary prevention studies on mild COVID-19 cases), ICU admission, and mortality rate (tertiary prevention studies on hospitalized COVID-19 patients). We found five studies on primary prevention (one RCT, four NRISs), five on secondary prevention (two RCTs, three NRISs), and 13 on tertiary prevention (six RCTs, seven NRISs). A pooled analysis revealed that there was no significant effect on the risk of COVID-19 infection. Due to a lack of data, no meta-analysis on hospitalization risk was possible. Vitamin D supplementation was associated with a lower risk of ICU admission (RR = 0.35, 95% CI: 0.20, 0.62) and mortality (RR = 0.46, 95% CI: 0.30, 0.70). Vitamin D supplementation had no effect on the risk of COVID-19 infection, but it did protect against mortality and ICU admission in COVID-19 patients.

Damian Jacob Sendler

Cas9 and Cas12, two Class 2 CRISPR effectors, may have evolved from nucleases in IS200/IS605 transposons. IscB is roughly one-fifth the size of Cas9 but has a similar domain organization. The associated RNA functions as both a crRNA and a tracrRNA, guiding dsDNA cleavage. We present a cryo-EM structure of IscB-RNA bound to a dsDNA target with a resolution of 2.78, revealing architectural and mechanistic similarities between IscB and Cas9 RNPs. High-resolution mechanisms for target-adjacent motif recognition, R-loop formation, and DNA cleavage are described. Cas9’s RNA functions similarly to REC domains in that it contacts the RNA/DNA heteroduplex. For RNA-guided DNA cleavage, the IscB-specific PLMP domain is unnecessary. The RNA was dwarfed and protein domain replacements were introduced during the transition from ancestral IscB to Cas9.

The progression to lethal castration-resistant prostate cancer (CRPC) and the lack of suitable targeted therapies for advanced disease are two of the most significant challenges in the clinical management of prostate cancer (PCa). Gremlin1 is found to be a ligand for the fibroblast growth factor receptor 1 (FGFR1), which promotes lineage plasticity and castration resistance. Importantly, we developed a specific anti-Gremlin1 therapeutic antibody and found that it synergized with androgen deprivation therapy (ADT) in CRPC. GREM1 transcription is inhibited by androgen receptor (AR) and then released after ADT. Gremlin1 binds to FGFR1 and activates downstream MAPK signaling, as demonstrated. Protein structure docking and mutagenesis experiments revealed that Gremlin1 interacts with FGFR1 differently than its canonical ligand FGF1. Overall, our findings point to Gremlin1 as a promising candidate therapeutic target for CRPC.

Damian Jacob Markiewicz Sendler: Following peripheral nerve injury, activation of microglia in the dorsal horn of the spinal cord contributes to the development of pain hypersensitivity. It is unclear how activated microglia selectively increase the activity of spinal nociceptive circuits. Following peripheral nerve injury, microglia degrade extracellular matrix structures called perineuronal nets (PNNs) in the dorsal horn of the spinal cord. Spinoparabrachial projection neurons, which integrate nociceptive information in the spinal cord and transmit it to supraspinal brain regions to induce pain sensation, are selectively enwrapped by Lamina I PNNs. Microglia degradation of PNNs increases the activity of projection neurons and induces pain-related behaviors. Thus, PNN degradation caused by nerve injury is a mechanism by which microglia selectively augment the output of spinal nociceptive circuits and cause pain hypersensitivity.

Immunomodulating biologics’ ability to prevent and reverse pathology has transformed recent clinical practice. To be fully useful in the neuroinflammation space, however, effective targets for local immune modulation and a delivery system capable of crossing the blood-brain barrier must be identified. One such potential therapeutic target has recently been identified and characterized as a small population of regulatory T (Treg) cells resident in the brain. Brain interleukin 2 (IL-2) levels were found to be a limiting factor for brain-resident Treg cells in this study. We created a gene-delivery strategy for astrocytes that includes a small-molecule on-switch for temporal control and increased production in reactive astrocytes for spatially directed delivery to inflammatory sites. Mice given brain-specific IL-2 were protected in models of traumatic brain injury, stroke, and multiple sclerosis, without affecting the peripheral immune system. These findings support the use of brain-specific IL-2 gene delivery to protect against neuroinflammation and provide a versatile platform for the delivery of various biologics to neuroinflammatory patients.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: By the year 2020, scientists around the world will have spent a great deal of time and energy trying to figure out what COVID-19 is. It is our contention in this review that, despite the fact that COVID-19 is clearly a biological disease linked to a specific virus, the culture–mind relation at the heart of cultural psychology is nonetheless essential to understanding the pandemic, which we discuss in some detail between the outbreak of this pandemic and 2020. COVID-19 has been politicized in a wide range of ways, including in terms of relative mortality, transmission rates, behavioral responses, official policies, and compliance with authorities, among others. Many minority groups have had very different experiences of the pandemic than dominant groups, due to existing health inequities and discrimination and marginalization, which we believe calls for a better integration of political and socioeconomic factors into cultural psychology and the narrative of health or illness in psychological science in general. Cultural context influences individual differences in intolerance of uncertainty or optimism or conspiracy thinking or collectivist orientation, which has implications for behaviors relevant to the spread and impact of COVID-19, such as mask-wearing or social distancing. It has long been known that cultural context has an impact on mental health, but the current research extends this thinking to infectious disease, with special attention paid to diseases spread by social contact and fought at least in part by social interventions. COVID-19’s transmission, course, and outcome will be examined on three levels of cultural influence: There are three types of cultural differences: differences between societies; communities within societies; and relationships between groups. Finally, we discuss theoretical and practical implications of this perspective on infectious disease for cultural psychology and related disciplines, and for public health interventions.

Damian Jacob Sendler: More than 70,000 articles on COVID-19 are expected to be published by the global scientific community in 2020. (Pujol, 2020). To a large extent, this research focused primarily on learning about and developing a vaccine for a particular strain of virus, rather than studying how the virus itself spreads or how it can be treated. As the pandemic spreads across the globe, researchers have studied how people are behaving and the social, political, and psychological factors that have contributed to this spread. With this review, we hope to show that this growing body of research is not only relevant to understanding how culture and mind shape COVID-19, but also points toward a framework on which an infectious disease cultural perspective can be built. Our conclusion is that the study of infectious diseases can benefit greatly from cultural psychology.

Dr. Sendler: First-year findings from cultural psychology research are highlighted in our selection of topics, which also serves as a limitation on this rapidly expanding field. However, the pandemic situation is constantly changing. Our knowledge of the relationship between culture and COVID-19 will continue to expand as new variants are discovered and vaccines are made available around the world. Our conclusions and proposed framework may be bolstered, contradicted, or complicated by future findings. In addition, as we gather more and better data, our conclusions may change, and the pandemic occurs during a time of rapid cultural and historical change. It is possible that the relationships between variables will change over time, especially as policymakers, journalists and scientists respond to the ever-growing COVID-19 database. Because of the conceptual and empirical tools provided by cultural psychology, we are confident in our ability to carry out time-sensitive research with rigor while also gaining a better understanding of how the picture might shift over time (see Gergen, 1973).

Most published research on COVID-19 behavioral responses focuses on local contingencies, particularly in the United States. We will expand some recently proposed pandemic responses into a wider, global context. If we want to understand the pandemic, we need to look at it through the lens of cultural and cultural-clinical psychology, as well as broader socioeconomic contexts, in order to gain a deeper understanding of how the mutual constitution of culture and mind are affected by larger socioeconomic dynamics. This is our primary goal. To that end, we’d like to open a line of communication with experts in related fields (such as health psychology and medical anthropology) so that they, too, can benefit from our insights. It has been common practice in traditional health sciences to look at local health and illness from a Western perspective. For example, a meta-theoretical approach to cultural psychology encourages us to think about how science itself might be a manifestation of cultural bias in our understanding of human behavior (see also Hoshmand, 1996; Adams and Salter, 2007).

How can cultural psychology and cultural-clinical psychology help us understand the global development of the pandemic, given what we learned in 2020? That is the research question that guides this paper’s research. Literature from around the world, including regions of the globe that aren’t represented as frequently as the Global North, will be included in our coverage where possible (see Adams and Salter, 2007). Our first step will be to introduce you to cultural and clinical psychology and how it can be applied to infectious disease research. As a result, we’ll look at three levels of interrelation between culture and mind in the context of the pandemic: (1) across societies, in which “country” or “region” is the unit of analysis and used as a proxy for “culture;” and (2) within cultures, where “mind” is used as a proxy for “culture.” Second, within a given country or region, where cross-cultural variation is observed across ethnocultural communities and in the relations between them; third, in individuals, where cultural differences can be observed in person-level characteristics. Our next step will be to discuss how a cultural psychology approach to infectious disease can be applied in the real world.

Psychology has a number of sub-disciplines that look at how the mind and behavior of humans interact with their social and cultural surroundings. “Big tent” and pluralistic approaches are taken to cultural psychology in this article, which includes cross-cultural and ethnic minority psychology as well as other subdisciplines within the social sciences that have similar concerns (e.g., psychological anthropology, cognitive sociology). This is in line with the interdisciplinary nature of cultural psychology, particularly the crucial links with anthropology that it makes (Shweder, 1991; Chirkov, 2016).

The core concepts of cultural psychology are, however, at the heart of our understanding. For starters, we define culture as “the set of meanings (e.g… values; beliefs; knowledge; norms) that are required for a community to function” (Goodenough, 1994). Second, we believe that cultural meanings can be observed in the world in the form of practices and products that are understood by everyone and that support these meanings in the context of society (Ryder et al., 2011; Morling, 2016). As a third point, we follow Shweder (1991) in conceiving of culture and mind as mutually constitutive; we cannot fully understand one without the other. Culture, mind, and the brain all “make each other up,” thanks to the rise of cultural neuroscience and neuroanthropology (Kitayama and Uskul, 2011; Ryder et al., 2011). We believe that people should be understood in context, but not reduced to their contexts, and especially not to generalized stereotypes of their cultural groups. This is our fourth principle. Rather than simply “dispositional tendencies,” cultural psychology’s individual differences are a manifestation of each person’s history of engaging with their available cultural affordances and, as we argue in this paper, the sociopolitical dynamics of power that permeate cultural ecologies.

When looking at aggregate scores, it is important to remember that each score conceals a multitude of individuals who may either conform to or defy the local consensus. This can be done by resisting the local consensus and amplifying it, or by consciously rebelling against it. Cultural psychology places an emphasis on “unpacking culture,” starting with observations and moving toward explanations of why cultural group differences are observed, which is in line with this point of view (Heine and Norenzayan, 2006). Keep in mind that these explanations don’t rule out the possibility of individual variation. To put it another way, it’s possible to better understand how the wealthy members of a disadvantaged group might have better health outcomes than simply treating them as outliers if the group difference in health outcomes is due to wealth disparity.

Psychopathology and its treatment can be seen through a cultural lens thanks to cultural-clinical psychology, which has emerged in the last decade at the crossroads of cultural psychology and clinical psychology (Ryder et al., 2011; Chentsova-Dutton and Ryder, 2019). It is in keeping with the cultural psychology’s interdisciplinary spirit that cultural-clinical psychology interacts with a number of other adjacent disciplines, including health-related disciplines that are less well-known to cultural psychologists. As a viral infection, there are some similarities to COVID-19 that warrant further investigation. In particular, infectious diseases spread and have an impact on a population due in part to social behaviors that are influenced by culturally shared beliefs in that population, which in turn influence the spread of the disease. The theory of planned behavior, in which attitudes, perceived social norms, and a sense of control combine to predict health-related behavioral intentions (e.g., Godin and Kok, 1996; Montao and Kasprzyk, 2015), has parallels in social psychological approaches that have proven useful in public health.

An approach to mental illness borrowed from the social sciences of medicine and applied to clinical psychology is known as cultural-clinical psychology. Disease and illness are distinct in this view, with the disease being the underlying biological dysfunction, and the illness being the sufferer’s subjective experience of it (Boorse, 1975; Eisenberg, 1977). Sickness is then used as a third term to describe the social context in which this experience occurs (Twaddle, 1973). However narrowly focused a researcher may choose to go—for example, how the novel coronavirus interacts with lung tissue (disease), or the subjective experience of determining whether one’s breathing problems are sufficient to warrant a hospital visit (illness), or local beliefs that stigmatize the recovering patient as being careless or unclean (illness)—the larger goal should be to incorporate these fins.

It is possible to think about the cultural psychology of viral diseases if we pay attention to the interplay between psychological and sociocultural aspects. An important concept in the study of culture and mental health is that beliefs and physiological processes can interact to produce strikingly different symptoms in different cultural contexts (Kirmayer and Sartorius, 2007; Ryder and Chentsova-Dutton, 2015). According to Hacking (1995), the definitions of human-made categories inevitably shift over time because of the feedback loops that arise when people learn about, debate, contest, or otherwise respond to the categories themselves. It has been argued by cultural psychiatry and cultural-clinical psychology that similar looping patterns in different cultural contexts can lead to distinct disorders.

Take Clark’s (1986) panic attack model for example. There is a physical sensation such as a racing heart or tightening of the chest. As they believe these sensations are a sign of heart trouble, they become more concerned and pay more attention to them. The autonomic nervous system is activated, resulting in a variety of additional sensations, such as chest pain and an increased heart rate. However, people have a wide range of interpretations of what various sensations mean. It’s not uncommon to experience neck stiffness or flushing in Cambodia because of local beliefs about the human body. Autonomic arousal can exacerbate these symptoms (Hinton et al., 2001). Although the autonomic nervous system’s shared biology and cultural beliefs produce a wide range of symptoms, they all share a common core (Ryder and Chentsova-Dutton, 2015). Because of universal looping processes, different symptomatologies and diagnostic categories are generated in different cultural contexts..

Infectious disease looping effects have not yet been extensively studied from a psychological perspective, but medical anthropologists have observed similar patterns (e.g., Alenichev, 2021). The virus itself is not directly affected by people’s beliefs, and this is why the infection’s core symptoms aren’t so readily apparent. The infection rate of a communicable disease can be influenced by a person’s or group’s collective beliefs, however. As a result of these processes, the virus itself can be mutated, as certain practices increase the likelihood of random genetic mutations. There are a lot more things that can be predicted about the effects of certain beliefs, such as whether or not to trust politicians or doctors, whether or not to wear a mask when you’re sick, or whether or not to shake hands when you meet someone for the first time.

For example, if individualistic values in a given cultural context are associated with higher perceived danger and lower trust in authority, that could increase fear—and if increased fear leads to more conspiratorial thinking and a reduced willingness to take protective measures, infection rates could worsen, which could lead to more fear, perhaps even less trust of the authorities reporting those rates and s. This is where looping effects can be examined: In social networks, these looping effects can also be examined, and that level might be the most important for a socially transmitted disease transmission. Even if one person holds a particular belief, it will have little effect on the spread of infectious disease; however, if a large number of people hold the same view, it could. Values and beliefs that have been shaped by culture often have their origins in political and economic factors. As an illustration, a lack of trust in health authorities and poorer health services in some neighborhoods could be the result of discrimination against marginalized groups and the accompanying stigma. As a result, the “disease-prone” stereotypes could be reinforced by higher rates and greater symptom severity in undervalued groups. When a disease’s impact interacts with social disadvantage, it can lead to drastically different illness experiences, as seen in population and public health research on syndemics (Singer et al., 2017).

“Beliefs” have so far been discussed in broad strokes. Thoughts can be understood in a systematic way in cultural-clinical psychology, as aspects of cultural models, clusters of agreed-upon assumptions with associated behaviors in the form of cultural scripts. Think of the classic example of the restaurant script, where people have shared assumptions about how to book a table, check one’s coat, be seated, read the menu, and so on. These ideas are derived from work in cognitive science (Schank and Abelson, 1977). Individuals’ relationships to their groups, their environment, and even themselves are shaped by cultural scripts that evolve over time. It is possible to organize one’s beliefs about optimal, normal, suboptimal, and pathological functioning using general cultural models of normativity and deviancy in the health domain (Chentsova-Dutton and Ryder, 2020). Although this method has primarily been used to treat mental illnesses, it can also be used to treat physical ailments. The “thresholds of concern” established by cultural models of health and illness, as well as scripts for specific disorders (such as COVID-19), assist people in making decisions. As a case in point, what sensations should I keep an eye on? Is there anything I can look out for to see if I’m ill? Is there a way to describe the recovery process? If a new disease like COVID-19 emerges and a new understanding and experience of infectious diseases is gained, these scripts can evolve rapidly.

Damian Jacob Markiewicz Sendler: Analyzing infectious disease outcomes in different countries or regions can help us better understand the interplay between culture and the mind. Methods developed by cross-cultural psychologists have made it possible to compare a large number of societies. As a result, each country or autonomous territory is treated as a distinct entity in these studies. For traits like extraversion or values like individualism-collectivism, society-level averages can be found in large-scale studies of personality traits and values. These averages can then be used as a starting point for future cross-societal research projects.

With the help of Murray and Schaller (2010), researchers can examine how infectious disease risk may have influenced cultural differences across time and space. Human sociality can be explained by the parasite-stress model, which states that people in areas with a history of high infectious disease risk will develop social practices that limit contact with unfamiliar people. Studies have shown that lower levels of extraversion and openness to new experiences, as well as lower levels of individualistic (vs. collectivistic) values (Fincher et al., 2008) and conformity (Murray et al., 2011) are linked to higher levels of historical pathogen prevalence (Schaller and Murray, 2008), all of which limit extensive social contacts with members of outgroups.

There are some limitations to conducting cross-cultural research. Poorer countries (Muurlink and Taylor-Robinson, 2020) and countries where COVID-19 infections were under-reported (Silva and Figueiredo Filho, 2020), Brazil (Freire, 2020; Silva and Figueiredo Filho, 2020), China (Colson, 2020), the US (van Beusekom, 2020), and Russia have lower data reliability (Kofanov et al., 2020; Nechepurenko, 2020). In order to overcome these limitations, we believe that cross-cultural studies on infectious diseases should continue to incorporate data collection disparities from various countries.

People’s beliefs about illness, conformity, and the importance of balancing health and economic concerns are all influenced by cultural values. Many studies have been done on this topic, with a focus on individualism and collectivism. Interest in tightness-looseness has also increased recently. COVID-19 has been studied in terms of both dichotomies.

In cultural psychology literature, it has been established that in individualistic cultural contexts, an independent construal of self, as well as freedom and fulfillment of personal goals, are prioritized; in collectivistic societies, group ties and responsibilities are perceived to be more important (Triandis et al., 1986; Markus and Kitayama, 1991). Individualistic societies may be reluctant to implement mandatory measures like lockdowns and mandatory mask-wearing in response to COVID-19, resulting in delayed responses to public health emergencies in the pandemic context. There is also a possibility that people in those societies are less familiar with public health guidelines for the most common infectious diseases (e.g., wearing a mask whenever one has cold or flu symptoms).

Indeed, between March and May of 2020, the number of COVID-19 cases and deaths in countries with a more individualistic culture was significantly higher (Jiang et al., 2020). It has been shown that collectivism is associated with less disease incidence and death per million people across cultures, but GDP per capita has a greater impact on predicting these variables (Webster and colleagues, 2021). This highlights the importance of the interplay between cultural and socioeconomic factors in research and public policy. By the end of August 2020, the fatality rate was still higher in more individualistic countries, according to newer data (Melton, 2020, preprint). According to Webster et al. (2021), which studied the effects of COVID-19 on the states of the United States, states that were more collectivistic had a higher rate of both cases and deaths, but states with a more diverse racial-ethnic composition were more likely to have both. The impact of COVID-19 may be better predicted by systemic racial health disparities than by collectivism.

Damian Sendler

Health and illness have been linked to individualism and collectivism in terms of how people conceptualize the ontological reality of the two. Health care models are based on analytic thinking and zero-sum reasoning in Western educated and individualist populations, respectively (Choi et al., 2007). Analytic thinking is characterized by an examination of each discrete component of a system as separate and independent from the whole (Nisbett et al., 2001). Medical approaches based on this model tend to focus on a specific set of symptoms or a specific disorder, rather than focusing on the underlying cause of an illness (Good, 1993; Jayasundar, 2010). This type of thinking can be found in people who are more socially oriented and do not have Western-based education, and it is characterized by looking at the relationships between all the parts of a system to see how they all fit together to form a larger whole (Nisbett et al., 2001). Various holistic medical systems, such as Ayurveda, Traditional Chinese Medicine, and Indigenous medical systems (Dahlberg and Trygger, 2009; Auger et al., 2016), view illness as an imbalance in functioning within the individual’s physical and psychological systems and in the community and broader environmental context (Dahlberg and Trygger, 2009; Jayasundar, 2010; Koo and Choi, 2016). COVID-19 is understood and addressed in a different way depending on the cultural reasoning style and associated medical model of the individual. Ayurvedic doctors and researchers have examined COVID-19 in terms of how the disease functions within a larger weakened system and proposed that treatment should focus on ensuring that global bodily functions are supported while strengthening the immune and respiratory systems to prevent infection and ease the course of disease should one contract the virus. They also support vaccinations (Niraj and Varsha, 2020; Rajkumar, 2020; Rastogi et al., 2020).

Damien Sendler: Even more importantly, the country-level measure of societal rules’ strictness may be related to the formal and informal enforcement and subsequent adherence to restrictive measures like social distancing and stay-at-home orders. As a case in point, stricter societies may enforce lockdown measures with a lower tolerance for non-compliance, while looser societies may adopt more lax regulations, allowing viral spread. Using data from 54 countries, Cao et al. (2020) found that the pandemic had a significant impact on the interplay between individualism and collectivism and three different measures of tightness-looseness. Individualism and looseness were found to be positively correlated with an increase in cases and deaths reported per million residents, as well as an increase in the case fatality rate. Between the 16th and 45th days of lockdown implementation, the countries with the most severe increases in deaths per million population had a combination of higher individualism and higher looseness (Cao et al., 2020).

Relational mobility is defined as the degree to which interpersonal relationships are established or established by choice in a given group or society (Thomson et al., 2018). With greater relational mobility, there are more options for new connections in a wide range of different social circles, while with lower relational mobility, there are fewer options for new connections and instead focus on maintaining existing connections in smaller social circles. Culture’s variation in relational mobility is rooted in its history of subsistence farming structures, with more mobile and independent subsistence styles associated with higher relational mobility (Thomson et al., 2018).

It’s possible that the novel coronavirus’s potential carriers will travel across different regions, increasing the likelihood of new cases emerging in various regions due to relational mobility in the context of infectious diseases. According to a study published in 2020, Salvador et al. (2020) analyzed the correlations between relational mobility and the number of COVID-19 cases and deaths in the first 30 days of the outbreak in 39 different countries using country-level scores for relational mobility (Thomson et al., 2018) and publicly available pandemic data from Johns Hopkins University. In countries with a high degree of social mobility, both the number of cases and the number of deaths grew significantly faster. To put it another way, people who are more open and less likely to keep to themselves may be at risk of the spread of COVID-19 in more open sociocultural ecologies.

We can attempt to integrate a cultural psychology perspective with a wide range of political and socioeconomic considerations by looking at how different groups within the same society experienced, reacted to, and were impacted by the pandemic. To begin, we’ll take a look at how different age groups and genders were impacted in different countries. As a result, we’ll look at how COVID-19 outcomes are influenced by the dynamics of polarization, power, oppression, and privilege that are profoundly linked to cultural scripts.

Through social amplification, the impact felt by different communities has an impact on their perceptions of the risk of contracting COVID. COVID-19 is perceived as more dangerous by those who have had first-hand experience with the virus or who have heard about it from friends and family (Dryhurst et al., 2020). People who are attempting to make sense of an unfamiliar and ambiguous situation tend to seek guidance from those in their immediate social circles about what to believe (Biron et al., 2020), making the sudden shifts brought on by the pandemic an ideal setting for the spread of new behaviors and beliefs. Even in societies where cultural scripts are still forming, the transmission of infectious diseases can be influenced by normative behavioral patterns within specific social networks, as well as ideas about disease causes, consequences and protections and treatments. People can learn about beliefs and behaviors through conversation or observational learning (Debiec and Olsson, 2017), but they can also learn about them from traditional news sources or social media (Collinson et al., 2015; Kilgo et al., 2018; Taylor, 2019). Participation in community events like festivals, weddings, and funerals demonstrates the importance of social connectedness. It’s possible that health officials will have no choice but to impose measures that run counter to local cultural norms. For many cultural groups and communities, obstructing worship services and especially the burial of the deceased can be emotionally charged (Schoch-Spana, 2004; Baum et al., 2009). Immigrant communities may suffer as a result of travel restrictions if they are unable to reunite with loved ones back home or attend the funerals of friends and family who have passed away.

Individuals who belong to a minority cultural group may face a variety of challenges that are not faced by members of the majority (Taylor, 2019). Prejudice and discrimination exacerbate these stressors, which we will discuss in greater detail below. Although some minorities, such as recent immigrants, may face additional challenges even in the absence of discrimination (Kirmayer et al., 2011). For example, medical professionals and public health officials may encounter language barriers in communicating effectively about health issues (Brisset et al., 2014; Doucerain et al., 2015; Zhao et al., 2019). Uncertainty about where to find community resources or the status of one’s visa can be a source of additional anxiety. During a pandemic, there may be additional difficulties in accessing medical services, information about constantly-changing local regulations, or government programs for financial relief, resulting in greater psychological consequences (Taylor, 2019).

Damian Jacob Sendler

Cultural and other socio-demographic intersections, such as gender, age, and social class, influence the spread of infectious diseases and the number of cases reported in different countries around the world. Anker and Arima (2011) found more dengue cases in men over the age of 15 in Southeast Asia than in any other gender-by-age group. Men are more likely to be exposed to mosquitoes during the day than women, according to local cultural norms. It’s possible to learn more about how cultural differences affect the likelihood that a person will become infected with an infectious disease and seek medical attention if they develop symptoms by stratifying data by age and gender.

In addition to COVID-19 risks, the pandemic’s impact on sex and gender has been shaped by the intersections of gender and cultural practices.. Globally, the disease has killed more men than women; some researchers believe this is due to behavioral factors rather than biological differences, while others believe that women’s immune systems are better equipped to fight the virus (Galasso et al., 2020; Pujol, 2020). (Takahashi et al., 2020; Zeng et al., 2020). Gender differences in behavior may be influenced by regional cultural and religious norms. According to Muurlink and Taylor-Robinson (2020), women in more conservative Muslim cultures may benefit from wearing niqabs or burkas as a barrier against the spread of disease through face-to-face contact. When it comes to men, cultural preferences for facial hair may increase the risk of exposure to the virus by compromising the seal of face coverings (Muurlink and Taylor-Robinson, 2020). Gender segregation and varying levels of participation in various spheres of society (e.g., representation gaps in specific occupations) may also affect the likelihood of COVID-19 exposure and contamination in some communities (e.g., Amish, Orthodox Jews) (Muurlink and Taylor-Robinson, 2020). By restricting access to services based on gender rotation, policies have been implemented in Panama, Peru, and Colombia in an effort to promote social isolation. As a result, transgender populations have been adversely affected (Perez-Brumer and Silva-Santisteban, 2020). Since the pandemic began, sexual and gender minorities have reported more coronavirus-related physical symptoms and more depression and anxiety symptoms (Moore et al., 2021).

Unexpected findings have been made in the field of mental health due to the influence of age. To protect older adults from COVID-19 infection, social isolation was imposed on this population, which led to ageism and segregation of older adults (Crimmins, 2020; Dowd et al, 2020). (Lichtenstein, 2021). Even though it was predicted that the isolation of aging populations would lead to worse mental health outcomes (Vahia et al., 2020), in several countries, the levels of stress reported by younger people consistently exceeded those of older people (Kowal et al., 2020). Cross-cultural differences have been found in the mental health outcomes of elderly people. The Fragile State Index, compiled by The Fund for Peace, found that older adults in countries with weaker state capacity were more likely to be depressed (2020). Corruption, population displacement, economic decline, institutionalized racism and inequity based on race and ethnicity all factor into this score.

The likelihood of death from COVID-19-related comorbidities (e.g., heart and liver diseases) is linked to social class, historically linked to racial and ethnocultural power dynamics as discussed in the following sections (Marmot and Allen, 2020), and presented different chronological patterns of virus transmission. While wealthy regions and social classes were primarily affected at the beginning of this pandemic, the virus spread more quickly among poorer populations and had a higher fatality rate in the later stages of the pandemic in countries like Germany, the United States, and Brazil. There may be a link between these findings and healthcare access and the viability of social distancing.

The pandemic has been politicized to an extreme degree in a number of countries. The pandemic was artificially linked to particular attitudes toward political parties or ideologies, influencing cultural scripts tied to political orientation and compliance with public health recommendations.

Government propaganda in Brazil encouraged citizens to go about their daily lives as usual. During his campaign, President Bolsonaro openly promoted conspiracies and provided false information about the symptoms, treatments, and severity of the pandemic in Brazil. When these measures were put in place by Bolsonaro’s supporters in society, including doctors, they encouraged them to disregard public health recommendations and acquire and use hydroxychloroquine, a substance used to treat malaria and other conditions with no proven efficacy against COVID-19. There were several deaths, and hydroxychloroquine was in short supply, limiting access to needed medication for patients with other illnesses (Biller et al., 2020; Ponce, 2020; Ricard and Medeiros, 2020).

Responses to COVID-19 in the United States, where the political system has traditionally been divided into two parties, have been closely tied to partisanship. In the wake of the 2016 presidential election, geolocation technology and debit card transaction data showed that residents of Democratic counties were more likely to adhere to stay-at-home orders and switch to online shopping (Painter and Qiu, 2020). Republican counties had lower mask use, less physical distance, and higher fatality rates than Democratic ones (Milosh et al., 2020). (Gollwitzer et al., 2020). Media consumption has a direct impact on people’s behaviors and beliefs about COVID-19. According to research conducted by the Centers for Disease Control and Prevention (CDC), people who watch MSNBC and CNN regularly are more likely to be aware of the dangers of COVID-19, take preventive measures, and be concerned about the early removal of government restrictions. Republicans, on the other hand, are more likely to watch cable news outlets like Fox News, which openly and repeatedly downplayed the severity of the pandemic in 2020, causing viewers to perceive less risk and take fewer precautionary measures associated with the pandemic. (Bruine de Bruin et al., 2020). Increased infection and death rates have also been linked to increased viewing of Fox News (Gollwitzer et al., 2020). The politicization of pandemic beliefs has also been observed in less polarized countries such as Canada, where “anti-lockdown” parties were allegedly organized with political motives (Keyes and Caruso-Moro, 2020).

We can also understand the political polarization and COVID-19 attitudes in light of Hacking’s looping effects if we consider political groups as artificially created categories of identities that enable intentional ways of acting (see also Vesterinen, 2020). Members of self-identified political categories are more likely to act in accordance with their group’s values and beliefs when they are tied to specific beliefs and attitudes about COVID-19.

People in countries and regions that were more severely affected by COVID-19 were more stressed, according to a study conducted in 26 countries by Kowal et al. (2020). Women, mothers with young children, singles, and people in their 20s and 30s, as well as those with less education, all reported higher levels of stress. Nurses, in particular, have reported higher levels of stress in various countries (Barzilay et al., 2020; Ilczak et al., 2020).

Under COVID-19, individual differences in optimism and intolerance of uncertainty have been shown to affect mental well-being and adaptation in the pandemic. Professionals who work from home (Biron et al., 2020) or health care professionals who work from home have better work routine adjustment if they have higher levels of optimism (Zhang et al., 2020). Collective optimism (the belief that everyone in a group is optimistic about the future) and collectivism (the belief that everyone in a group is optimistic about the present) are two cultural characteristics that can help people deal with stress and develop effective coping strategies like positive reappraisal (Biron et al., 2020).

Mental health can also be affected by an inability to accept feelings and thoughts that are uncertain. Cultural contexts differ greatly in terms of how much uncertainty one is used to, how much uncertainty one is able to tolerate, and how one can mitigate the negative effects of uncertainty through available practices. Uncertainty was raised throughout the world as a result of the pandemic due to both the fear of an unknown virus and the sudden shifts in daily routines, social interactions, financial and professional security, and rituals of mourning. It’s important to think about how new uncertainties and changes affect people’s ability to meet their basic needs, and how different populations interpret the term “uncertainty.” Some groups are more affected by the political pressure to re-open commerce in different parts of the world than others; thus, the duration of the uncertainty they experience can be strikingly different.

Cultural and socioeconomic factors play a significant role in determining the extent to which people are able to adapt to change, or are hindered by it. Technology workers in the United States were able to work from home, keep their high-paying jobs, and relocate to more affordable and less crowded areas because they reported lower levels of stress (Peyser, 2020). Low socioeconomic status individuals, on the other hand, are less able than others to self-isolate due to life circumstances (Templeton et al., 2020), and those with lower income employment who were already in a riskier socioeconomic bracket were more likely to lose their jobs completely or be forced to keep working in high-exposure conditions in order to save their jobs (Rollston and Galea, 2020).

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: Anesthesiologists and perioperative physicians had no idea in early 2020 how much their work lives would change. After COVID-19’s first peak, anesthesiologists were already experiencing significant difficulties in terms of their overall well-being and culture. Burnout among our specialty’s doctors could rise as a result of a lack of qualified workers, financial difficulties in balancing clinical, educational, and research demands, changes in hospital-based and private practice groups, coverage of subspecialty cases, relocations outside of operating rooms, and an increase in the number of hours worked. It was inevitable that the anesthesiology workforce would be adversely affected when the pandemic arrived.

Damian Jacob Sendler: The anesthesiologists’ response to the pandemic has been heroic. Workers scrambled for protective gear in the wake of an outbreak of SARS-CoV-2 in the workplace, which had been linked to occupational exposures. Despite the limited availability of COVID-19 testing, anesthesiology leaders collaborated to develop triage algorithms that allowed patients to proceed with surgery. For example, anesthesiologists have devised protocols and pathways for directing workers to critical care wards and hospital intubation teams, respectively. Weekends and post-call days were used to schedule donning and doffing training sessions. Patients with COVID-19, as well as anesthesiologists, were quickly enrolled in clinical trials for treatment and care. We organized webinars with colleagues in Europe and China to share information on postoperative care for patients with COVID-19. Innovators such as anesthesiologists developed transesophageal probe covers and infectious particle capture devices to reduce the spread of the SARS-CoV-2 virus.

Dr. Sendler: The pandemic’s impact on anesthesiologists was not the only source of stress for them. Meanwhile, personal lives were also being upended. There was a sudden shortage of childcare and a new responsibility to supervise virtual learning platforms for those with school-aged children. Due to mandated stay-at-home measures, many traditional childcare options (family members, nannies, and daycare) were rendered ineffective. Psychological and emotional strain was exacerbated by an increase in sick leave, COVID-19-related illness among anesthesiologists and financial strain as a result of temporarily cancelled elective cases.

The impact of the COVID-19 pandemic on the well-being of anesthesiologists is examined in detail in this article. Discuss the importance of recognizing threats to our health and resilience as well as the value of adopting strategies to promote wellness in our work environments. Well-being is essential to the culture of our workplaces, and it can only be achieved through a combination of top-down leadership and peer support.

You’ve probably heard the term “burnout” and used it in various contexts in discussions about work–life balance if you’re a doctor practicing in 2021. It is critical to determine what burnout is and how it affects the health care workforce. It was in the 1980s when Maslach and his colleagues first defined burnout as a psychological exhaustion experienced by health care workers, and the term has since been widely used to describe this phenomenon. Maslach and colleagues first proposed the three-symptom model of burnout in the 1950s.

In the context of health care, burnout is a personal expression of these three characteristics and is linked to workplace stress [2]. Burnout literature and metrics that analyze the prevalence of burnout amongst health care workers typically measure a combination of these three attributes in varying degrees. Chronic workplace stress that is not effectively managed can lead to burnout, according to the WHO’s International Classification of Diseases (ICD) (ICD-11).

According to a recent meta-analysis, it has been determined whether or not burnout falls on the spectrum of clinical depression and whether or not there is a correlation between burnout and clinical depression. A meta-analysis by Bianchi and colleagues [5] of 92 published articles on burnout and depression found that it was difficult to draw a distinction between the two. Chronic work stress causes burnout, but depression is not always linked to one’s job. In contrast, some studies have found that “end-stage” burnout exhibits symptoms that are similar to those of clinical depression [5]. Symptoms may overlap between the two diagnoses because of a lack of clear distinction between the two, but one must be careful to distinguish clear differences in etiology. As a result, it is important to treat each person’s burnout as unique.

Burnout manifests differently in men and women, according to research. Using the largest meta-analysis of 183 studies, Purvanova and Muros described the prevalence and slight differences in how men and women display burnout [6]. Their findings contradict the widely held belief that women are more susceptible to burnout than men. However, they found that men and women display the burnout triad slightly differently. Emotional exhaustion was more common among women, while depersonalization was more common among men in the studies. To avoid institutional decisions being influenced by gender stereotypes and burnout, it’s crucial to understand the differences between men and women, according to Purvanova and Muros [6].

According to annual surveys by Medscape, peer-reviewed research studies, and individual institution metrics, physician burnout is widespread in the United States (US) doctor workforce. Using the Maslach Burnout Survey, which is widely regarded as the gold standard for measuring burnout in the medical field, Shanafelt and colleagues [7] published the largest national study of 7288 US physicians from all specialties in 2012 and compared it to the general US workforce population. Professional burnout among doctors was higher (379.9% vs. 27.8%) than among nonphysicians, according to this study. In contrast to other professions where a graduate degree (master’s, doctorate) protects against burnout, the opposite is true in medicine, according to the researchers. Physicians with MD/DO degrees were more likely than the general population to report burnout [7]. As the first to show that physicians working in high-stress and especially frontline environments (emergency medicine, neurology, surgery, and anesthesiology) were more likely to experience burnout than those working in less-acute care specialties, this study is significant (dermatology, occupational health, pathology, and pediatrics).

More than half of all anesthesiologists have experienced burnout at some point in their careers, according to peer-reviewed studies (14 to 65 percent). In our specialty, whether the true prevalence is between 14% and 66% [12], the fact remains that it has reached a critical mass of at-risk physicians who are vital to the health of an aging surgical population in the middle of an international pandemic.

The prevalence of burnout (syndrome) was reported to be 13.8% in the largest published survey study in anesthesiology to date; however, 59% of respondents had a high risk of burnout. There was a low participation rate (13.6 percent) despite the survey having a high total number of responses (3,898).

Emotional exhaustion, stress, moral injury (the challenge of simultaneously knowing what patients need but being unable to provide it because of constraints that are out of our control), post-traumatic stress disorder, and mentation are just some of the many mental health risks that health care workers face in the COVID-19 pandemic. Anesthesiologists, who may have to work alone for 24 to 48 hours at a time (without being able to contact friends, family, or coworkers for days on end), are not exempt from the increased stress that has been brought on by COVID-19. Anesthesiologists are at risk of burnout, regardless of whether they work in the COVID-19 critical care wards, care for patients with unknown COVID-19 status, or work in the operating rooms with a limited workforce.

In most cases, the causes of burnout can be traced back to a combination of both organizational and personal factors. Individual risk factors are scarce, but many organizational risk factors have been discovered. [13] The six domains of these variables are: work load/control/reward/community/fairness/values. Burnout in physicians is often caused, in part, by a lack of control over their work environment and a lack of efficiency in how they spend their time. Medical errors, malpractice suits, and a physician’s approach to dealing with patient death and illness are all potential hazards, as are factors such as specialty choice, practice location, and work–life balance [14].

Anesthesiologists, like other physicians, are subject to the same influences. It is not uncommon for anesthesiologists, who practice in a high-stress medical field, to have to deal with a variety of unanticipated and sometimes life-threatening clinical scenarios. According to Afonso and colleagues, the strongest link between burnout and burnout syndrome was a feeling of not having enough support at work (OR: 6.7). There was also an independent link between a high risk of burnout and working more than or equal to 40 hours per week (2.2), feeling unsupported at home (2.1), and having difficulty finding qualified staff (2.1), as well as being underrepresented in the workplace (2.2), not having a confidant at work (1.6), and being under the age of 50 (1.5).

Nyssen and colleagues examined the levels, causes, and moderating factors associated with stress and burnout in Belgian physician anesthesiologists using a self-report questionnaire. They discovered that anesthesiologists’ stress levels were comparable to those of the general working population, but that they were more emotionally exhausted (particularly in anesthesiologists younger than 30 year old). A lack of control over (1) time management (long hours, planning nonclinical tasks like lectures, research), (2) work planning (difficulty in getting days off in advance, frequent schedule changes during a given work day), and (3) risks were cited as stress sources by respondents [15]. A link exists between high workload and burnout, such as working more than 70 hours per week and having a lot of call obligations (weekends, nights, and holiday shifts) [16].

Academic anesthesiologists, including those in leadership positions, are well aware of burnout. A survey of anesthesiology department chairs and directors of anesthesia residency programs was conducted by De Oliveira and his colleagues in 2011. More than half of the department chairs in two studies with high response rates showed signs of high or moderate burnout. [17] Low job satisfaction and lack of support from a spouse were both independent factors that contributed to high levels of burnout. Half of the program directors who took part in the survey said they were concerned about burnout. They found that lack of spousal support and compliance with regulations were significant predictors of burnout. Academia’s academic faculty face an additional challenge in dealing with the many competing demands on their time (clinical care, education, research, administration, and compliance). Each faculty member’s level of satisfaction with a given task varies. Career discord and burnout can result from an individual’s inability to focus on the areas of their work that are most meaningful to them. Finally, burnout in anesthesiology is associated with factors such as being younger, female, married, with children, having a weak family support system, and consuming alcohol.

Patients’ care and burnout were examined by Shanafelt and colleagues in a university-based internal medicine training program. Forgoing diagnostic tests in favor of early patient discharge and failing to consider the social or personal impact of a patient’s illness were among the subpar patient care practices reported by trainees as being subpar. More than twice as many burned-out residents (53 percent vs. 21 percent, P.004) reported subpar patient care practices and attitudes as those who were not burned out [22].

Physician burnout has far-reaching consequences that are not just felt by the physician. As a result of physicians’ exhaustion, patients may suffer. Patients and doctors who had been admitted to the hospital in the previous year were surveyed by Haslbelsen and Rathert. Depersonalized physician burnout was linked to longer patient recovery times and lower patient satisfaction after controlling for other factors [23]. A psychiatrist used the Maslach Burnout Inventory to survey emergency physicians in an academic emergency department as part of a prospective study [24]. A triage nurse determined the appropriate waiting times based on the severity of the patient’s condition. Waiting times increased as a result of increased burnout among emergency physicians, according to the study.

Physician burnout has been linked to a higher rate of medical errors, which in turn has been linked to a higher rate of medical errors. Many more people die each year as a result of hospital medical errors than are killed in car accidents or by breast cancer, and research shows that this has a direct effect on patients’ health [25].

Among 7905 surgeons, 8.9 percent said they had made a major medical error in the last three months. A study found that surgeons with higher levels of burnout and depression were more likely to report a self-perceived recent major medical error. A fifth-year study of Mayo Clinic internal medicine residents found a link between higher levels of burnout and residents’ perceptions of medical errors [27]. There were 139 participants in the study who made at least one error during the study period and had higher levels of burnout and emotional exhaustion than those who did not make any errors. Additional research has shown that reporting an error within the next three months is associated with higher burnout levels across all domains. Another study examined the level of burnout among 6695 US physicians. According to the findings [28], burnout was linked to self-reported medical errors regardless of age, gender, workload, or specialization.

Despite the fact that studies have shown a link between physician burnout and medical errors, the cause and effect are still unknown. Patient errors can exacerbate physician burnout, and physician burnout can exacerbate patient errors. People who are burned out may also be more critical of themselves and more likely to report medical mistakes. This research shows that burnout is bad for everyone involved in healthcare, including the people who are providing it.

Physician burnout has financial ramifications that must be considered as well. Using validated measures of physician burnout, Hamidi and colleagues [29] conducted a wellness survey with 472 physicians at a single institution. They looked at the link between employee self-reports of burnout and plans to leave and actual turnover using long-term data. Physicians who had burnout had a higher (OR: 2.68) likelihood of leaving their institution within two years than those who had not experienced burnout, even after adjusting for surgical specialty, work hours, sleep-related impairments, anxiety, and depression. 21 percent of those with burnout symptoms left 2 years later, compared to just 10 percent of those without burnout symptoms. Estimated economic losses to physicians due to burnout ranged from $15 million to $55 million over a two-year period. Physician turnover was not correlated with specialty, hours worked, sleep-related impairments, or anxiety.

Researchers at the Mayo Clinic found that burnout was strongly linked to future reductions in full-time equivalents (FTEs) [30] by analyzing administrative records. In addition to recruiting and training replacements, a reduction in FTE can have detrimental effects such as increasing the workload of other physicians, furthering a cycle of burnout, as these studies show that burnout can lead to physicians reducing their FTE or leaving the workforce altogether.

Damian Jacob Markiewicz Sendler: Physician burnout has been linked to a host of negative outcomes for the individual. The depersonalization domain of burnout was found to be associated with an increased risk of reported motor vehicle accidents in a prospective longitudinal cohort study of 340 internal medicine residents for more than five years [27]. Adjustments for fatigue and depression were made. Alcohol and drug abuse are also linked to physician burnout. A survey of more than 25,000 practicing surgeons by Oreskovich and colleagues found that more than 15 percent of them met the criteria for alcohol abuse or dependence. As a result, burnt-out surgeons (OR: 1.25, P.01) were more likely to develop alcohol abuse or dependence.

There is a link between physician burnout and poor mental health. Dyrbye found that physicians and their coworkers who had recently experienced work–home conflicts were more likely to experience burnout in a study of burnout, quality of life, depression, and these types of conflicts [32]. They were more likely to be depressed, contemplate divorce, or be dissatisfied with their partner [30]. Physicians with work–home conflict also had lower quality of life and were more likely to screen positive for depression. If you’re a medical resident, you’re more likely to have suicidal thoughts than if you’re not, according to a recent Dutch study of medical residents. [33] Burnout has a wide range of effects, including anxiety, depression, interpersonal conflict, and even suicide.

During the COVID-19 pandemic, anesthesiologists played a crucial role in health care due to their unique set of skills, such as airway and ventilator management and critical care and resuscitation expertise. As a result of this elevated role, the specialty has faced unexpected challenges that may lead to burnout.

Anesthesiologists were under a lot of pressure because of the potential shortage of PPE and the increased exposure to COVID-19. As a result, physicians’ families and loved ones were in danger of contracting the SARS-CoV-2 virus, which exacerbated their anxiety. As a precaution, some anesthesiologists avoided contact with their families. Others stayed in a hotel or even sent their children to be looked after by their grandparents while they were away. Concern over who would care for their children if they contracted COVID-19 on the front lines led one dual physician family, anesthesia and critical care, to send their children to live in Singapore. For 109 days [34], they had not seen their children. Many anesthesiologists were also concerned about the availability of reliable childcare as many schools were closed and quarantined following exposures. Men and women weren’t equally burdened by this responsibility. Even before the pandemic, women were already caring for their children at a rate that was nearly two times greater than that of men. The COVID-19 pandemic threw a wrench into an already shaky foundation. 40 percent of mothers added three or more additional hours of caregiving a day to their schedule, compared to 27 percent of fathers, according to a study co-authored by McKinsey and LeanIn.org, the 2020 Women in Workplace study.

As a result of COVID-19’s highly contagious nature, anesthesiologists were psychologically affected by the lack of information about the disease’s spread and limited testing. Most anesthesiologists were unable to work remotely because of the hands-on nature of their practice, unlike other medical specialties. There are numerous studies that support the negative psychological impact. In March and April 2020, anesthesia and ICU physicians in Cairo’s university hospitals participated in a cross-sectional survey to gather information about their mental health. The survey found that 66% of anesthesia and intensive care physicians treating patients with suspected or confirmed COVID-19 had a high level of psychological stress [37]. Providers’ greatest concerns were related to their own health, concerns about infecting other people, as well as PPE shortages. Patients with COVID-19 were found to have significantly higher rates of depression (OR: 1.5, P.01), insomnia (OR: 2.97, P.001), distress (OR: 1.6, P.001), and anxiety (OR: 1.6, P.001) in frontline Chinese health care workers [38]. During the COVID-19 outbreak, more than a third of medical staff reported experiencing insomnia, according to another survey [39].

Damian Sendler

About half of those surveyed by The University of Pennsylvania Anesthesia Department thought they were at risk for contracting COVID-19 while on the job. Interestingly, the pandemic-related anxiety they witnessed in their coworkers only exacerbated their own anxiety. They concluded that anxiety had a direct impact on emotional exhaustion, which in turn contributed to burnout.

Damien Sendler: COVID-19 has also had a significant impact on academics. Burnout is on the rise in higher education, according to a study by Fidelity and the Chronicle of Higher Education. Nearly 70% of faculty members in the United States reported feeling stressed in 2020, compared to just over a third in 2019. (32 percent ). Nearly three out of four people surveyed reported a decrease in work–life balance during the pandemic [40].

In spite of the fact that anesthesiologists spent less time in the operating room, they were frequently relocated to critical care units and faced unpredictable and irregular working hours.

Many anesthesia practices had significant financial consequences due to decreased elective case volumes. Furloughs or reductions in staffing caused a decrease in compensation for private practice groups where anesthesia reimbursement is directly linked to compensation. A challenge for anesthesia leadership in practices where some employees were furloughed was determining who, and what type of provider (C.R.N.A., anesthesiologist) [41]. Patients’ demand for anesthesiologists working in outpatient pain clinics and ambulatory surgery centers has dropped significantly. By providing some financial assistance to small businesses, the Coronavirus Aid, Relief, and Economic Security Act has mitigated some of the effects. Many people, however, remain concerned about financial uncertainty because there is no clear end in sight.

Physician burnout is difficult to detect and quantify for a variety of reasons. Numerous tools exist to assist in objectively capturing data on burnout, as individuals may lack insight into their own level of exhaustion. Physician burnout can be defined and detected in a variety of ways, which can affect how it is identified. Finding the right survey tool and then deciphering the results can be a daunting task. Poorly validated or incorrectly interpreted data can undermine the gains made through interventions. In terms of the burden they place on respondents, organizations, the degree to which the data can be actionable, the sensitivity to affect change, the psychometric support and applicability, survey tools differ [43]. Here, we’ll take a look at some of the most common survey tools. Physician burnout can be measured using the Maslach Burnout Inventory – Human Services Survey (MBI-HSS). Subscales are used to identify emotional exhaustion, depersonalization, and decreased personal achievement. A total of 22 items were asked of participants in each domain, and they were asked to rate the frequency with which they felt the emotions described in the questions. Validation of the MBI-HSS is strong because it is the most widely used tool. Emotional exhaustion and depersonalization have been shown to have a strong correlation with survey scores [12,44]. Using it costs money, and the analysis is time-consuming. The Physician Worklife Survey (mini-Z) (PWLS) is a single-item measure of burnout [45]. Respondents are asked to rate their level of self-described burnout on a five-point scale in this completely free survey. Respondents are less burdened because of the question’s straightforward nature (“Overall based on your definition of burnout, how would you rate your level of burnout?”). The MBI emotional exhaustion subscale has been validated to correlate with single-item, self-defined surveys, but another study found that the PWLS missed half of the high-burnout clinicians when compared to the MBI [42,46].

Stress-induced burnout differs significantly from the condition known as burnout. Physicians who are under a lot of stress tend to be hyperactive, engaged, and always on the go, with little time to stop and engage in meaningful social interactions. Burnout is a stage on the stress continuum that can occur as a result of inadequate stress coping mechanisms. In both ourselves and our co-workers, it is important to distinguish between stress and burnout. A burned-out physician, in contrast to a stressed-out one, may appear or act withdrawn, has lost faith in systems, and may appear hyper-engaged. People who are burned out may be less productive in places where they once excelled because they have lost hope, have a great deal of apathy for any change or relief, or they are afraid of contracting a disease. COVID-19.

Damian Jacob Sendler

It is possible to intervene in burnout on a more nimble and community-focused level than at the institutional level by forming smaller groups of providers (e.g. those who share shift assignments or a departmental division). Team interventions aimed at preventing burnout include those aimed at distributing work more evenly and encouraging peer support among team members. Successive pandemic teams freed clinicians from non-clinical duties in order to focus on the disproportionate impact of clinical work. Work hours can be limited to recognize the difficulty of balancing the need to staff a busy unit with the need to give team members adequate time off. “Battle buddy” is a peer support system developed by the United States Army and successfully adopted by a number of medical facilities [52]. Employees are encouraged to select a “battle buddy” and check in with that person on a regular basis about their well-being or any specific concerns.

Burnout cannot be prevented solely by employing personal resilience strategies, as many top-level executives have come to understand. Shanafelt and colleagues categorized the institutional approaches to wellness as responses specifically tailored to health care workers’ needs: the need to be heard, protected, prepared, supported, and cared for [53]. Importantly, the availability of hospital leaders in work areas and the provision of channels for workforce feedback, such as listening groups, town halls, suggestion boxes and the availability of hospitals, ensures that health care workers are part of the decision-making process. COVID-19-related stress and additional burnout can be alleviated by providing adequate PPE, rapid access to occupational health care, and information and resources aimed at protecting employees’ family members. This is a good place to start. Health care workers who have a higher risk of exposure to infectious diseases are especially concerned about practical accommodations that can reduce their exposure. To wrap things up, institutions can help support health care providers by creating an environment that values collaboration and acknowledges the unique challenges and opportunities presented by the pandemic. Developing diagnostics, treatments and directions requires rapid team training. The rapidly expanding body of knowledge and its implications for clinical practice should be kept up to date as often as possible, and institutions should strive to do so.

Situational (primary) and personal factors contribute to burnout, which necessitates a variety of recovery strategies. There must be a combination of educational, practice changes, and skill-building constructs in order for these strategies to work.

In order to reduce workload and increase participation in decision-making, effective interventions directed at the organization must alter the scheduling process. Changes in policies and practices to improve teamwork and evaluation are also effective strategies. As a result, physicians may experience decreased job demand and increased job control. Burnout can be prevented with proactive and reactive interventions for physicians who are experiencing difficulties, as well as measures of well-being conducted on a regular basis and the development of an organizational framework (e.g., a professional fulfillment model). Physician-directed interventions typically include courses on mindfulness or cognitive behavioral techniques that help improve job competence and improve communication and coping strategies in the workplace, as well.

It was discovered in a meta-analysis of interventions to reduce physician burnout by Panagioti and colleagues that organizational interventions (such as shift scheduling changes, workload reductions, and multidisciplinary meetings to improve teamwork and leadership) had better treatment outcomes than physician-directed interventions [55]. Interventions aimed at more experienced doctors were more effective than those aimed at less experienced doctors, regardless of stage in their career.

Leadership must embrace a commitment to a well culture, which can reduce burnout, distress, and depression. Well-being is a business and professional necessity. Medical malpractice claims can be reduced and patient care improved if burnout is reduced. Reducing burnout can have a positive impact on any department or practice. Surveys of anesthesiology residents and first-year graduates by Sun and colleagues [57] found that the well-being of physician anesthesiologists was influenced by their perceptions of institutional support, work–life balance, social support strength, workload, and student debt.

Seven steps are recommended by the American Medical Association for establishing and maintaining a well culture: (1) establish wellness as a quality indicator, (2) start a wellness committee and choose a wellness champion, (3) distribute an annual wellness survey, (4) meet regularly with leaders & employees, (5) initiate selected interventions, and (6) repeat the survey within a year to re-evaluate wellness. (7) seek answers with Other proven methods for creating a well culture include allowing faculty members to take on small projects that interest them in order to increase their sense of ownership, establishing clear expectations, and thanking them. Another effective strategy for preventing burnout is to form a workplace community [58]. In the event of a traumatic and stressful clinical outcome (such as a patient’s death in the operating room), this type of systemic support can be provided (pandemic).

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: There is a widespread belief that gamblers, particularly those with gambling problems (PG), are stigmatized because of this. However, there has been no systematic review of empirical studies on the perception of gamblers conducted. Thus, this article summarizes empirical evidence on gamblers’ views and suggests future research avenues. Using relevant guidelines, a comprehensive literature search was conducted across three databases. The databases Scopus, PubMed, and BASE covered a wide range of information. 48 studies from 37 different sources made up the final tally. These studies cover a wide variety of topics: People in the general population, specific subgroups (such as students or social workers), and even problem gamblers themselves have been examined in a number of studies. People’s attitudes toward casual gamblers don’t matter all that much.

Damian Jacob Sendler: People with gambling addictions are frequently singled out in discussions about the subject of gambling. There are many misconceptions about gambling addiction, but the negative effects it has on the lives of those who suffer from it are rated quite high. PG is described as “irresponsible,” “greedy,” and “weak or stupid” all at the same time. In this article, only a few examples of open discrimination are mentioned. Media portrayals of PGs have been implicated in studies as a cause of stigma.
Gambling addiction is a complex issue that has many unanswered questions. For example, how does a person’s age, culture, and sexual orientation affect their views? In these areas, more study is needed.

Dr. Sendler: Gambling is becoming increasingly accepted as a normal pastime in Western societies. Adults enjoy gambling on lotteries and sports, with a large percentage of them taking part. Playing a game of chance has the potential to harm one’s health and the environment in a way that few other pastimes can. Because of the potential harm it can do to one’s health and well-being, problematic gambling is included in the same category as excessive consumption of alcoholic beverages and illicit drugs (Browne et al. 2020).

Gaming can lead to stigmatization as one of the unfavorable side effects. Stigmatizing behavior serves a variety of purposes, including highlighting the difference between “normal” and “stigmatized” behavior. Many people who have gambling addictions are stigmatized or viewed in a negative light because of their condition (Carroll et al.; Hing et al. 2016b; Palmer et al. 2017). People with gambling problems are often stigmatized, but this has received scant attention in the scientific literature (Hing et al. 2013). Only a few studies have looked into it, but the findings are unambiguous (Dhillon et al. 2011; Hing and Russell 2017a; Miller and Thomas 2017a; Palmer et al. 2017; Peter et al. 2018). If you’ve got a problem with gambling, you’re more than likely to see it as a sign of your own inadequacy.

Self-stigmatization ensues, and the downward spiral continues. Consequently, stigmatization serves as a major barrier to treatment because people with mental health issues are reluctant to open up and may withdraw from relationships (Brown and Russell 2019; Hing et al. 2013; Miller and Thomas 2017b).

Problem gambling is assumed to be stigmatized in some form or another, regardless of the type of gambling one engages in (Horch and Hodgins 2015). That said, most studies to date have looked at how people with gambling addictions are stigmatized rather than the actual problem of gambling itself (Miller and Thomas 2017b). Gamblers’ views are being organized empirically with this in mind.

To prevent stigmatization, it is critical that researchers conduct a systematic literature review of empirical studies examining the perceptions of people who gamble or have gambling problems (Schomerus and Rumpf 2017). We’re only just beginning to learn about the social stigma attached to gambling and the people who engage in it. Gamblers are stigmatized at a much higher rate than people with a wide range of mental health issues, substance use disorders (both illicit and legal), or other conditions, according to study after study. Knowing this information can also help with the development of health policy. Stigma-reduction strategies from other industries could also help the gambling industry (such as mental illness).

As a general rule, drug use and problem gambling are seen as more depraved than alcohol abuse (Arbour-Nicitopoulos et al., 2010; Feeney, 2013). For example, in Arbour-Nicitopoulos et al. (2010), Feeney in 2013; Hing and colleagues in 2015; Horch and Hodgins (2008). People with schizophrenic disease were stigmatized more than problem gamblers, despite the fact that mental health problems were less stigmatized (Arbour-Nicitopoulos et al., 2010; Feeney, 2013). (Hing et al. 2015; Horch and Hodgins 2008).

Stigmatization was greater for those who had been officially diagnosed as problem gamblers (Palmer et al. 2018). An increase in the stigmatization of problem gamblers can be attributed to a number of factors including their age, gender, lower self-esteem, more severe problem gambling, and the use of secrecy to deal with their issues (Hing and Russell 2017b).

The majority of people did not view gambling as a bad thing. Sports bettors were less stigmatized than other types of gamblers (Lopez-Gonzalez et al. 2018). EGM gamblers were viewed and characterized in a negative light (Miller and Thomas 2017b). Gambling games with a greater emphasis on gamblers’ abilities may be to blame for this. It would appear that gambling itself was not stigmatized, but only problematic gambling behavior (Hing et al. 2015).

People who participated in the study believed that gambling addiction was more difficult to conceal than alcoholism or schizophrenia (Hing et al. 2015, 2016d). In addition, a sizable majority thought that problem gambling was “at least somewhat noticeable” or “fairly noticeable” (Hing et al. 2015, 2016d) (Hing et al. 2016e). As a group, people with gambling addictions didn’t appear to match the public’s perception that their condition was obvious (Hing et al. 2015). This means that it may not get the same level of attention as other addictions, like drug and alcohol abuse.
Gambling disrupts a person’s ability to work or study, live on their own, and maintain a long-term romantic relationship, according to a study (Hing et al. 2015, 2016d).
There is no doubt that problem gambling is as disruptive as alcoholism, but it is less so than schizophrenia, according to researchers (Hing et al., 2015), who label it “disruptive” or even “highly disruptive” (Hing et al. 2015). People with gambling problems feared that the public would view them as erratic because of their self-stigma (Hing and Russell 2017a).

Unlike schizophrenia (Hing et al. 2016d) and even more so (Blomqvist 2009), the majority of respondents (Hing et al. 2015, 2016d, e) believed that problem gambling could be treated in the same way that alcoholism could be (Hing et al. 2015).
In contrast to those who had used drugs or smoked previously, those who had a history of doing so were more pessimistic about their chances of quitting (Blomqvist 2009). Recovery from problem gambling was thought to be easier than recovery from mind-altering substance addictions if they were left untreated (Koski-Jännes et al. 2012), but treatment for “hard drugs” or alcohol addictions was considered more important (Blomqvist 2009).

Blomqvist (2009) found that recovering from problem gambling was extremely possible, whether or not they received treatment. Those who participated in Cunningham et al. (2011) and Feeney (2013) were divided on whether or not people with gambling problems could recover on their own without the help of others.
Professionals viewed self-improvement as more difficult than nonprofessionals (Koski-Jännes et al., 2012). Koski-Jännes and Simmat-Durand found that French professionals were more open to the idea of untreated recovery than those in Finland. Treating those with gambling addictions is also seen as less necessary by those in the general population (Cunningham et al. 2011).

Gambling addicts aren’t generally considered to be dangerous (Dhillon et al. 2011; Hing et al. 2016d; Peter et al. 2018). According to Hing et al. (2015), problem gambling was considered to be “somewhat perilous,” but the respondents believed it was unlikely that those with gambling problems would endanger others and more likely that those with gambling problems would harm themselves.

People with gambling issues were thought to be less dangerous than those with alcoholism or schizophrenia, both in terms of danger to others and danger to oneself (Hing et al. 2015; Horch and Hodgins 2015). Some games are rated higher than others based on their genre: Traditional casino gamblers and eSports players were seen as more dangerous than internet gamers (Peter et al. 2018).

Having an addictive personality (Carroll et al. 2013; Feeney 2013) or a lack of willpower were viewed as the root causes of gambling disorder. The lack of willpower might also mean that the gambling habits of friends and relatives are taken over (Feeney 2013). Control, discipline, or even intelligence were cited as another problem (Miller et al. 2014). Horch and Hodgins (2008) attributed gambling disorder to negative character traits and stressful life events. The most likely cause of stress was found to be a stressful life situation (Dhillon et al. 2011; Hing et al. 2015, 2016d, e). Social workers in Finland and France seemed to believe that the problem was societal rather than individual. Unlike the Finnish social workers, their French counterparts disagreed that the individual was solely responsible for their own recovery (Egerer 2013). Individuals have been held responsible in most studies (Blomqvist 2009; Gay et al. 2016; Horch and Hodgins 2008, 2015; Konkolo Thege et al. 2015; Koski-Jännes and Simmat-Durand 2017; Koski-Jännes et al. 2012; Miller and Thomas 2017b).

Behavior addictions were seen as having a higher prevalence of character flaws than substance use disorders (Konkol Thege et al. 2015). As a result, people with gambling problems were viewed as more responsible for their own issues than people with substance use disorders (Koski-Jännes et al. 2012; Koski and Simmat-Durand 2017; Koski-Jännes and Simmat-Durand 2017).

In a series of studies that followed Angermeyer and Matschinger (2003), researchers looked at three different types of emotional responses: pity, anger, and fear. Respondents mostly expressed pity, anger, and fear for those who suffer from gambling addiction (Hing et al. 2015, 2016e). The authors of Gay et al. (2016) and Horch and Hodgins (2008) found that people had similar or nearly equal levels of anger and pity for problem gamblers, but much lower levels of fear as a result of their feelings toward them. Gamblers in the online gaming industry, as well as those in casinos, drew more attention than the Internet gamer (Peter et al. 2018).

Damian Jacob Markiewicz Sendler: Schizophrenia sufferers were more pity-worthy than those with gambling or alcohol addiction issues, who were rated at the same level. Angry responses to gambling and alcohol abusers were similar, while those with schizophrenia were less enraged than those with other mental health issues. Those with alcoholism and schizophrenia were more likely to be feared than those with gambling addictions (Hing et al. 2015).

Stigmatization is greatly aided by labels — for example, in order to receive adequate treatment (Grunfeld et al. 2004). (Hing et al. 2016b; Peter et al. 2018). There have been several studies looking into whether or not problem gambling is seen as a disease or a mental health disorder and whether it can be diagnosed as such.

Addiction or both addiction and disease have been linked to gambling problems (Cunningham et al. 2011). Most of those polled agreed that gambling addiction was a medical condition that could be diagnosed (Hing et al. 2015). “Compulsive gambling” was classified as a disease rather than a “habit” or a “sin” in an early study by Crawford et al. (1989).

Damian Sendler

However, in Blomqvist (2009), the risk of becoming addicted to gambling was rated slightly higher than the risk of becoming addicted to alcohol (Konkolo Thege et al. 2015; Lang and Rosenberg 2017).

Stereotypes about people with gambling problems are difficult to challenge because they are based on culturally transmitted beliefs rather than on personal experience (Hing et al. 2016e). Hing et al. (2015), 2016e; Horch and Hodgins (2008), 2015; Miller and Thomas (2017), “irresponsible,” “greedy,” “antisocial,” “foolish,” and “untrustworthy” were all frequently attributed to him. Other common descriptors included “impulsive,” “irrational,” and “untrustworthy” (Hing et al. (2015), 2016e; Horch and Hodgins (2013)).

It was common for people with gambling issues to refer to themselves in these terms: “stupid,” “weak,” or “losers” (Hing et al. 2015, 2016b; Miller and Thomas 2017b) (Hing et al. 2015, 2016b). They also assumed that the general population viewed them as a group of “impulsive, irrational, anti-social,” “greedy, untrustworthy, unproductive, and deviant” gamblers (Hing et al. 2015). (Hing and Russell 2017a).

As a result of the media’s emphasis on gambling’s negative consequences and the individual’s responsibility, people with gambling problems felt that the media contributed to the formation of stereotypes (Miller et al. 2014). They were viewed as a deviant group, apart from the rest of society, and were viewed as having only themselves to blame for their addictions (Leung 2016; Miller et al. 2016).

Gamblers in movies are depicted as masculine and cool, self-control and the ability to enjoy oneself, according to studies (Egerer and Rantala 2015). Inexperienced gamblers were the only ones to encounter difficulties (Sulkunen 2007). When it comes to how gamblers are depicted, things have changed over the years: from a sinner in the 1950s to skilled and intelligent people in the 1980s to comedic characters lacking morality in the 2000s (Chan and Ohtsuka 2011).

Damien Sendler: Problems with alcoholism and schizophrenia were found to be more likely than gambling addiction to lead to a decline in social status (Hing et al. 2015). When it comes to employment, child care, and interpersonal relationships, there was a general consensus that people with gambling addictions will be treated less favorably or even discriminated against (Hing et al. 2016e). People with gambling problems are less likely to be discriminated against than those without, according to a study conducted by Horch and Hodgins (2015). There were very few instances of discrimination (Hing and Russell 2017a), attributed to the concealability of problem gambling (Horch and Hodgins 2015), as well as the fact that many affected individuals do not disclose their gambling problem. Responses that were critical included criticisms of wasting money or suggestions to improve one’s quality of life (Hing et al. 2016b).

Research has been done on participants’ willingness to interact with people who have gambling addictions. The respondents were less likely than people with alcoholism or schizophrenia to keep a distance from one another (Hing et al. 2015).

People in this condition, especially those who had been officially diagnosed, tended to want to keep a distance from each other (Hing et al. 2015, 2016e; Lang & Rosenberg 2017; Rockloff & Schofield 2004). (Palmer et al. 2018). According to other research, there is little appetite for racial segregation (Gay et al. 2016; Horch and Hodgins 2008). People who were more familiar with people who had gambling addictions wanted less social distance from them (Dhillon et al. 2011). The more people are aware of the issue, the more effective strategies can be devised in the fight against stigma.

The type of gambling also influenced the desire for social distance. Online casino gamblers were more popular than e-sports bettors, but casino gamblers were less popular than online e-sport gamblers (Peter et al. 2018).

Damian Jacob Sendler

Statistically significant research has been found for populations in Australia, Canada, Finland, Sweden, and the United Kingdom (UK). Cross-sectional surveys were conducted almost exclusively. As a result, a shift in public perception of gamblers could not be studied. Both studies focusing on the effects of respondents’ sex and age were not available; however, this aspect was considered in some studies as one of many factors (e. g. Hing and Russell 2017b). It is impossible to draw conclusions about the perceptions of recreational gamblers because most studies focused on problem gambling. An increasing amount of comparable data from various countries and/or over various time periods would be useful.

It was found that problem gambling was widely believed to be difficult or impossible to detect. But the impact on the lives of those affected was found to be quite significant. Treatment and recovery were hotly debated topics. The overwhelming majority of respondents seemed to believe that it is the individual’s responsibility to find a solution. Gambling addiction as a mental illness appears to be a new concept to the public. It may be beneficial to have enough information available.

Those with gambling addictions were referred to as having a variety of negative characteristics. There are some truths to these claims, but many of them are exaggerated. As a sign of self-stigmatization, the gamblers’ negative self-perception was mirrored by this negative perspective. The media’s portrayal of people with gambling issues only serves to exacerbate the problem. This may be a good place to begin in the fight against stigmatization.

Because gambling addiction is easier to hide than other addictions, only a few examples of open discrimination were cited. The general public wanted to keep at least some distance from people with gambling problems, but the desire for distance diminished as familiarity grew with those with the problem. In public awareness campaigns, this information can be used to show that “ordinary people” can develop gambling addictions. It has been shown that the desire for social distance may vary depending on what type of gambling one is engaged in. Future studies should therefore compare the views of slot machine gamblers, casino players, sports bettors, and other gamblers. Increased awareness of the prevalence of problem gambling and the people who suffer from it could help alleviate stigmatization.

The current work has a number of flaws, many of which are the result of inadequate human and financial resources. If different search terms, other databases, and/or other sources (e.g. manual searches) had been used, the search results might have been more varied and specific. The quality of the studies was not rated because of time constraints. It would have been reasonable to take into account publications in additional languages. To add insult to injury there isn’t any way to measure how reliable each individual’s rating is. It was a team effort to select the studies, and all relevant decisions were thoroughly debated. Meta-analytical statistical methods could be used in the future to combine parts of the studies.

Many studies have looked at how the general public perceives people who have gambling problems, but other aspects have received less attention. This area of study has only recently begun to be studied. As a result, there aren’t many studies looking at gambling from the point of view of the general population in many countries. Furthermore, there are no long-term studies available. These, however, are necessary in order to gain an understanding of the phenomenon’s dynamics. A qualitative research approach could also be used to monitor individuals with gambling issues over a longer period of time. An investigation into stigmatization and self-stigmatization could yield valuable information.

Investigating how the media portrays people with gambling addiction is an intriguing research topic (press, official documents, films etc.). In light of previous research, new projects could be launched with a solid foundation. In countries where the issue of gambling addiction has yet to be addressed, the media’s portrayal of people with gambling problems could be an interesting topic of investigation.

Sexe and age of respondents had little or no impact on the respondents’ attitudes, for example. Furthermore, cultural aspects have been overlooked (Dhillon et al. 2011). There are also very few empirical studies that look at how the general public feels about gambling for fun. It’s also worth noting that only a few studies have examined the perspectives of professionals on their clients, indicating the need for more research in this area in the future (Schomerus 2017). Access to treatment for those who need it will be made easier as a result of this. In order to accomplish this, health policy measures should be implemented with a specific focus on stigmatization. Because of this, public health may be improved as a result.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: An advantage of using generalized linear mixed models (GLMMs) is that they can be used to estimate both the fixed and random effects of a dependent variable that isn’t ordinal, numerical, or qualitative. Additionally, GLMMs can model autocorrelation when the dependent variable has multiple measures. It was the goal of this study to determine how often and how frequently GLMMs are used in psychology, and to summarize how they are presented in published articles. We focused primarily on frequentist models in this regard. We searched the Web of Science for articles published between 2014 and 2018 that used GLMMs in psychology. From 2014 to 2018, 316 empirical articles were chosen for trend analysis. We then conducted a systematic review of 118 GLMM analyses from 80 empirical articles indexed in Journal Citation Reports in 2018 in order to evaluate the quality of the reports.. Over time, the use of GLMMs has grown in popularity, as evidenced by the fact that 86.4% of the articles published were from quartile 1 or 2. When it comes to GLMMs, the majority of relevant information has been left out, despite their increasing popularity in the field of psychology. Improved report quality is needed according to current GLMM recommendations.

Damian Jacob Sendler: The complexity of data analysis methods varies. Analysis of variance (ANOVA) and regression analysis are two of the most commonly used techniques in the health and social sciences because they are based on the general linear model. Assumptions such as normal distribution, homogeneity of variance, and independence of errors are not always met in real-world settings when testing quantitative variables. Advanced analysis is provided by the generalized linear model (GLM) and linear mixed model (LM). As the name implies, the GLM is just another name for linear regression in a more generalized form. When the assumptions of independence and constant variance are violated, the LMM can be used to incorporate random effects factors. A more complex version of the linear mixed model, the generalized linear mixed model (GLMM), incorporates random effects and extends the LMM to include other types of response variables. If we are only dealing with fixed effects or random effects, then our choice of model depends on the metric of the response variable and its distribution. As a result, each of the aforementioned models serves a distinct purpose and is best suited for a specific type of data. GLMMs are used in psychology in this article. Readers interested in GLMMs should consult Dean and Nielsen (2007) and Stroup (2007) for a more in-depth discussion (2013).

Dr. Sendler: The skewness and kurtosis values obtained in health, social science, and educational research frequently depart from the normal distribution in a clear way (Micceri, 1989; Lei and Lomax, 2005; Bauer and Sterba, 2011; Blanca et al., 2013; Arnau et al., 2014; Bono et al., 2020). Non-normality in the distributions of real psychological data was found by Micceri (1989), Blanca et al. (2013), and other researchers. Analysis of 440 achievement and psychometric measures by Micceri (1989) identified several classes of non-normality in the distribution. There were 693 distributions examined by Blanca et al. (2013), who found that the vast majority of them were non-normal. Recent systematic reviews of empirical studies in the fields of health, education, and social science have found that a high percentage of non-normal distributions have been used in the studies, with the most commonly used ones being gamma, negative binomial, multinomial, binary and lognormal in order.

Data in psychology frequently follow distributions other than the normal, as shown by these studies. However, despite the fact that ANOVA has been shown to be tolerant of non-normality (Kanji 1976), Khan and Rayner, 2003; Schmider et al., 2010; Ferreira et al., 2012; Blanca et al., 2017), it is not suitable for multinomial or ordinal data, and it is also not optimal with count data (Aiken et al., 2015). As a result, researchers in the field of applied statistics must pick a statistical technique that is suitable for their data rather than attempting to use classical approaches at all costs (e.g., by transforming data so as to achieve normality or using non-parametric analyses). In psychology, nested sampling and repeated measures are common study designs that imply non-independence of observations. GLMMs are well-known to applied psychologists as a flexible tool for analyzing such data, but their complexity has kept them from being widely used. ANOVA is, in fact, the most commonly used analytic technique in psychological research, according to a number of reviews (Edgington, 1964, 1974; Reis and Stiller, 1992; Schinka et al., 1997; Kieffer et al., 2001). Studies by Skidmore and Thompson (2010) and Counsell and Harlow (2017), as well as others in the recent era, have found that ANOVA, correlations, and regression are the most commonly employed techniques in psychology. Following regression, ANOVA was found to be the most commonly used data analysis procedure in a Blanca et al. (2018) review of 663 empirical studies in various areas of psychology published in prestigious journals in 2017.

GLMs are defined by Thiele and Markussen (2012) in terms of regression models that can be used by researchers to model a wide range of dependent variables through linear combinations involving one or more predictor variables (fixed effects). Using a link function, the response variable’s values can be transformed to match the scale of the linear predictors. As a result, the distributions and link functions are in agreement. An appropriate distribution and link function for the available data must be found before modeling can begin (Garson, 2013). A Poisson or negative binomial distribution is appropriate for count data if the variance is greater than the mean (overdispersion); proportions and binary outcomes are both binomial variables, and a logit link function is used as a connecting function. Each distribution has a natural link function, but less commonly used alternatives may be better suited to the data in some cases (Thiele and Markussen, 2012). Modeling binomial data with a probit link is one option, while modeling large-mean count data with an identity link is another. Identity link can also be used to model the negative binomial distribution. Other distributions and link functions may be available depending on the software package. To get the best fit and parameter interpretation, Thiele and Markussen (2012) suggested fitting models with a variety of links to the data.

Also keep in mind that GLMMs have some random effects that can change when the experiment is repeated. Subjects in a drug study, classrooms in an education study, or the passage of time in repeated measurements are all examples of random effects. With random effects, the intraclass correlation (ICC) can be calculated in multilevel modeling. Grouping structure can explain a significant portion of the variance in outcomes, according to Hox (2002). It is also possible to think of the ICC as the expected correlation between any two randomly selected members of the same group (Hox, 2002). It is the proportion of the total variance in the outcome that is due to differences between units at higher levels that Heck et al. (2010, 2012) call the ICC.

Another issue to keep in mind when it comes to GLMMs is overdispersion. Incorrect standard errors are generated by this phenomenon, and as a result, the data have a greater variance than the statistical model would predict or expect (Bell and Grunwald, 2011). Real-world data often have a much higher standard deviation than the mean. Type I error rates were found to be significantly inflated by Milanzi et al. (2012) when overdispersion was ignored, implying that the likelihood of detecting a fictitious effect rises. As a result, in psychological studies, it is possible for overdispersion to lead to incorrect conclusions. Count results that are heavily skewed by many zero observations (e.g. total number of drinks, number of drinking problems or days of drinking), for example, from the field of addictive behavior, are combined with repeated assessments (e.g., longitudinal follow-up after intervention). By using hierarchical or multilevel models to analyze longitudinal substance use data, Atkins et al. (2013) tackled the issue of overdispersion. Statistics based on the assumption of normally distributed residuals fail miserably when applied to these data. It’s also important to note that when using generalized linear models, data with many zeroes cannot be modelled by the probability distributions. This type of data is much better suited to GLMMs for count regression models like overdispersed Poisson or negative binomial regression, zero-inflated or Tobit (Atkins and Gallop, 2007; Coxe et al., 2009; Hilbe, 2011; Thiele and Markussen, 2012; Aiken et al., 2015).

A study by Milanzi et al. (2012) found that while GLMMs can account for the heterogeneity caused by correlated measurements, additional sources of heterogeneity may affect statistical inferences if ignored. Due to repeated measurements and additional overdispersion, longitudinal Poisson data may have a high degree of heterogeneity.

Information on the estimation method should also be included. In the absence of this information, it is difficult to determine not only the model’s suitability, but also its reliability, validity, and accuracy. The dependent variable and the random effects to be included in the model influence the estimation method selection (Bolker et al., 2009). Many factors must be taken into account when selecting the best method from the many available options. When the standard deviations of the random effects are large, the penalized quasi-likelihood (PQL) method produces biased parameter estimates, especially with binary data (Bolker et al., 2009). For Poisson and binomial variables, PQL estimates can be skewed if the mean counts within groups are less than five, or if the mean number of either successes or failures is less than five (Thiele and Markussen, 2012). Other examples include Laplace approximation yielding less biased estimates with a large number of clusters, while bias is greater when there are fewer clusters in the data set (McNeish, 2016).

Finally, the information criterion, which is used to evaluate or compare various models and take into account the best model fit, must be considered. This is where the Akaike information criterion (AIC) comes in. An information criterion that is very similar to AIC is the Bayesian or Schwarz criterion (BIC). In comparison to the AIC, the BIC prefers simpler models (Keselman et al., 1998). Another option for information criterion evaluation is AIC (corrected AIC for small sample sizes, quasi-Aic for overdispersed data). Different indices may perform equally well, so the choice is left up to the researcher’s discretion. As a result, authors may choose to use a variety of fit indices in the same study.

GLMMs have become more popular as a result of statistical software. Even though GLMM theory and concepts have been around since the early 1990s, the inclusion of PROC GLIMMIX in SAS has made these techniques more widely available and usable in the behavioral and social sciences (Charnigo et al., 2011). R, STATA, and SPSS are some of the more popular software packages that include GLMM fitting procedures. Despite the fact that statistical software is readily available, these models remain complicated. Furthermore, GLMM computation algorithms may fail to converge due to a complex random and fixed effects structure.

Psychologists are starting to use generalized linear mixed models (GLMMs) more frequently, but they are still far less common than in other fields like ecology (Bolker et al., 2009; Johnson et al., 2015; Kain et al., 2015), psychophysics (Moscatelli et al., 2012), biology (Thiele and Markussen, 2012), medicine (Cnnan et al., 1998; Platt et al Casals et al. (2014) conducted a systematic review of the use and reporting quality of GLMMs in clinical medicine, and found that while these models became more popular between 2000 and 2012, the report quality was poor. There has yet to be a psychology systematic review of this type, and we believe that such a study would aid in the proper application of GLMMs in the field.

There were two main goals in this investigation. GLMMs are frequently used in studies published in high-profile psychology journals, and the trend in this regard was examined in a first step. Because it’s important to show how these models can be used in psychology, as well as to explain why and how, we conducted a systematic review to show how they can be used, with an emphasis on frequentist models. The quality of the report was important to us, so we looked at articles published in the field of psychology to see if they contained all the information necessary for GLMMs.

Damian Sendler

Generating generalized linear mixed models is a combination of generalized linear models and generalized linear mixed models (that can handle non-normal data by using link functions and fitting distributions from the exponential family such as the binomial, multinomial, Poisson, gamma, lognormal or exponential). This means that GLMMs are better suited for the analysis of data with distributions other than normal, whether continuous or discrete in nature. These random effects must be used in conjunction with a distribution, link function, and structure that are all explicitly specified. It is possible to estimate parameters and test significance using a variety of methods, and their suitability depends on the data.

GLMMs can be extremely useful to psychologists because they allow the analysis of categorical data as well as counts or proportional responses to be performed on the responses. GLMMs also allow psychologists to generalize their findings by incorporating random effects. Because of this, GLMMs rarely appear in research published by prominent psychology journals despite their many advantages (Blanca et al., 2018). Thus, the purpose of this study was to examine the use of these models in psychology between 2014 and 2018. We were able to learn more about how GLMMs are used and reported in psychology through a review of empirical studies published in 2018 that used them. So we were able to see where the results were lacking and, in turn, assess the overall quality of the psychological reports that used GLMMs. These statistical analyses should be used correctly, and we hope to encourage psychologists to use them more frequently.

Although at a slower rate than that observed by Casals et al. (2014) in clinical medicine between the years 2000 and 2012, the number of articles in various fields of psychology that used GLMMs increased between 2014 and 2018. A similar thing happened when LMMs were used prior to GLMMs in medicine and gradually introduced into psychology (Bono et al., 2008). When researchers in psychology become more aware of the advantages of GLMMs, we hope that they will also be widely used.

For the years 2014–2018, we examined 198 JCR-indexed journals for articles related to psychology. PLOS ONE was the journal with the most articles involving GLMMs in its archives. If these models are used in first or second quartile journals, it suggests that the use of these more advanced analytical models is linked to publication success in journals that have a higher impact factor.. Substance Abuse, Psychiatry, and Multidisciplinary Sciences were the most common JCR categories to which articles in this journal corresponded. A large number of articles using GLMMs were published in the United States, followed by the United Kingdom, in terms of the country of publication. The majority of the first authors were from the United States, followed by Germany, Australia, the United Kingdom, the Netherlands, and Canada (all at much lower frequencies).

Although gamma and negative binomial distributions are widely used in health, education, and social sciences (Bono et al., 2017), our results show that they are still underutilized.. According to Casals et al. (2014), clinical medicine, we found that the response variable’s distribution was most commonly binomial. In spite of the fact that our total number of GLMM analyses was greater than the number of articles examined by Casals et al. (2014), the percentages reported in both studies are consistent with the type of distribution and other variables examined.

We found that more than half of the GLMM analyses we looked at failed to provide information on the distribution’s shape or the function that links variables together. These two variables are naturally linked, but it is important to note that different link functions may be appropriate for different distributions (Garson, 2013). Furthermore, it is common practice to use a different distribution than the one that best fits the data when there is overdispersion. Overdispersion is common, for example, in Poisson data sets.

To ensure the validity of GLMM estimates, it is important to report the estimation method used in a study. For each model, we found an estimation method in only 17.7% of analyses, which is similar to the percentage found by Casals et al. (2014) in clinical medicine. It is likely that the authors used the default method when the estimation method is not reported (e.g., pseudo-likelihood is the default method in glimmix in SAS). However, this should be specified.

Damian Jacob Markiewicz Sendler: Maximum likelihood was found to be the most commonly used method for parameter estimation in the psychology field. When comparing models with fixed and random effects, maximum likelihood can underestimate the standard deviations of random effects (Bolker et al., 2009). Although the goal was to compare models, our review found that maximum likelihood was mostly used with small samples (less than 100). For GLMMs with more than two or three random effects, the Gauss–Hermite quadrature can provide more accurate estimates of fixed effects and variance components (Pan and Thompson, 2003). (Bolker et al., 2009). There was only one random effect in the two GLMM analyses that used it, so it was an appropriate method. In addition, we discovered three studies that used restricted maximum likelihood (REML). When the dependent variable can be modeled with a normal distribution, this method is most appropriate (Thiele and Markussen, 2012). REML was used in three separate analyses, one of which used a binomial distribution, while the other two did not.

Damian Jacob Sendler

It was found that PQL was the most commonly used estimation method in clinical medicine because it is fast to compute (Breslow and Clayton, 1993). Only a small percentage of GLMM analyses focused on psychology reported the estimation method, and none used PQL.

However, Casals et al. (2014) found that the percentage of studies reporting the goodness-of-fit method was lower in the field of psychology than it was in clinical medicine (69.5 percent to 84.3 percent). The AIC was the most commonly used method in both our study and that of Casals et al. (2014). In order to determine whether or not the method employed is the most appropriate, it is critical that this data be reported. When we looked at GLMM analyses, seven used the AIC with samples of less than 100 when the AICc would have been more appropriate. The goodness-of-fit method was not specified in 15 analyses involving small samples (less than 100), so it is unclear if the most appropriate criterion was used. AICc was used with small samples in only two out of the eight GLMM analyses examined (149 subjects).

Damien Sendler: For the fixed effects test, we found that very little information was provided, which is consistent with findings from Casals et al. (2014). However, small and moderate sample sizes shouldn’t use this method because it’s not recommended for likelihood ratio tests of fixed effects that use maximum likelihood to estimate parameters (Bolker et al. 2009; Cheng et al. 2010). (Pinheiro and Bates, 2000). A likelihood ratio test was used in six of the GLMM analyses we examined, but no specific estimation method was specified in any of them. As a result, three of the six GLMM analyses that used the likelihood ratio test for fixed effects had a sample size of fewer than 100 participants.

We were unable to quantify the statistical modeling strategies (forward selection, backward elimination, best subset, and stepwise procedures) because they were not, as a rule, described. In spite of the fact that statistical modeling was used in only half of the GLMM analyses, almost all of the remaining studies used a full model that included all of the available predictor variables, even if they were not significant. When there are a large number of predictor variables, statistical modeling can be beneficial. Unbiased estimates are provided by full models, but they also contain predictors that are of no consequence. Statistical modeling for inference may or may not be used depending on the study’s goals. Stepwise procedures for inference have been criticized because the order in which parameters are entered or removed can affect the selection result, the parameter estimates can be biased, and multiple tests involved in the procedures inflate type I errors (Burnham and Anderson, 2002). The best subset modeling with GLMM can easily become computationally expensive when there are multiple fixed or random effects, as Thiele and Markussen (2012) recommend that model building is done by backward model selection.

Most of the GLMM studies reviewed did not report the random effects test, which is consistent with findings from clinical medicine (Casals et al., 2014). For random effect inferences, the likelihood ratio test is useful, but only for nested models. This necessitates that the hierarchical structure be made clear. A single random effect encompassing participant variation was the focus of the majority of the analyses examined here.

The autocorrelation of such data can be modelled using structured covariance matrices, such as the autoregressive, using GLMMs, which are common in psychology. There was very little discussion of the covariance matrix structure in any of the analyses examined here. As a result, it’s not clear if psychologists prefer structured or unstructured covariance matrices in their research. Some statistical software does not allow the researcher to define the covariance structure when GLMMs are used (Thiele and Markussen, 2012).

Despite the fact that ignoring overdispersion can cause issues, 90.7 percent of GLMM analyses did not specify whether it was assessed. Casals et al. (2014) found the same results in the field of medicine. Overdispersion, on the other hand, is only a problem for some types of distribution.

Additionally, it’s critical to mention the statistical software used, as this can have an impact on the estimation methods used and the amount of time it takes to run the calculations. Most commonly used statistical software suites in these studies were SAS and R. SAS’s standard procedure for fitting GLMMs was originally part of the glimmix package. We found lme4 (implemented in R) to be a popular package for fitting GLMMs. SPSS, STATA, and HLM were the most commonly used software suites. Even for statisticians, GLMMs are difficult to implement, even with statistical software. Furthermore, it is common for models to fail to converge, particularly when there are many random and fixed effects.

It is our primary goal in this article to examine whether the information provided in studies using generalized linear mixed models (GLMMs) published in psychology is sufficient for researchers with experience in these models to evaluate the methodological quality of studies and the validity of the results. We found that report quality in psychology was similar to that observed in clinical medicine by Casals et al. (2014). The use of GLMMs is well-known in statistical literature, but the psychological literature frequently employs models with only fixed effects. As a result of a lack of familiarity with complex models used in applied psychology, there is a tendency to report statistical significance without taking into account other important aspects.

As opposed to looking for anomalies in their application, the purpose of this article was to examine how GLMMs report key information. Despite this, we discovered that they were not always used correctly. In light of this, we suspect that the analyses may have a high number of model misspecifications. As a result, scientists should proceed with caution and a thorough knowledge of GLMMs when performing these types of analyses.

We believe that GLMM results should be presented in psychology journals in accordance with a set of minimum standardized guidelines following a review of the literature. The following is the minimum information that should be included in any statistical analysis: measurement scale and distribution of the dependent variable, link function, estimation method, goodness-of-fit method, fixed effects test, statistical modeling, random effects test, variance estimates of random effects, covariance structure for repeated m The inclusion of random effects in a GLMM analysis is particularly interesting. Examples and recommendations are provided by Stroup et al. (2018) on how to configure the random effects structure. The quality of GLMM analysis in psychology could be improved if information on power calculations was made available. When determining power output, readers can refer to Stroup et al. (2013, 2014). (2018).

There is a need for better reporting when using GLMMs in psychology, suggesting that there is a lack of understanding of what information from GLMM analyses should be presented. According to our systematic review, most of the important information about GLMMs was not stated in most of the articles included. Because of this, it is difficult to evaluate the GLMM approaches used because of the lack of reporting on key aspects (e.g. estimation method, link function, goodness-of-fit method, and overdispersion evaluation). Moreover, none of the articles reviewed contained all of the relevant data.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler, M.D. – Employers are increasingly concerned about the mental health and well-being of their employees, especially in the wake of the COVID-19 pandemic. Despite the fact that the virus has been around for over a year, many employees are still afraid of contracting the disease or spreading it to others, whether they are family members, coworkers, friends, or complete strangers. 1,2 There are additional pandemic-related stressors that have further affected employees’ mental health, including high ambiguity and uncertainty, social isolation due to physical distance measures, changes in both work and domestic duties, and concerns about financial and job security. 3 Recently, during the COVID-19 pandemic, workers were more likely to report mental health symptoms such as increased guilt (24%), insomnia (38%), agitation (50%) and sadness (53%), as well as emotional exhaustion and fatigue (54 percent ). 4

Damian Jacob Sendler: Mental illness has a devastating effect on the economy. As an example, the US economy lost $210.5 billion (2010 USD) as a result of depression, with about half of that amount paid for by employers. 5 Depression is often accompanied by other long-term conditions, which increases the financial burden on employers and healthcare providers. Comorbid conditions like cardiovascular disease and diabetes account for about 60 percent of the cost of depression. 6 It has also been found that the working-age population has higher rates of anxiety, substance abuse, and mental health issues than any other group in the population. 7 Work is a major source of stress for adults in the United States, and job-related stress has been linked to poor mental health8. Many of these workplace stressors are linked to an increased risk for a variety of mental health issues, such as depression and anxiety. 9

Dr. Sendler: Absenteeism and presenteeism, two common manifestations of poor mental health, have significant indirect costs in addition to the direct ones associated with treatment (ie, performance decrements while continuing to work). Absenteeism and tardiness cost an estimated $1.7 trillion a year in direct and indirect costs in 2010, and these figures are expected to rise to $1.8 trillion a year by 2030, according to the World Health Organization. 10 When it comes to promoting good mental health, employers are looking for guidance on action steps that are evidence-based, cost-effective, and broad in scope.

But employers often find it difficult to assess their employees’ mental health needs because mental health conditions are still stigmatized. A culture of silence and discrimination prevents employees from speaking up for themselves or asking for assistance. Employee assistance programs (EAPs) offer mental health services that are often underutilized, despite their widespread availability. Employees with mental health conditions are reluctant to seek help because they are afraid of being discriminated against by coworkers and superiors, social exclusion, and being perceived as incompetent. This can have a negative impact on employee performance, interpersonal relationships, and workplace well-being. 11

In 2016, the Johns Hopkins Bloomberg School of Public Health (JHSPH) hosted a public health summit titled: Mental Health in the Workplace. The current state of workplace mental health practices was discussed by professionals from a variety of fields. An open call to action to improve workplace mental health was made at the summit’s conclusion, and a list of recommendations for further research and actions by employers was provided. 12 Recommendations made by the consortium included: 1) developing a quantitative scorecard for measuring mental health in the work environment, 2) transforming workplace cultures to value mental well-being, 3) increasing the accessibility of workplace mental health information, and finally, 4) setting up an award to recognize exemplary programs and to encourage employer participation in mental health initiatives

JHSPH and The Luv U Project have partnered to create the Carolyn C. Mattingly Award for Mental Health in the Workplace (Mattingly Award), which focuses on developing evidence-based criteria for this award.

1 A corporate social responsibility award that recognizes outstanding efforts to improve mental health in the workplace could boost the reputation and brand of companies that are already doing this and inspire others to do the same.

It’s easy to overlook the importance of organizational culture because most companies with established organizational structures already have recurring behavioral patterns in the form of distinct power relationships and political structures that are deeply ingrained in their workplace environment.

18 These behavioral patterns will then have an impact on other organizational variables and workplace behaviors. Workplace values and norms, physical and social environment, and “unconscious assumptions that make up the culture of an organization” are all possible variables. 18 As a result, establishing a strong mental health culture can have a significant impact on the awareness, utilization, and impact of mental health programming efforts. A company’s culture is made up of a variety of elements, including the actions and attitudes of its leaders and managers, as well as any guiding documents or official policies. When taken as a whole, these represent the company’s core values and can help or hinder the mental health of employees.

In addition to having a supportive corporate culture, employers must offer comprehensive coverage for mental health services as part of their health insurance plans. People who need mental health treatment are often discouraged from seeking it because of the difficulty in finding a provider in their area and the high out-of-pocket costs. 20 Access to numerous mental health professionals, a wide range of mental health benefits covered, lower or no cost-sharing for treatment, and the elimination of unreasonable service limits, such as the number of outpatient sessions covered, lifetime spending caps or restrictive prescription medication rules, are all part of the solution. These components are also included in the solution.

The MHPAEA mandates that companies provide employees with equal access to both physical and mental health services.

21 As a result of the Affordable Care Act’s expansion of the MHPAEA’s mandates, mental health and substance use disorder services were included as one of ten “essential health benefits,” and many insurance plans were required to cover preventive services like mental health screenings. 22 Despite paying 12 percent more than Medicare for services provided by other physician specialties, private insurance companies pay 13 percent to 14 percent less than Medicare for mental health coverage, according to a Congressional Budget Office report, highlighting the growing gap between inadequate mental health coverage and higher cost-sharing payments. 23 One way to ensure that employees can afford needed mental health treatment is to address this cost barrier. Organizational outcomes are positively correlated with workers’ access to high-quality mental health services. For example, depression treatment has been shown to reduce absenteeism and presenteeism by 40% to 60%.

Employee assistance programs (EAPs) frequently offer mental health counseling and support services for employees who are dealing with personal or work-related stressors. The effectiveness of an EAP program can vary widely depending on a number of factors, including the provider, the scope of services offered, the program’s use, the organization’s culture, and the level of care provided. 25 An original program to address alcohol abuse in the workplace has expanded to include a wide range of services, including clinical assessments and brief counseling as well as referral to community resources that provide counseling services, including those focusing on financial wellness. 26

By partnering with insurance carriers and offering mobile applications and telemedicine, EAPs have evolved from their original models to ensure that the services they provide are more widely disseminated and accessible.

As a result, EAPs have been able to play a more prominent and important role in the management of behavioral health risks.

Damian Sendler

Companies that place a high value on employee well-being have employee assistance programs (EAPs) that provide access to counseling, substance abuse treatment, and referrals to local providers who accept the company’s insurance. The low use of EAPs by businesses is one of the main issues they still face. 28 Although a majority of civilian workers in organizations with 100 or more employees have access to an EAP29 and despite substantial evidence indicating that EAPs increase the well-being of employees who actively use the services,30 utilization averages just 2% for basic EAPs bundled with other benefits, and 8% for more comprehensive full-service EAPs. 31 Employee assistance programs (EAP) with a proven track record of success are more likely to be utilized, which in turn increases the likelihood that those in need will be able to get the help they need. The use of EAP services alone will not suffice to determine whether or not a company’s mental health needs are being met; a multi-method assessment is required to place EAP usage within the context of a healthy or unhealthy company culture.

Anxiety and depression in the workplace have been linked to high levels of workplace stress, and long-term exposure to this type of stress can harm one’s mental health as well as their physical health.

32 In a study examining EAP impact on clinical outcomes, employees who used EAP services performed better clinically than those who did not use EAP services. 33 EAP professionals are trained to identify and address the root causes of employee mental health issues in order to meet the needs of a wide range of workforce populations. 33

Employers may also provide other types of stress management programs in addition to EAPs, with the goal of lowering blood pressure and cholesterol while also helping employees cope with stress and anxiety.

34 It is possible to categorize them as follows: cognitive behavioral therapy (CBT), relaxation/meditation/mindfulness techniques (RMT), system restructuring (RSR), multimodal interventions, or alternative interventions. 35

Organizational factors that cause stress are being examined more closely by employers in order to develop programs to alleviate these stressors, which have a direct impact on health and well-being outcomes.

Damian Jacob Markiewicz Sendler: There are many factors that contribute to work-related stress, including heavy workloads, lack of control and autonomy, work-life conflicts, increased technological demands, and unpredictable schedules. As part of the 36 strategies for preventing and reducing stress, supervisors can improve communication and management support while also ensuring that workloads are in line with employees’ abilities and resources.

For a work environment to be healthy and safe for employees’ mental well-being, it is essential to prevent and address issues such as physical and verbal abuse, sexual harassment, and other forms of discrimination. It is possible to develop chronic health conditions as a result of psychological and physiological stress caused by workplace discrimination and harassment. 38 Inequality in the workplace, such as unequal treatment or limited opportunities, can be exacerbated by a workplace that is racially or gender imbalanced. 39 For both employees and organizations, toxic work behaviors can cause long-term distress from negative emotions that result in increased staff turnover as well as a decrease in job satisfaction and attrition. 40

It is possible to reduce or eliminate these harmful practices through policies and training. Workers with mental health conditions can benefit from workplace orientation programs that include training on the normative behaviors associated with bullying, harassment, and discrimination, as well as information about their right to confidentially report these issues to human resources personnel.

Damian Jacob Sendler

Ergonomic office design concepts must be considered in order to prevent injuries. Office location, layout, and workspace can have a significant impact on the well-being of employees, both physically and emotionally. 43 Employees’ physical, mental, and cardiovascular health can be improved by ensuring that their work environments and work tasks are as closely aligned as possible. Lower back pain and tendonitis from physically demanding jobs are common work-related musculoskeletal injuries that can lead to long-term health problems and disability. Promoting health-conscious attitudes, coworker support, reducing repetitive work, and better work postures are all examples of protective ergonomic factors.

Individuals’ mental health can only be improved if their workplace has a supportive culture. Changes in the “physical surroundings and social, economic, or organizational systems” are necessary to achieve this goal of promoting and improving mental health in the workplace. 45

Opportunities for social connections and self-care can be found in a supportive work environment. Creating an inclusive and connected workplace is a social process that requires organizational responsiveness in order to achieve mutual understanding and make accommodations for people with mental health conditions. 42 Employee well-being, reduced fatigue, and lower rates of burnout are all linked to workplaces that provide opportunities for stress recovery and mental recharge, such as quiet rooms to rest in and breaks from work like vacation days, work-free weekends, and “real” lunch breaks. 46 In order to foster a positive work environment, it is important to alter the physical and social surroundings. 47

Damien Sendler: Employees’ nutrition and fitness needs can be met in a holistic work environment, for example, by providing healthy food options in cafeterias and providing nutrition education. While not every workplace has the resources to provide on-site fitness facilities, employers can lower the barriers to physical activity by offering employees discounts on fitness club memberships or hosting activity challenges. 7 Participants in workplace wellness programs showed lower stress levels, improved social satisfaction, higher energy levels, and improved self-efficacy and quality of life after the program was completed, according to a study that examined employee health using the validated SF-36 mental health scale.

Employees’ perceptions of mental health in the workplace can be influenced significantly by leadership’s openness and consistency in providing it. It is impossible to implement workplace mental health policies without the full support of the company’s leadership at all levels. Employees’ perceptions of the company’s commitment to health promotion are shaped by the emphasis that leaders place on improving mental health in the workplace. 49 Making mental health an integral part of corporate leadership is an important step in reducing the stigma around mental health issues. As a result of leadership training, employees are able to learn more about mental health benefits, resources, and the importance of emotional well-being from their managers. To close the gap between employee mental health needs and the resources available to address those needs, training leaders in adapting their management style to the needs of employees is essential. Rather than relying on employees to openly discuss their mental health issues, leaders can take the lead by modeling desired behaviors and providing support services to address workplace stressors and psychological impediments to individual and team well-being.

Establishing positive organizational climates can be done with positive leadership practices. Workers who have mental health issues can benefit from workplace leaders taking on the role of wellness champions. This will not only increase awareness of mental health issues and encourage people to seek help, but it will also increase the likelihood of successful treatment delivery. 50

Management at all levels can demonstrate supportive supervision by encouraging employees to identify and address the sources of stress and conflict in their personal and professional lives.

36 This has been shown to have a positive effect on employee job satisfaction, physical health, and productivity in the workplace.

Measurement of employee mental health and well-being outcomes is essential to establishing the impact of organizational mental health efforts. EAP awareness, utilization and satisfaction with available resources and a decrease in stigma related to mental health are all indicators of success. There are currently no standardized metrics for determining what constitutes “success” in a mental health program at work. Employee engagement and satisfaction with their work environment, supervisors and colleagues, participation in health-promoting programs and services, as well as an improvement in psychological well-being indicators can be used as indicators of a healthy company culture’s success. It is critical for employers to clearly define their overall goals and objectives for such programs in advance, and to continually monitor the key metrics linked to those goals and objectives throughout the program’s life cycle. To be eligible for the Mattingly Award, a workplace mental health program must meet the following criteria: structure, process, and outcomes.

Programs aimed at reducing workplace stigma aim to improve mental health knowledge, attitudes, and behaviors regarding mental illness There is still widespread workplace discrimination against people with mental illnesses, as evidenced by a recent study that found that nearly half of the general population (47%) was unwilling to work or socialize with people who had been diagnosed with depression. 51 Fear of social exclusion, lack of opportunities for advancement, and over-inferring of mistakes to illness are some of the reasons why people avoid disclosing their mental health status. 52

Healthy workplace cultures are those that encourage, humanize, and prioritize the well-being of their employees. However, negative outcomes may reflect unhealthy work cultures that include high levels of stress, unmanaged risk factors, unpleasant or dangerous working conditions, and in more extreme cases, discrimination and harassment as well as dysfunctional power dynamics that can lead to hostile work environments or violence. Simple assessment tools and surveys can be used to determine the overall well-being of employees and the effectiveness of workplace interventions in order to evaluate these outcomes. Psychosocial, organizational, and environmental categories of assessment tools exist. PHQ-9 and GAD-7 surveys are examples of psychosocial tools, while the CDC Worksite Health ScoreCard, 53 the Hero Scorecard, 54 and the Workplace Health Achievement Index55 are examples of organizational tools. An environmental assessment focuses on identifying and addressing health and safety hazards in the workplace, and this may include making sure that workspaces are ergonomically designed to prevent injury, eliminating exposure to chemical or biological toxins, providing personal protective equipment like N95 face masks and protective clothing, and implementing adequate security measures to reduce the risk of violence in the workplace.

New approaches to workplace mental health have emerged due to the widespread use of technology and the increased interconnectedness that characterizes today’s world. Technology-based approaches can be found in some initiatives, while others are based on theory and focus on making resources more accessible.

Another interesting side effect of telehealth is the rise of tele-mental health innovations. Apps aimed at training mindfulness, improving cognitive performance, and reducing work-related stress are becoming increasingly popular among businesses. 56 Anxiety and depression symptoms can be effectively treated with the help of e-health interventions that are targeted, individualized, and less likely to be biased. Growing evidence suggests that mobile platforms can improve healthcare delivery. 56 EAP underuse has resulted in a lack of attention to employees’ mental health needs, and many employers believe that these new technologies will help employees track and monitor their own mental health and locate relevant resources while protecting their privacy. 50

In light of the increasing focus on behavioral health offerings by more employers,57 there is a growing need for innovative solutions that help increase awareness and access to care resources. Employers can offer behavioral health services at the workplace by partnering with providers to develop tailored mental health plans that meet each organization’s unique preventive and care solutions as healthcare mobility solutions become more cost-effective and integrated into primary care.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: While diabetic macular edema and retinopathy are better treated, the lower rate of fundus examinations due to a lack of medical resources means that diabetic retinopathy is harder to diagnose and treat. It is therefore critical to implement an automated diabetic retinopathy screening program and identify biomarkers that are more specific and sensitive in order to reduce the incidences of poor vision and blindness.

Damian Jacob Sendler: A common microvascular complication of diabetes, diabetic retinopathy (DR) is a leading cause of blindness among the elderly. In the early stages of diabetic retinopathy, hyperglycemia and altered metabolic pathways cause oxidative stress and neurodegeneration1. Early signs of non-proliferative diabetic retinopathy include vascular endothelial damage, microaneurysms, and dot intraretinal hemorrhage (NPDR). The hard exudates seen under fundoscopy are caused by the breakdown of the blood–retinal barrier and the leakage of multiple inflammatory cytokines and plasma proteins. Capillary occlusions lead to torturous capillaries and retinal ischemia as the disease progresses. In this stage, “cotton wool spots” can be seen. Neovascularization, vitreous hemorrhage and retinal detachment are all possibilities in the final stages of diabetic retinopathy.

Dr. Sendler: The prevalence of diabetic eye disease in Taiwan ranged from 3.75 to 3.95 percent between 2005 and 2014, and the prevalence of poor vision and blindness ranged from 0.29 to 0.35 percent. Increase in diabetic retinopathy from 14.3% in 2006 to 15.9% in 20133 has been reported for Korea. While women with type 2 diabetes had a higher prevalence of diabetic retinopathy, men had more severe retinopathy, poor vision, and/or blindness than women. All-cause, cardiovascular, and non-cancer mortality were all predicted by the severity of diabetic retinopathy4. Diabetes retinopathy has been linked to an increased risk of life-threatening arrhythmias, according to another study.

Chronic diabetes, high blood sugar, and high blood pressure all increase the risk of developing diabetic retinopathy. The progression of diabetic retinopathy is strongly linked to an increase in HbA1c levels6, 7 and intensive glycemic control reduces the incidence and progression of retinopathy8. Glycemic variability has been linked to diabetic retinopathy in type 2 diabetes9, according to recent studies. Preventing diabetic retinopathy also necessitates controlling postprandial hyperglycemia10. Furthermore, there is strong evidence that hypertension and diabetic retinopathy are linked. Retinopathy deterioration can be slowed by controlling blood pressure. Additionally, nephropathy, dyslipidemia, smoking and a higher BMI are all modifiable risk factors for diabetic retinopathy12, 13 and 14, respectively, which can help prevent its progression.

Damian Sendler

Despite the known risk factors for diabetic retinopathy, studies have revealed wide variations in the progression and severity of the disease. As a result, locating additional biomarkers for use in risk stratification or monitoring the effectiveness of treatment for diabetic retinopathy is critical.

Diabetic retinopathy and the pathogenic process are linked through the use of systemic biomarkers such as C-reactive protein (CRP)15, homocysteine16, and advanced glycation end products (AGE)17. Plasma proteomic analysis uncovered a slew of new biomarkers. These include RBP1 (retinol-binding protein), DPP3 alpha (diphosphoinositide polyphosphohydrase 3 alpha), neuroglobin (NGB), and CD160 antigen18 (CD160) downregulation in diabetic retinopathy, while HBG2 and CD160 were upregulated. Neuroglobin plasma levels, which differ significantly between the control and diabetic retinopathy groups18, may be a potential biomarker for diabetic retinopathy among the five proteins listed above. Metabolomics, micro RNAs, and genetic biomarkers are also being studied extensively.

Samples of vitreous and tears, as well as ocular imaging, are all examples of ocular biomarkers. In diabetic retinopathy, the vitreous contained increased angiogenic factors, such as VEGF21 and PDGF22, and decreased anti-angiogenic factors, such as pigment epithelium-derived factor (PEDF)23. A higher rate of retinal microaneurysm turnover24, larger retinal vessel diameters25, and retinal neurodegeneration detected by optical coherence tomography (OCT)26 were all linked to the development of diabetic retinopathy. New biomarkers for diabetic retinopathy and its clinical outcomes have not yet been used in clinical practice and require further validation studies.

Damian Jacob Markiewicz Sendler: Preventable blindness can be prevented by screening for diabetic retinopathy, which is the leading cause of visual impairment. Macular edema (ME) or proliferative diabetic retinopathy (PDR) are the first symptoms that patients with diabetic retinopathy (DR) experience. For ME or PDR-related visual impairment, panretinal laser photocoagulation (PRP) and injection of intraocular VEGF inhibitors are both effective but are better at protecting the eyes from further decline in vision. A screening program for diabetic retinopathy could help diabetics maintain their vision if implemented early enough.

Damian Jacob Sendler

In 2018, the International Council of Ophthalmology (ICO) and the American Diabetes Association (ADA) issued new guidelines for the screening of diabetic retinopathy, stating that the timing of the first eye examination and the minimum screening examinations are necessary for appropriate referral to an ophthalmologist. First eye examinations for type 2 diabetes patients should begin as soon as the diagnosis is confirmed, but this time frame should be extended to five years after the onset of diabetes for type 1 diabetics. Eye exams and retinal exams are included in the minimal screening process, however. Human-based telemedicine or an automated computer system can be used to analyze retinal imaging29. The first automated diabetic retinopathy screening program has been approved by the FDA since April 201830, with a 96.8 percent sensitivity and 87 percent specificity for detecting referable diabetic retinopathy31. When used in conjunction with telemedicine, a smartphone retinal camera has shown great promise in the detection of diabetic retinopathy32. Diabetic retinopathy screening can be cost-effective if an individual’s risk of developing proliferative retinopathy or macular edema is taken into consideration.29, 33, 34 When compared to routine annual screening for type 1 diabetes in the US, it was estimated that it would save $1 billion over the next 20 years. Type 2 diabetes screening needs to be validated using the same individualized schedule used for type 1 diabetes.

Damien Sendler: Diabetic retinopathy can be effectively treated with medical control of blood glucose, blood pressure, and serum cholesterol levels, as well as intraocular managements27, 28. Anti-VEGF therapy, including drugs like ranibizumab, bevacizumab, and aflibercept, has changed the way diabetic macular edema (DME) patients are treated. It has become increasingly clear that all three anti-VEGF agents are effective in reducing diabetic macular edema and improving vision since 2010. Although in eyes with diabetic macular edema, aflibercept may result in better visual acuity than bevacizumab at 2 years41, this is not always the case. It is still unclear how often and how long patients should receive anti-VEGF therapy injections, despite recent advances in the field. Intravitreous anti-VEGF injections may be required in the first year of treatment for the majority of patients, but as remission is maintained, these injections become less frequent.

Panretinal laser photocoagulation, in contrast, has been shown to be effective in reducing the risk of vision loss in patients with proliferative diabetic retinopathy42, 43. Patient’s with all stages of PDR and severe NPDR are considered the preferred treatment option for PRP44. Intravitreous injection of anti-VEGF has also been shown in recent studies to be a safe alternative treatment for PDR, in addition to PRP. Eyes in the anti-VEGF (aflibercept) group attained better visual-acuity outcomes than those in the PRP group at one year of follow-up in the CLARITY study. There was no difference in visual acuity outcomes between the anti-VEGF group (ranibizumab) and the PRP group at both 2 and 5 years of follow up in the Diabetic Retinopathy Clinical Research Network study47, 48. DME and PDR treatment options are compared in Table 1 to see how each compares to the other. However, when translating the results of clinical trials into real-world clinical practice, adherence to frequent follow-up, treatment burden, and patients’ preferences must be taken into account.

Due to a lack of medical resources, the diagnosis and treatment of diabetic retinopathy were delayed due to diabetic macular edema and diabetic retinopathy treatment progress. When diabetes is detected early, the prevalence of poor vision and blindness can be reduced. This necessitates the implementation of an automated diabetic retinopathy screening program, as well as the identification of biomarkers that are more specific and sensitive.

Dr. Sendler

Damian Jacob Sendler

Sendler Damian

Damian Sendler: People’s attitudes toward health issues have shifted dramatically as a result of social media. A comprehensive understanding of how social media has impacted public health research is still lacking. 

Damian Jacob Sendler: One hundred and twenty-five different research areas have been identified, including a wide range of diseases, populations, and other important topics in physical and mental health. In public health research, social media plays two major roles: first, it generates a lot of interest in public health research, and second, it provides a research context for public health research. Using social media for health intervention, human-computer interaction, as a platform for social influence, and for disease surveillance, risk assessment, or prevention is of significant interest in public health research. Even when it’s used only as a reference, recruiting participants, or collecting data, social media can be used as a context in public health research. The use of cutting-edge computational methods is rare in this new field, which relies heavily on both qualitative and quantitative research methods.. 

Dr. Sendler: Many aspects of people’s daily lives have been impacted by the widespread use of social media. A significant role has been played in health management and disease control in both developing and developed societies [1]. The use of social media in the prevention and control of a wide range of diseases, including infectious, chronic, and emerging diseases, has been documented [2-4]. People of all ages, genders, and socioeconomic backgrounds have used social media to gather data on health-related issues, including children, pregnant women, and the elderly [5,6]. 

Agencies use social media to accomplish a variety of health-related tasks. Health information, links to health services, and communication with others who share the same interests are all common uses of social media for the general public [10]. Social media (e.g., Facebook, Grindr, mobile apps) is a multifunctional tool for public health professionals and organizations to launch interventions that efficiently reach a wide range of the population [11-14]. Public health management, including disease surveillance, assessment, and control, can benefit from the large volume of mobility and discourse data on social media (eg, Twitter) [15-17]. 

Research conducted on social media platforms with public health goals, including this study’s social media–based public health research, has seen an increase in scholarly interest. Social scientists and health professionals have made significant contributions, but the overall picture of how social media has been integrated into public health research is still incomplete. There have been previous systematic reviews on social media–based public health research that focused on a specific domain or topic. The effectiveness of social media interventions for a wide range of specific health outcomes, such as the promotion of safe sexual health behaviors [22], vaccine uptake [23], noncommunicable disease management [24], and HIV prevention [19], was extensively studied in numerous systematic reviews. Scholars tend to specialize in one or two areas, failing to see how social media can shed light on other areas of study. However, because they are narrowly focused on a single topic, these reviews have difficulty spotting patterns that are common across different fields and assembling a comprehensive picture of social media-based public health research. There were only a few original articles in the existing reviews [25,26]. Few studies were even found in a review of systematic reviews [18]. The limited literature included in this emerging and fast-growing subject area may not provide a comprehensive picture of social media–based public health research. 

Social media–based public health research trends were presented in three dimensions: overall publication growth, specific disease publication growth, and journal outlet expansion over the past two decades. 

Empirical research was very limited in this area for the first decade (2000 to 2010), which is shown in Figure 2 as a result. Between 2011 and 2018, there was a noticeable rise each year. As the internet, and particularly social media, evolved, so did these kinds of fads. Facebook, Twitter, and Instagram were all launched before 2010, but they have only recently gained widespread acceptance across the globe. Social media–based public health research is a field that responds to technological advancements, according to this study. Prior studies have shown that internet research has evolved in lockstep with technological progress [29]. [30] 

Damian Sendler

Over the last few decades, social media has become an increasingly important part of research into a variety of diseases. When cancer, HIV and diabetes became more prevalent in 2010, there was an enormous increase in research. For the period between 2000 and 2018, the prevalence of other diseases such as flu and hepatitis A and B remained relatively stable while the prevalence of Ebola and the MERS virus increased steadily. 

799 journals published studies in these areas, according to the journal outlets (see Figure 3). It is shown in Table 1 that there are 15 prominent journals in this field. In total, 331 articles were published in the Journal of Medical Internet Research, accounting for 9.68 percent of the total number of articles. For this reason, the research in this area has also been covered in a number of sister journals of JMIR, such as the JMIR mHealth (165 publications), JMIR research protocols (114 publications), and JMIR public health and surveillance (49 publications). PLoS One, BMC Public Health, Studies in Health Technology and Informatics, AIDS and Behavior, and BMJ Open are also highly regarded, accounting for more than 1.5% of all articles published in this area. 

On the basis of similar concerns and associations, the 25 research themes were grouped into six research clusters. It began with a focus on health education, which was divided into 4 sections: health education for schools and students, oral and dental health education for families, mobile health and patient decisions. The final section was devoted to prenatal health education. Preventing disease is the goal of health education, which aims to increase people’s awareness of and confidence in their own ability to care for their own health. Health education has traditionally focused on the classroom and the home as the primary settings for students to develop healthy health beliefs and practices. Increasing scholarly attention has been paid to sexual health education on condom use and pregnancy. 

The second cluster focused on using mHealth to improve health management. Weight loss, diabetes management, social media and alcohol consumption, substance abuse, food and asthma, vaccination and immunization were all included in this cluster. mHealth and weight control Thus, social media can assist in the management of health issues. Using social media to influence unhealthy behavior and encourage the adoption of better ones is becoming increasingly popular. 

The third cluster, cancer studies, includes women’s cancer, reproductive cancer, cancer survivors, and social media caregiving for cancer patients. Cancer is a major cause of death and a major public health issue. As a result, cancer research has received constant attention. 

mHealth and HIV, men and HIV, infectious diseases, health campaigns, and HIV stigma all fall under the umbrella of the fourth cluster, which is focused on infectious diseases. In this line of research, social media provides new avenues to reach vulnerable populations and focuses more attention on campaigns to reduce the stigma of infectious diseases. 

The fifth cluster dealt with mental health concerns. Both mental health and substance abuse and depression and digital technology are included in this cluster. There has been an increase in the prevalence of mental health issues in today’s society. When it comes to mental health problems, digital technology is both a cause and a solution. 

Health and human mobility, health marketing, health surveillance, and eHealth–miscellaneous were the topics of the sixth cluster, which focused on social media-enabled extended health research. With the abundance of geographic data, large-scale user behavior data, and extensive online discourse on social media platforms, these research areas have flourished.

Damian Jacob Markiewicz Sendler: In public health research, social media is used to provide a new context for research or to generate new interest in public health research. In the early stages of using social media as a research tool, social media was only considered a reference, a platform for recruiting participants, and a data source. As a reference, social media was used primarily as a tool for health management and intervention when it was first adopted. There are a variety of ways in which researchers use social media as a platform for recruiting participants, including distributing questionnaires or posting recruitment announcements on sites like Facebook (Grindr for the men who have sex with men group). As a data source, social media could contribute to collecting data in text, image and video formats and collecting published posts and articles for meta-analysis or scope review. 

Damian Jacob Sendler

Human-computer interaction characteristics, social influence platforms, disease surveillance and risk assessment or prevention can all be studied using social media when it generates significant interest in public health research. 

The following are the four subroles that social media has been shown to play in research on public health interventions: First, a real-time interactive intervention tool that aims to alter personal and environmental risk factors for health; second, a one-way information distribution tool; third, a place where people go to find health information, such as YouTube and other platforms; and fourth, an experiment to see if social media platforms can serve as intervention tools. 

In this role, social media was used to reveal (1) the public’s attitudes toward technology and social media for health use, (2) characteristics and behaviors of social media users and groups, (3) factors influencing the health behaviors or attitudes of social media users, and (4) consequences/influences on health behaviors caused by (popular) social media. 

People and groups can change their health behaviors through the following methods: (1) building online support groups for patients, such as cancer patient groups on Facebook, (2) promoting physician-patient communication or information seeker–provider communication, (3) increasing the effectiveness of health-related marketing, and (4) changing public health behavior at a societal level through the use of social networking and social media. Social influence in online communities can be depicted using any of these methods. 

Traditional quantitative methods dominated public health research with social media data, while cutting-edge computational methods had a minor impact. 30% used surveys, 24% conducted experiments, 22% used qualitative methods (eg, in-depth interviews and focus groups), and 8% used digital methods (e.g. text mining and sentiment analysis), as well as 5.6 percent of articles used traditional content analyses. 

Using a bottom-up approach, this research provided an overview of social media-based public health research in the U.S. and Europe. This study concluded that (1) social media has penetrated almost all health-related processes and domains since 2010, showing a dramatic increase in the research body; (2) existing social media-based public health research mainly focuses on 25 themes in 6 clusters; (3) social media generally played two roles in this emerging research area by analyzing publication trends, research themes, roles of social media and research methods adopted. Scholars can gain a better understanding of the current state of research in this field, as well as what is being overlooked or overlooked. Scholars from different fields can learn from each other and work together to improve health and disease prevention. An in-depth look at three significant issues with theoretical and methodological implications for social media-based public health research is presented here. 

Damien Sendler: In light of the rapid development of social and mobile media, social media has made its way into nearly every aspect of health care. Public health research has had to adapt to this dramatic shift in the field. According to previous studies, nearly one-third of internet studies since 2009 have focused on eHealth and mHealth, and there is a trend toward digitization in health care. It’s no secret that social media has revolutionized many long-established aspects of public health, such as disease surveillance, health promotion, and health education. There has been a significant shift in how people find and share health information, discuss health issues, and practice healthy habits as a result of the rise of social media Smoking cessation, substance abuse, weight control and HIV prevention are just a few of the health behaviors that can be changed through social media. Studies on social media and public health have concluded in the past that these domains of public health can benefit from the use of social media by increasing access to healthcare, facilitating online professional consultation, and enhancing the efficiency of healthcare delivery as well as prescription medication uptake [19,39]. Because of social media’s ability to lower intervention costs, increase user engagement, increase efficiency, and document the process better, a growing number of public health campaigns are incorporating social media into their efforts [40]. 

New areas of public health research have emerged as a result of the convergence of public health research with social media [41]: Research in the field of mHealth and social media-enabled health “Digital campaigns in targeted populations” and “surveillance and Twitter” are two common new research topics [42,43]. It’s possible to use user-generated content and geolocation information to predict outbreaks of emerging diseases or visually map their diffusion routes and locate the risky population [44]. [44] It is possible to study online health behaviors such as online health information-seeking, online social support, and online medical consultations through the digital trace on social and mobile media [45]. Furthermore, in the age of social media, certain health-related topics have attracted an increasing amount of attention. The study’s 25 themes include, for example, mental health issues as significant concerns. The adoption and use of social media may help or worsen mental health issues, but no one knows for sure [46]. 

An in-depth investigation is needed in this relatively new field. Public health research can benefit from new social media phenomena and new questions that have emerged as a result. Scientific research can help the field keep up with technological advancements and establish a realistic understanding of what social media can and cannot do in public health by responding to new phenomena in a timely manner. For now, public health researchers should focus on scientific questions raised by these new phenomena and address them either through the use of already-developed methods and information, or the exploration of entirely new approaches and resources. 

However, when public health research meets social media, the dominant research methods are traditional quantitative methods, even though computational methods are becoming more popular within the field. Using social media in public health research can and should be expanded upon. Public health research is directly impacted by the potential of social media in recruiting participants and developing measurement tools. 

Participant recruitment for public health studies is made much easier thanks to social media. Researchers in the field of public health face an uphill battle when trying to enlist the help of members of marginalized populations, such as people living with HIV/AIDS or those struggling with mental health issues [19,47]. Recruiting a large number of people from specific social groups to participate in public health surveys and experiments should be possible because of the size and diversity of social media users. The more important point is that participants recruited from online platforms such as Facebook and Amazon’s Mechanical Turk can have significant heterogeneity in their demographic characteristics (e.g. age ranges, genders, races, and cultural backgrounds) [48]. As a result, it is important to note that the representativeness of participants recruited via social media needs to be empirically evaluated in particular contexts. It is impossible to generalize Amazon’s Mechanical Turk workers’ health status and behaviors to the general population in the United States. Researchers should exercise caution when extrapolating conclusions from their studies without first conducting an empirical assessment of the representativeness of the participants they enlisted on social media. Since social media is increasingly used to recruit participants, ethical issues have become more prominent and difficult. Social media anonymity makes it difficult or impossible to obtain informed consent from participants before they are recruited. Can researchers assume that when people accept the terms of service of a social media platform, they have given their explicit or implicit consent to participate in any experiment or intervention carried out on the platform [50]? This is an area where there is no widely accepted ethical standard. The scientific community must work together to set standards for ethical and responsible conduct in this new field of study.. 

Public health research can benefit from the use of social media because it provides new data on established concepts or new insights into emerging trends. In digital traces, rich semantic information can provide a social telescope [51] with which ordinary users can observe or infer what health information is generated, shared and consumed. For empirical studies on who connects with whom in various contexts, digital traces facilitate multiple social and interactive relations. More and more people are using social media to monitor epidemics or track emotional contagions. More and more studies are relying on social media user-generated content to keep tabs on new diseases as they emerge, in order to minimize their effects or keep track of public health trends [54-56]. Cross-validating new measures derived from social media data with established measures in the field of public health is essential when adopting new measures derived from social media data. Using Google Flu Trends as an example, it’s easy to see why cross-validation is so important. Traditional flu surveillance methods adopted by the US Centers for Disease Control and Prevention (CDC) were outperformed by Google Flu Trends when it was first launched. Flu cases in the United States are overestimated by Google Flu Trends [58]. In public health and beyond, the validation of empirical measures is an ongoing process [59].

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: Recently, research has increasingly focused on the interactions between multiple social determinants, interventions aimed at upstream causes of mental health issues, and the use of computer simulation models to represent complex systems. However, methodological difficulties and inconsistent findings prevent a definitive understanding of which social determinants should be addressed to improve mental health, and within which populations these interventions may be most effective.

Damian Jacob Sendler: Frameworks for social determinants study how people’s health is influenced by their living and working conditions [1]. Inequalities in life expectancy, child mortality, and disease burden among disadvantaged populations are thought to be driven by these conditions (i.e., social determinants) [1]. Conceptual frameworks for social determinants are built on the premise that there is a “social gradient,” in which people with lower social status face greater health risks and have a shorter life expectancy than those with higher social status [2]. Observed differences in social determinants can be reduced through targeted social and economic policies and programs.

Dr. Sendler: People’s socioeconomic status affects their risk of mental illness and their ability to access mental health services, which in turn improves outcomes. Allen and colleagues [4] used a multi-level framework that included: a life-course approach covering prenatal periods through old age; community-level contexts such as environment and health care systems; and country-level contexts such as political and economic factors, cultural norms, and specific policies [4]. Mental illness disproportionately affects the poor and disadvantaged, and stress and physical health act as multipliers of the negative effects of social determinants over time [4]. Other studies describe the impact on health over multiple generations of cumulative advantages and disadvantages [5].

Damian Sendler

A distinction between “upstream” and “downstream” determinants has emerged as social determinants frameworks have evolved. Upstream social determinants (e.g., economic opportunities) act as “fundamental causes” and typically have an impact on health through downstream social determinants, according to Braveman and colleagues [5]. (e.g., living conditions). Gender and race/ethnicity, as well as educational attainment, occupational status, and social support, are included in the definition of social determinants of health (p. 383). Racism and daily stress are also highlighted in this work [5]. Chronic stress affects mental health outcomes via biological pathways, according to Fisher and Baum [6]. Low socioeconomic status has been linked to mental health problems in lower socioeconomic groups, including stress from navigating everyday circumstances and anxiety about insecure and unpredictable living conditions.

There has been an increase in evidence in the last three years that social determinants have an effect on mental health outcomes in particular populations. Even in countries with universal healthcare, where employer-provided health insurance is less essential to accessing services, unemployment, precarious employment, and employment conditions continue to be linked to increased psychological distress [7, 8]. An increase in the rates of serious mental illness among migrant workers in Singapore was linked to hostile interactions with employers (i.e., injury disputes, threats of deportation). Similarly, nursing assistants who worked for profit-making companies and who were subjected to management dominance and emotional stress were more likely to endorse depressive disorders [12]. Other social determinants can be moderated by one’s employment status. According to some research, men’s mental health suffers more than women’s when they are unemployed [13]. According to researchers, nativity status and mental health among women working in Spain were linked by occupational social class (i.e., manual or non-manual labor) [14].

Damian Jacob Markiewicz Sendler: People with low incomes and a lot of financial stress are more likely to have poor mental health, according to studies in Sweden. It has been found in Korea, Europe and North America that people with other disadvantages have similar findings [7, 8, 10]. Katz-Wise and colleagues [17] found that transgender adults in the United States who had lower incomes were more likely to engage in self-harm, suicide attempts, and depression. Low-income pregnancies were linked to higher rates of depressive and anxious symptoms [18], but this link was partially mediated by financial stress (e.g., insufficient food, transportation, or housing). Chronic exposure to low-quality housing conditions (e.g., inadequate heating, overcrowding) has been shown to have a negative impact on the mental health of youth and adults [19, 20]. Mental health issues have also been linked to food insecurity and a poor diet [21–23] in the United States and Canada.

Damian Jacob Sendler

It has been shown time and time again that discrimination based on a person’s race/ethnicity, immigration status, sexual orientation, or employment status is harmful to one’s mental health [24–28]. Additionally, among African asylum seekers in Hong Kong [29] and Iraqis in Sweden [16], higher levels of depression and worse mental health were found to be associated with reported discrimination experiences. Discrimination that people in the United Kingdom believe they have experienced has been linked to increased levels of psychological distress over time [30]. According to Khan and colleagues [31], the “fundamental cause” of depression and a predictor of anxiety is multifactorial discrimination (i.e., based on multiple minority identities).

The quality of one’s mental health can be greatly influenced by the quality, or lack thereof, of one’s family relationships. Families that have a high level of satisfaction and connectedness are less likely to suffer from depression [7, 29]. As “reduced involvement” fathering (as opposed to “authoritative” fathering) has been linked to more internalizing and externalizing symptoms among Mexican youth in the United States [32], it is possible that parenting styles influence mental health. PTSD, anxiety, and aggression have been linked to a history of abuse and neglect from a family member [33, 34]. Social support, belonging to a group, and trust in others have all been linked to better mental health [9, 35, 7, 10, and 9], and it has been found that having a large social support network, including family and friends, reduces the risk of developing mental health problems, personality disorders, and psychotic experiences [36]. Migrants, refugees, and transgender people, for example, may find it especially helpful to participate in their communities and receive social support.

Damien Sendler: Community characteristics, such as urbanicity or neighborhood safety, have been frequently examined in contemporary social determinants research. Gay and bisexual men who live in rural areas are more likely to suffer from depression and other mental health issues than those who live in urban areas. Mental health outcomes can be predicted in large part by one’s perception and experience of one’s neighborhood’s safety [40, 41]. Dissatisfaction with living conditions and neighborhood safety were linked to lower depression levels among Chinese urban residents [42], while conflicts with local government over neighborhood planning were linked to higher depression levels [43]. U.S. researchers found no correlation between the quality of a neighborhood and the mental well-being of young people, even when controlling for other relevant factors [20]. Experiencing community violence as an adolescent has been linked to an increased risk of depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms [40, 41]. Major depressive disorder and generalized anxiety disorder may be more common in people who live in areas with high prison admission rates in the United States [44]. According to Bor and his colleagues [45], a unique community-level predictor was examined—police killings of unarmed Black Americans in the state. People of color who lived in states where at least one such killing had occurred in the previous three months reported an increased number of days during which their mental health was “not good” in that research [45]. The same was found in a study of the 2014 unrest that erupted in Ferguson, Missouri, following the death of Michael Brown, who was shot and killed there [46].

Furthermore, recent studies have confirmed the importance of several fixed characteristics such as race/ethnicity, nationality, gender and sexual orientation in addition to studying dynamic social determinants of mental health. Certain mental health symptoms have been linked to racial/ethnic minority status [40, 30], while other studies have examined how race/ethnicity interacts with other variables to affect mental health. Racial/ethnic minorities frequently report poorer mental health than White respondents among LGBT adults in the United States, for example [31]. Black and Latinx ethnicity predicted higher post-traumatic stress in New York City residents affected by Hurricane Sandy [47]. The direction and magnitude of the relationship between race/ethnicity and psychological well-being depends largely on whether other social and health variables are included in the analysis, suggesting that race/ethnicity may play more of an indirect role in influencing mental health.

Nationality and status as a migrant have been shown to have negative effects on mental health around the world [15]. Further evidence suggests that, although migrants initially show better mental health than the native population, this advantage usually diminishes over time [10]. Parents of Latinx children in the United States who have experienced negative immigration-related impacts since January 2017 were more likely than other parents to report high levels of psychological distress [49]. A number of studies have found that women consistently report lower levels of mental well-being than men. Neurodevelopmental and disruptive and impulse control disorders may be less likely to meet diagnostic criteria for these individuals [13]. Transgender identity and sexual orientation continue to be associated with a range of behavioral health outcomes, including self-harm, suicide, depression, and other serious mental illness [17]. Although the differences in mental health based on fixed characteristics such as race/ethnicity and gender are important to note, they are more likely to be a result of oppression or discrimination rather than an inherent vulnerability.

Mental illness can affect social determinants such as homelessness, school dropout, marital instability, and economic insecurity, although this is less frequently discussed [52–54]. When one’s mental well-being is compromised, it affects one’s personal choices and, in turn, the living conditions that limit one’s options. The World Health Organization [55] has described how mental health symptoms can have a cumulative and dynamic impact on socioeconomic status and other social determinants at each stage of life using a life-course approach. I Multiple social determinants can intersect and contribute to the onset of behavioral health disorders in young adulthood, which is critical. Individuals’ ability to navigate social norms and structures, such as school, work, or the justice system, can be negatively impacted by mental health symptoms at this stage of life [56, 57, 58]. These risk factors can then limit future earnings, create barriers to socioeconomic advancement, and increase the likelihood of developing a mental illness. Another factor that contributes to social inequality is the lack of access or long-term connection to behavioral health services for young adults [59].

It has been shown that interventions aimed at increasing housing stability, community functioning, perceived well-being and quality of life, and increased self-esteem are effective for people with mental illness [61]. Programs like Individual Placement and Support (IPS) have been shown in a meta-analysis of interventions aimed at increasing employment rates to be highly effective [62]. However, IPS program implementation is hindered by a lack of funding [63]. Although Housing First programs have been linked to better housing outcomes, lower rates of inpatient hospitalization, and a more stable use of health services for people experiencing homelessness and mental health challenges, these programs did not significantly reduce clinical symptoms [61, 64]. Before providing housing, mental health needs should be addressed, according to studies [61].

In Canada, food insecurity rates have decreased as a result of social policies aimed at improving housing stability [65]. Individuals’ perceptions of government assistance may moderate the benefits of national programs like the Supplemental Nutrition Assistance Program, which has been linked to poor mental health outcomes [21–23]. National efforts to reduce poverty, such as the Earned Income Tax Credit, may reduce depressive symptoms and improve self-esteem among beneficiaries [67].

Mental health disparities can be reduced by community-based interventions that build community trust and safety, mitigate violence and crime, or improve neighborhood deprivation. [68, 69]. Several studies have found a link between better mental health and fewer depression symptoms when regional and national programs focused on urban planning (e.g., increasing public access to green spaces). Stress reduction, increased physical activity, and/or a stronger social network are all possible explanations for these findings [73]. Social inclusion and connection initiatives have also yielded promising results [74]. A number of behavioral health outcomes have been linked to programs that encourage participation in social media, social marketing, schools, primary care, and parental relationships [75]. An evidence-based prevention strategy that aims to reduce youth substance use, violence, and other problem behaviors community-wide is implemented through stakeholder coalitions [76]. In addition to reducing drug use initiation and delinquency rates, this strategy has also resulted in a reduction in overall projected health and justice costs [76].

Investing in and integrating social services with mental health care has been shown to have a positive impact on outcomes. When it comes to improving patient engagement and treatment utilization, community health workers (CHWs) have been credited [77] and CHWs have also successfully implemented interventions targeting the social determinants of mental health conditions [78]. When primary care providers link socioeconomically disadvantaged patients to appropriate social and cultural activities, there have been mixed results in terms of mental health benefits [79–80]. Many social prescribing studies, however, were found to be small in scale and to employ poor study designs in a recent systematic review. It is suggested that reducing disparities in mental health can be achieved by providing universal primary health care access, given that people in countries with universal health care have better emotional well-being [81, 82].

Social determinants affect mental health in a variety of ways, often over a long period of time, and at various levels within complex systems [69]. Beyond generalized linear models, researchers have used analytical strategies to estimate these non-linear and time-varying relationships. Complex systems can be simplified by using simulation models, for example, and they can be useful in understanding system dynamics related to social factors.

When clinical event timing (i.e. incidence, relapse) is critical, state-transition and network models can be particularly useful for simulating disease progression among populations [84]. For example, Scata and colleagues [85] used a state-transition model to model the spread of suicidal ideation among people with psychological distress. Their findings suggested that educating people about the dangers of suicidal behavior through prevention programs and social media campaigns could reduce the spread of suicidal thoughts. Heterogeneous social networks, made up of people from different socioeconomic backgrounds, may help to strengthen the network’s resistance to disease transmission [85].

Agent-based models (ABMs) simulate and evaluate the combined effects on a system of the actions and interactions of multiple agents (e.g., patients and providers) [86–88]. According to Silverman [88], an ABM model of a behavioral healthcare system was used to examine how changes in the patient’s employment status and/or provider workflow affected re-hospitalization rates and the number of days spent in the hospital. ABMs are more time and cost-effective than randomized control trials for testing intervention effectiveness and assessing policy impact [84].

Researchers must exercise caution when distinguishing “allowable” from “non-allowable” [89] differences in social determinants, especially when measuring mental health disparities, even though simulation techniques allow for this. Simulation should not be used to alter “allowable,” or “justifiable,” social determinants of health (such as age and sex). To account for differences in health caused by “non-allowable” determinants (such as employment or education), simulation adjustments may be necessary. Reweighting and propensity score matching were employed by Alegra and colleagues [90] to correct for “non-allowable” social determinants. There was a strong correlation between better mental health outcomes and an increase in employment; however, there was a weak correlation between an increase in education or income. Existing survey designs can easily incorporate these weight-based approaches, making them useful for weighted survey analysis.

Social determinants research in recent years has also used descriptive (unsupervised) and predictive (supervised) machine learning algorithms to interpret existing patterns and behaviors as well as to predict future events. Systems can learn the structure of input data without explicitly providing outputs, enabling the identification of previously unknown data patterns [93]. It has been shown that LGBT adolescents’ interview responses can be clustered into distinct social determinant clusters using k-means clustering methods [94, 95]. Mental health problems (such as anxiety, depression, suicidality, and other forms of psychological distress) were more common in children and adolescents who had little or no family support. While this is not the case, supervised learning methods do allow systems to learn a mapping function (such as classification or prediction models) when both input and output data are present [96]. There have been numerous studies that use penalized regressions, random forests, and neural networks to show how factors like income and social support affect health [92]. There is some evidence that nonclinical data about individual and community-level social factors can be used to predict mental health outcomes and service need, but performance improvement results have been mixed [97, 92]. When compared to traditional models, machine learning algorithms are able to account for more complex, dynamic relationships, and thus identify new social factors [98].

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: Due of the pandemic produced by the SARS CoV-2 virus, a large portion of the world’s population is in partial or total lockdown at the time of writing this article. This health emergency, which has wreaked havoc on our country of Spain, has changed and will continue to change our social traditions, economy, and, of course, our health-care system in unpredictable ways. This article seeks to foresee some of the changes that will occur in the field of mental health and mental illness care, as well as the specialty that deals with it: psychiatry. In its broadest definition, psychiatry encompasses components of medical psychology, as well as preventive and health promotion, which are unquestionably part of the specialty’s theory.

Damian Jacob Sendler: Many psychiatrists have returned to practice as general practitioners and are bolstering COVID-19 patient care teams. At this time, the importance of basic medical training and the early years of residency, when practical training in medicine and neurology is needed for excellent psychiatric practice, is recognized. The current health crisis has reminded us once again that psychiatry is a medical specialty, and that psychiatrists can and should act as doctors, both in the field of our specialty and when, as in the current crisis or other circumstances (accidents, disasters), our most basic medical knowledge is required. Without lessening the importance of psychological and social determinants in the practice of psychiatry, the current crisis has emphasized and will continue to emphasize the medical paradigm that underpins the specialty’s practice and the importance of excellent public health.

Dr. Sendler: Medicine, like psychiatry, cannot be separated from the psychological aspects of medical treatment that are critical to the practice of any discipline that cares for the sick, including, obviously, psychiatry. Hospitals have been forced to adopt standards for the psychological care of patients, their relatives, and professionals in the middle of a health crisis. Patients require this because COVID-19’s infectious characteristics require them to spend long days and weeks in social isolation, separated from their loved ones and comforted only by professionals wearing masks and gowns that make them virtually unrecognizable and who do much of their observing from a distance. Families, on the other hand, are in more need of information and support because they are unable to be with their hospitalized loved ones. Health professionals, on the other hand, are working longer hours than ever before, in often precarious conditions due to a lack of equipment and resources, caring for patients with health problems that are different from those they usually see and that pose an unpredictable risk of sudden deterioration and death, all while watching their own strength eroded by the wear and tear of so much professional dedication,1 as we will discuss in greater depth below.

Damian Sendler

This pandemic will highlight psychological support as a health tool for the three aforementioned categories, and it will promote collaboration in the practice of health psychology between psychiatrists and clinical psychologists, as well as nursing and social work teams.

Liaison psychiatry has risen to prominence during the COVID-19 epidemic, despite its reputation as a “small” discipline of psychiatry that is subordinate to medical and surgical specialties and underfunded in healthcare systems depending on income produced. Once it is proven that a patient has COVID-19 in addition to their psychiatric condition, several hospitals have chosen to transfer them to different specialist wards, leaving the administration of these patients to the consultation and liaison psychiatry personnel. In several institutions, employees assigned to consultation and liaison psychiatry have taken over psychological support for patients who have been isolated owing to infection, relying on clinical psychologists and nursing personnel in addition to psychiatrists. Liaison psychiatrists have also had to learn and recognize the side effects and interactions of a variety of drugs (chloroquine and hydroxychloroquine, tocilizumab, remdesivir, atazanavir, lopinavir/ritonavir, favipiravir, azithromycin, and many others) that are currently being used against SARS CoV-2, in addition to well-known drugs like corticosteroids and interferon beta When given as a bolus, corticosteroids can generate manic symptoms,2 and interferon (particularly alpha, but also beta) can cause depressive symptoms. 3 & 4 Hydroxychloroquine can cause anxiety and, in rare cases, psychosis, and it can interact with antipsychotics, raising phenothiazines levels. 5 Quetiapine, lurasidone, ziprasidone, and pimozide, as well as some benzodiazepines like midazolam and triazolam, can all be significantly increased by atazanavir and liponavir/ritonavir. 6 Atazanavir, remdesivir, chloroquine, and hydroxychloroquine levels are all reduced by carbamazepine. In patients with alcoholism, disulfiram and nalmefene should be stopped. SARS CoV-2 infection may diminish the white blood cell count in clozapine-treated individuals, necessitating a dose reduction. 7 Although there is a link between antipsychotic use and an increased risk of pneumonia (not proven in the case of coronavirus infection), there are multiple confounding variables, and the benefit–risk balance for psychopharmacological treatment is generally positive. 8

When the pandemic is over, it is hoped that the vital work of consultation and liaison psychiatric teams would be more recognized, if not increased.

Home care, including its more intensive version, home hospitalization, is playing an important role in avoiding hospital admissions for mental disorders (which would put patients at higher risk of contracting COVID-19) and ensuring good care for patients who are not candidates for telemedicine care for a variety of reasons. COVID-19 must be checked for, and the home care workers must be suitably protected, keeping a safe distance at all times. 9 Although not all patients are candidates for this type of care, the COVID-19 pandemic has demonstrated that home care can often replace admission to a psychiatric hospitalization unit, especially in situations like the current one, where many psychiatric wards have had to be converted into COVID-19 wards, and it allows for certain treatments such as long-term injectables9, white blood cell counts to be monitored in patients treated with clozapine,7 and an increase in the number

Damien Jacob Markiewicz Sendler: People with intellectual disabilities and/or autism, as well as patients with severe mental problems and limited functionality who live with older carers, require this type of home care. During a pandemic, it is advisable to phone all such patients’ homes and, if there is no answer, to perform a home visit, as the caregiver may have died and the individual with a mental disease may require care. Home care is a misnomer in the situation of homeless persons, many of whom have mental illnesses, but it has a similar meaning when caring for this group in shelters and other secure locations. An increase in this population, which is so sensitive to diseases and economic crises, is projected in nations without a strong public health system.

Finally, nursing homes, which have been hit hard by the disease, have been candidates for home care, reducing unnecessary hospitalizations. In brief, after the acute phase of the pandemic, home care, including in-home hospitalization, should be pushed.

Damian Jacob Sendler

Transitioning to remote care via outpatient televisits by telephone, chat, or video contact was one of the first strategies generally embraced in all countries. Physical examination is less important in mental health than it is in other disorders, thus it is undoubtedly the field that is best suited to this transition. 10 Even yet, the psychopathological evaluation is limited, particularly when using an audio-only telephone route without visual information. Although it is likely that face-to-face visits will resume after the epidemic, this crisis has demonstrated that many unnecessary journeys can be avoided and that remote communication can, at least in part, replace or supplement in-person encounters. After the COVID-19 epidemic, this is surely one of the lessons we should have learned.

As has been done in other nations such as China and South Korea, big data approaches will likely be used to combat the virus. Those with a technologically savvy populace and smartphone access will use these tools to negotiate the return to social normalcy. As a result, mHealth, or mobile health, will play an increasingly important role in the future, and it can also be utilized to promote mental health11, 12 if the issues of anonymity and data protection are effectively addressed. 13 In Spain, the Spanish Society of Psychiatry has issued a number of recommendations. 14 Post-COVID-16 Psychiatry will increasingly leverage digital resources, such as apps, to provide mental health care, as a case management and empowerment tool. 15

During the pandemic, billions of people have been confined to their homes around the world. Some countries have been tighter than others, but in general, very strict measures have been created, such as Spain’s proclamation of a state of emergency, which has kept the majority of the people at home for weeks (save for vital services). Lockdown can cause tension and worry, and some patients may experience decompensation as a result. The Spanish Society of Psychiatry has issued suggestions for mental health care for the general public. 14 It can be especially difficult for children16, 17, especially those with neurodevelopmental issues, who are stressed by routine changes (e.g., autism spectrum disorders or intellectual disability). The Spanish Royal Decree of State of Emergency allows people with disabilities to get out and walk, though the greater complexity of treating these patients if they become infected, the requirement that they be accompanied by a family member, which creates many opportunities for infection, and the fact that, in the context of such a health emergency, they may not be candidates for a critical care bed due to a so-called “therapy ceiling,” make it less desirable. Therapeutic adherence may be jeopardized in some circumstances. People with Alzheimer’s disease or intellectual disabilities may struggle to comprehend the importance of staying at home. Patients with schizophrenia and other serious mental illnesses, who have their own demands, may be more vulnerable.18 Due to the difficulties in acquiring drugs, addicts may experience withdrawal symptoms, and other addictions, such as drinking, smoking, and online gambling (other than sports betting, which may worsen due to game cancellations), may worsen. The lockdown situation might be especially dangerous for women and children who have been victims of domestic violence. COVID-19 patients, like families whose loved ones are admitted to the hospital, feel lonely and miss out on communication with their relatives. During lockdown, feelings of hatred, indignation, frustration, and guilt are prevalent, and they can make living together difficult. According to studies done during the lockdown, it is recommended that individuals and families restrict their consumption of pandemic news, exercise, eat a nutritious diet, and participate in a variety of leisure activities. 19 In addition to relaxation and mindfulness approaches, reducing screen time before bed can help prevent insomnia. 20 Some of these emotional abnormalities will fade away when the lockdown relaxes (depending on the pandemic’s positive outcome), while some people may experience long-term repercussions such as anxiety disorders and despair.

Damien Sendler: COVID-19 has resulted in extraordinarily high mortality because the majority of the world’s population is not immune to the virus. The elderly and those with preexisting illnesses or immunodeficiencies have been particularly vulnerable, although health care workers have also been exposed to a greater virus load. COVID-19 death comes with the added cruelty of seclusion. Death in solitude not only causes pain to those who die, but it can also create pathological grief in others who are close to them, as well as health professionals, who are sometimes the only ones available to help the terminally ill patient. Experts in end-of-life and palliative care can advise health professionals in charge of managing communication with the patient and family to prevent the aftereffects of these deaths in solitude. Once again, the importance of health psychology cannot be overstated. A calm, understanding demeanor, active listening, and compassionate care for persons in suffering are all beneficial. Aspects of symbolism and spirituality are also essential. If their caretaker dies, certain people with serious mental illnesses may be at the mercy of their condition. In the next section, we’ll look at how grief and guilt affect healthcare practitioners. When the health emergency is over, we’ll realize how critical it is for hospitals to have teams and professionals who are experts in supporting terminally ill patients and their families, as well as their most vulnerable colleagues, such as intensivists, oncologists, hematologists, and others, and all those who have been on the front lines during this crisis. We must be prepared to foresee the high prevalence of difficult mourning that will almost certainly follow by putting in place preventive programs that identify high-risk people early on. A situation like this should boost the frequently marginalized practice of mental health prevention. 21

As we discussed in the sections on the psychological aspects of medical practice and grief, health professionals have been burdened by an abundance of work, generally precarious safety conditions, anxiety about the risk of infection, and a higher level of selflessness when forced to perform tasks for which they were unprepared.

1 Knowing they are under danger, several people have cut off communication with their family or confined themselves to hotels or their own medical facilities. Although many psychiatrists have continued to work remotely with patients, it is possible that in the near future they will be faced with a large number of consultations, patients with exacerbations, and health professionals suffering from burnout or post-traumatic stress disorder. Burnout is already a recognized diagnosis by the World Health Organization, and it’s not surprise that if work pressure continues, the number of cases among healthcare workers would rise, particularly among those who work in nursing homes, where mortality is exceptionally high. The mental health of professionals is jeopardized by various factors in this epidemic. 22 To begin with, the etiological agent is unknown, there is no proven effective treatment, and it is difficult to anticipate who would develop the most serious problems that will necessitate critical care. Second, because of the high demand, professionals in disciplines that do not typically treat patients of this sort are forced to do so in this situation (we’ve seen pediatricians apply sedative to dying 80-year-old patients). Third, health care providers are unprepared or trained to let people die who they could save in normal circumstances; a shortage of critical care beds has forced them to deny intensive care beds to doctors who request them because their patients are not a priority due to age, comorbidity, or other factors (the “therapy ceiling”). This denial puts a significant deal of emotional strain on doctors, who observe how people who may have been rescued just a few weeks ago are now unable to be saved. Prioritizing important beds comes with a lot of responsibility and, in many circumstances, guilt. Many of these judgments have resulted in moral harm, which will undoubtedly be felt in the future. 23 Fourth, because not limiting their emotional side would cause them to collapse if they did not operate in a detached manner, many professionals work in a dissociated manner due to workload and the need to make non-consensus judgments. Finally, there is a challenge that tires out professionals: fear of infection (for themselves, which also means having to stop working and aiding colleagues, and for infecting their family, particularly the elderly), as well as guilt at not doing more owing to fear’s constraints. Sixth, there is often a sense of powerlessness and hopelessness that has been learned. A patchwork where a day when the professional has given everything is followed by a day with considerably more work and stress. There is a sense of lack of internal control with demands that one cannot act upon or modulate, and good work is not rewarded – or perhaps the contrary – and there is a sense of lack of internal control with demands that one cannot act upon or adjust.

Rest and detachment are necessary for the prevention of burnout and stress problems. As a result, shifts and breaks should be scheduled after peak demand, and the health system should provide relaxation, gym, and reading places in the facilities itself, with mandated time made aside for these activities. A professional who is psychologically well is a source of health. Healthcare workers, particularly their mental health, must be better cared for in the post-COVID-19 era.

People with mental illnesses will, without a doubt, be direct and indirect victims of the epidemic.

25, 26, and 27. Although the number of emergency room visits and hospital admissions for patients with psychiatric disorders dropped dramatically during the health emergency, allowing many hospitals to use psychiatric beds for infected patients without mental illnesses, a rebound effect is expected in the medium term. At reality, other non-psychiatric medical problems, such as strokes and heart attacks, are being seen in the emergency room considerably later and with more significant symptoms than typical. Fears of infection and confinement are probably factors in the decrease in demand. In the near future, what telepsychiatry, home care, and psychiatric consultation fail to resolve will most likely be reflected in an increase in acute crises and exacerbations of psychotic and affective disorders. In the medium term, the temporary closure of day hospitals and rehabilitation centers may potentially be a source of concern. Adherence issues could also be a factor. It will be required to reopen resources that have been closed or reduced to a bare minimum as quickly as feasible after the pandemic, as well as to enhance inpatient and outpatient mental health and primary care services.

Thousands of teaching activities have been canceled or postponed as a result of the pandemic, including major events and conferences (the first and most important of which is the MWC, formerly the Mobile World Congress, which was scheduled to be held in Barcelona in February 2020) and many dedicated to psychiatry, such as the European Psychiatric Association and the American Psychiatric Association’s congresses. Conferences that had been planned for the fall have already been canceled. Many educational activities have gone online since the lockdown began, and the majority of them will most likely continue to do so throughout 2020, as the lockdown will not be eased quickly, leaving the celebration of major events to the end. Clinical and scientific sessions at facilities that are themselves modest will be the first in-person events to recover. Despite the fact that the crisis will encourage distance learning, social interaction and face-to-face information exchange are essential components; conferences also serve a social function by assisting us in coping with day-to-day healthcare efforts and promoting research through collaboration that is often established after personal acquaintance.

Confinement, on the other hand, has aided the creation of educational resources such as review articles and books. Many scholars have used this time to carefully review scientific issues, and the submission rate of this sort of scientific article does not appear to have decreased.

Furthermore, the health emergency has impacted resident training in psychiatry, clinical psychology, and mental health nursing, with many being drafted to serve COVID-19 patients or give psychological support to patients, their families, and professionals. Even medical students have gotten involved in the fight against the catastrophe. This will almost certainly be an useful learning experience, and scheduled rotations and internships will almost certainly resume soon, but some of these young people may be affected psychologically by their time on the front lines.

In terms of research, the epidemic has significantly increased scientific collaboration. Many journals, such as the New England Journal of Medicine, have begun offering open access to all articles on COVID-19, and collaborative clinical trials have been designed, approved, and executed in record time, despite the fact that many researchers have had to temporarily leave their jobs in order to shelter in place. The scientific community has shattered barriers and is working together to find therapies and vaccines. Some of these projects will look into the consequences of lockdown as well as many of the unanswered questions about COVID-19 and mental health that we explore in this post. Beyond the infectious disease, it is anticipated that this tragedy will highlight the importance of biomedical research and, like public health, will receive the fiscal and social support it deserves. The goal is that governments will devote a larger portion of their funding to collaborative translational research and health registries, as Spain has done with the CIBER consortium28. 30, 29 In summary, following the epidemic, virtual conferencing and distance learning will be considerably strengthened, allowing for the elimination of much, but not all, travel. Collaborative research will be improved, and the rate of knowledge growth, including in mental health, could be accelerated significantly. The polar opposite would be a huge blunder.

Damian Jacob Markiewicz Sendler

Dr. Sendler

Damien Sendler

Sendler Damian

Damian Sendler: As a result of more than two decades of random, double-blind clinical studies, the effectiveness and safety of ivermectin as an early therapy for COVID-19 have been shown. The authors, who have worked on Helicobacter pylori combination medicines, now offer a COVID-19 therapy combination that has been shown to be extremely successful in clinical studies. Methods and patients: On average, the authors gave this new combination of ivermectin and doxycycline with zinc, as well as vitamins D and C, to 24 COVID-19 patients who refused hospitalization because of their high-risk characteristics, such as hypoxia. After 24 hours, all of the patients had improved from 87.4 percent to 93.1 percent in oxygen saturation (p = 0.001). No one was admitted to the hospital or died in this study, which was conducted in accordance with the background-matched CDC database controls. Even in outpatients with moderate to severe symptoms, triple combination treatment is safe and effective.

Damian Jacob Sendler: Currently, there are no viable therapies for COVID-19 individuals who are ambulatory or in the early stages of the disease. Patients who have been diagnosed as HIV positive are sent home to quarantine themselves. But there is a growing body of data that some repurposed medications, given early, may dramatically enhance outcomes and even eliminate or postpone the need for immune-modulators, antiplatelet/antithrombotic treatment, and the provision of oxygen [1].

Dr. Sendler: Ivermectin (IVM), a medication that has been used safely in 3.7 billion doses globally since 1987, is one of the most widely investigated COVID-19 treatments. According to a recent assessment by Nobel Prize co-winner Dr. Satoshi Omura on IVM activity against COVID-19, the data shows that it is effective [4]. Many randomized, controlled studies (RCTs) have examined IVM alone for the treatment of COVID-19, with statistically significant therapeutic benefits in almost all of them and a 62 percent decrease in mortality risks on average [5]. IVM therapy for COVID-19 has recently been the subject of five studies published in high-quality medical publications, all of which found substantial therapeutic advantages for IVM compared to controls, the majority of which were statistically significant (p 0.002) [6–10]. IVM has been used in RCTs for COVID-19 therapy at cumulative doses of 1500 g/kg [13,14] and 3000 g/kg [15,16] over 4 or 5 days without or with moderate and temporary side effects. IVM is widely used in non-Western nations to prevent and treat COVID-19, especially in the early stages of the illness.

Damian Sendler

Despite the fact that the COVID-19 study found a link between IVM therapy and improved clinical outcomes, there has been some disagreement over the best way to treat acute infections due to the use of different therapeutic regimens, particularly those that include broad-spectrum antibiotics and zinc. While early multidrug therapies, which claimed an 87 percent and 75 percent reduction in hospitalizations, both with a p-value of 0.01 in 869 high-risk subjects, left the optimal management strategy ambiguous due to IVM and hydroxychloroquine (HCQ) usage, [15] it was unclear what the best course of action was. Based on the best available evidence, there is an urgent need for an effective, safe, and practical combination treatment formulation.

IVM interferes with cytoplasmic-nucleus communication, generating a hostile environment for viral aggregation while lowering cytokine-mediated inflammation at the cellular level. To prevent further infection with the COVID-19 virus, IVM blocks the spike protein’s binding to ACE2 receptor, which in turn suppresses pathogenesis. Finally, positive modifications in cellular innate immunity have been linked to IVM [16].

An antiviral medicine combination developed by the authors’ group has been demonstrated to be especially beneficial as a co-therapy for treatment early in COVID-19 to reduce symptom duration and avoid hospitalization. Only when used in conjunction with other treatments can IVM be considered curative [1,6,17]. Thus, the scientists picked a combination of safe and widely accessible drugs, licensed for various uses and without drug–drug interactions or QT prolongation, as well as one that slows intracellular viral multiplication and has some anti-inflammatory characteristics for their study.

A single component of combination treatments for intracellular viral diseases such as hepatitis B and C has seldom proven curative and has been used effectively to treat TB, H. pylori infections, leprosy, and leprosy, as well as leprosy for intracellular bacterial infections. Even when many antiviral medicines are combined, they cannot entirely cure but only decrease the viral burden [18]. With a high cure rate and little medication resistance when used in combination, IVM is best recognized for its broad-spectrum effectiveness against parasite infections. IVM by itself is not a “magic bullet,” despite its value. Combinations may help lessen individual dosages while also reducing negative effects.. IVM was mixed with doxycycline and zinc as active components and vitamins D and C as substitute ‘excipients’ provided to augment prevalent clinical deficits in elderly patients to cover all age groups.

Coagulation treatment with oxygen supplementation (SpO2) levels as low as 70 percent was used in patients who refused to be sent to the hospital and insisted on being treated on an outpatient basis, according to the results of this research. Participants in a clinical study named Combination Therapy to Treat COVID-19 Infection received treatment from an experienced clinical trials staff.

Damian Jacob Markiewicz Sendler: Patients in Los Angeles, Ventura County, California, and other parts of the United States were referred to the study by their doctors or via word of mouth. NCT04482686 is the clinicaltrial.gov identifier for the clinical studies that these individuals were recommended to enroll in (which is a double-blind RCT). Some patients, whose SpO2 was less than 90%, were judged too ill to participate in a placebo-controlled experiment and were so excluded from this study. For a variety of reasons, including the fear of dying in a hospital, the participants declined hospitalization. During the months of August 2020 and February 2021, participants who were disqualified from other trials and refused to travel to the hospital were treated off-label via telemedicine. This open-label study was approved by the Institutional Review Board (IRB) after a swab reverse transcription quantitative real time PCR (RT-qPCR) diagnostic was made. To be eligible, participants had to test positive on a PCR for COVID-19, provide informed permission, be under the age of 18, and agree to use two highly effective methods of pregnancy control if they were of reproductive potential themselves Allergies or pharmacological interactions with the combination treatment components, as well as any of the specified comorbidities, such as seizure risk, and pregnancy, were all grounds for exclusion from the study.

Damian Jacob Sendler

Within 72 hours of patients arriving at Ventura Clinical Trials, treatment started. All participants who passed the screening process were recruited sequentially. As part of the “IVM Combination Therapy” (ICT), patients received oral doxycycline (100 mg twice daily), IVM (12 mg on days 1, 4, and 8), zinc (25mg twice daily), vitamin D3 (1500 IU twice daily), and vitamin C for 10 days as part of a “IVM combination therapy” (1500 mg twice a day). Only 10 days of ICT classes were offered.

There were two patients (#10 and #23) whose SpO2 levels were so low that they got 36 mg IVM (rather than 12 mg) as their first dose of IVM on day 1.

A daily diary (Supplementary Figure 1) was kept by each participant for the first 10 days of the study. EKGs, blood pressure, temperature (in °F), and oxygen saturation (SpO2) were measured using medical equipment that was supplied to the patient at home. Pathology received swabs from participants on days 1, 5, 10, and 30 for testing of SARS-CoV-2. According to the guidelines, pregnancy tests were carried out.

SARS-CoV-2 negative PCR, symptom remission, progression to hospitalization and patient survival were the end goals of this study.

Damien Sendler: COVID-19’s open-label study with an untreated control arm was unable to recruit high-risk, extremely hypoxic patients, thus the treated group’s survival was compared to the general population’s survival rate. From the CDC database of COVID-19 participants, an externally controlled trial (ECT), or synthetic control arm, was constructed [20]. Information available includes the age range, the existence of any chronic disease (COVID-19 vulnerability or otherwise, conditions not indicated), date of infection and if the COVID-19 diagnosis has been confirmed in the laboratory. The researchers drew on the records of all patients who satisfied the following criteria: were 50 years or older, had a laboratory-confirmed diagnosis of COVID-19, had death/survival, race/sex, and infection dates prior to March 2021, and had any concomitant conditions. It was done after the authors had gathered their own data to better match their individuals, all of whom had some comorbidity and the majority were over the age of 50. This synthetic control arm data selection CSViewer version 1.3 was used to examine the CDC database.

They describe for the first time an outpatient ICT that averted hospitalization and resulted in a 100 percent survival and cure in COVID-19 patients with hypoxia who were not chosen. In quest of a treatment for COVID-19, the authors, who have developed combination therapies for H. pylori, tested numerous other IVM-based combinations on ambulatory COVID-19 patients and discovered that the aforementioned combination was very beneficial as a therapy. It was necessary for certain patients to use HCQ or additional components, similar to how H. pylori resistant to triple treatment occasionally required quadruple therapy. They admit that they couldn’t examine every possible combination of substances in this research, but such investigations may be valuable for future refining. IVM may be applied using weight-based dosing [22], but it may also be necessary to provide the correct amounts to cover all COVID-19 strains.

It has been shown that COVID-19 mortality is influenced by hypoxia. As an example, oximetry revealed that some of these individuals presented with levels of hypoxia ranging from as low as 73% to as high as 84% and even as high as 85%. In several patients, the recovery began within 12 hours and the mean SpO2 rose from 86.5 to 93.1 in the first 24 hours of therapy. The symptoms, including the disappearance of cough, fever, and weariness, all improved at the same time. It also took around 11.5 1.6 days after starting therapy for the first negative PCR to occur. ICT was used to treat critically sick patients who would normally have been admitted to the hospital, but none of them were and none died as a result of it.

A limited sample size of patients in the’synthetic control arm’ of an ECT trial shows that ICT outperformed it statistically. Studies with this treatment group show that ICT may be used if symptoms and risk factors for COVID-19 development exist, even in instances where the PCR findings are not yet available. The use of ECT arms is on the rise, particularly in cases when the’standard-of-care’ control arm might prove lethal [23].

Combination antiviral treatment is being investigated because we’re learning that most intracellular infections, whether bacterial or viral, cannot be treated with a single medicine. Multiple medications can treat a wide range of viral infections by targeting a variety of viral replication pathways. H. pylori treatments, for example, have developed resistance to even two-drug regimens. Multidrug treatments are likely to be more successful in decreasing viral load and minimizing resistance and variation generation [24], as discussed for HIV [18]. This is particularly true when employing three or more different drugs at once. When treating scabies, nematodes, strongyloidesis, microfilaridermias and Onchocerca volvulus alone, resistance has already developed [17,25–28]. Diseases based on the eukaryotic organism infection, not viral, are less susceptible to mutations and hence more resistant to treatment. To avoid IVM resistance in COVID-19 and its future versions, it is necessary to prevent IVM resistance in these disorders on a regular basis. We cannot allow IVM resistance to develop clinically and be shown experimentally before it is addressed because of the present condition of the pandemic. The IVM in COVID-19 is not a monotherapy but should be used in conjunction with other medications, particularly with increasing reports of vaccination breakthrough infections caused by mutant strains. ‘No replication, no mutation’ may be possible with combination treatment, allowing for faster cures, resistance avoidance, and the overcoming of mutant strain emergence.

Intracellular coronavirus replication needs a combination of antiviral medications in order to stop the virus from reactivating. Even though other alternatives have been suggested, the authors chose the aforementioned combination because of its effectiveness, component safety profiles, affordability, and absence of drug–drug interaction. The authors note that other candidates may also block coronavirus replication independently. Although doxycycline is not considered effective on its own, the combination of IVM and doxycycline has been shown to be somewhat effective for COVID-19 [7], potentially (statistical trend) more effective than the HCQ and azithromycin combination [29], and mechanistically theorized as synergistic [30]. As zinc is a fundamental component of antiviral action, it would work well with the ionophores (IVM and doxycycline) to enhance zinc’s intracellular concentration and speed up viral clearance. There have been no reports of medication interactions between zinc, IVM, and doxycycline [35]. Azithromycin has been linked to QT prolongation, but none of the other medications on this list has that problem [22,36–38].

For patients with COVID-19, a 10-day combined treatment of IVM, doxycycline and zinc is recommended to alleviate symptoms [6,7]. For COVID-19 treatments, the authors have selected a safe IVM dosage of 36 mg over 10 days, which has been recommended for parasites [39]. Staggered IVM dosing over ten days is recommended because of the long plasma half-life (up to 66 hours) of the medication [40]. Zinc entrance into cells would be made easier if IVM at plasma levels were readily available for the length of the experiment. It follows that a multimodal regimen is more likely to treat COVID-19 than IVM alone, as several publications have previously shown [41].

There were no biases in the selection of participants for this research, which recruited successive volunteers (i.e., when subjects came forward, they were enrolled and none were turned away). ICT activity seems to have quickly restored SpO2 and reversed other symptoms, which cannot be explained solely by the development of immunity. According to the study’s authors, the study’s limited sample size (n = 24 participants who agreed to therapy) may restrict its applicability. The initial group of patients to present to Ventura Clinical Trials included these people, and more data is being gathered. Some very sick individuals may be reluctant to participate in a clinical study that is less well-known. Extending the sample size, testing other IVM doses, and investigating the microbiome’s mechanistic contribution to IVM’s success in COVID-19 will be the focus of future investigations by the authors.

There is no way to conduct an RCT with severe COVID-19 without simultaneously enrolling a control group. It was concluded that “Placebo-controlled studies of ivermectin therapy among patients with COVID-19 infection are no longer ethical and active placebo-controlled trials should be stopped” because of the consequences found in the two participants who denied treatment and did not live. It is because of this that this research relied on an experimental control group known as an ECT or’synthetic’ control arm [23]. It’s time for IRBs to authorize synthetic arm research and reject COVID-19 experiments that include a control arm, according to Lawrie.

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

Damian Jacob Markiewicz Sendler
Damien Sendler
Sendler Damian
Dr. Sendler

Damian Sendler: Researchers have long considered tau proteins to be a prime target for new drugs because of their role in neurodegenerative illnesses like Alzheimer’s and Parkinson’s. Tau’s role in these diseases and the way the protein distributes throughout the brain has been re-examined by researchers, who claim to have discovered fresh insights.

During periods of high neuronal activity, researchers at the Buck Institute for Research on Aging in California discovered that tau interacts with proteins on the outside of synaptic vesicles, rather than inside them. Vesicles contain neurotransmitters, chemicals that convey information between neurons.

Damian Jacob Sendler: New insights into how tau is produced can provide the framework for future studies aimed at preventing pathogenic tau from spreading around the brain, according to the study’s principal author. The deterioration of a neurodegenerative illness is closely associated with the expansion of tau throughout the brain.

Damian Sendler

Neuronal mitochondrial proteins were also identified to bind to the protein by the researchers. However, when the tau proteins are sick, this activity appears to affect neuronal bioenergetics, or the ability of cells to convert energy. Tau proteins were downregulated in brain tissue when they interacted with mitochondrial proteins, according to the researchers. This demonstrated an association with the severity of the condition.

The findings of the institute were published in the journal Cell this month, culminating in what the researchers named a “tau interactome.” Neurons produced from human induced pluripotent stem cells were used by the researchers to make their discoveries.

In order to find new treatments for neurodegenerative disorders, such as Alzheimer’s, it is critical to understand how disease affects cells, says the study’s primary author, Tara Tracy, Ph.D., an assistant professor at the Buck Institute.

Tau can be secreted from neurons and moved across cells, but how it works and the cellular tools required have never been fully understood, according to Tracy.

These tau tangles are linked to a wide range of diseases, including Alzheimer’s, Parkinson’s, frontotemporal dementia, and more. Research scientists and biopharma companies working on cures for these diseases now have a sense of urgency, Tracy added.

Anti-tau antibodies, on the other hand, have had a difficult time making it to the clinic. In October, Eli Lilly halted development on a tau-targeting midstage asset. “I would be reluctant to invest in really any anti-tau antibody,” Daniel Skovronsky, M.D., Ph.D., said at the time.

A different Alzheimer’s drug, which targets amyloid, another molecule critical to neurodegenerative research, is on the way from Big Pharma to the FDA’s door.

Neurodegenerative therapies that target tau formation are also available from Eisai, AC Immune, and Amylyx.

Damian Jacob Markiewicz Sendler: Other proteins may also be targets for Alzheimer’s therapy, according to recent study. An alternative to the poisonous combination of amyloid and tau is clusterin, a newer, friendlier protein that could provide a path forward. Findings from a Stanford University study could lead to novel treatments for Alzheimer’s disease, as the protein was more frequent in mice that exercised.

Salamanders, starfish, crabs, lizards, and newts are just a few of the unique organisms that have the ability to regrow limbs.

Although scientists have long endeavored to comprehend and duplicate these exceptional powers, which evade most animals, including humans, in a drive to restore limbs for millions of patient amputees, including diabetics and victims of trauma, it has never been possible.

Damian Jacob Sendler

Scientists in the United States announced on Wednesday that they had successfully stimulated the recovery of an amputated leg of a Xenopus laevis frog (a kind of African clawed frog).

Damien Sendler: Using a small silicone dome, a mixture of five different medications was applied to the test frogs’ spike-like stump by the Harvard Wyss Institute and Tufts University-based team of scientists. The mixture was only used for 24 hours, but the limb was nearly totally functioning after 18 months. In water, frogs were able to swim and sense touch. Toes grew, but the webbing between them was absent.

Our very breath can be used to extract DNA. It may be useful in the search for endangered species.
On Wednesday, Science Advances published the findings of the study.

James Monaghan, an associate professor in the biology department at Northeastern University, described the findings as “amazing” and “exciting,” respectively. He was not a part of the study.

“As with salamanders, Xenopus can regrow their limbs almost completely, but they also have the ability to form scars following amputations. There is no pattern to the spikes that Xenopus adults regenerate following an amputation, unlike limbs in other frogs “Monaghan clarified the situation.

A limb that generally regenerates merely a spike was shown to have some patterning in this study.

Regenerative capacities may be dormant in frogs and other animals, according to the study’s researchers, who found that a single dose of the medications sparked months of regeneration in the frogs.

The team affixed a dome to a frog’s stump containing a cocktail of the chemicals.

The team’s frog-stump-attached dome, which held a narcotic combination, is displayed.

“Because humans lack the regeneration spike found in Xenopus frogs, a rapid application of this technique in humans is doubtful. A short application of a medication mixture, however, reveals that endogenous regeneration mechanisms can be boosted “According to what Monaghan had to say,

Dr. Sendler: In this case, rather than trying to “micromanage its growth,” the scientists relied on activating latent systems in the frog’s physiology, according to study author Mike Levin, a biology professor at Tufts and director of the Allen Discovery Center.

First live robots can now reproduce, according to scientific findings
“Regenerative medicine, in my opinion, can only be achieved by harnessing the collective wisdom of the body’s cells.. Every single one of these organs has already been constructed by them. During embryonic development, they did it. All of the data is still accessible “Levin had this to say.

I want to find extremely simple stimuli that will jump-start cells and persuade them to develop whatever you want them to build, so that is my ultimate goal.”

Anti-inflammatory and limb-building compounds were found in the medications. Because it was the first time they tried it, Levin said a different combination of medicines and growth factor might be more effective in the long term.

“It has a normal-looking girth and traits, including some bumps that are beginning to form toes, of a limb. It lacks several of the proper terminal structures. We did not go as far as the long toes and the webbing, but we could have if we had let it run longer “he asserted, according to her.

On more than 100 frogs, the results were “not flawless in every case,” according to the researchers. According to Levin, there may have been discrepancies in the surgery to attach the dome to the frogs, which could be a contributing reason. It would then be tested on mammals, such as mice, in the next phase of the research.

Additionally, Levin and his colleagues have employed frog stem cells to construct what they call xenobots—self-replicating living robots that can reproduce themselves. Understanding the signals that drive cells to become complex tissues, such as a limb or a whole organism, is a common thread in both fields of study.

For individuals who have lost limbs due to trauma or sickness like diabetes, Ashley Seifert, an associate professor of biology at University of Kentucky who studies animal regeneration but was not involved in the research, advances in prosthetics provide more promise than limb regeneration.

“In the future, would it be possible to regrow parts of the human body? Possibly, but it is impossible to tell how long we will have to wait “Seifert remarked that.

“When regenerative biology completely accepts novel regeneration models, particularly for some species of mammals, this will be a step in the right direction. This study and others like it will assist us in figuring out why and how regeneration works in some cases and fails in others.”

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

Damian Jacob Markiewicz Sendler
Damien Sendler
Sendler Damian
Dr. Sendler

Damian Sendler: An email from Johns Hopkins Medicine senior vice president and chief operating officer Robert Kasdin informs all workers that non-clinical personnel will be allocated to patient care support duties as a result of staffing constraints and the recent uptick of COVID-19 cases. 

The email states that only personnel who volunteer to serve in a COVID-19 ward will be allocated there, and staff members may choose their preferred reassignment location, days, and hours. 

According to a statement from the health system’s spokeswoman, Kim Hoppe, non-clinical personnel will not be providing direct patient care or bedside assistance. 

Non-clinical requirements will be alleviated from the clinical staff, according to Hoppe. 

Damian Sendler

A few hours a week could be allotted to jobs like maintaining a stockroom, cleaning, transferring a patient after their release from the hospital, and directing traffic, among others. 

According to Hoppe, the redeployment is part of a crisis response strategy that was in place before the outbreak of the COVID epidemic to deal with events such as extreme weather. 

It comes at a time when Maryland’s healthcare facilities are being overrun by the omicron variety and a lack of qualified healthcare workers. 

Damian Jacob Sendler: Due to COVID-19, burnout, and increased pay, many healthcare personnel are quitting their jobs at hospitals in search of better opportunities. 

Towson St. Joseph Medical Center and Johns Hopkins Bayview Medical Center have both declared a catastrophe since only a few weeks ago, as has Baltimore Washington Medical Center and two other hospitals in the University of Maryland Upper Chesapeake Health network. 

For example, hospitals might postpone non-urgent procedures to maintain bed capacity, reassign personnel, and alter patient-to-nurse ratios when they go into crisis mode. 

There have been recent efforts to alleviate the workforce shortages in Maryland, its counties, and colleges. 

In December, Gov. Hogan promised $100 million in cash to increase hospital and nursing care staffing levels. ” 

He proposed legislation earlier this month that would allow for elements such as allowing nursing students to be more responsible, bringing back retired nurses and making it possible to bring in nurses from other states to work in the state. 

A 411 percent rise in the number of patients admitted to Howard County General Hospital with COVID19 from the middle of December to the beginning of January was disclosed by Howard County Executive Calvin Ball last week. 

Maryland said in November that it would enable nurses to graduate early so that they could join the fight against the epidemic. 

The University of Maryland Medical System launched a $5.1 million program to attract nurses from the state’s community colleges in the beginning of December. 

An already-stressful situation for American hospitals was made worse by the omicron version. 

Nearly 500,000 healthcare professionals have been let off since February 2020, according to the US Bureau of Labor Statistics. 

As the Ebola outbreak worsens “chronic nursing workforce issues that have persisted for years,” the American Nurses Association wrote to the Department of Health and Human Services in September requesting that it designate the nurse staffing shortfall a national emergency.

Damian Jacob Sendler

The number of persons hospitalized with COVID in Maryland has remained over 3,000 while the state’s healthcare staffing difficulties persist. 

On Tuesday, there were 3,462 people admitted to the hospital; on Friday, that number had dropped to 3,363. 

Over the last seven days, state authorities have added 435 Marylanders to the list of those who have died from COVID. 

Johns Hopkins Medicine personnel were informed by email this week that Kasdin had agreed to participate in the effort. 

According to his journal entry, he “supplied central supplies to clinical departments across JHH on Monday and worked in patient transport on Tuesday.” 

“I have constantly thought that serving the missions of JHM is a privilege and that has never been more true than during my two shifts,” he said in an email, “and that has never been more true than during my two shifts.” 

The urea cycle removes nitrogenous waste from the breakdown of protein in the body. Ammonia levels may reach to hazardous levels if the OTC enzyme is not present in this process. The most frequent urea cycle problem is an OTC deficit. Until date, no medications have been able to treat it. 

One of the OTC genes is situated on chromosome sex (X chromosome). As a result, the disorder’s symptoms tend to be less severe in female neonates. Male neonates, who have just one X and one Y chromosome, suffer greatly from a shortage in the OTC gene: Ammonia poisoning in newborn males is typically lethal because to OTC insufficiency. There was a shortage of over-the-counter medications in the United States. 

Damian Jacob Markiewicz Sendler: The first step was to extract liver cells from skin samples of patients. To begin, skin samples were collected from both OTC-deficient patients and a control group (healthy individuals). The samples were developed into stem cells via a lengthy and laborious procedure. In 2012, Shin’Ya Yamanaka was given the Nobel Prize in Medicine for developing this engineering approach. 

As a senior physician at Inselspital’s Department of Pediatrics, Dr. Alexander Lämmle says, “We were able to generate liver cells like those seen in patients utilizing induced stem cell technology.” The induced liver cells, however, excrete considerably less urea than healthy liver cells, and this is true whether the cells come from healthy controls or patients with urea cycle disorders, according to the researchers. 

An investigation by researchers found out why this was happening. Aquaporin 9, a transport protein in the cell membrane, was absent from the technologically created stem cells. The artificial liver cells are still young and fetus-like, which is why this shortage occurs. 

In the cell membrane, aquaporins control the movement of water and other molecules. The aquaporin 9 is in charge of urea transport. Further research has led to a technique that induces aquaporin 9 production in stem cells. Because of this, the technologically created hepatic cells have altered their conduct. Urea was excreted in the same way as healthy cells break down and expel ammonium. This lays the groundwork for a test with synthetic liver cells that works as intended. 

Damien Sendler: Deficiency in OTC proteins is defined by the fact that they do not function adequately. Like most bigger proteins, they need assistance or chaperones to form and function correctly. According to Professor Dr. med. Johannes Häberle of the Children’s Research Center at the University Hospital Zurich’s University, “The chaperones guarantee that the enzyme molecules are folded appropriately and that the enzyme is correctly prepared for its usage or reset after use.” In order to learn more about the OTC deficit and, of course, prospective remedies, the novel test model is currently being utilized to evaluate OTC chaperones. “”

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

Damian Jacob Markiewicz Sendler

Damien Sendler

Sendler Damian

Dr. Sendler

Damian Sendler: Postviral anosmia accounts for up to 40% of all occurrences of adult olfactory impairment [1,2]. When the SARS-CoV-2 epidemic began, it was probably predictable to witness a rise in cases. Although olfactory impairment is common, it has been largely ignored until now because of its usefulness as a diagnostic marker and its great incidence. COVID-19-induced olfactory impairment, underlying pathophysiology, recovery rates, and treatment strategies are discussed here. 

OLFACTORY LOSS IN COVID-19: PREVALENCE AND PRESENCE 

Damian Jacob Sendler: In March 2020, olfactory loss appeared as a possible indicator of COVID-19 after early press reports in Germany, Korea, and Iran [3]. A meta-analysis of 3563 patients published in May 2020 revealed the mean prevalence of self-reported loss to be 47 percent (95 percent CI: 36 percent –59 percent) in, ranging from 11 percent to 84 percent in included case studies [4]. 

Only 35 percent of 60 hospitalized patients self-reported that they had lost their sense of taste or smell, but 98 percent of the patients tested positive for the condition on psychophysical tests [5]. It is possible to overstate the incidence of persistent olfactory loss due to COVID-19-related olfactory dysfunction if only psychophysical measures are used [6]. 

Damian Sendler

For individuals with COVID-19, loss of smell may be the sole presenting symptom [3]; additional symptoms predominate in 20% (95 percent CI: 13% –29%) of reported cases from May 2020 and appear concurrently in another 28% (95 percent CI: 22% –36%) of cases [4]. 7] of 114 patients with proven COVID-19 infection indicated that 47% of the patients suffered odor loss, while fewer than 5% of the patients reported additional sinonasal symptoms such rhinorrhoea and nasal congestion. [7]. Patients with COVID-19-related anosmia do not have the usual rhinitic symptoms of a cold, according to other research [8]. 

Olfactory impairment has been suggested as a possible predictor of the severity of COVID-19. Patients who were admitted to the hospital were substantially less likely to have anosmia or hyposmia (26.9% vs 66.7 percent, P 0.001), according to an early research by Yan et al.[9]. According to systematic studies, the incidence of self-reported scent loss in hospitalized patients was 31%, but it rose to 67% in mild to moderately symptomatic home-isolated patients [4]. While this is true for the first week after infection, another research of 106 individuals [10] revealed no link between olfactory function and illness severity. Researchers from the same group found no link between viral load and the degree of olfactory loss in a second investigation [11]. Another prospective research [12] found no statistical connection between baseline olfactory loss and the severity of chest CT results. Because of respiratory symptoms and anorexia, the authors believe that short-lived olfactory impairment may be ignored in more severe illness because of the overriding respiratory symptoms and the concomitant anorexia, which leads to lower nutritional intake. In Spain, an independent study group found the same results [13]. 

Damian Jacob Markiewicz Sendler: In one research, women were shown to be more likely than males to have anosmia (72.4% vs. 45.2% vs. 65.8%; P = 0.02) [14]. Angiotensin-converting enzyme 2 (ACE2) receptor expression in the olfactory epithelium decreases with age, according to a recent comprehensive study [15]. In addition, the prevalence of underlying OD may be growing. Varied virus variations are associated with different levels of olfactory impairment, and this seems to be true across geographic regions as well as temporal periods during the pandemic [17, 18]. 

Mechanisms of Olfactory Dysfunction in Covid-19 

It remains unclear what causes anosmia in COVID-19 even though there is a growing body of data. Due to the swelling of the nasal cavity, there may be olfactory conductivity loss as well as damage to the olfactory epithelium (OE). 

Damian Jacob Sendler

Even while nasal congestion is less common in COVID-19 than with other endemic coronaviruses, oedema inside the olfactory cleft may contribute to early OD impeding the supply of odorants to the OE [19,20]. However, MRI scans of individuals with COVID-19-related OD within 15 days after start showed a high incidence of total occlusion of the olfactory cleft, whereas other radiological examinations of patients with more chronic loss found this to be a rare finding. 

Postviral olfactory loss has been linked to olfactory epithelial damage [23]. Axonal injury to olfactory nerve fibers was found in postmortem examinations of COVID-19 patients who had anosmia and demonstrated localized atrophy of the OE [24]. Recovering olfactory epithelium was seen as early as day 4, but was still incomplete by day 14 in animal models of SARS-CoV-2 [25], which were infected via nasal injection. 

The OE’s sustentacular supporting and basal cells contain ACE2 receptors, which are critical for SARS-CoV-2 viral entrance [27,28]. Even if the ORNs do not express ACE2 or get infected directly, damage to these cells may lead to decreased sensitivity and cilia loss, leading in OD. As direct ORN damage would need a longer length of time to resolve OD, this explanation is compatible with the early recovery trend. Both mature sensory neurones and sustentacular cells have been detected in the ORNs in recent in vivo experiments utilizing mucosa brush sampling [26], demonstrating entrance into the ORNs itself and evidence of cell death in both groups. 

Damien Sendler: According to animal models and olfactory epithelial biopsies obtained after the death of COVID-19 patients, there is evidence to suggest that the loss of odorant receptor expression on otherwise intact ORNs is caused by an inflammatory process. Golden Syrian hamsters with SARS-CoV-2 showed that the local immune response increased macrophage expression, which may hinder healing of the OE and restoration of ORNs [25]. Viral persistence has been found in the olfactory epithelium of individuals with persistent loss, along with ongoing inflammation, increased IL6, and apoptosis. [26▪]. Basal stem cells’ regeneration ability has been demonstrated to be greatly reduced by inflammation, and this process may possibly explain for long-term olfactory impairment [29] Anecdotal claims of improved recovery after vaccination may be a result of more efficient virus clearance. 

The retrograde axonal transfer of viruses to the OB and CNS has been extensively shown [31,32]. Coronavirus particles have been detected inside the OB three days after inoculation, and within the cortex seven days later [33]. A comparable route of viral entry via the OB and fast invasion of the CNS was seen in ACE2 transgenic mice infected with SARS-CoV-1 [34]; equally high viral RNA loads were identified throughout the whole pathway from the olfactory endothelium to the bulb [26]. Hyperintensity in the olfactory bulb has been recorded in a number of studies [35,36,37], however it was only seen in 19% of individuals in a neuroimaging cohort [38]. Patients with long-term COVID-19-induced OD may benefit from baseline imaging that shows severe OB atrophy two months after symptoms first appear on MRI scans obtained before to infection [39]. Two individuals with chronic COVID-19 OD were discovered to have hypometabolism on PET imaging in the rectus gyrus [40]. There is no clear indication that SARS-CoV-2 was transported backwards into the OB from the OE, but these investigations have shown signs of neurotropism, atrophy, and hypometabolism as a result of this loss of function. 

There needs to be more study into the mechanism of olfactory loss since it will help us develop new treatments. 

Recovering OLFACTORY LOSS FROM COVID-19 

For many years, researchers have used questionnaires or objective olfactory tests to assess recovery rates and risk factors for persistence. A large percentage of patients reported full olfactory recovery in as little as 10 days, according to early data [41]. Self-reported studies [43,44,45,46] show that recovery rates range from 31.7 percent to 89 percent. 

Self-reporting, on the other hand, seems to overstate the extent of recovery (in contrast to under-estimating the initial prevalence of olfactory loss.) Boscolo-Rizzo et al.[46] showed a considerable discrepancy between self-reported olfactory function and psychophysical assessment; surprisingly, only 41% of 112 patients with self-reported normal sense of smell at 6 months demonstrated normosmia with UPSIT testing. [46] 

Six-month and longer-term results are now available in a growing number of research studies. According to Leedman et al.[47], 64 percent of patients with verified COVID-19 were normosmic at 6 months, 3.5 percent were anosmic, and the rest were hyposmic as determined by UPSIT testing, as reported by Leedman et al.[47]. The results of a case-control research conducted by Dr. Boscolo-Rizzo [48] showed that 46% of patients and 10% of controls had olfactory impairment, with 7% of COVID-19 cases being anosmic on average, 401 days after infection. Even with the greatest recorded recovery rates with COVID-19, a large percentage of individuals globally will still suffer from severe olfactory impairment. 

PAROSIS AND PHANTOSMIA IN THE QUALITATIVE OLFACTORY DISESFUNCTION 

According to many patients, the development of parosmia often occurs within two or three months after the onset of symptoms [49]. Parosmia may occur in certain people even if they have not previously reported losing their sense of smell. “COVID scent” has a noxious burnt-chemical-like aroma, and is typically considered unpleasant. Coffee, onions, garlic, pork, citrus fruits, and toothpaste are all common irritants [50]. 

We do not know what causes parasmia and phantomia. As shown by results of lower ORN numbers and the prevalence of immature neurones in histological investigation of the olfactory epithelium, one explanation holds that there are fewer working olfactory neurones, resulting in an inadequate odorant characterisation [51]. As an alternative, it has been posited that parosmia may be the result of aberrant activity on positron emission tomography (PET) and functional magnetic resonance imaging (MRI). 

Although anecdotal evidence exists for the use of anticonvulsants, such as gabapentin, to decrease distortions in severe instances, there is little data to support therapeutic recommendations.

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

Damian Sendler: The current Covid-19 rise in the United States, spurred by the Omicron variety, could peak later this month, but the next few weeks are essential, according to a health expert. 

Dr. Ashish Jha, dean of Brown University’s School of Public Health, cautions that long-term planning is required to minimize more strain on the health-care system as hospitals get overcrowded, schools struggle to keep pupils in class, and testing continues tough to obtain. 

Damian Jacob Sendler: “We’re seeing two types of events: a large number of vaccinated people becoming infected, and a large number of unvaccinated people becoming infected.” We’re doing just well. “There are a lot of unvaccinated people and high-risk people who haven’t gotten boosted, and they’re really filling up the hospitals, and so our hospital systems are under a lot of stress,” Jha said on ABC’s “This Week.” 

“Then we have to start thinking about a long-term strategy for how do we manage this virus and not go from surge to surge feeling like we don’t really have a longer-termed approach,” Jha added. 

Damian Sendler

According to the US Department of Health and Human Services, around 24% of hospitals are experiencing a “critical staffing shortage.” 

Nearly 1,200 hospitals, or roughly one-fourth of the approximately 5,000 hospitals that reported this data to HHS on Saturday, claimed they are now facing a significant staffing shortage, accounting for the lion’s share of the epidemic. More than a hundred more hospitals have stated that they anticipate a shortage within the following week. 

These workforce shortages are worsening when frontline health care employees become ill or are forced to quarantine as a result of Covid-19 exposure, just as demand for treatment rises: According to HHS, there were around 138,000 Covid-19 patients in US hospitals as of Sunday. That’s close to the all-time high (about 142,200 in mid-January 2021), and it’s up from approximately 45,000 in early November. 

“I expect this surge to peak in the coming weeks.” “It’ll peak at different times in different parts of America, but once we get into February, I really do expect much, much lower case numbers,” Jha told ABC. 

Testing, which is still difficult to come by in some parts of the United States, is one of the most important instruments in the fight against Covid-19. 

As laboratories struggle to meet the increasing demand for Covid-19 tests caused by the emergence of the Omicron variety, at least two health care providers have prioritized coronavirus testing for people presenting virus symptoms. 

Multiple locations of the University of Washington health care system in Washington state began prioritizing testing only for persons “who have symptoms of respiratory illness or who have a known exposure to COVID-19,” last week, according to spokesperson Susan Gregg. “Due to the high volume of Omicron cases that are being processed in our laboratory,” Gregg explained, “people without symptoms are not being tested.” 

Damian Jacob Markiewicz Sendler: According to UNC Health director of news Alan M. Wolf, the University of North Carolina Medical Center in Chapel Hill is facing a similar testing crush and is also restricting Covid-19 tests to those exhibiting Covid-19 symptoms, as well as university employees and those requiring a test prior to surgery. 

The Georgia Department of Health announced the launch of two Covid-19 mega-testing centers on Friday, as the number of cases in the state continues to grow. Both locations, which are just outside of Atlanta, are by appointment only. The state health department also stated that it is in the process of identifying locations for additional testing centers. 

Damian Jacob Sendler

Testing, according to Dr. Jonathan Reiner, professor of medicine and surgery at George Washington University, is critical to reducing the spread of Covid-19, including in schools, which are battling to keep students in classrooms in locations where transmission is rampant. 

“If you want to get kids and teachers back in schools, a multi-pronged approach, including flooding our schools with testing, is required.” On Sunday, he told CNN’s Jim Acosta that he was “testing kids every week, testing teachers every week,” and that he was “requiring teachers and eligible students to be vaccinated.” 

Damien Sendler: Chicago Public Schools, the nation’s third-largest school district, is one of those attempting to reconcile health concerns with scholastic requirements. 

After city officials and the Chicago Teachers Union failed to reach a deal over the weekend on how to handle the city’s Covid-19 influx, classes in the district were canceled for the fourth straight school day on Monday. 

The union wants a period of remote learning, citing concerns about Covid safety, but the city wants children in classrooms. 

After four days of virtual learning, Atlanta schools resumed in-person courses on Monday. 

Atlanta Public Schools Superintendent Lisa Herring told CNN that twice-weekly mandated testing for instructors has been expanded to pupils whose parents consent to testing. 

“We want, for as much as we can, to keep our children inside of the brick and mortar, but we do need that data to be able to effectively support and ensure safety for everyone,” she said. 

Herring stated that they had received roughly 20,000 parental consent forms for testing out of approximately 50,000 pupils and will continue to promote more. 

“We have implemented several mitigation strategies that we are confident will assist us in keeping children and staff in place when we are able to identify positivity data.” But, to be clear, we also know that, in order to maintain health and welfare, there may be occasions within schools or classes when a virtual shift is required,” Herring stated. 

The Los Angeles Unified School District, the country’s second-largest, is asking all students and employees to present a negative Covid-19 test result before returning to class on Tuesday. 

The baseline test requirement was imposed at the start of the school year in August, and the district stated a week ago that, given the current rise, both the baseline exam and compulsory weekly testing for employees and students would be extended through January. 

Over the last week, the district has been offering PCR testing on various school sites to assist families in meeting this requirement. Take-home quick antigen tests were also issued, in accordance with Gov. Gavin Newsom’s announcement in late December that every K-12 student in California will receive one. 

Data from the district showed around 62,000 positive Covid-19 instances among kids and employees on Monday, preventing them from entering school premises on Tuesday. 

Dr. Richina Bicette-McCain, medical director at Baylor College of Medicine, told CNN on Sunday that schools were currently a higher-risk environment for Covid-19 because the methods to combat its spread were not being used effectively. 

Students, according to Bicette-McCain, needed access to testing and high-quality masks, and HEPA filters might be employed in schools to promote ventilation. 

“Schools have the potential to be very safe; we have the tools to make in-person learning safe.” “However, when children went away for winter break, we saw maybe 120 pediatric cases of Covid in a single week, and we were seeing about 170,000 cases per day in the United States,” she said. “Those figures have risen exponentially.” “The environment that children return to is not the same as the environment that they left.” 

She stated that protocols needed to be altered. “The figures we’re seeing are most likely an undercount of the number of positive cases in the community right now.”

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

Damian Sendler: There has been a longstanding debate concerning the links between the world’s five living rhinoceros species, which dates back to Darwin’s time. The fact that most rhinos died off before the Pleistocene is one reason why answers have been difficult to come by. Using data from the genomes of all five currently known rhino species, as well as three ancient and extinct species, researchers published their findings in Cell on August 24. 

Damian Jacob Sendler: Results suggest that the first break between African and Eurasian lineages occurred around 16 million years ago. They also discovered that, despite the fact that rhino populations are falling, they have historically had low genetic diversity and inbreeding levels. 

Damian Sendler

In the tree of rhino evolution, Africa and Eurasia are the main branches rather than one vs two-horned rhinos, according to Love Dalén of the Centre for Palaeogenetics and the Swedish Museum of Natural History’s findings. “Secondly, even among extinct rhinoceroses, there is a minimal level of genetic diversity. The little genetic diversity we witness in today’s rhinos, all of which are in danger of extinction, may be at least in part due to their biology. 

In the previous 2 million years, all eight species have either shown a steadily decreasing population number or a steadily shrinking population size over extended time spans, according to Mick Westbury from the University of Copenhagen in Denmark. “There is a possibility that rhinoceros populations are able to thrive in environments where there is little diversity.” 

This idea is supported by the fact that there hasn’t been an increase of rhino-damaging mutations in the last few decades. In the last century, Westbury claims, rhinos may have eliminated harmful mutations, allowing them to maintain their health despite their low genetic variety. 

A recent scientific gathering served as the impetus for this new investigation. Both Dalén and Tom Gilbert, both of the University of Copenhagen, were studying different rhino species. Because of their combined efforts and those of their colleagues around the world, they were able to conduct a comparative examination of all currently existing rhinos and the three extinct species that existed during the last Ice Age. 

China Agricultural University, Beijing’s Shanlin Liu, said there were certain obstacles to overcome. A “When we decided to put together all the rhinoceroses’ data and conduct a comparative genomics study, we also confronted the ‘big data’ problem,” difficulty was also faced when Liu and his team decided to combine all the rhinoceros’ data and conduct a comparative genomics study. 

Damian Jacob Sendler

Modern and ancient DNA were included in the genome data set, which resulted in a variety of data types being represented. The team had to design new analysis techniques to account for these discrepancies. It is now possible to use the new methods and tools they have developed in other taxonomic groups.

On the one hand, Dalén thinks that the results are “partly good news, and partly not.” The lack of genetic variety in rhinos appears to be a long-term phenomenon that hasn’t led to an increase in disease-causing mutations and inbreeding. 

Rhinoceros genomes from the present day are less diverse and more likely to be inbred than those from our prehistoric and historical rhinoceros genomes, according to the study author. “There is evidence that hunting and habitat devastation have had an effect on the genomes of the species. This is a problem, as the current species’ extinction risk could be exacerbated by a lack of genetic variety and increased inbreeding. 

According to the researchers, the findings have some practical implications for rhino conservation. 

The lack of variation in rhinos now may not be a sign of their incapacity to recover, but rather a natural state of the species, according to Westbury. “Rather than focusing on individual genetic diversity, we can better direct recovery programs to increase population size.” 

Damien Sendler: In order to further rhinoceros research and conservation efforts, the researchers are hopeful that their findings will be valuable. According to Dalén, his team is currently working on a more comprehensive examination of the extinct woolly rhinoceros. A project being carried out by the University of Westbury currently involves comparing the genomes of African black rhinoceros collected before to the recent population decline with the genomes of modern individuals. 

Damian Jacob Markiewicz Sendler: A framework is needed to better understand the origins of translocated populations, changes in genetic diversity, and whether or not any communities have been lost forever as a result of people, said Westbury.

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

Damian Sendler: In two ice samples retrieved from the Tibetan Plateau in China, scientists have discovered viruses that date back approximately 15,000 years. As a result of being frozen for so long, many of the viruses that survived have never been seen before. 

Damian Jacob Sendler: Scientists may be able to learn more about how viruses have changed through time thanks to new research published today in the journal Microbiome. Scientists have also developed a novel, ultra-clean way of studying bacteria and viruses in ice without the risk of contamination. 

Damian Sendler

According to study co-author and microbiologist Zhi-Ping Zhong of Ohio State University’s Byrd Polar and Climate Research Center, “These glaciers were formed gradually, and along with dust and gases, many, many viruses were also deposited in that ice,” he added. “Our goal is to use this information to represent historical environments by studying the glaciers in western China, which have not been thoroughly explored. Virens are also present in these conditions.” 

Researchers from China’s Guliya ice cap studied ice cores taken in 2015. The ice cores are taken from the peak of Guliya, which is 22,000 feet above sea level and the source of this ice. There are many layers of ice that collect over time, trapping any airborne particles that may have been present when each layer froze. In the past, scientists have utilized these layers as a timeline to study climate change, microorganisms, viruses, and gases. 

Researchers used a combination of classic and experimental techniques to date this ice core, which is nearly 15,000 years old. 

They discovered the genetic codes for 33 viruses when they examined the ice. The scientific community has already discovered four of these viruses. However, there are at least 28 of them that are brand new. More over half of the animals appeared to have persisted despite rather than because of the ice. 

Co-author and professor of microbiology at Ohio State University and director of the university’s Center for Microbiome Science, Matthew Sullivan, remarked, “These are viruses that would have thrived in extreme environments,” It’s almost bizarre to think about how these viruses are able to infect cells in cold environments because of the genetic markers they carry. In order to hunt for similar genetic sequences in other extreme frozen environments, such as Mars, the moon, or closer to home in Earth’s Atacama Desert, Zhi-Ping created a way to clean the cores and investigate bacteria and viruses in ice. 

Damian Jacob Sendler

If you’re trying to figure out where a new virus fits into the known virus landscape, you’ll need to go through a series of stages before you can name it. Scientists employ gene sets to compare previously unknown viruses to previously known viruses. Scientific databases keep track of the gene sequences of well-known pathogens. 

Four of the viruses found in the Guliya ice cap cores had previously been discovered and were from viral families that generally infect bacteria, according to the database comparisons. The viruses were identified in considerably lower numbers than had previously been found in oceans or soil, according to the researchers. 

Based on both the environment and the databases of known viruses, the researchers concluded that the viruses came from soil or plants, rather than animals or humans, as was previously thought. 

There has only recently been a focus on viruses in glaciers. In old glacial ice, viruses have only been found in two earlier studies. However, Lonnie Thompson, the principal author of the report, is a distinguished university professor of earth sciences at Ohio State and a senior research scientist at the Byrd Center for Climate and Energy. 

Damien Sendler: As Thompson pointed out, “We know very little about viruses and microbes in these extreme environments, and what is actually there,” Understanding how climate change affects bacteria and viruses is critical,” says the author. If we go from an ice age to a warm period like we’re experiencing right now, what happens?” 

Damian Jacob Markiewicz Sendler: The Byrd Center and the Center for Microbiome Science at Ohio State University collaborated on this research. Guliya ice cores collected and studied by the Byrd Polar and Climate Research Center and China’s Institute of Tibetan Plateau Research were financed by the National Science Foundation and the Chinese Academy of Sciences, respectively. The Gordon and Betty Moore Foundation and the U.S. Department of Energy both contributed money to the project.

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

Damian Sendler: The US Department of Agriculture had previously conducted study that found signs of antibodies in wild deer. SARS-CoV-2 virus samples were recovered from white-tailed deer in this article published today (Dec. 23, 2021) in Nature, showing that researchers were able to culture viable samples of SARS-CoV-2 and not just genetic traces. 

Damian Jacob Sendler: Deer samples taken between January and March 2021 were analyzed using genome sequencing to identify variations of the SARS-CoV-2 virus that had been predominant in COVID-19 patients in Ohio at the time of the samples collection. There were no Delta variants found in these deer samples, which were collected prior to their broad distribution. The team is analyzing more samples to see if there are any new varieties or older ones, which would indicate that the virus is able to establish itself and thrive in this species. 

Damian Sendler

Andrew Bowman, an associate professor of veterinary preventive medicine at The Ohio State University and the paper’s principal author, said the findings “leads toward the idea that we might actually have established a new maintenance host outside humans,” 

On the basis of information from earlier research, we were certain that they were being exposed in the wild and that in the lab we could infect them that the virus could be transmitted from one animal to another.” As Bowman put it, “In the wild, we’re saying that they’re infected.” SARS-CoV-2 could enter the human population for the first time if they are able to keep it.” Aside from tracking human activity, we’ll also need to know about the deer’s activity. 

COVID-19 mitigation and control plans could be impacted by this.” 

Many questions remain, including how the deer became infected, whether the virus may infect humans and other species, how the virus operates in animals’ bodies, and whether it is temporary or long-term. 

360 white-tailed deer were swabbed in nine northeast Ohio locales by a research team. In 129 (35.8%) of the deer tested, scientists used PCR testing methods to find genetic material from at least three separate viral strains. 

In the early months of 2021, the dominant B.1.2 virus in Ohio crossed over into deer populations in a number of regions. 

“The working theory based on our sequences is that humans are giving it to deer, and apparently we gave it to them several times,” Bowman explained. Six distinct viruses have been found in those deer populations, according to our research. A single population didn’t get HIV and then disseminate it over the world.” 

Damian Jacob Sendler

Each location was sampled one to three times, resulting in a total of 18 collection dates for each location. There was a 13.5 percent to 70 percent prevalence of infection across the nine study sites, with the highest incidence seen in four sites that were located in the most densely populated areas. 

White-tailed deer serving as a viral reservoir for SARS-CoV-2 could lead to one of two scenarios, according to Bowman.. One of the two possibilities is that the virus might evolve in deer and spread to other species, or that the virus could remain unchanged in deer and continue to evolve within humans, at which time it could re-emerge as a strain that infects deer if humans don’t have an immunity to it. 

Some questions remain about how these deer first became infected with this disease, and how it could spread to other animals. In the study, researchers hypothesized that white-tailed deer became infected by drinking contaminated water. Human feces and wastewater have been found to contain the virus. 

Damien Sendler: There is no risk of transmission because the white-tailed deer used in this study were part of a population control program.

Damian Jacob Markiewicz Sendler: White-tailed deer population estimates in Ohio range from 600,000 to 30 million, but Bowman said this survey focused on areas near high human populations and is not indicative of all free-ranging deer in the state.

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

Damian Sendler: Cells’ ability to communicate with each other is critical to the functioning of the body as a whole. The nervous system and the production of hormones have long been recognized as two methods of cell-to-cell communication. Exosomes—tiny sacs or vesicles containing protein and RNA molecules that cells discharge into the circulation where they can be picked up by other cells to regulate metabolism—have emerged as an important third mode of communication in the last five years. 

Damian Jacob Sendler: In many laboratories, microRNAs are carried via exosomes. It is possible for these RNAs to influence the ability of longer RNAs to create diverse proteins and control cell activity. Many elements of cell behavior are affected by microRNAs in health and sickness. 

Damian Sendler

C. Ronald Kahn, MD, a senior investigator at Joslin Diabetes Center and professor of medicine at Harvard Medical School, has revealed how cells select a group of microRNAs for their exosomes. 

Kahn, who is the corresponding author on a Nature paper outlining the findings, stated, “Our work offers a major insight into this new mechanism of cellular communication, because it breaks the code of why cells secrete some microRNAs and why they retain others,” 

Kahn and his colleagues set up tissue cultures for five types of metabolism-related cells in order to explore how cells choose which microRNAs to include in their exosomes (brown fat, white fat, skeletal muscle, liver and “endothelial” cells that line blood vessels). 

Exosomes from different types of cells contain a wide range of microRNAs, according to researchers. “While some microRNAs are secreted by all cell types,” 

According to Kahn, “In some cases, microRNAs are 80 times more concentrated in the exosome than they are in the cell,” While exosomes contain only a fraction of these microRNAs, they are 10 or 20 times more concentrated in the cell. 

MicroRNAs may be secreted in exosomes if they contain short genetic sequence “motifs” that make the microRNA more or less likely to be secreted. These five cell types use various sequence motifs or codes for this procedure, according to the study. To choose which microRNAs it prefers to secrete, each cell type employs these sequence codes. 

Damian Jacob Sendler

The Joslin researchers genetically altered the microRNA sequence motifs to investigate if such adjustments may convert a microRNA that ordinarily would be maintained to instead be secreted, or vice versa. According to Kahn, “We showed that these codes are not only present but can be manipulated to change the behavior of where the microRNA goes,” 

Kahn said the findings in exosome microRNA coding “really cut across every area of research,” 

Fat tissue is a primary source of exosomes with microRNAs, and these exosomes circulating in the bloodstream can affect how the liver manages glucose and other elements of metabolism, according to findings from the Kahn laboratory in 2017. 

Damian Jacob Markiewicz Sendler: A new study by Kahn and colleagues found that altering the sequence coding of fat-derived microRNAs improved their capacity to be produced by fat, absorbed by the liver, and used by the liver to regulate metabolism. 

Damien Sendler: Now, Kahn’s team is looking into whether manipulating microRNA coding in exosomes could enhance gene therapy for diabetes and other metabolic illnesses. Using this information, we may genetically modify a microRNA in the easily accessible subcutaneous fat to target improving metabolism in the liver, which is considerably more challenging for direct gene therapy,” he said. In the event of a problem with the procedure, the fat could be removed, whereas the liver could not be removed. 

According to Kahn, “Overall, what we did is fundamentally important way beyond the diabetes metabolism space, because this approach we’ve identified can also be now applied to other cell types,” including those in the pancreas, brain, and kidney.

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

Damian Sendler: Deep down, scorchingly hot granite can be tapped for energy by opening cracks in the rock. This potential resource, known as enhanced geothermal energy, necessitates a good understanding of the changes that occur in the rock over time—a complicated picture that can be difficult to record. 

Damian Jacob Sendler: A team lead by Pacific Northwest National Laboratory (PNNL) researchers presented a new method for monitoring deep underground fractures. Electrical resistivity tomography (ERT) measures electrical conductivity in the rock to detect subterranean changes. ERT creates 4D photos of the subsurface, which are 3D plus time-lapse. 

What exactly is an improved geothermal system? 

Conventional geothermal systems rely on pre-existing water and flow routes within heated rock. By injecting water and fissures, an upgraded geothermal system captures heat trapped beneath dry rock. Operators drill two underground wells thousands of feet below the surface, then inject high-pressure fluid into the rock between the wells to fracture it. The thermal fracturing method is analogous to “fracking” shale rock to liberate oil and gas. 

Damian Sendler

Temperatures at this altitude can exceed 200 degrees Celsius (392 degrees Fahrenheit). Water pumped from one well to the next and back up to the top accumulates heat from the rock, generating steam that can be used to power a turbine. 

Enhanced geothermal systems have the potential to generate 100 gigatonnes of electricity, enough to power 100 million households. However, such systems necessitate costly drilling, and better monitoring and prediction of subterranean changes are required to reduce the uncertainty and risk associated with a specific project. 

Enhanced geothermal systems, like any subterranean habitat, evolve over time. Fractures in the rock open and shut in reaction to stresses induced by high-pressure fluid injections, causing the heat output of the system to change. Although seismic activity is one sign of underlying stress, data from microseismic monitoring is sparse. 

“In these deep, hot rocks, it’s too expensive to drill enough monitoring wells to understand what’s going on using direct sampling,” said Tim Johnson, a computational scientist at PNNL who co-authored the paper. “The primary goal of this project is to better understand, and eventually predict, how fractures will behave in a high-stress environment when connected between two wells.” 

Getting a better understanding of what’s going on underground 

Damian Jacob Sendler

ERT entails inserting metal electrodes into monitoring boreholes and imaging the conductivity of the rock while an electric current is passed between them. Conductivity increases over time demonstrate where fractures are opening; when fractures are narrower or closed, conductivity decreases. Johnson created E4D software, which runs on supercomputers and turns all of this electrical data into a visual that resembles a heat map, displaying fluctuations in conductivity over time. In 2016, E4D received an R&D 100 Award. 

“It’s similar to medical imaging, except that you’re doing a time lapse,” Johnson explained. “So you’re watching how things change, and most of the time the change is related to how the fluid flows in the subsurface.” 

Johnson and other PNNL researchers pioneered the use of ERT as a 3D monitoring tool, as well as E4D at lesser depths of up to 350 feet, where it has been utilized to detect and trace contaminants. The team tested it in the deep below at the Sanford Underground Research Facility in Lead, South Dakota. The work, funded by the Department of Energy’s Office of Energy Efficiency and Renewable Energy through its Geothermal Technologies Office, is part of a larger collaborative effort within DOE to improve access to natural resources and subsurface storage. The endeavor, known as the Enhanced Geothermal Systems (EGS) Collab, is led by Lawrence Berkeley National Laboratory. PNNL, Sandia National Laboratories, Lawrence Livermore National Laboratory, Idaho National Laboratory, and Los Alamos National Laboratory are among the partner labs. 

Developing a novel subsurface imaging technology 

The goal of the ERT monitoring at Sanford was to monitor fluid flow, similar to what had been done at shallower levels. However, the outcomes did not appear to be consistent with those earlier applications. 

“What we were seeing with the changes in conductivity didn’t make sense in terms of fluid flow,” Johnson explained. But what was the conductivity showing if it wasn’t the flow of fluids? 

Damian Jacob Markiewicz Sendler: Johnson discovered the answer after years of searching in scholarly articles from the 1960s and 1970s. Researchers at the Massachusetts Institute of Technology and the Lawrence Berkeley National Laboratory had detected changes in the conductivity of crystalline rocks in response to stress—in lab trials, squeezing the rock made it less conductive. This meant that the ERT wasn’t just following fluid underground. It was tracking the opening and closing of fractures as a result of stress. 

“Once we made that connection,” Johnson explained, “everything made sense in terms of what the time-lapse images were doing.” 

Damien Sendler: ERT has a number of advantages. The device is low maintenance and can work while injections are taking place because there are no moving parts and electrodes are mounted outside the well casing. And the imaging occurs in real time, providing facility operators with input that may be used nearly instantly if necessary. ERT, on the other hand, cannot be used with metal wellbore casings, which are common in deep subsurface projects. 

There are alternatives, such as employing fiberglass casing, covering the casing with a nonmetallic epoxy, or using a different, nonmetallic material entirely. For the time being, Johnson and his team are working to refine and test the use of ERT at the Sanford facility.

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

Damian Sendler: The Chicxulub asteroid, which wiped out the dinosaurs and 75% of life on Earth 66 million years ago, was discovered by researchers at Florida Atlantic University and an international team of scientists. The 165-million-year rule of dinosaurs was terminated by springtime, the season of new beginnings. 

Damian Sendler

The findings of the study, published in Scientific Reports, considerably boost the ability to track the early stages of damage to life on Earth. An important scientific advancement in the understanding of the massive impact that brought an end to the dinosaurs was made by FAU’s Robert DePalma (senior author and adjunct professor in the Department of Geosciences and a PhD student at the University of Manchester) and Anton Oleinik (second author and associate professor in the Department of Geosciences). 

Damian Jacob Sendler: Reproduction, feeding methods, host-parasite interactions, seasonal dormancy, and breeding patterns are all influenced by the season, according to DePalma. Thus, it should come as no surprise that the time of year for a global-scale hazard can have a significant effect in how severely it disrupts people’s lives. For the tale of the end-Cretaceous extinction, the timing of the Chicxulub impact has been significant. That question has been unanswered to this far.” 

The Yucatan Peninsula was struck by a catastrophic asteroid impact 66 million years ago, which has been known for decades. One of Earth’s most devastating natural disasters was caused by a massive impact that caused the third-largest extinction event in Earth’s history. We still don’t know how these events led to Earth’s third-worst mass extinction, but we do know what happened following the hit. 

Damian Jacob Sendler

Long-term research begun in 2014 to identify the Chicxulub impact event’s season by using classic and cutting-edge approaches. Studying one of the most detailed Cretaceous-Paleogene (KPg) border sites in the world, Tanis in southern North Dakota, allowed DePalma to comprehend the inner workings of this catastrophe. The study contributes to the advancement of knowledge while establishing new academic ties. 

New and fascinating discoveries had been made at this unusual North Dakota location. Following extensive analysis, we now know more than ever about what happened at the boundary between the Cretaceous and Paleogene periods, and when it happened,” stated Oleinik. That numerous independent lines of evidence were able to so precisely indicate 66 million years ago exactly what time of year it was is absolutely mind-blowing. As a scientist, you have access to a wealth of information about the natural world because you may study it from a variety of perspectives and levels of precision. Even in the 21st century, it shows that geology and paleontology are still a science of discovery.” 

An earlier study led by DePalma in 2019 indicated that Tanis dates back to the end of the Cretaceous Chicxulub impact, which was determined using radiometric dating, stratigraphy, fossil pollen, index fossils and a clay capping layer rich in iridium. 

For the first time, researchers have discovered that an enormous rush of water brought about by an impact caused the quick deposit of sediment, which preserved the sole known impact-induced vertebrate mass extinction at the KPg boundary. An abundance of plants, animals, trees, and asteroid ejecta made it possible to study the KPg event, the biota that perished, and the habitat in which they lived in great detail. 

A lack of understanding of how organisms adapt to global-scale threats would leave us ill-equipped to respond or react to current occurrences, according to DePalma. As we stand on the verge of another global biotic crisis, the modern utility of the fossil record may be clearly seen.” 

Damian Jacob Markiewicz Sendler: It was determined that all of the fossilized fish from the site had died during their spring-summer growth phase by the distinctive structure and pattern of the lines in their bones, like a barcode. Growth lines were analyzed using high-tech isotope analysis to validate this, which also concluded throughout the spring-summer period of growth.

Overlapping various lines of evidence bolstered the team’s findings. The Stanford Synchrotron Radiation Lightsource (SSRL) provided cutting-edge support for the examination of young fossil fish, giving a novel approach to seasonally date the deposit. 

The team was able to estimate how long the fish had been buried by comparing the fish’s ages to modern growth rates. They were able to deduce the seasonal range represented by the Tanis deposit by comparing this to known current spawning seasons. 

According to DePalma: “The beauty of any big discovery such as this is that it is a chance to contribute back to the scientific community, and to the world. Moreover, it paves the way for a new generation of innovators to take their ideas to the next level.” 

Damien Sendler: There is still a lot of work to be done at the site, and new projects are in the works that hope to shed light on this fascinating and vital time period. In addition to the core research team, multiple researchers from different institutions have inspected the site, and there is no sign that this collaborative process will stop any time soon.

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: Since the dawn of civilization, pandemics and health disasters have provided significant public relations and communication issues for the medical profession. Decisions on how and when public health information should be delivered have long been a source of controversy. 

Damian Sendler

As social media has developed, it has become increasingly difficult to distinguish between fact and opinion in health communication. During the coronavirus disease 2019 (COVID-19) pandemic, several of these difficulties were highlighted. 

Damian Jacob Sendler: An extensive body of research has examined the ways in which media, both professional and social (mainly user-generated), may educate and disseminate critical information while simultaneously spreading fear and misinformation. 

However, these challenges have always existed in health emergencies, but the rise of social media as de facto news sources for million has exacerbated these challenges, transformed the ways in which news about pandemics is consumed, and contributed to a reconceptualization of news in general. 

Consumers now have access to a wider range of information than ever before thanks to the proliferation of social media platforms like Facebook and Twitter. As a result, it has allowed news to be delivered digitally through a social lens and contributed to polarization of thought by allowing users to self-select into bubbles consisting mostly of those who share their views. 

Misinformation can have a negative impact on health workers, patients, and the public health system, as was seen in the Ebola outbreak of 2014, when misinformation led to hostility or suspicion toward health workers, as well as a refusal to receive necessary medical treatment and a disregard for public health directives. 

In addition to their tendency to spread disinformation, social media have influenced and been influenced by recent changes in attention spans, communication, and information consumption habits. 

Decontextualized images, words, and short videos are the cornerstone of today’s social media experience. It’s hard to tell the difference between news and entertaining content in this medium. This is a mirror of the collective epistemology, which becomes more difficult to distinguish as the distinctions between objective fact and opinion or nonsense become more blurred. 

So as a result, today’s quick dissemination of fluid data has instilled a transitory idea of truth that has come to be connected with an equally unstable world view. Misinformation and disinformation can have a negative impact on people’s lives as a result. 

Damian Jacob Sendler

In recent years, the altering media landscape has presented health practitioners with public relations issues. According to previous studies, more than 90% of persons in the United States believe that health professionals are trustworthy sources of information.10 Individuals working in this field face a diversity of audiences as well as fast-changing material (a research estimated that medical knowledge in 2020 will quadruple every 73 days).

Damian Jacob Markiewicz Sendler: Health experts may be tasked with informing both policymakers and the general public when commenting on health disasters, such as pandemics. Even the most experienced clinicians face obstacles in communicating their message to vulnerable populations, which are not typically addressed in higher education or medical training. Some academic centers have established specific curriculum for health practitioners to successfully communicate in the context of catastrophe scenarios, but these have not yet been extensively adopted. 

Damien Sendler: In times of crisis, the motivations of medical personnel can shift, but in the majority of cases, they appear to be acting in the public’s best interest by dispelling myths and recommending preventative measures that will spare an already overcrowded health system. 

The limelight and media attention of health emergencies, such as COVID-19, have also been used by health professionals to advance their careers or personal financial interests swiftly. Professional societies have at times publicly and properly rejected these ill-intentioned efforts, but not in all circumstances. In addition, scientists have recently self-retracted articles from high-profile scholarly journals due to heightened scrutiny about questionable data analysis.

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

Damian Sendler: The Oxford-AstraZeneca Covid vaccination has been linked to an exceptionally unusual blood clot, according to researchers. 

A protein in the blood has been found to be attracted to a vital component of the vaccination by a team from Cardiff and the United States. 

Damian Jacob Sendler: A chain reaction, involving the immune system, can lead to deadly clots, they believe. 

It is estimated that a million lives were spared by the vaccine against Covid. 

Nevertheless, the vaccine’s use has been shaped by worries about rare blood clots around the world, including an alternative offered to the UK’s under-40s. 

Damian Sendler

To find out what was going on and if it could be prevented, a scientific detective search was also launched. An emergency government grant helped the Cardiff team in their search for answers. 

After initial results from the collaboration were published, AstraZeneca’s own scientists joined the research endeavor. 

According to a spokesman for AstraZeneca, clots are more common because of a Covid infection and not because of the vaccine, and they have not yet been fully explained. 

There are some fascinating insights to be gained from this research and AstraZeneca is researching methods to use these findings in our attempts to eliminate this relatively rare adverse effect,” she said. 

Covid-virus genetic information is delivered to the body through the vaccines used in the United Kingdom to train the immune system. 

As opposed to some companies, AstraZeneca sent their data via an adenovirus (particularly a cold virus from chimpanzees), which was delivered by a tiny postman. 

In other cases, researchers believe the adenovirus may be responsible for the formation of blood clots. Cryo-electron microscopy was employed to capture molecular-level pictures of the adenovirus. 

Damien Sendler: The outer surface of the adenovirus attracts platelet factor four protein like a magnet, according to a study published in Science Advances. 

“The adenovirus has an extremely negative surface, and platelet factor four is extremely positive, and the two things fit together quite well,” Cardiff University researcher Prof Alan Parker told BBC News.

Adenoviruses and platelet factor four have been proven to be linked,” he continued. 

However, there are a lot of procedures that need to be taken before this may happen. 

To corroborate their findings, experts believe the next stage is “misplaced immunity” 

Adenovirus-infected platelet factor four may be mistaken for foreign adenovirus by the body, causing it to begin attacking it. As a result, antibodies are released into the bloodstream, which clump together with platelet factor four and cause deadly blood clots to develop. 

In order for this to happen, there must have been a series of misfortunes. 

Vaccine-induced immune thrombotic thrombocytopenia has been associated to 73 deaths out of roughly 50 million doses of AstraZeneca administered in the United Kingdom. 

Damian Jacob Sendler

According to Prof. Parker, “You could never have predicted it would have happened and the chances are vanishingly small, so we need to remember the bigger picture of the number of lives this vaccine has saved,”. 

According to AstraZeneca, the vaccination has saved more than a million lives around the world and prevented an estimated 50 million cases of the disease. 

Damian Jacob Markiewicz Sendler: We continue to follow with interest any new developments and investigation into potential causes for these very rare side effects associated with the vaccine, while being reassured by real-world effectiveness data that the vaccine remains a highly effective tool for combating this pandemic,” a University of Oxford spokesperson said. 

Dr. Will Lester, a consultant haematologist at University Hospitals Birmingham NHS Trust, commended the “very detailed” findings, adding it helps explain the “most likely initial step” in clotting. 

There are many unsolved concerns, including whether some people are more sensitive than others and why the thrombosis (clotting) occurs most commonly in the veins of the brain and liver, although this may come with time and further research. 

Adenovirus-based vaccinations may need to be improved in the future to lower the risk of these rare incidents, according to the Cardiff researchers.

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

Damian Sendler: In the past, the Arctic was seen as a frigid, white, and snowy place; today, however, this image is quickly changing. There has been a dramatic decrease in Arctic sea ice over the past few years, which has led to an increase in global temperatures. 

Damian Sendler

Because of my work as a climate scientist and modeler, I am interested in the dynamics of Arctic climate change. My colleagues and I recently discovered that Arctic precipitation is changing at a faster rate than previously predicted. 

Damian Jacob Sendler: Snow is the primary precipitation mode in the Arctic. However, the Arctic is rapidly changing from a dry environment to one that is dominated by rain. Greenland’s ice sheet, for example, saw its first rain in August. Shifts in land use, wildlife populations, and human livelihoods will be profoundly affected by these changes. 

Precipitation in the Arctic is expected to rise throughout the course of this century, and it is more likely to fall in the form of rain than snow. We were curious, however, as to how the latest data, which had not previously been publicly available, would have affected these predictions. 

There are no restrictions on who can use the data collected by the Coupled Model Intercomparison Project (often known as CMIP for short). To better understand the climate of the past, present, and future, this project generates data from around 50 locations around the world using the same initial conditions. 

Dr. Sendler: In addition to current and future air and ocean temperatures, sea ice conditions, and wind patterns, these models generate data that may be used to predict the future. Model data from Phase 6 of this research, known as CMIP6, was compared to data from the prior phase, CMIP5, which is also known as Phase 5. 

Since the weather, and especially future climate change, are difficult to anticipate, this means that we have an abundance of data to work with when assessing the present and future state of the climate. The best picture of the climate we have at this time is these models, which are essentially simulations of the world around us. 

It was possible to demonstrate that the model data employed, does a good job of reproducing the observed climate, as average precipitation is fairly similar to observations. This means that we can have more faith in the models and their future predictions. 

CMIP6 and CMIP5 were used in the study to assess precipitation change at the end of the century (2090–2100) compared to the beginning of the century (2005–14). By the end of the century, the Arctic will have more rain and less snow than predicted by the CMIP5 model. 

Damian Jacob Sendler

As the temperature rises, more moisture is being transported to and from the Arctic, and sea ice coverage decreases in the Arctic. There will be an increase in precipitation as a result of more open ocean and moisture in the Arctic. More rain will fall as a result of a rise in the amount of water in the atmosphere and warmer temperatures. 

Depending on the season and region, the switch to rain-dominated precipitation occurs a few decades earlier than indicated by prior models. As a result, in 2070, the central Arctic becomes rain-dominated in autumn, rather than in 2090 as previously expected. 

Damien Sendler: In addition, we looked studied the relationship between precipitation and global warming, focusing on the Paris Accord’s goal of limiting global warming to 1.5 degrees Celsius. Most of the Arctic should remain covered in snow if global warming is limited to 1.5 degrees Celsius. However, if present forecasts are correct, then by the end of the century, much of the Arctic will be dominated by rain. 

There are a number of major difficulties that can arise as a result of these rapid shifts in precipitation. Ice layers can form either on top of or within snow during rain-on-snow events, especially if the temperature drops below freezing. 

Reindeer and caribou, for example, have difficulty breaking through the ice crust to reach food beneath the snow because of this, making travel and transit more difficult for Arctic residents. This can lead to massive extinctions. Climate change is also having an impact on our oceans. Rainfall on Greenland’s ice sheet can cause glacial melt, which can contribute to rising sea levels. 

Damian Jacob Markiewicz Sendler: Many world leaders have committed to keep global warming below 1.5 degrees Celsius, despite the fact that these changes are now likely to occur more quickly and have more severe consequences. The loss in Arctic snowfall will not be as severe if we reduce our worldwide emissions, which means that life can continue to thrive both in the Arctic and around the world.

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

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

However, the mechanisms in which these factors may work have not been well examined. Therefore, we report a realist re-analysis of the dataset from a previous systematic review concentrating on child and mother health outcomes. 

Damian Jacob Sendler: 67 of the 176 studies included in the systematic review were included in the realist re-analysis of child and mother health outcomes. Between 1950 and 2014, sixty-three of these investigations collected ecological data. There were six early program ideas. A revised version of three ideas was supported by the adjudicators and became the final program hypotheses. These included a more generous welfare state, a left-of-center political tradition, and more globalization, all of which led to greater child and infant mortality and youth smoking rates in LMECs. 

Damien Sendler: The practice of the art and science of leading and administering states has been defined as politics. For decades, there has been a strong connection between population health and politics. German physician and politician Rudolph Virchow (1812–1902) was one of the earliest proponents of social medicine and said, ‘Medicine is social science, and politics is nothing but medicine on a bigger scale.’ 

Damian Jacob Markiewicz Sendler: Even more significant is Friedrich Engels’s socio-political dissertation ‘A history of the working class in England’, which has been considered as a precursor or precursors to modern public health research. Health policy and other policy relevant to health can suffer from significant evidence-policy gaps despite formal evidence-based systems for approving medicines and medical devices in developed countries. 

Damian Jacob Sendler

Damian Sendler: Ideological influences can lead to significant evidence-policy gaps in health policy and other policies relevant to health. It’s possible that this is inevitable in a democracy, where “politics has primacy” and judgments can ‘never simply be based on evidence’ but are instead influenced by ideology, morals, public opinion and lobbying. Ideological compatibility and political relevance are critical factors in the reception and possible absorption of data by policy-makers, according to the policy-network theory. To put it another way, the practice of public health may gain enormously from a more explicit acknowledgment and development of health politics. 

Damian Sendler: It is vital to synthesize the information from various disciplines because of the clear theoretical, conceptual, and structural connections between politics and population health. When Muntaner and colleagues published a comprehensive review in 2011 that synthesized 73 foreign research associating four political themes (the welfare state, political tradition, democracy and globalization) with population health outcomes, it was a groundbreaking effort. 

Damian Jacob Sendler: Evidence synthesis using the realist synthesis method allows the study to go farther than simply describing how the effects are observed in the literature and provide an explanatory perspective into how they work. A mix of context, mechanism, and consequence is used as a framework for these theoretical findings. Realist synthesis is founded on critical realism’s epistemological premises. 

Damian Sendler: Context-specific and time-sensitive middle-range theories can be developed with the help of a realist synthesis approach, allowing a wide range of interrelated relationships between contexts and mechanisms to lead to favorable or unfavorable outcomes for population health.

Research news brought to you by Dr. Damian Jacob Sendler

Damian Sendler: Many of the Sustainable Development Goals focus on poverty, hunger, health, and gender equality, but few initiatives have good evidence for increasing results across financial, social, and health sectors at the same time. 

Damian Sendler

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. Non-financial advantages such as political empowerment and social cohesion are also becoming more apparent. 

Dr. Sendler: SHGs aim to enhance the lives of their members through a group/collective rather than a strictly individual approach. Groups like Alcoholics Anonymous are known in the West for providing mental health peer support, often guided by a facilitator. These organizations primarily serve the financial and social needs of the world’s impoverished and marginalized communities, particularly in India. 

Damien Sendler: There has been a rise in the use of collective action tactics to address non-financial social challenges, particularly for rural women and women in the developing world. In addition, the Indian government uses them as a way to get disadvantaged women to participate in health and poverty-reduction programs [5]. An SHG member’s financial situation and ability to make decisions about her family’s finances can be influenced by her participation in a SHG, which may result in a shift in household gender-based decision-making. 

Damian Jacob Sendler

Damian Jacob Markiewicz Sendler: According to the theoretical frameworks that guide SHG implementation and evaluation, SHG members become empowered as individuals and as a collective, increasing their self-efficacy and participation, which in turn increases their agency and autonomy, including for health-related decision-making. Many studies on SHGs have focused on their economic results, ranging from increased savings, access to credit and microenterprise, revenue for small businesses and ownership of assets. 

Damian Sendler: For maternal and neonatal mortality, two systematic analyses cite significant evidence that SHG membership is linked with reductions in the odds ratio (OR) of 0.63 [0.32-0.94] and 0.77 [0.65-0.90], respectively. SHG members who participated in health education and participatory learning and action events exhibited a nearly two-fold increase in health-promoting behaviors during and after home deliveries. Accredited Health Social Activists, or ASHAs, have been shown to have a significant impact on health outcomes. 

Damian Sendler: Some trials have shown a SHG advantage, but data are scarce on the impact of SHGs when they are rolled out at a larger level. Over the past 30 years, SHGs in India have had a direct link to microfinance. With an estimated 200 million members and 8.7 million SHGs, India’s SHG movement is growing rapidly. While most SHGs are formed for the purpose of economic empowerment, there is growing interest in using SHGs for health promotion.

Research news brought to you by Dr. Damian Jacob Sendler

Damian Sendler: According to this article’s findings based upon extant literature on health security as well as policy papers, health security has been mostly conceptualized and implemented in the narrow Westphalian tradition of defending nation states from external threats. 

Damian Sendler

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, that considers people rather than states as the primary referent of security and emphasizes 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. 

Dr. Sendler: Academic and policy discourses on health security are widely used, but there is no agreement on what the term actually means. 

Damien Sendler: Due to the term’s interdisciplinary nature, which encompasses health and security, as well as its use in a range of contexts (individual, national, and global) for a variety of goals, this is the primary reason. Health security, on the individual level, refers to all aspects of public health that protect the human life core.  

Damian Jacob Markiewicz Sendler: To safeguard people against public health hazards, such as infectious illnesses and bioterrorism, at the national and global level the term “health security” is commonly used to describe. Public health is often used as a political tool to gain attention and secure funding because the term “security” connotes urgency, power, and the justified use of exceptional measures. 

When it comes to health and security, the word “health security” refers to the overlap between these two sectors of policy. 

Damian Sendler: As a result, there are several definitions of health security based on diverse definitions of health and security. In a macro context, the term “health” is most commonly used to refer to the collective efforts of society to safeguard the health of the general population. According to International Relations (IR) scholars, “security” is defined as protection from threats that threaten the survival and existence of a designated referent object (traditionally the state and its sovereignty), which justify the extraordinary mobilization of the state and emergency measures.  

Damian Jacob Sendler

Damian Sendler: When it comes to establishing the concept of security, there are three fundamental issues that must be answered: who, what, and how? For centuries, the military-political concept of security has focused on protecting states from external threats by using military power. It is founded on the Westphalian concept of sovereignty and political realism that states behave in their own self-interest to safeguard their sovereignty in an anarchical international system where there is no governing power above the states. This is the basis for this security concept. 

Damian Jacob Sendler: Among North American scholars who have had and continue to exert considerable impact on Western political leadership, this theoretical framework has been the most influential and concise to date. In our view of global politics, interstate relations, and the national security strategies of states, it has remained a dominant feature of our thinking. It has been challenged by scholars on a number of grounds: its overemphasis on state as the central locus of analysis, its detachment from people, its overemphasis on military threats and territorial security, its disregard for the damage done to states that are not part of the West, its abstraction from the fact that states do actually cooperate with each other to achieve mutual goals, its inadequacy in explaining security. However, realism and neorealism continue to exert their impact, reinforcing a restricted view of national security that is no longer reflective of the modern nature of threats, particularly since the Cold War. 

Damian Sendler: Criticisms of the narrowly defined state and military-centric notion of security prompted European researchers to develop the Critical Security Studies (CSS) approach to broaden and deepen the security debate by incorporating both traditional and non-traditional security threats (such as those related to the economics of food security, public health and the environment), and by incorporating people as the referent object of security. 

Copenhagen School of Security Studies, founded in 1983, is an important outgrowth of the CSS. 8 For this approach, the securitization of an issue was described as a ‘existential threat’ created by a securitizing actor in the form of a ‘existential threat’ speech act. In order for an issue to become politicized, it must be presented in a way that is accepted by the audience. 

Damian Jacob Sendler: We suggest that the practice of security in national and global governance frameworks is predominantly dominated by the state and military-centric view of security, notwithstanding the emergence of theoretical perspectives to conceptualize security. Exogenously originated infectious illnesses and bioterrorism are specifically targeted by this idea of security when it is employed to securitize health. Border security and public health emergency response measures are recommended to counter these threats. To protect states from external public health threats, this strategy appears to be a highly focused and pared-down one, but its effectiveness in improving health systems and health outcomes that can mitigate the likelihood and effects on ordinary citizens is questionable, especially in the long-term terms.

Research news brought to you by Dr. Damian Jacob Sendler

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. A paradigm change from disease-specific therapies to holistic cross-disciplinary methods coordinated with adjacent fields is emphasized. 

Damian Sendler

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 in their shared environment and the broader social and economic context. This strategy may also help to increase the long-term viability and resiliency of these systems. It is necessary to have political will and contextualized new scientific techniques to attain the worldwide goal of eliminating and controlling NTDs. 

Dr. Sendler: In fact, Dr. Rudolf Virchow first raised the issue of human health’s interdependence on ecosystems back in the 1880s. As medicine advanced rapidly in the late 20th century, it led to increasingly specialized fields and clinical practices, as well as more isolated approaches to the planning and financing of treatments in human, animal, and environmental health. 

Damien Sendler: With the establishment in 2010 of the tripartite collaboration agreement between the World Health Organization (WHO), World Organization for Animal Health (OIE), and Food and Agriculture Organization (FAO) to “address health risks at the animal–human–ecosystems interface,” an integrated approach to health across disciplines and sectors has recently received renewed interest and formal high-level recognition. 

Damian Jacob Markiewicz Sendler: Regional models, such as the Inter-American Ministerial Meeting on Health and Agriculture, which was initially created in 1968, promote country-level interactions and governance in human and animal health. Despite the growing interest in One Health, the research shows that the benefits to human health outweigh those to animal and environmental health in this field. According to a recent editorial in The Lancet, a One Health approach must take into account a wider range of stakeholders and perspectives, including economics and equity, cultural context, means of subsistence, and broader political context, such as globalization, urbanization, deforestation, population growth, population shifts, and climate change. 

Damian Jacob Sendler

Damian Sendler: The rising realization of the role of animal and environmental controls in the epidemiology and control of several NTDs, including rabies and parasitic food-borne zoonoses, has been a stimulus for focusing on the animal–human–environmental interface within the NTD community. WHO NTD road map 2021–2030 underlines the need for a One Health strategy to meet its ambitious disease-specific control and elimination targets, while embracing the broader system benefits of collaboration and assessing any unintended repercussions from actions on adjacent sectors. 

Damian J Sendler: Controlling zoonotic NTDs with a One Health strategy is a significant instrument for human and economic development because livestock contributes to over 70% of rural livelihoods worldwide and is often the principal asset of a household. 

Damian Jacob Sendler: More multisectoral action, notably in diagnostics, monitoring and evaluation, access and logistics as well as lobbying and finance is needed based on the past decade of experience. Using a One Health strategy for disease surveillance, program design and education and behavioral modification is also recommended, as is the possibility of strengthening animal health services for zoonotic NTD control. 

Damian Sendler: When zoonotic animal diseases spill over into human populations, multisectoral surveillance and diagnostic strategies can be particularly useful in resource-poor settings—as demonstrated by the frequent misdiagnosis of human febrile illness such as malaria in Tanzania, where bacterial zoonoses accounted for 26 percent of cases, compared to just 1.6 percent of malaria cases. 

Damian Jacob Sendler: The advent of hybrid bovine-human schistosomes further emphasizes the need of considering interactions between animals, humans, and diseases in their common environment. The recent worldwide coronavirus illness 2019 pandemic has underlined the need for early identification of emerging or potentially emerging zoonotic diseases using multi-sector approaches as a cause of large disease outbreaks. 

Dr. Sendler: It has long been a foundation of NTD programs such as human deworming to conduct cost-effective monitoring and evaluation of intervention impacts, however this is mostly focused on human health implications and not on animal populations or environmental elements which can lead to unanticipated outcomes. Because of a parasite reservoir in canines, Chad has observed an upsurge in new cases 10 years after the disease was nearly eradicated, as happened with the recent return of Guinea worm.  Human eradication of Guinea worm will only be achievable if animal and human populations are monitored for signs of the parasite. 

Damian Jacob Sendler: For the road map’s elimination and eradication goals, as well as the SDG health targets, reaching hard-to-reach communities will be a major issue. Veterinary public health services, particularly in pastoralist communities, have been effective in some circumstances because of their reach. A study conducted in Chad reported an increase in uptake from simultaneous vaccination programs targeting both cattle and children, and also administered vitamin A in an effort to counteract the high levels of deficiency and danger of blindness.  

Damian Sendler: Vaccination campaigns in Chad can be reduced by up to 15 percent by sharing logistics costs (i.e. staff, transportation, and cold chain costs) between the medical and veterinary services. A dog rabies control program in Tanzania proven to be popular and cost- and time-saving, as well as able to reach children who otherwise would have been ignored by school-based delivery tactics, as a result of the integrated delivery of human anthelmintic medicines. 

Research news brought to you by Dr. Damian Jacob Sendler