Damian Sendler Oncologic disease is on the rise as a result of advancements in medicine, better living conditions, and longer life spans. The fact that more and more patients are surviving cancer or living with the disease for an extended period of time is also extremely encouraging. While the fight for survival continues, the importance of improving patients’ quality of life has come to the fore. However, patients’ physical and mental health and well-being are profoundly affected by psychosocial issues, even if these issues don’t directly affect the course of the disease. There has been a recent rise in the field of psycho-oncology, which aims to address these issues and provide support for cancer patients as they face a variety of challenges throughout the disease. Here, we provide a summary of current knowledge on the body-mind interactions in cancer and an overview of the wide range of psycho-oncologic care, paying particular attention to treatment of pain, fatigue, sexual problems and fear of progression.

Damian Jacob Sendler There are a wide range of physical and psychological issues that arise from cancer and its treatments. Physical discomfort, exhaustion, and a diminished sense of self-determination are just a few of the symptoms that can have a significant impact on one’s overall well-being. This has resulted in a dramatic increase in the demand for psychosocial interventions to treat and support patients with cancer and cancer survivors. The development of psycho-oncology as a new interdisciplinary discipline has also been aided by other historical developments. The de-stigmatization of cancer and mental illness, the evolution of the doctor-patient relationship, a shift away from survival rates and life expectancy in favor of quality of life, and the growth of palliative care are a few examples.

Dr. Sendler Oncology’s use of psycho-oncology has grown steadily since the 1970s. Numerous organizations have been formed to coordinate supportive care networks and conduct systematic research, including IPOS (International Psycho-Oncology Society, founded in 1984), national societies in the majority of the world’s industrialized countries, and a slew of guidelines has been developed. In addition, the scope of psychooncologic treatment has been steadily expanding in line with the evolving concept of health-related quality of life.

Psychosocial factors play a role in both the onset and progression of cancer, and the disease itself brings with it a slew of new psychological burdens and changes to one’s life.

In contrast to health behavior and socioeconomic status, the role of stress and personality factors in cancer development and prognosis is less clear1, 2. A variety of cancer-related processes, such as DNA damage and repair, apoptosis, migration and invasion, and angiogenesis, may be affected by the major stress pathways of the hypothalamic-hypopituitary axis and the release of adrenal hormones. Stress has been shown to have a significant impact on tumor genesis and progression in a variety of experimental designs in animal models of disease. 3-7 Such findings have yet to be applied to the treatment of patients. Even though there is a statistically significant correlation between major life events and cancer incidence,8-9, recall bias may distort the results in a retrospective design. Studies in the future have shown that depression, personality traits, life events, and the development of cancer have little or no connection. 10

There is some evidence to suggest that cancer patients who suffer from mental illness, particularly depression, have a worse prognosis.

11,12 However, this correlation has not been proven to have a causal effect. If depression-related processes directly impact cancer progression, or if other, interdependent factors like health behavior mediate this effect is still up in the air.

The question of whether or not psychosocial interventions can help cancer patients live longer has been hotly debated.

13-15 For example, a recent study on nonmetastatic breast cancer found that those who received psychosocial interventions were more likely to live longer than those who did not.16,18 In parallel studies of the same cohort, downregulation of proinflammatory and metastasis-related genes and upregulation of type I interferon response genes were found. 19-21 Psychosocial interventions have yet to be shown to have a significant impact on cancer progression or survival. As research gathers momentum, it’s becoming increasingly clear that stress — and the social support it fosters — both influence the progression of cancer. Figure 2 depicts the role of psychosocial factors in cancer progression and development. Interrelations should not be overemphasized in light of inconsistent evidence and small effect sizes. Medical professionals and the general public tend to underestimate the impact of psychological factors in the development of cancer. In the past, ideas like the “cancer personality” have harmed cancer patients by causing them to attribute guilt to themselves in ways that aren’t true. 22 In light of the current data, it is unjustifiable to force cancer patients to undergo psychotherapy in order to extend their lives.

Psychooncological interventions may not be desired, required, or beneficial for all patients. There is a problem, however, in that many caretakers fail to recognize the need for support and thus fail to meet it. As a result, all cancer patients should be routinely screened for psychooncologic distress to monitor their progress. Distress has been used instead of “psychiatric,” “psychosocial,” or “emotional” because it is more acceptable and less stigmatizing to patients. 24 The National Comprehensive Cancer Network (NCCN) guidelines recommend the use of an easy-to-use distress thermometer and a short list screening for practical, physical, emotional, and family issues, as well as spiritual and religious concerns. 25 Various short screening tools have been analyzed in a comprehensive study. 26 In addition to the screening, the patient should be informed about the variety of psychooncological services available and their desire for psychosocial support should be assessed. Following the discovery of pathological findings, a more thorough clinical evaluation of mental health issues should be conducted, along with recommendations for appropriate treatment options. When patients agree to and utilize appropriate psychosocial services, screening for distress is feasible and leads to better outcomes. 27 However, this is not a universally held opinion. In spite of the fact that most guidelines recommend screening, a systematic review found that the evidence did not support a positive impact on distress symptoms.

Damian Sendler

In cancer patients, pain is one of the most common sources of physical distress. 29 The tumor’s invasive growth is the primary cause of the pain, but it can also be caused by other factors, such as surgery, chemotherapy, or radiation, as well as immobility. The World Health Organization (WHO) cancer pain ladder is used as a guide for medical treatment. 30 Aside from that, mental health care should also be provided. A strong body of evidence shows that pain and emotional distress are interconnected. Multiple meta-analyses and high-quality randomized controlled trials have shown that psychological and cognitive behavioral treatments can reduce pain severity and interfere with function (RCTs). CBT, psychoeducation, hypnosis, relaxation, yoga and exercise have all been shown to be effective in different stages of the disease. 31-34 The goal of these treatments is to help patients better cope with and accept pain, as well as increase their sense of self-efficacy, reframe negative thoughts, modify their behavior, and change their attentional focus. The use of treatment options and communication with health care providers are also supported by educational interventions.

Even though cancer-related fatigue is at least as common and important a cause of distress and reduced function in patients at various stages of the disease as pain, it is less often addressed and recognized by health care providers.

35,36 At the end, 84% of the patients reported fatigue, and even among long-term survivors, between 17% and 56% reported fatigue as a major symptom that negatively affected their quality of life. 37 Frustration is a common symptom of cancer, but its underlying causes are still a mystery. Proinflammatory cytokines, anemia, electrolyte disturbances, weight loss, metabolic disorders, infection, or the effects of chemotherapy and radiotherapy, as well as the use of sedative drugs, are all possible physical causes of cancer-related symptoms. 38,39 Excessive sleep deprivation, stress, and physical discomfort can all contribute to tiredness. 40 The NCCN guidelines and the consensus group recommendations of the European Association for Palliative Care provide practical treatment guidelines and algorithms (EAPC). 41 Education, energy expenditure planning, and physical exercise are part of symptomatic treatment. A stimulant-based pharmacological treatment is also available, but it’s not without its risks. 42 A number of clinical trials have shown that aerobic training and, in some cases, resistance or strength training, can help alleviate fatigue. 43-45 The goal of energy expenditure interventions is to tailor a patient’s level of activity to his or her unique capabilities and requirements. Prioritizing and delegating are among the most important aspects of daily life, as they allow people to focus on the things that are most important to them. Rest, stress reduction, learning relaxation techniques, and engaging in enjoyable activities can all help restore energy levels. Acceptance strategies and attentional processes can also be the focus of psychotherapeutic efforts to combat negative or catastrophizing thinking.

Damian Jacob Markiewicz Sendler There are numerous ways in which cancer can impact one’s sexuality, both directly and indirectly. Sexual dysfunction can be harmed by both the cancer itself, as well as surgical treatment, such as chemotherapy, radiation therapy, or surgery for gynecological tumors. Sexual function can be negatively impacted by changes in hormones caused by a disease or by treatments such as chemotherapy, hormone therapy, or surgery. In addition to the physical effects of cancer, such as fatigue, pain and emotional distress, or strains on a relationship with a mate, there are also psychological effects. 46,47 An individual’s overall well-being suffers greatly when they experience sexual dysfunction.

A person’s method of dealing with life’s difficulties varies greatly. In the face of a life-threatening illness, sexuality may lose significance for some patients, but for others, it takes on new significance as a means of preserving pleasure, vitality, and emotional connection.

Hormonal therapy, erection aids, reconstructive surgery, and educational and counseling interventions may be used to help patients. Sexual or couple therapy may be necessary from time to time. There has been some success with multimodal treatment programs, but evidence is still lacking. 48

Some types of cancer can impair reproductive function, but chemo- and radiotherapy are the most common causes of infertility. For men, freezing sperm is a simple way to preserve fertility, but for women, it can be a challenge. Ovarian transposition prior to pelvic radiation and the cry opreserva Lion of fertilized ovum are well-established methods, but they may be helpful only in certain situations. Cryopreservation of unfertilized ova or ovary tissue are other, less well-researched options. All of these techniques, however, are quite invasive. This can be a stressful time, and fertility preservation decisions must be made while dealing with other treatment decisions that already have a significant emotional toll.

Damian Jacob Sendler

Patients who are faced with these decisions, fears about reproduction, or the loss of reproductive function due to treatment are in need of assistance. Cancer heritability, chemo- or radiotherapy-induced genetic damage, or the pregnancy’s impact on recurrence risk are all common concerns for prospective parents (eg, in hormonereceptor-positive breast carcinoma). In these situations, it’s critical to get all the facts and work with the reproductive medicine team.

Many cancer patients suffer from mental health issues such as depression, anxiety, and difficulty adjusting. There are approximately if percent of depression and dysthymia, 10.2 percent of an anxiety disorder, and 12.5 percent of adjustment disorder point prevalences in the general population. 50 Cancer patients who have psychiatric comorbidities have a lower quality of life and a lower prognosis. 51 Depressive episodes in cancer patients are treated in much the same way as depressive episodes in non-cancer patients, and this has been specified in numerous guidelines. 50,52,53 In the diagnosis process, however, special attention is needed because of the overlap between cancer symptoms and depression. It’s also important to keep in mind the potential side effects and interactions of antidepressant medications (eg, the interactions between some antidepressants and tamoxifen). Psychotherapeutic interventions have been shown to improve depressive symptoms in cancer patients at various stages of the disease, according to a large body of research. 54,55 There has been research into traditional therapeutic approaches like cognitive behavioral therapy, and more recently, the development of specialized treatment programs. The specific treatment setting, the stage of disease, physical distress symptoms, and the existential threat must all be taken into account in psychotherapeutic treatment. ‘ It is not uncommon for psychotherapy and medication to be used in the treatment of anxiety disorders in a similar manner to that used in non-cancer patients. 56,57

A distinct entity in cancer treatment is the fear of recurrence (also the fear of progression). One of the most common concerns of cancer survivors is the “fear, worry, or concern that cancer will return or progress. DSM 5 and ICD-10 do not define it, and it must be understood as an adaptive reaction rather than an unrealistic or neurotic fear. Fear of recurrence, on the other hand, can cause severe emotional distress. Specific questionnaires have been developed and validated for fear of recurrence in the evaluation of anxiety disorders. 58 As many as 70% of patients fear a recurrence of their illness, and they report feeling isolated in dealing with this issue. 59 Progression anxiety can be treated using a variety of approaches. Using cognitive behavioral principles, a group therapy in a rehabilitation inpatient setting was shown to reduce anxiety about progressing, and it has also shown some promising effects in an outpatient pilot phase, with a few modifications. Self-observation, exposure-based techniques, refraining techniques, and the implementation of behavioral changes are the most important aspects of the process. 60,61

It has recently been shown in an RCT that patients who have survived breast, prostate, and colorectal cancer benefit greatly from another program based on Leventhal’s Self-Regulation Model of Illness that employs a combination of psychoeducation, cognitive restructuring, and behavioral modification in an individual therapeutic setting.

Over the past year, 62 pilot studies have shown promising results or are currently in progress.

On the whole, psycho-oncology research advances our knowledge of the mind-body connection, and it has challenged long-held assumptions about cancer’s mechanism of action. Using a psycho-oncological therapeutic approach, cancer patients can experience better physical and mental well-being, as well as improved quality of life. Psychotherapy must be tailored to the unique needs of people facing life-threatening conditions as well as those grappling with existential questions and spiritual longings, as standard psychiatric treatment falls short in this case. The future of therapy is bright, but it necessitates more scrutiny and differentiation.

Dr. Sendler

Sendler Damian Jacob

Damian Jacob Markiewicz Sendler

Damian Sendler STING-type I interferon is activated by binding to double-stranded DNA (dsDNA), which triggers activation of cyclic GMP-AMP synthase (cGAS). MDSs and AML are caused by mutations in the DEAD-box helicase 41, DDX41, which is a DEAD-box helicase (AML). When infected with DNA viruses, we found that DDX41-KO cells produced less type I interferon. In DDX41 KO cells, activation of cGAS and STING is affected, which suggests that DDX41 functions upstream of cGAS.. It has both ATP-dependent and ATP-independent DNA unwinding activity in the recombinant form of DDX41. Wild-type DDX41 has higher levels of cGAS dinucleotide synthesis activity, while the mutant R525H from MDS/AML has decreased unwinding activity. In both DDX41-deficient and -proficient cells, R525H overexpression results in an increase in type I interferon production. Our findings suggest that DDX41 uses its unwinding and annealing activities to regulate the homeostasis of dsDNA and single-stranded DNA (ssDNA), which, in turn, regulates the activation of cGAS-STING..

Type 2 Diabetes Patients Receiving Sodium-Glucose Cotransporter-2 Inhibitors Instead of Metformin: Cardiovascular Outcomes

Damian Jacob Sendler First-line sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have been shown to have a lower risk of cardiovascular events than metformin.

First-line treatment with SGLT-2i or metformin for adults with type 2 diabetes (T2D) was compared to control groups.

An observational cohort study of the general population.

Observation Point: Claims data from two major U.S. commercial and Medicare databases (April 2013 to March 2020).

Participants: Patients with type 2 diabetes (T2D) aged 18 or older (Medicare >65 years) who began treatment with SGLT-2i or metformin from April 2013 to March 2020 and who had not previously taken any antidiabetic medication were identified. Pooled hazard ratios and 95% confidence intervals (CIs) were presented after a 1:2 propensity score matching in each database.

An SGLT-2i (canagliflozin, empagliflozin, or dapagliflozin) or metformin is the first-line treatment.

Dr. Sendler All-cause mortality (MI/stroke/mortality) and hospitalization for heart failure (HHF/mortality) were the primary outcomes of this study. Infections of the genitals, as well as other health issues, were evaluated.

Results: SGLT-2i initiators had a similar risk of MI/stroke/mortality (HR, 0.96; 95 percent CI, 0.77 to 1.19) compared to metformin initiators, but a lower risk of HHF/mortality (HR, 0.80; CI, 0.66 to 0.97) during a mean follow-up of 12 months (matching 8613 to 17 226). HHF risk was lower in SGLT-2i-treated patients (HR, 0.78; CI, 0.63 to 0.97); MI risk was also lower (HR, 0.70; CI, 0.48 to 1.00); and the risk of stroke, mortality, and MI/stroke/HHF/mortality was similar in SGLT-2i-treated patients and metformin-treated patients. There was a higher risk of genital infections (HR 2.19; CI 1.91 to 2.51) among those taking SGLT-2i compared to those taking metformin (HR 2.19; CI 1.91 to 2.51).

Through lymphatic transdifferentiation, specialized blood vessels can be formed.

A cell’s lineage and trajectory during development are important determinants of its identity as a cell. Endothelial cells (ECs) of blood and lymphatic vessels differentiate and specialize to meet the specific physiological needs of each organ1 and 2 in the vascular system, respectively. Lymphatic ECs (LECs) have been shown to derive from a variety of cellular sources3,4, but no other cell types have been linked to lymphatic ECs. Zebrafish anal fins have been used as a model to study the development of specialized blood vessels through the transdifferentiation of LECs, which are recurrently imaged and traced in this study. Our findings reveal a link between cell ontogeny and functionality by showing that lymphatic rather than blood ECs are used to generate anal-fin vessels. A single-cell RNA sequencing approach is used to identify the various cell populations and transdifferentiation transition states. The anal-fin regeneration process demonstrates that LECs in adult fish retain both potency and plasticity for the generation of blood ECs, similar to normal development. LEC transdifferentiation appears to be a natural mechanism for the formation of blood vessels, and our findings show that the ontogeny of ECs is linked to their functional capacity in vivo.

COVID-19 Sequelae and Immunity in the Long Term

People who are diagnosed with COVID-19 are more likely to have long-term symptoms than those who recover from the illness. Post-acute sequelae of SARS-CoV-2 infection are thought to be caused by a number of different pathophysiologic mechanisms (PASC).

The goal of this study is to examine the long-term health effects and recurrence of symptoms in a group of people who have recovered from COVID-19 and healthy controls.

Damian Jacob Sendler

NIH Clinical Center Bethesda, Maryland, United States.

Damian Jacob Markiewicz Sendler Adults with confirmed SARS-CoV-2 infection who had been symptom-free for at least six weeks were included in the study regardless of whether or not they had PASC. Persons with no known history or evidence of SARS-CoV-2 infection were included in the control group, regardless of their current health status. A similar time period and location were used to enroll both groups.

Physical examination, laboratory tests and questionnaires, cognitive function testing, and cardiopulmonary evaluation were performed on all participants regardless of the presence of symptoms. Additional immunologic and virologic testing was done on a subset of the patients.

Findings: The study included 189 people with laboratory-documented COVID-19 (12 percent of whom were hospitalized during acute illness) and 120 people with negative antibodies to COVID 19. 55 percent of the COVID-19 cohort reported symptoms consistent with PASC at the time of enrollment, compared to 13 percent of control participants. There was a higher risk of PASC in women and those with anxiety disorders. Standardized tests revealed lower levels of quality of life in participants who met the criteria for PASC. Physical examinations and diagnostic tests rarely revealed abnormal findings. Anti-spike protein neutralizing antibody levels were negative in 27% of the unvaccinated COVID-19 cohort and in none of the vaccinated COVID-19 cohort. Participants with PASC were found to have no evidence of persistent viral infection, autoimmunity, or abnormal immune activation.

As a result, only a small percentage of those who took part in COVID-19 required hospitalization. The reported prevalence of PASC in this cohort may have been overestimated because those with PASC may have been more eager to participate. Prior to enrollment, the study did not capture PASC that had already been resolved.

As a result, people who received COVID-19 reported a high level of ongoing symptoms. Diagnostic testing revealed in the majority of cases no clear cause for the reported symptoms. After COVID-19, there was a great deal of variation in antibody levels.

Neuroblastoma treatment is being improved.

Damien Sendler Tumors of sympathetic origin, such as neuroblastomas, can manifest in a variety of ways, ranging from localized or spontaneously regressing disease to widespread metastasis. When it comes to high-risk neuroblastomas, the sympathetic and parasympathetic nervous systems can be used as a target for treatment. High-dose chemotherapy with autologous stem cell transplantation, differentiating agents, and immunotherapy with anti-GD2 monoclonal antibodies have improved 5-year survival rates for patients with metastatic neuroblastomas from 20% to 50% over the past few decades. ALK inhibitors, immunotherapies, and radiopharmaceuticals will be added to standard induction regimens in the next generation of trials aimed at enhancing initial response rates in patients with high-risk neuroblastomas. Patients with relapsed and/or refractory disease are the focus of a number of trials aimed at enhancing the antitumour immune response and improving the effectiveness of maintenance regimens in order to extend disease remission. Advances in understanding neuroblastoma pathogenesis and in identifying the drivers of high-risk disease are discussed in this review. We then discuss how this information has improved risk stratification, risk-adapted therapy, and the development of new therapies..

Placenta-specific genes that are activated by large-scale chromatin reorganization promote aging.

As the chromatin organization at the nuclear periphery erodes, so does nuclear deformation, a characteristic of dying cells. Such gradual changes in higher-order genome organization have remained a mystery as to how they influence local epigenetic modifications to drive the mechanisms of cell ageing in the body. Large-scale epigenomic studies on isogenic young, senescent and progeroid human mesenchymal progenitor cells (hMPCs) have revealed a hierarchy of integrated structural state changes that manifest as heterochromatin loss, euchromatic weakening, switching in interfacing topological regions, and increasing epigenetic entropy…. Pregnancy-specific beta-1 glycoprotein (PSG) genes, which accelerate hMPC aging and could be used as biomarkers of aging, are activated by epigenetic de-repression. Our findings can be used to better understand how the epigenomic landscape changes with cellular aging, as well as to pinpoint aging-related causes and potential treatment targets using a genome-topology-based approach.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: Exercise-based cardiac rehabilitation programs play a significant role in secondary prevention of coronary artery disease. There is a lack of participation in exercise-based rehabilitation programs in some populations. Yoga has been linked to better cardiovascular health, making it a viable option for cardiac rehab programs. Yoga-based cardiac rehabilitation may reduce cardiovascular risk factors and improve physiological and psychological outcomes in patients with coronary artery disease, according to a review of current randomized controlled trials. A medical database search turned up six randomized controlled studies, and meta-analysis was performed on the data to determine the various outcomes. With yoga’s addition to standard care, cardiac health and quality of life were positively affected. The left ventricular systolic function was also improving. This cohort’s improvement in cardiac risk factors, MACE, and mental health has yet to be proven, but it was not inferior to standard or enhanced care, and the benefits became more pronounced at longer follow-up. Longer-term studies with more patients and a larger sample size will help determine whether yoga-based rehabilitation is beneficial in the long term.

Damian Jacob Sendler: More than a third of people die each year from cardiovascular disease, making it the leading global killer. Approximately 126.5 million people around the world have been diagnosed with coronary artery disease, making it the most common type of heart disease. In the UK, that number rose to 311,519 hospitalizations and 64,132 deaths in 2018. 2

Dr. Sendler: Even though interventional and pharmacological therapies are frequently required, risk factor modification plays a crucial role in secondary prevention in patients who have already experienced a coronary event. In patients with cardiovascular disease, exercise-based cardiac rehabilitation (CR) has been shown to reduce cardiovascular mortality and hospitalization, and improve physiological and psychological well-being. 3 As part of the comprehensive recovery program, physical activity is not undertaken in isolation, but rather is integrated into healthy eating, smoking cessation, medication adherence, and stress management, all of which contribute to a healthier lifestyle. A sedentary lifestyle, obesity, and hypertension are all risk factors for cardiovascular disease that can be reduced by aerobic exercise, which increases myocardial perfusion and decreases myocardial oxygen demand. Patients with ischemic heart disease have access to exercise-based cardiac rehabilitation in 111 countries around the world, and it is recommended as a class 1 treatment in European and American clinical practice guidelines. 4–6 However, a variety of other forms of exercise have been tested in an effort to increase CR uptake, enable tele-based programs, and look at lower-cost options.

Yoga is a form of exercise and weight loss program that incorporates physical postures, breath control, and meditation. It has been shown to improve peak oxygen consumption and quality of life in other rehabilitation programs, such as in pulmonary rehabilitation programs for COPD and heart failure. 7,8 As a preventative strategy for COVID-19.9–11 and other conditions like anxiety and depression as well as chronic pain, it has also been shown to be beneficial in numerous other studies. As yoga is more common in India, a low-cost model could increase accessibility and familiarity, which could lead to greater uptake of the practice in the United States. Certain subgroups like women, the elderly, and those with low income, who are traditionally underrepresented in conventional CR, may benefit from this approach more in countries with higher incomes and more developed rehabilitation programs.

Yoga-based rehabilitation has not yet produced conclusive evidence of its benefits, in part because the studies that have examined it have been heterogeneous, looking at different patient groups, comparators, and outcomes. This lack of uniformity makes determining its appropriateness for clinical practice difficult. A review of current randomized controlled trials was conducted to examine the evidence for yoga-based cardiac rehabilitation and to examine whether it improves physiological and psychological outcomes in patients following acute coronary disease compared to standard care.

To see if yoga had an effect on physiological and biochemical parameters, the RCTs examined a wide range of cardiovascular risk factors.

There was a statistically significant difference in BMI reduction between patients who underwent a yoga-based rehabilitation program and those who underwent standard exercise rehabilitation (p=0.001).

13 He showed statistically significant reductions in heart rate and blood pressure levels in comparison to only pharmacological treatment. 15 Even though Tillin and colleagues did their research outside of India, they found no differences in the physiological cardiovascular risk factors they examined: ambulatory, resting and exertional blood pressures; resting heart rates; BMI; waist-to-hip ratios; percent body fat mass; and peak VO2. 16 Over a period of three months, the intervention group’s ambulatory blood pressure dropped from an average daytime ambulatory systolic pressure of 115 millimeters mercury to 113 millimeters mercury (p=0.5).

Blood glucose levels and lipid profiles have been linked to an increased risk of cardiovascular disease in three separate studies. They found that yoga participants had better glycemic control, but it wasn’t statistically significant. Compared to the control group, there was a statistically significant change from baseline for those with poor glucose control (p=0.008 for fasting blood glucose levels >100 mg/dL and p=0.003 for levels >200 mg/dL), but not for those with good control (p=0.41 and 0.032, respectively). When looking at blood glucose levels, Tillin et al. found no statistically significant difference between the two groups (0.05%, confidence interval [CI] -0.23 to 0.33, p=0.7).

Participants’ lipid profiles were examined by Raghuram et al, Tillin et al, and Sharma et al. At three months, neither Tillin et al. nor Sharma et al. found a statistically significant difference in triglycerides, total cholesterol, HDL or LDL. There was a statistically significant reduction in total triglycerides (p=0.03), total HDL (p=0.001) and total VLDL after one year of treatment. There was no significant difference in total cholesterol or total LDL between the groups, but there was a significant reduction in the yoga group compared to the control group in patients with a high baseline LDL (100 mg/dL). There was no subgroup analysis in Tillin and Sharma. Figures 5–7 show a non-statistically significant trend favoring the yoga group in risk management for cardiovascular disease. According to Raghuram et al., the baseline mean triglyceride, total cholesterol, and fasting blood sugar levels were all higher in the Indian cohort than in the UK cohort.

Clinical patient-reported measures and measurements of LVEF and diastolic function on echocardiogram have been used to examine changes in cardiac function.

Damian Jacob Markiewicz Sendler: Three studies looked at clinical measures of improvement in cardiac function. Sharma et al used the Duke Activity Status Index (DASI) and derived metabolic equivalents from these self-administered functional scores to determine patient-perceived improvement in cardiac function and found that those who underwent the yoga-based program had significantly better scores at three months than a control group (p0.001). Additionally, in the group that practiced Yoga-CaRe, Prabhakaran et al. discovered a slight improvement in self-reported return to pre-infarct activity (88.3 vs. 87.0; p=0.039). There was no difference between groups in the subjective assessment of cardiac function using the International Physical Activity Questionnaire administered by Tillin et al (p=0.8).

After a 12-week yoga program, patients with acute MI had their heart rate variability compared to standard care, which did not include an exercise-based rehabilitation program, which was published by Christa et al in 2019.

17 It was discovered that adding yoga interventions to standard medical therapy improved parasympathetic activity and overall cardiac autonomic tone in patients.

LVEF was examined in two separate studies following yoga-based rehab. With no difference between groups, Raghuram and coworkers found that CABG resulted in significant improvement in LV systolic function. After a year of yoga rehab, patients with less than 53% functional capacity had a greater improvement than those who did not. Ejection fraction improved from 47.5% to 53% in the yoga group, whereas the control group only improved from 49.5% to 49% (p=0.02). Because patients with an EF below 30% were excluded from the study, it is impossible to say whether a low aerobic exercise program would be even more beneficial for those with more severe LV dysfunction. According to Sharma et al, there was no difference in LV function between the groups (this may be due to the short follow-up period of only three months), but Raghuram et al found a difference after six months. There was no statistically significant difference found in meta-analysis (Figure 8). There was no statistically significant difference between the yoga and control groups in the improvement of left ventricular diastolic function (p=0.04).

Only one randomized controlled trial has looked at the reduction in MACE following a yoga-based intervention, and that was conducted by Prabhakaran et al. Personalized yoga exercises, breathing control techniques, meditation, and relaxation exercises were all part of the Yoga-CaRe program that was implemented in multiple Indian centers. In addition to three sessions of educational advice, the improved standard of care program did not routinely offer an exercise program.

Major adverse cardiovascular event (MACE) was defined as death from any cause, MI, CVA or emergency cardiovascular hospitalization without death. After making a mid-trial change to MACE criteria to include emergency cardiovascular hospitalizations in order to achieve higher event rates, the study was still underpowered to detect a 20% reduction in MACE.

They screened 6737 patients and enrolled 3959 between August 2014 and March 2018, and the patients were well matched at baseline. MACE occurred in 6.7% of Yoga-CaRe and 7.4% of standard enhanced care patients, with an incidence of 0.9 (95 percent confidence interval 0.71–1.15).

A reduction in cardiovascular hospitalization was seen in the Yoga-CaRe group, but this was underpowered. There was no statistical difference in total MACE. In terms of MACE risk, those who had previously had coronary artery disease (0.49) and did not have diabetes (0.65; 95 percent CI 0.47–0.91) were statistically more likely to benefit from Yoga-CaRe.

Many studies have found yoga to have a positive effect on both cardiovascular and psychological health.

11,18 Patient-reported scores for psychological health were evaluated in four RCTs. Both the Cardiac Depression Scale (CDS) and the Hamilton Anxiety Rating Scale (HAM-A) showed a significant decrease in scoring, both with p 0.001. Yoga-base-adjusted CaRe’s mean (EQ-5D-5L) was 1.50 (95 percent CI 0.53–2.48; P=0.002), whereas Prabhakhan et al. found their OQL questionnaire (EQ-5D-5L) results in favor of the yoga group at 12 weeks, with 77 points versus 75.7. In the yoga group, self-reported depression, anxiety, and stress levels improved, but this difference was not statistically significant when compared to the control group. Only the increase in the patient’s overall positive affectivity following the intervention (PANAS p=0.02) was statistically significantly better with yoga than the control group in this study. While the QOL questionnaire (EQ-5D-3L) and perceived stress score scale were not significantly different between groups, Tillin et al. found no difference in their findings.

Prabhakhan et alresearch .’s was the only one to compare the health habits of different groups and found no difference between the high rates of medication adherence and the cessation of tobacco use. Both the educational sessions in both programs and the patient selection cohort likely had an impact on this result. Patients who were not likely to complete the rehabilitation program were excluded from the study. Once participants were enrolled in the study, there was no difference in their adherence to the exercise program based on their age or gender.

Damien Sendler: Less aerobic activity is required in yoga-based cardiac rehabilitation programs in Europe than in traditional exercise-based rehabilitation programs. Cardiovascular rehabilitation’s fundamental principles are upheld by yoga-rehab, however: a structured exercise program that improves functional capacity in a safe environment while promoting healthy behaviors in order to lower the risk of cardiovascular disease. According to previous studies, the practice of yoga lowers blood pressure, heart rate variability, abdominal obesity, insulin resistance and hyperlipidemia, all of which are risk factors for heart disease and other types of cardiovascular disease. 18 Yoga was found to have the greatest impact on lowering 10-year cardiovascular risk when compared to other lifestyle changes (16.7 percent ). 19

After examining the results of six randomized controlled trials (RCTs) examining the effects of yoga on cardiac rehabilitation in patients with coronary artery disease, no clear benefits of yoga can be discerned, due to the evidence’s current limitations, which make interpretation difficult.

Damian Sendler

Weight loss was observed in one study, but no significant difference was found in any of the other cardiac risk factors examined. Because meta-analysis favors yoga, it’s possible that the small sample size in that study is to blame. Biochemical risk factors did not differ significantly between studies with 3-month follow-up, but Raghuram et al found reductions in HDL and VLDL at one year. However, a meta-analysis found yoga to be beneficial in reducing triglycerides, total cholesterol, and LDL, albeit with varying baselines and patient populations. Most of the studies, except for Tillin et al., reported an improvement in cardiac function. After a year, the echocardiogram showed an improvement, but only in those who had a lower baseline function. At one year, the ejection fraction had increased by six percent. Despite the fact that many accreditation services now recommend reporting ejection fraction as a range rather than an exact number, the measurement cannot be said to be reliable. When it came to the primary outcome and subgroup analysis, only one study examined whether yoga had any impact on MACE. A meta-analysis of studies examining psychological health found that patients in the yoga groups had a 50 percent improvement in their stress levels.

As a result of the diverse populations studied, a small number of studies yielded different results. Some studies only included those with LV systolic dysfunction, while others included patients with normal function. Some studies focused on men only, while others examined a variety of ethnic groups with varying baseline characteristics. Some studies had a 3-month follow-up period, while others had a 1-year follow-up period. Many of the 1-year studies found that the 3-month follow-up period was too short to see a difference in outcomes. Furthermore, the sample sizes of the majority of the studies make it difficult to draw firm conclusions. With nearly 4,000 participants, Prabhakhan et alstudy .’s was the largest to date. It was necessary to include additional MACE events midway through the trial because this was still an underpowered study, and it reflects the difficulty in recruiting enough patients to find statistical significance.

Several different outcomes have been examined in these studies, but it is difficult to determine the validity of results without some degree of standardized repetition. The majority of studies were conducted in India, making it difficult to generalize the findings to other populations; this is reflected in the differences between Raghuram et al and Tillin et al in baseline characteristics. The yoga group’s loss to follow-up was significantly higher than the normal cardiac rehab group’s in the only study conducted in the UK (37.5 percent vs 12.5 percent , respectively). An unwillingness to continue attending yoga classes was documented in the study’s small sample size (40 participants at the outset). According to the research, women and the elderly, two underrepresented groups in traditional rehab, have not increased their participation. Prabhakhan et al. found a lack of interest in recruiting women and the elderly, and men made up the majority of participants in all of the studies they looked at.

Damian Jacob Sendler

Cardiovascular rehabilitation in low- and middle-income countries has been hindered by a lack of resources, affordability, and patient and physician participation in rehabilitation programs..

As a result of the reduced equipment and location of classes as well as the fact that yoga is already widely practiced in Asia, the costs associated with a yoga-based program are significantly lower than conventional cardiac rehabilitation.

In general, studies show that including yoga in cardiac rehabilitation programs improves patients’ subjective perceptions of health and their overall well-being. A trend was also seen in those who had previously had an impaired left ventricular systolic function. This cohort’s improvement in cardiac risk factors, MACE, and mental health has yet to be proven, but it was not inferior to standard or enhanced care, and the benefits became more pronounced at longer follow-up.

In spite of the fact that it has not been proven to be superior, yoga-based cardiac rehabilitation may be a suitable alternative rehab, particularly in communities where engagement is likely to be better and where patients are therefore more likely to persist beyond the initial program. As a low-cost alternative, it could be considered when the MDT recruitment process is difficult or when the patient’s geographic location prevents them from accessing treatment options.

Other areas of cardiac rehabilitation, such as the treatment of heart failure, may reap the benefits of improved autonomic function as well. Longer-term studies with more patients and a larger sample size will help determine whether yoga-based rehabilitation is beneficial in the long term.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: In light of demographic shifts and an increasing elderly population, efforts are being made to extend the lives of these people through both pharmacological and nonpharmacological means. The goal of this article is to discuss one such strategy, namely the effect of the Mediterranean Diet (MedDiet) on cognitive functions in both cognitively unimpaired and impaired elderly people, based on a literature review of recent clinical studies. A review of peer-reviewed, full-text English-language journal articles published in Web of Science and PubMed between January 1, 2016, and February 28, 2021, is part of the methodology. According to the findings, following the MedDiet plan has a positive impact on memory in older adults with and without cognitive impairment, both in the short and long term. According to the findings, older adults who adhered more closely to the MedDiet diet had better overall cognitive performance. In addition, older people who follow the MedDiet plan experience fewer depressive symptoms, less frailty, and shorter hospital stays as a result of their efforts.

Damian Jacob Sendler: There has been a dramatic increase in the elderly population around the world. To be exact, there were 703 million seniors in 2019 who were 65 years old or older. This number is expected to more than double by the year 2050, reaching 1.5 billion people [1]. Health problems such as worsening vision and hearing, but also a deterioration of mental abilities, are becoming more common as the population grows older [2].

Dr. Sendler: When it comes to our ability to adapt and learn in the face of constantly shifting environmental conditions, cognitive functions encompass the entire range of mental processes that go into these tasks. Other examples of this include the ability to learn new things; to remember what you’ve learned; and to express yourself creatively in the form of speech, writing or drawing [3]. These are all signs of dementia, a neurodegenerative disorder that affects the brain’s ability to process information [4]. As the disease progresses, a person’s autonomy and self-sufficiency are gradually eroded, leading to eventual disability [5]. Although it can’t be cured at this point in time, both pharmacological and nonpharmacological therapies can at least delay its progression [6]. For the most part, pharmacological therapies are limited to four drugs, such as donepezil, galantamine and rivastigmine; they can only improve the mental state of the patient temporarily and slow down the pathological process [7].

As a result, it is imperative to take steps to prevent brain degeneration from occurring. Numerous non-pharmacological therapies have been shown to be effective at preventing cognitive decline in old age. Exercise, which should be done at least three times per week, cognitive training like doing crossword puzzles or reading, and a healthy diet are all recommended [9]. The Mediterranean diet appears to be one of the best options [10], as evidence suggests that following the MedDiet more closely is linked to a slower rate of cognitive decline and a lower risk of developing Alzheimer’s disease. It’s not yet clear what MedDiet does, but the findings suggest that this may be a multifactorial process. Saturated fatty acids and the anti-inflammatory and antioxidant actions of the entire group of active biomolecules present in this diet are the most important active molecules with a protective effect on nervous tissue or metabolism. Additionally, the MedDiet’s caloric restriction and balanced nutrient intake, which has a positive effect on metabolic processes in the body, such as insulin resistance and blood glucose levels and lipid profile, is a significant factor [14,15]. There are a lot of vegetables and fruits in the MedDiet along with a variety of beans and grains as well as a lot of olive oil and seeds as well as a variety of herbs and spices. It discourages eating unusual red meats and sugary desserts. Fish consumption and alcohol consumption have been shown to slow cognitive decline.

MedDiet adherence during middle age has been linked to a 36% to 46% greater chance of healthy aging [16,17,18]. According to Critselis and Panagiotakos [18], elderly people who follow the MedDiet diet have a 269 percent higher chance of aging successfully and a 33 percent lower risk of death. Another study claims that MedDiet reduces the length of hospitalization and the mortality rate of patients in the hospital, as stated by Buglio and colleagues [19].

Damian Jacob Markiewicz Sendler: Adherence to MedDiet has a positive impact on both cognitively impaired and unimpaired elderly populations, particularly on their memory, both in the short and long term. In addition, better global cognitive performance in older people is linked to higher adherence to the MedDiet [25,27,28,29,30]. This has been shown in other studies on the subject [33,34].

Mantzorou et al. [28] also found that better adherence to MedDiet was associated with younger age, female gender, higher educational attainment and better anthropometric measurements. According to Okubo et al. [35], females have become more particular about the nutrients they choose in their diet as a result of the dietary approach. Researchers found that those who avoided smoking and drinking alcohol, had a higher level of educational attainment, and spent more time outside during their studies performed better on cognitive tests than those who did not. There is a greater emphasis on nutrition among women of all ages [27] than among men of the same age group. This is also partially true for cognitively impaired female AD patients, according to de la Rubia et al [26], who found that female patients with AD recover more quickly when exposed to MedDiet.

Damian Sendler

Among patients with Alzheimer’s disease (AD) and Parkinson’s disease, the results of studies that looked at the impact of MedDiet on cognitive functions show that this dietary pattern benefits episodic memory, temporal orientation, semantics memory, language, and concentration [26,32].

To further enhance cognitive performance in the elderly, this review found that MedDiet should be supplemented with higher doses of certain foods, such as coconut oil [26], extra-virgin olive oil (EVOO) [30], or fresh, lean pork [32].

Damien Sendler: In healthy older people, polyunsaturated fatty acids and flavonoids, in particular, have been shown to play an important role in improving cognitive performance [36,37]. Actually, the neurobiomembrane’s primary constituents are fatty acids, which can have a significant impact on processes like nerve signal transduction and neurotransmission at synapses[38]. As Gu et al. [39] found, adequate intake of PUFA from fish was positively associated with gray matter volume in Alzheimer’s dementia patients. [38] PUFAs (omega-3) improved white matter integrity and processing speed, according to Strike et al. [40]. In most prospective cohort studies [41,42], the effect of fish consumption on cognitive decline appears to be positive. The antioxidant carotenoid astaxanthin appears to be a neglected but interesting molecule. In salmon, shrimp, and lobster, the dark red-orange color comes from algae that produce this biomolecule. Antioxidant, anti-inflammatory, and antiapoptotic effects of astaxanthin can be seen in the brain after it crosses the blood-brain barrier [43].

Additional research has shown that extra-virgin oil, particularly its component, secoiridoid oleuropein, may reduce the risk of cognitive decline. Studies on the effects of EVOO on cognition are few and far between [30]. Studies on the protective effects of EVOO on brain structures over long periods of administration (e.g. 6.5 years) [45] have not looked at the effects of low doses administered for short periods of time. Low doses of EVOO supplementation have been shown to have an effect on cognitive function tests in the literature [45–46,47], while long-term use of MedDiet containing EVOO may prevent cognitive decline and have a beneficial effect during the long prodromal phase of dementia [48].

Damian Jacob Sendler

Anti-inflammatory and antioxidant nutrients are an important part of MedDiet nutrition in terms of preserving cognitive abilities. Folic acid (especially oleuropein) [44] and phenolic flavonoids (especially oleuropein) [44] as well as lipophilic biomolecules (particularly alpha-tocopherol and beta-carotene) [29,30] are examples of this class. Other chronic diseases, such as autoimmune or cardiovascular, can benefit from MedDiet as well [49].

MedDiet variants with lower calorie intakes have been studied in addition to the standard MedDiet. MedDiet combined with low-carb diet, which reduced carbohydrate intake (initially 40 g/day, then 70 g/day) and increased protein and fat intake [50]. With poultry and fish replacing beef and lamb, this Med/LC diet had a low red meat content.

According to the current research, an overall higher dietary variety, including relevant nutrients like MedDiet, and no single foods, has a greater impact on cognitive performance in older people. In addition to MedDiet, there are other healthy diets that reflect regional dietary habits. MedDiet has a variety of dietary alternatives, such as a Nordic diet (NPDP) or a MedÉire diet (53), both of which emphasize traditional, sustainably produced, and locally sourced foods. NPDP moderate-to-high adherence may predict better preserved cognitive function among older adults in Nordic countries than neurodegenerative delay, Mediterranean diet, dietary approaches to stop hypertension and the Baltic Sea diet, according to Shakersain et al. [52].

Some research has found no link between following the MedDiet and improved cognitive function in the elderly, however [54,55]. The Hill [56] study, for example, found no link between MedDiet adherence and beta-amyloid deposition in a group of healthy Australian women, which is consistent with the findings of other studies on this topic.

Both cognitively impaired and non-cognitive older adults benefit from adhering to MedDiet. In addition, it reduces depressive symptoms, weakens the elderly, and shortens their hospital stays.

More clinical trials are needed to confirm MedDiet MD’s ability to reduce the risk of cognitive impairment.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: Disfigurement and disability are common outcomes of psoriasis, a chronic, recurrent immune-related skin disease. As a result of the stigma associated with psoriasis and the general public’s limited knowledge of dermatology, people with psoriasis experience poorer mental health, a lower quality of life, and less effective treatment options. This review summarized the frequently used questionnaires and scales to evaluate stigmatization in patients with psoriasis, and recent advances on this topic. Feelings of Stigmatization Questionnaire, Questionnaire on Skin Complaints, and 6-item Stigmatization Scale have all been commonly used in research. It was found that these questionnaires helped researchers better understand the connections between a patient’s psoriasis and their psychiatric health conditions, quality of life, and feelings of social stigma. In order to combat the stigma associated with psoriasis, policymakers, dermatologists, psychologists, psychiatric researchers, and patients must all work together. Other areas of research could focus on these existing topics as well as other areas like non-patient stigma, biologics, and how to deal with it; these are just a few ideas that could be pursued in the future.

Damian Jacob Sendler: characterized by red, scaly plaques with distinct borders (1–4). Psoriasis is now recognized as a systemic disease rather than just a skin condition (5). Other organs, such as the joint (6) and cardiovascular system, may be affected by psoriasis (7). There is also an increased risk of psychiatric disorders, such as depression, anxiety (eight), bipolar mood disorder (nine), personality disorder (ten), and cognitive impairment (12). (11). Patients with psoriasis may be subjected to a significant physical and psychological burden, which can have a negative impact on their health, personal lives, and professional careers (12). Psoriasis can have a significant negative impact on a person’s physical, emotional, and social well-being (13, 14).

Dr. Sendler: Discrediting perceptions of a person’s biology or social status are assigned to them in the process of stigmatization, making them stand out from the rest of the population (15, 16). Many people with psoriatic disease and other dermatologic conditions feel stigmatized because of their visible skin lesions and a lack of public awareness about the diseases. Other cultural or social factors may also contribute to stigmatization (15, 17). Because of their “unclean skin” and public concerns about infectivity, Susskind and McGuire reported in the 1950s that psoriasis patients might be subject to curiosity, hostility, and disgust from the public (18). Patients with psoriasis could benefit from increased awareness of the disease’s status as a non-infectious condition (19). More than 8,000 people with moderate-to-severe psoriasis from 31 countries participated in a global survey in 2018. (20). Psoriasis-related discrimination and humiliation had a negative impact on the respondents’ work, personal relationships, and health status, according to 84 percent of the participants. There may be social and psychological difficulties for psoriasis patients, especially when they have to expose their bodies (21). Patients with psychological distress may lose hope and feel powerless in the face of their illness, which can negatively affect their treatment outcomes (21, 22). Stigmatization, sociodemographic characteristics, disease-related variables, and psychiatric disorders in psoriasis patients have been studied more and more in recent years. Patients with psoriasis may be stigmatized to varying degrees, depending on the type of questionnaire used (16, 23).

A survey of 100 psoriasis patients conducted in 1989 by Ginsburg and Link, using the “Feelings of Stigmatization Questionnaire,” uncovered six distinct aspects of stigma (24). Thirty-three questions form the basis of this disease-specific questionnaire. “Anticipation of rejection, feeling flawed, sensitivity to other people’s attitudes, guilt and shame, secrecy, and positive attitudes” were the six dimensions. A lack of compliance and worsening status can result from stigmatization. Stigmatization of psoriasis patients has serious consequences for their well-being as well as for their treatment in the clinic.

To measure stigmatization in psoriasis patients, researchers have employed the Feelings of Stigmation Questionnaire. Psoriasis patients are more likely than the general population to encounter gross rejection because of their skin condition, according to research conducted in 1993 by Ginsburg and Link, primarily from the gym, pool, hairdresser, or place of employment (25). Rejection can cause a person to feel stigmatized, which can have negative consequences on their emotions and careers. Stigmatization was found to be linked to depression in psoriasis patients who completed the Feelings of Stigmation Questionnaire and Beck Depression Inventory (26). According to the Feelings of Stigmatization Questionnaire (FSFQ), 115 psoriasis patients were found to be more stigmatized by lesions on the back of their hands than by overall disease severity (12). The fear of infection, especially when shaking hands, being touched, or touching the same objects, could be one explanation for this association. It was found that stigmatization predicted quality of life worse than any other analyzed variable. Psoriatic patients’ stigmatization and quality of life were examined by Jankowiak and coworkers in 2020. (27). Feelings of Stigma Questionnaire (33 items) and Dermatology Life Quality Index (DLQI), respectively, were used to measure stigma and life quality. Various domains of stigmatization were found to be linked to gender, age, and quality of life, according to the researchers.

Questionnaire on Skin Complaints was developed by Schmid-Ott and colleagues in 1996, based on the Feelings of Stigmatization Questionnaire ( 28). It was used to identify the various dimensions of stigma in 187 psoriasis patients. – Self-esteem, retreat, rejection, composure, and concealment were identified as five factors. Skin disease patients with psoriasis and other skin disorders could benefit from filling out this survey to gauge their feelings of social stigma. The same research group also evaluated its validity and concluded that it was valid and reliable in evaluating stigma feelings in atopic dermatitis and psoriasis patients (29). After the first use of this questionnaire in 2003, researchers began using a shorter version of it for the first time (30). Cronbach’s alpha of 0.7 indicated that the 23-item short form was more cost-effective and more reliable than the longer version. Rejection, self-esteem issues, and composure were all found to be correlated with factors in the questionnaire based on factor analysis. Patients with psoriasis and atopic dermatitis had a moderately high correlation between the Questionnaire on Experience with Skin Complaints and the DLQI.

The Questionnaire on Experience with Skin Complaints, a dermatology-specific instrument, has also been frequently used to evaluate stigmatization in psoriasis patients. A study published in 2013 by Böhm and colleagues looked at the relationship between disease severity, gender, stigma, and quality of life (31). The stigmatization levels of 381 patients were measured with the Questionnaire on Experience with Skin Complaints. Skin-related quality of life was negatively affected by psoriasis severity, which was found to be associated with greater stigmatization. Both men and women were subjected to the same levels of stigmatization, but the effects on men and women were vastly different. When Bangemann and colleagues adopted the short version of the Questionnaire on Experience with Skin Complaints in 2014, they found that stigmatization was a significant predictor for quality of life (8). In addition, the best predictor of depression and anxiety was one’s overall level of well-being.

Skin disease stigmatization was first measured in 2003 using a Likert scale with the following six items: not attractive because of skin disease, others staring at skin disease, others uncomfortable touching me because of skin disease, others believing that skin disease is contagious, others avoiding me because of skin disease, others occasionally making annoying comments about skin disease (32). In patients with psoriasis and atopic dermatitis, Cronbach’s alpha was over 0.8, indicating good internal consistency for this six-item stigmatization scale. Perceived helplessness was found to be the strongest predictor of stigmatization in both psoriatic and atopic dermatitis patients, according to a study published in the journal Psoriasis. There are two drawbacks to be aware of. It’s possible that self-report measures underestimate the stigmatizing effect of clinical status. Aside from that, psychological factors that may be relevant to long-term skin conditions should be taken into account as well

Damian Sendler

These six-item scales are dermatology specific, and have been commonly used with the Feelings of Stigmatization Questionnaire and the Experience with Skin Complaints Questionnaire, respectively. Stigmatization questionnaires and other assessments, such as the Psoriasis Area and Severity Index (PASI), Acceptance of Illness Scale (AIS), Satisfaction with Life Scale (SWLS), and DLQI, were also used to examine disease severity, quality of life, and feelings of stigmatization (33, 34). Most patients with psoriasis reported feeling stigmatized because of their condition, and face involvement appeared to be the only independent factor that influenced the level of stigmatization (33). In a study of psoriasis patients, akuta and colleagues looked at the links between the location of skin lesions and symptoms of depression, social anxiety, body dysphoria, and a sense of stigma (35). Psoriasis has been linked to poor mental health in a number of areas of the body that have been labeled as “sensitive.” For this study, researchers examined the level of stigmatization of 166 patients with plaque psoriasis, and found a correlation between the level of stigmatization and other variables (36). Males, rural residents, the unmarried, and those with a longer history of illness were all more likely to be stigmatized than females. A study by Kowalewska and colleagues in 2021 will examine how severe psoriasis affects patients’ quality of life and feelings of stigmatization (37). People’s quality of life was determined by their disease severity, and stigmatization levels were strongly correlated with their PASI scores, according to researchers.

Among Indian patients with vitiligo and psoriasis, a cross-sectional study conducted in 2011 examined the stigma they faced (38). Stigma prevents people from participating in social activities, which is a major problem. For this study, researchers used the Participation Scale, which has been successfully used in programs aimed at reducing social stigma and promoting social integration (39). Patients with psoriasis were found to have more limitations in their daily lives, with 28 percent taking part in as little as possible in domestic and social activities and 2.7% having restrictions of the most extreme kind.

Damian Jacob Markiewicz Sendler: Initially used in 2015, the psoriasis Internalized Stigma Scale was applied to patients with the condition (40). As a result of internalized stigma, people tend to internalize negative feelings and beliefs about themselves, which lowers their self-esteem and happiness in life and increases their risk of depression and suicide (41). The Cronbach’s alpha of the Psoriasis Internalized Stigma Scale was found to be 0.89. The Dermatology Quality of Life Index (DQoL) scores were strongly correlated with the Psoriasis Internalized Stigma Scale (r=0.726). Using the Psoriasis Internalized Stigma Scale, a multi-center, cross-sectional study of 1,485 psoriasis patients was able to identify the factors influencing internalized stigma ( 41). There was a strong correlation between disease severity, visible body parts (such as the genital area or folds or joints), poor quality of life, negative views of general health, and psychological illnesses. Researchers from several different institutions compared their findings on the internalized stigma of children with psoriasis (42). Internalized stigma in pediatric patients was linked to a lower quality of life, health, and mental health issues. – Psoriasis itself, rather than disease severity or involvement of visible body parts, genital area, or folds, was the most important factor in the development of internalized stigma in pediatric patients.

Patients with psoriasis who completed the Perceived Stigmatization Questionnaire in 2021 reported higher levels of stigmatization than those who completed the questionnaire at an older age or with less severe disease, as well as more frequent scratching and dysmorphic self-consciousness (43). In a study of burn survivors, Cronbach’s alpha 0.93 confirmed the reliability of the Perceived Stigmatization Questionnaire, which is a 21-item, five-point Likert scale with six categories (never, almost never, sometimes, often, always) (44).

Immune-mediated skin disease psoriasis is a chronic and recurrent disfigurement and disability for patients (1, 45–48). As a result of the lack of public awareness of dermatology, psoriasis patients are often stigmatized in their work and personal lives, which can have a negative impact on their quality of life and even cause mental illnesses such as anxiety and depression. The stigmatization of psoriasis patients has been assessed using a variety of questionnaires over the past few decades (16). Some of the most important findings in the study of psoriasis stigma have come from the use of questionnaires like the Stigmatization Questionnaire, the Questionnaire on Personal Experience with Skin Complaints, and the 6-item Stigmatization Scale.

Damian Jacob Sendler

Sociodemographic variables, disease-related variables, and personality traits were all found to influence the stigmatization level of psoriasis patients. Some studies (27, 49) found a link between gender stigmatization and certain sociodemographic factors, while others found no such link (26, 34). People with psoriasis were more likely to be stigmatized if they had a lower level of education (50), lacked professional knowledge (51), or lived in the countryside (52). The public’s understanding of psoriasis, particularly its non-infectious nature, could help alleviate the disease’s social stigma and increase patients’ acceptance (53). When it comes to disease-related variables, onset age was found to be linked to feelings of stigmatization in patients, and those with an early-onset age were more vulnerable (24, 54, 55). Those with psoriasis in their early adulthood were more likely to suffer from social stigma because they were still establishing their social networks and making contact with a wider range of people (55). Consequently, physicians should pay more attention to patients under the age of 18. Furthermore, some studies found an association between stigmatization and the distribution and severity of skin lesions (12, 31, 35, 50). Stigmatization of patients with skin lesions in the most visible areas was associated with greater social exclusion and a lower quality of life. As a result, when treating psoriasis, the location and severity of the lesions, as well as the patient’s overall health, must be taken into account. Type D personality was also linked to stigmatization, possibly as a result of the suppressed emotions and behaviors brought on by the fear of being rejected (50). As a result, type D personality testing may be required to gauge the level of stigmatization experienced by the patients. Type D personality The proper predictors provided a framework for patients at high risk of stigmatization, promoting screening and intervention procedures for further implementation of tailored evidence-based treatment (50).

Damien Sendler: Psoriasis stigmatization studies involving non-patient populations are now common. Psoriasis awareness in Germany was studied by Sommer and colleagues in 2018. (56). Psoriasis was considered communicable by only 9% of the people polled, and 27% of those polled said they wouldn’t have a personal relationship with someone who had the condition. Psoriasis sufferers were also assessed for prejudice and stigmatization in the general German population by the same group (57). By a wide margin, those afflicted with the condition were seen as disadvantaged and disgusting. Psoriasis sufferers were generally unwelcome in the study, and some participants thought they should “take better care of themselves.” In some cases, biases arose because of factors such as one’s race, gender, or education level. Psoriasis stigma was examined by Pearl and colleagues in 2019 as they compared the attitudes of the general public and medical students to the disease (51). In their surveys, medical students found fewer stigmatizing attitudes than the general public, which suggests that a public education campaign about psoriasis could help reduce the stigmatization of those who suffer from the disease.

For mild psoriasis, topical agents are the best option, while systemic treatments are the best option for moderate to severe cases. According to Nijsten and colleagues in 2005, four traditional systemic treatments for psoriasis were evaluated for patient satisfaction (58). Fewer than 40% of those who tried the four treatments said they were happy with their choices. Dermatologists began to develop new pathogenesis-based therapies, such as various biologics, as a result of a better understanding of pathogenesis. A number of biologics have been shown to be safe and effective in the treatment of psoriasis, particularly in moderate to severe cases (13, 59, 60). It is recommended by the American Academy of Dermatology-Nationwide Plaque PD Foundation guidelines that biologics should be used as a first-line treatment for moderate to severe plaque PD. As a result of biologics’ introduction, patients’ adherence to treatment and satisfaction with treatment increased, and their quality of life improved (62). As reported by Tennvall and colleagues in 2013, patients who received biological treatment for at least 12 months had the highest satisfaction and lowest DLQI scores compared to those who received topical treatment and those who received both systemic and/or biological treatment (62). In 2015, Schaarschmidt and coworkers evaluated how satisfied patients were with four different treatment approaches (63). Participants who received biologics reported the highest levels of satisfaction on the Treatment Satisfaction Questionnaire for Medication, with ustekinumab receiving the highest score. In 2018, Ichiyama and colleagues found that treatment satisfaction was correlated with disease severity and quality of life impairment (61). Biologics improved the skin condition and quality of life of patients, whereas non-biologics did not, according to the results of the study. In patients with psoriasis, the use of biologics is likely to reduce the level of stigma they feel as a result of their disease’s severity, stigma, and impact on their quality of life (31). Biologics’ impact on psoriasis patients’ self-perception is an area that will require additional investigation in the future.

The stigmatization of psoriasis should be addressed, and patients should receive the psychological and social support they need. A subset of psoriasis patients was studied to see if stress had any effect on their disease’s onset or progression (64). The physical and psychological aspects of psoriasis management must be taken into consideration. In addition to medication, psoriasis treatment includes relaxation techniques, cognitive-behavioral therapy, and support groups for sufferers of the condition (65). To combat psoriasis patients’ social stigma, dermatologists and psychiatric specialists should work together. For visible chronic skin diseases, Germen has implemented a “Destigmatization” program based on the WHA resolution (66). In regions where psoriasis is prevalent and stigmatized, such activities are of great importance and require the cooperation of policymakers, dermatologists, psychologists, psychiatrists, researchers, and patients (67).

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: There are many ways to think about the self, and each of these ways has a distinct impact on how we perceive ourselves and the world around us. Given that there are many “selves,” the current review suggests that seven fundamental self-processes can be identified to help us better understand the experience of having dementia. The embodied self is one that is manifest as physical awareness; the agentic self is one that is linked to acting as an agent and influencing life circumstances; the implicit self is one that is linked to non-conscious self-processing; the critical self is one that defines the core of self-identity; the surrogate self is one that is based on third-person perspective information; and the extended self is one that includes external objects or existences that are incorporated into the self. These are discussed in terms of self-awareness and how they can be used to understand the experience of dementia.

Damian Jacob Sendler: We can all grasp the idea of a “self,” despite the fact that it’s a difficult one to pin down. A first-person point of view is the lens through which most of us see the world on a daily basis. According to William James’s philosophy of mind and other works, we can only understand ourselves in relation to the person who is experiencing our thoughts and feelings. (1) This is a common philosophical approach to understanding the self (1, 2). First-person ontology is defined as a fundamental property of consciousness by Searle (1). Phenomenologically speaking, our first-person experiences attest to the existence of a subterranean construct, the self, which shapes our perception of the world.

Dr. Sendler: neurological and psychiatric conditions alter our perception of ourselves, providing further evidence for this property of our minds. Many different neural processes are implicated in the wide range of self-changes observed, and these have been found to be associated with specific brain regions, as evidenced by the variety and variety of these changes. It’s critical to remember that when we talk about “the self,” we’re talking about processes rather than something physical in our heads. This avoids the homunculus fallacy of reifying the concept (3). As will be shown in the following sections, these self-processes can be applied to a wide range of situations. An important point to note is that there is no infinite regress or circularity.

As a result, one’s self-perception is likely to be the result of a complex interplay of self-processes. Self-related abilities, such as bodily awareness, agency, and autobiographical memory, are the result of different brain networks in interaction with the environment, including interpersonal values and cultural norms (4). These various self-processes may have a hierarchical relationship, with some establishing themselves earlier and providing the framework for more advanced processes, according to some researchers (5). Certain aspects of the self are at the top of this nested hierarchy approach, responding to the essential processes that allow the emergence of more complex self phenomena (5).

Dementia research that focuses on the “self” has many important ramifications. Relatives and caregivers may find it difficult to see beyond dementia as a diagnosis and disease state because of its neurodegenerative nature. As a result, the term “malignant social psychology” has been coined to describe caregiving practices that diminish the personhood of dementia patients (6). People with dementia (PwD) are weakened and stigmatized by institutional and individual practices that have depersonalizing elements, and this could lead to an overabundance of disability (7).

Humanizing care practices by examining the impact of dementia on self-processes, relying on retained abilities, and fostering a sense of personhood in those with the condition may be possible with this research. Dementia-related impairments must be taken into account in order for this to work effectively. We can only provide better care for people with dementia and their families if we can identify which aspects of their personality are more adaptable to change and which are more vulnerable.

In light of this, the purpose of this article is to discuss how dementia can affect one’s ability to engage in self-processing. There will be a focus on seven distinct types of self-expression: embodied, agentic, critical, implicit, surrogate, extended, and emergent. Each of these will be examined in depth. A final concept, “the emergent self,” was created to fill in the missing notion that the various aspects interact to form emergent properties, the sum of which is greater than the sum of its parts; this was accomplished by selecting these seven aspects as the main constructs that explain totality of the self and that have been considered individually in relation to PwD. Using both a cognitive neuroscience and a social psychology/ethnographic approach, these aspects of the self will be examined. In the conclusion, future research directions and clinical implications are discussed.

A growing body of research suggests that our physical selves are fundamentally shaped by our physical selves (5). Rather than being part of the physical world, the body is seen as a vehicle that allows us to exist as a distinct individual in this world (8–10). In some studies, bodily capacities, such as multisensory integration, interoception, and agency (12–14), emerge as a unified experience of the body through perception and action. Studies have shown that the temporoparietal junction and the extrastriate body area are neural correlates of the embodied self, taking into account the various aspects of the embodied self (15, 16). Somatosensory representations are linked to visual and proprioceptive information by Piras et al. (17) in a resting-state functional connectivity study, which may influence individual self-attribution (17). Other kinds of selves, such as those that require higher levels of brain function, are said to be built on top of the grounded self (5, 18). Some cognitive abilities may be structured or preserved in the context of dementia because of the bodily processes that take place in the body (19).

The persistence of the self in PwD, despite cognitive decline, has been demonstrated by numerous studies. For instance, Kontos (20) demonstrates in an ethnographic study that people with severe dementia may retain aspects of their own selves. These findings may be explained by the idea that human existence is grounded ontologically on implicit processes (21), with the embodied self existing prior to cognitive forms of knowledge and not having to emerge from them as previously suggested (20). Such processes are more resistant to neurodegeneration because they are structured by interaction with the body’s control mechanisms.. Actions such as dancing, caring, and gestural communication can show this embodied dimension through the interplay between corporeal (i.e. physical movement) and social characteristics of the body (“social and personal meaning” associated with movement) [(20, 21); see also (22) for a summary].

When we communicate, our facial expressions, gaze, body movements, intonation and tone of voice are all examples of our embodied self’s natural expression of the body (8). When discussing dementia, gestures are an important topic because they offer a different perspective on how people with dementia (PwD) communicate. PwD who have lost their ability to communicate verbally are still able to communicate non-verbally through eye gaze, facial expressions, and movement (23, 24). Although PwD have shown impairments in facial expression recognition, several studies have suggested that facial reactivity to emotional stimuli, such as films (25), computer tasks (26), and faces, has been preserved, albeit attenuated, in PwD. (27). In these studies, participants’ responses were consistent with the emotional stimuli, suggesting that even in the most severe stages of the condition, bodily processes remain intact. Similarly, across the spectrum of dementia severity, facial expressions have been shown to be responsive to pain stimuli (28).

Artistry and creativity by drawing is another example of embodied self, which is often maintained in dementia. Even in the later stages of Alzheimer’s disease (AD), there have been reports of people with severe cognitive impairments who, despite their condition, are still able to draw (29, 30). Because it represents the expressiveness of the body despite or beyond cognition, the longer-lasting persistence of creativity is linked to one’s “embodied self.” Furthermore, the body is able to learn and transform its perceptions into meaningful and symbolic forms (31).

PwD’s appearance is a major consideration when examining the embodied self (20). Dementia sufferers may benefit from keeping their hair, clothing and cosmetics in line with their gender identity as a form of emotional support (32–34). According to Gove (35), stigmatization occurs when PwD appearance is deemed insufficient in certain social settings. PwD may become alienated from their appearance due to the loss of self-care autonomy in later stages of dementia, with family members or caregivers taking on these responsibilities and adopting their own ways or institutional norms to carry out these tasks (35). As a result of this, some authors have suggested that the process used to care for PwD appearance is more important than the final outcome in terms of shaping the self at this level (36, 37).

Interoceptive processing (i.e., awareness of visceral states) is impaired in dementia, but the embodied self is shown to be preserved. Remaining-state functional connectivity alterations in specific hubs of the brain’s frontotemporal-insular network (FTI) were found in people with Alzheimer’s disease (PwAD) and behavioral-variant FTD (bvFTD), which were associated with impairments in different interoceptive dimensions (accuracy, learning, and awareness). Using stethoscope feedback, both patient groups showed a decrease in interoceptive awareness and an overestimation of their ability to detect interoceptive changes (interoceptive learning). The AD group was found to have a distinct deficit in this type of learning, which may be linked to memory issues. Other interoceptive disturbances, such as altered pain and temperature processing, were also reported in bvFTD, with both hyper- and hypo-responsiveness observed (39). Gray matter volume changes in the right mid and posterior insula were found to be connected to these alterations (39, 40). It has been found that healthy people have similar neural correlates of interoceptive awareness. This includes the insular cortex.

“Sense of agency” refers to the sensation of being able to direct one’s own actions and thus have an impact on the course of external events (43). To understand this phenomenon, we must look at the subjective experience of a voluntary action, including the intention to act, decision-making about possible actions, and the actual act-starting itself (44, 45). Volition is a term that refers to experiences connected to a sense of ownership that occur concurrently with the activity of peripheral somatosensory receptors while the body is in motion. This is another aspect of the agency concept (43). Lastly, one’s sense of agency includes a connection between one’s subjective experience of one’s own actions and observed changes in the external world as a result of the one’s actions.

For example, the feedforward intentional model by Heilman, Barrett and Adair (46), in which signals relating to intention to act are compared with kinesthetic action signals, regulates awareness of bodily action, and also provides the sense of agency for those suffering from anosognosia, which is an awareness of deficit. There are still many unanswered questions about the neural correlates of the sense of agency, but evidence suggests that agency may rely on the connectivity between frontal and prefrontal motor areas involved in movement initiation and the parietal cortex, which supports the monitoring of perceptual events. Neuroimaging studies have also shed light on the importance of resting-state activity in regions that prepare visual and motor information for integration. There is a general consensus that the brain’s resting activity in action-related perceptual and motor circuits must interact in order for the person to feel in command (17).

To put it another way, the concept of agency in social psychology refers to people actively participating in their own self-awareness as it evolves and changes over time. In Bandura’s (49) account of human agency, there are three fundamental aspects: (1) forethought, which is about adapting self-interest to past experiences and providing direction, coherence and meaning to one’s life; (2) self-reactiveness, which is about self-regulation and motivation of actions during the execution of a plan; and (3) self-reflectiveness, which is about the role of people not only as agents of actions but also as observers of their own actions and their own thoughts.

Many cognitive abilities, including language, deliberation, and purposeful action, are directly linked to the concept of agency, which is typically studied by focusing on decision-making and self-reflection capacities (49, 50). Schacter’s (51) dissociable interactions and conscious experience model, for example, holds that consciousness mediates the interaction between fundamental cognitive abilities. People with Parkinson’s disease (PwD) may have a reduced sense of agency due to a deficiency in decision making and self-reflection, according to the literature (52). The experiences of agency in people with cognitive difficulties may necessitate a broader definition of agency. The phenomenological perspective of models like Kontos (53), based on the understanding of agency in PwD as originating primarily from bodily information, action, and goal-directed behavior, respond to this demand (44, 45). Recognizing the social-emotional and cognitive foundations of reflexivity would enable the recognition of agency in PwD even at the most severe stages of the condition (54, 55). This is supported by current research. A recent study by Boyle (56) found that people with mild and moderate dementia were able to demonstrate a sense of agency through behavioral and emotional responses despite their limited decision-making capacity (56).

The literature also discusses the possibility of a link between agency and autonomy (57). Dementia patients have few options in their daily lives to practice and maintain a sense of agency and autonomy because of their decision-making impairments. Decision making, shared decision making, and pseudo decision making were all described in a systematic review by Bosco et al. (57) that examined the experience of agency in people with disabilities. A person with a disability’s ability to make decisions is affected by each of these pathways in a different way (57).

There have been a few studies that have looked at the impact of dementia on human agency. Some studies have examined whether people with severe dementia show emotional reflexivity in their interpersonal relationships, such as Boyle and Warren’s (55). (i.e., PwD and their spouses). Even though PwD’s abilities for deliberation, discourse, and social interaction were limited, they were able to demonstrate emotional reflexive abilities that were necessary for them to exercise agency in their daily lives, according to the researchers. As a result, it’s possible that people with disabilities communicate their thoughts and feelings through mechanisms other than verbal language (55). The strategies used by caregivers to promote and maintain PwDs’ autonomy and agency were also highlighted by Chung et al., reinforcing the significance of social factors for agency in this population (58).

For this reason and others, the findings emphasize the importance of assisting people with dementia (PwD) to practice and maintain a sense of agency, which is closely associated with their sense of self (59). By allowing patients to take part in meaningful activities, these practices give them a sense of agency, commitment, purpose, and community (60). There is evidence that lack of support can cause behavioral and psychological symptoms such as restlessness, wandering, depression and agitation if it is not provided (58).

According to Damasio, our sense of self is based in part on information that is stored in implicit states (18). Researchers have found that people have knowledge of themselves that isn’t accessible to them directly (e.g., unrecognized thoughts and feelings) but can be accessed indirectly (61). Clinical and experimental evidence shows that in a variety of neurological conditions, behavioral and emotional responses can be influenced by implicit information processing [for a review, see (62)]. Self-representations, preferences and attitudes that are implicit in nature are considered to be implicit in this context of the implicit self Implicit self-awareness has yet to be explained in the literature, but studies on neurological patients suggest that implicit processing involves more subcortical regions, such as the basal ganglia and the amygdala, than explicit processing. This supports more cortical regions (63, 64). Following these neural findings, authors suggested the existence of parallel routes, implicit and explicit cognitive mechanisms, for processing similar information (62, 65, 66).

A condition known as anosognosia, a neurological term for the inability of people with disabilities to recognize their own physical and mental changes, is common among people with diabetes (67). Self-report and clinician/informant opinion or task performance are frequently used to contrast awareness in people with disabilities (PwD) (68). PwD have been shown to be able to change their behavior and activities in response to their illness experience even when they are explicitly unaware (69, 70), and this has been incorporated into models of self-awareness (71). According to the cognitive awareness model (CAM; (71–73)), for example, implicit information about ability can be processed in a parallel manner (see also Piras et al. (74) for an extension of this model and an investigation into self-awareness in people with mild cognitive impairment). A clinical observation led to the development of this idea, which suggests that despite being unaware, there may be nonverbal signs of understanding or representation of difficulties (62). One way this can happen is through jokes, symbolic references to dementia-related disabilities that aren’t acknowledged, or compliance with treatment and caregiving practices even if such care isn’t deemed necessary to the person because of ignorance (62).

Other research into the emotional reactivity and behavioral changes in dementia supports the idea that these processes are linked to the implicit self.. It’s been found that people with dementia have an increased level of emotional reactivity when exposed to material about the disease. Dementia-related words were included in Martyr et al. (75)’s modified form of the Stroop test, with a bias toward such words indicated by slower responding. Response times to salient words were faster in PwD and their caregivers than they were to neutral words. Patients’ awareness of their condition had no effect on this effect (75). Emotional interference operates at an automatic unconscious level, and awareness may be retained at an implicit level, based on these findings.

Using emotional reactivity to film material in mild Alzheimer’s disease (AD), researchers have found further evidence of an implicit self in dementia (25). Film clips about dementia and cancer were shown in the negative material, as were neutral and positive ones. PwAD’s reactivity was consistent with the stimuli’s valence despite its reduced responses. Patients with reduced awareness exhibited a higher frequency of negative facial expressions, which is critical. Implicit self-processes, such as “leakage” of involuntary expressions or “reactivity” that bypasses voluntary control, were interpreted as a representation of implicit self-processes (25). In PwAD, emotional reactivity to failure in tasks has also been observed, despite reduced awareness (26).

Damian Jacob Markiewicz Sendler: Observational and experimental studies have yielded evidence of behavioral adaptation. Adaptations such as relying on co-pilots (77) and avoiding driving in unfamiliar environments (77) have been observed in PwAD (76), with self-imposed driving restrictions (78). Researchers studying metacognition found that even though they couldn’t accurately predict performance, PwAD still allocated their study time appropriately (decreasing the amount of time spent on repeated materials), according to Moulin, Perfect, and Jones (79). Effective use of study time suggests some strategic, albeit unnoticed, processing has taken place. According to Geurten et al. (80), despite the fact that PwAD suffers from impairments in explicit metacognition, implicit introspection may be preserved. However, despite a lack of explicit acknowledgement of poor performance, PwAD asked for cues more frequently after incorrect than after correct responses, at levels comparable to controls (80). As a result, tasks are more frequently terminated after a series of errors, suggesting that PwAD persistence in tasks is influenced by current performance (81).

In sum, these findings point to implicit processing of affect, preferences, and knowledge of one’s own self. Long-term implicit affective preference and behavioral change can be observed to what extent is still unclear. Despite the loss of declarative memory for the events that elicited the emotional response, some studies suggest that emotional responses persist in PwAD. In response to films (82), as well as music (83), this has been observed (83). A study by Bomilcar et al. investigated long-term task preferences by having participants perform tests that they’d previously completed either successfully or unsuccessfully a week prior (81). When the first session’s performance was included in statistical models, the second session’s task preference was only observed, suggesting that initial moments of awareness may boost long-term adaptation even if the content is no longer explicitly available.

Autobiographical memory is a critical component of our sense of self, as it is the explicit records of information we have about ourselves. When someone asks us who we are, we frequently turn to our own past experiences for an answer. It’s possible that memory is responsible for the self’s ability to maintain its identity. As such, it is not surprising to learn that a number of theories have emphasized its role in maintaining one’s sense of self. Locke’s original philosophical structure suggests a reciprocal relationship between long-term memory and the self, with memory constraining the self’s structure and the self’s self-modulating encoding and retrieval of long-term memory (84). (85). To better understand the fundamental forms of the self, Damasio proposes an autobiographical self, which is comprised of both past and future thoughts about one’s life (18, 86). Rather, the memory records themselves provide a sense of one’s own autobiographical self, which eliminates the need for any further reification and thus prevents an endless loop from forming.

Damian Sendler

Anosognosia comes in a variety of forms, with primary, executive, and mnemonic anosognosia all being included in the Cognitive Awareness Model (CAM) (71–73). Mnemonic anosognosia may be the most common form of inadvertence in Alzheimer’s disease (AD). As part of the model, a personal data base (PDB) is created to store and update personal information. Normally, experience updates the PDB, but in PwAD, memory impairments prevent this. The concept of a “petrified self” has been proposed when looking at the relationship between the self and memory from the perspective of memory changes and the loss of self-awareness in dementia (4, 87). The term “loss of self-awareness” was coined as a metaphor to describe two key aspects of Alzheimer’s disease (AD) memory loss. Due to the damage to medial temporal lobe structures and anterograde amnesia, the updating of self-concepts would be limited, with PwD incorporating only a limited amount of new information about themselves. Secondly, a core identity in PwD would be supported by long-established autobiographical information, particularly semantic memory, which has been consolidated and has become hippocampal independent. That’s why we came up with the metaphor, which was meant to capture a PwD’s sense of self based on personal history, but one that was less able to adapt to new autobiographical information.

We’ll be looking at the second part of that statement, which refers to a core of self-identity that was formed prior to the onset of the disease and serves as a foundation for one’s self-concept even when memory is impaired. Autobiographical information, including recent and distant memories, is retrieved via a diffuse network of brain regions, including the hippocampus, medial prefrontal and parietal cortexes, as well as other parts of the brain (88, 89). An analogy with the concept of developmental apex points is used to describe this critical self. Consistent across cultures, it has been found that autobiographical memory has a recency effect (a better recall of recent information, as observed in other memory processes) (85). There is also a “reminiscence bump,” which is characterized by higher recall of autobiographical memories from adolescence and early adulthood. Neurobiological and social explanations have been offered for this phenomenon, stressing an early critical phase of the self’s development around early adulthood, which draws on memories from this time period (91, 92). These two levels of explanation are likely to interact.

A temporal gradient for episodic and semantic autobiographical memory has been observed in AD, with better recall of distant vs. recent material (93–96). Some studies have found no differences in memory retrieval across life stages in AD [e.g., Irish and colleagues (97)]. According to Barnabe and colleagues, the method used to solicit memories may have an important impact when there is reminiscence bump (98), with the autobiographical interview (99) leading to lower temporal gradients due to memory allocations across more life periods.

Damien Sendler: Semantic dementia appears to reverse the pattern of autobiographical memory, with better recall of recent as opposed to distant memories (100). This reveals the different neural substrates for memories depending on the degree of their consolidation. An extensive review by Lenzoni and colleagues (87) suggests that episodic memory relies on the hippocampus to be impaired early in AD and to show a steeper gradient than semantic memory, which is only affected in later stages of the condition. Personal semantics, the cognitive store of personal information, appears to be the foundation of the critical self in AD. As a result, childhood and adolescent memories play a significant role in shaping the identity of people living with dementia (PwAD) (100).

In recent studies, the AD patient’s critical self has been examined. People with mild Alzheimer’s disease (AD) rely more on their autobiographical memory than healthy controls to maintain their sense of self continuity when concerned about potential threats to continuity, as demonstrated by El Haj et al (101). People with dementia (PwD) who have a sense of subjective continuity are more likely to have poorer mental health than those who don’t (102). Tippett and colleagues point out that despite deficits in episodic memory (which support phenomenological continuity), self-continuity can be preserved in AD by using semantic memory to construct life narratives (semantic continuity) (103). Better semantic continuity, according to their findings, may be particularly relevant for explanations of self-continuity, while self-persistence confidence may be linked to more general and simplistic continuity explanations (103).

According to extended cognition, human minds and cognitive systems are built on the interaction of embodied agents with the environment. This theory contends that the environment plays a significant role in driving cognition, which is broadly defined to include processes that extend beyond the brain (127). Material vehicles of cognition such as numbers, words and symbols are used to represent environmental processes in this context (128, 129). Media such as photos and films, multi-sensory environments, and evocative objects are all examples of extended cognition that help people remember their past. This includes the PwD’s home environment, where familiarity with objects and architecture may provide support for action, for example.

An extended self can be deduced from this perspective by looking at the relationship between external objects and oneself. McClelland emphasizes agency and sense of control for the incorporation of objects into the self, whereas James suggests that we consider external objects as part of ourselves if they are able to induce affective states (2). (133). Rather than focusing on objects as mere extensions of the self, Belk proposes that they may define one’s sense of identity (134). Individual (e.g., jewelry, car, make-up, and clothing) and family (e.g., home and furnishings) are the first two levels of the extended self, while community (e.g., neighborhood) is the third level (134).

Damian Jacob Sendler

Heersmink (135, 136) argues that the extended self is linked to the autobiographical memory in this sense. To create a narrative self, it is necessary to remember personal memories, and the environment, including objects and people, aids this process. Consequently, we can speculate that the extended self may support and interact with the medial prefrontal and parietal cortices as well as the hippocampus (88, 89).

For people with Parkinson’s disease (PwD), the concept of extended cognition may be particularly relevant. In a classic thought experiment, Clark and Chalmers describe Otto, a man with Alzheimer’s disease, using a notebook as a memory system (128). A person without memory impairments can have access to memories “stored” in a properly functioning semantic memory system and use them to guide their actions, and Otto has this access through his notebook. As an integral part of Otto’s overall memory system, Otto’s notebook serves as both a physical object and an active agent in his thoughts (128, 129).

According to a number of studies, the use of assistive technology can improve memory and other cognitive abilities in people with disabilities (137), as well as summarize results in relation to electronic devices (138). Studies have shown that even in the most severe cases of dementia [e.g., (139)], improvements in various abilities can be seen, but it has been suggested that the focus of the studies should be broadened. A lesser emphasis is placed on enhancing quality of life, addressing behavioral issues, fostering social interaction, and engaging in recreational activities when it comes to most electronic devices (138, 139). Assistive technologies are advocated for PwD in order to promote social interaction and decision-making, both of which have a significant impact on a person’s sense of self in dementia (140).

PwD’s sense of self was examined in depth by Crete-Nishihata et al (130). PwD and mild cognitive impairment (MCI) were used in this study to examine the effects of personal memory technologies (such as multimedia biographies, photos, and home movies). It was found that these external aids facilitated the recall of personal memories. Participants’ self-esteem and apathy were both raised and decreased as a result of the interventions that used external sources as memory triggers (130).

The literature on awareness of cognitive changes provides additional evidence of extended self-processes in dementia. Cross-cultural studies have explored the role of values and contextual factors in self-appraisal of ability, tapping into community and group levels of the extended self (134). People with dementia (PwD) in India are less aware of their memory issues than their relatives, according to a study by Mograbi et al. (141). (142). According to previous studies, dementia and its symptoms in this region are less commonly understood as a health problem, and are more likely to be viewed as a normal part of aging by people with dementia (PwD) and their caregivers (143, 144). This supports the idea that people’s self-reflection, which can be considered an extension of their self, is influenced by the meaning they assign to aging based on external sources (such as culture).

PwD clinical management could benefit greatly from the framework and model proposed in this article, which also points to promising directions for future research. PwD can be better understood in terms of its representation and experience if we consider the role of the body and embodied practices in PwD. A new perspective on caregiving and services can be gained by understanding the continuity of the self in dementia through bodily embodiment. In this view, even in cases of impaired verbal ability (146) and cognitive decline (20, 147–149), the body is seen as capable of experiencing and communicating desires. Every dementia patient is an individual who expresses themselves through and through their body, and the embodied self concept affirms the need for person-centered perspectives that support personhood in this disease (6).

As a result of excessive focus on self-reflectiveness, the notion of diminished agency in PwD may have led to important implications in care for the condition, including in how clinical decision making is allowed and supported… Enhancing PwD’s ability to express their preferences, act, and take responsibility can be achieved in part by helping them develop a stronger sense of agency. To emphasize the importance of caregiver training in assisted autonomy, which enables them to recognize the various stages of dementia and accurately recognize the functional level of PwD (57). Family members will be given formal training in support of PwD activity engagement at home (58). Other methods of assessing the sense of agency in dementia, such as those that engage with individual intersubjectivity directly and explore personal meanings, should be investigated in future research (58).

The concept of a “implicit self” has an effect on how dementia patients are assessed and treated. Implicit processes may be more complex than previously thought, indicating the need to consider this dimension in our interactions with people with disabilities (62). Complex stimuli such as social judgments and decision-making may be affected by PwD’s implicit awareness according to this perspective. If you look at it from the point of view of clinical assessment, this shows how tailoring it can help prevent overly negative emotional reactions or exposure to potentially traumatic experiences. Patients with dementia may benefit from rehabilitative paradigms that rely on their implicit abilities (150). PwD’s implicit preferences, knowledge, and nonverbal behavior are critical in both situations. Testing the effectiveness of new care paradigms and better understanding long-term behavioral changes in dementia are research priorities.

It has been found that core aspects of identity are maintained, which may help to maintain selfhood in dementia, while also pointing to possible interventions that could be implemented. In the case of reminiscence therapy, for example, the past history of a person is taken into consideration. A delicate balancing act between the need for PwD to learn new information and associations and the desire to keep them safe must be done (151). Neuroimaging studies may help predict which individual profiles may have difficulties with declarative aspects of identity through further research into memory consolidation, which may reveal which elements gain hippocampal independence sooner. Consider how autobiographical memory interacts with other self-processes in dementia, such as implicit preferences (like music) and motor habits embodied in procedural memories (e.g., dancing).

Patients with dementia can benefit from the presence of surrogate self-processes. A third-person perspective on one’s own information can be used to foster self-awareness and improve clinical outcomes, for example If interventions are sensitively implemented, they may have important clinical consequences, such as reducing risk-taking and treatment compliance, as well as increasing caregiver stress and burden (152–155). In addition, the preservation of general semantic knowledge could be used to support treatment decisions. Using vignettes in clinical settings, for example, can be expanded to provide additional information and aid in decision making. An in-depth examination of the ways in which perspective-taking and related abilities, like theory of mind and empathy, are impacted by PwD is necessary before these tools can be developed.

Researchers should look into how dementia patients process external stimuli as part of their internal processing. By using multimedia tools (130) and environmental stimuli (131), empirical studies found that external objects can improve memory retrieval in people with Parkinson’s disease (PwD) (131). Future studies should investigate the impact of external aids on selfhood, even though extended cognition theories are routinely used in neuropsychological rehabilitation, for example, compensatory strategies. Dementia patients’ external sources of self-identification should also be considered, to avoid unnecessary losses that could weaken their self-identity (e.g., moving from their own home to a nursing home) (129, 135). Other factors that may have an effect on a person’s sense of personhood in dementia, such as social connectedness and agency, should be included in current research, as previously mentioned (137, 138, 140). Programs aimed at raising public awareness about dementia are especially important in light of the increased importance of the extended self and its ties to social networks.

Finally, the concept of a “emergent self” emphasizes the importance of helping people with disabilities maintain their sense of self by promoting compensation and continuity. There must be room for multiple expressions of self, whether bodily, agentic, implicit or identity-based, and compensation for losses must be sought through surrogate and extended processes. Dementia’s seven forms of self are, of course, not what is being discussed here. We, on the other hand, emphasize the fact that these processes are fueled by a variety of sources for each individual with dementia. The uniqueness of each individual emerges from the combination of these multiple selves and others beyond, making it easier to take a person-centered approach.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler: An entirely new coronavirus has been discovered and efforts have been made to develop vaccines for it. Many factors play a role in people’s willingness to receive vaccinations. As a result, the focus of our review was on vaccine hesitancy in the context of the COVID-19 pandemic, specifically in relation to the COVID-19 vaccine.

Damian Jacob Sendler: Vaccine hesitancy, according to the WHO, is a behavior influenced by a variety of factors, including lack of trust in the vaccine or the provider, laziness, and a lack of value for the vaccine (access). Those who are hesitant to get vaccinated come in all shapes and sizes, and there is no one size fits all when it comes to vaccines. All vaccines may be accepted by those who are hesitant about vaccines, while others may refuse or delay some vaccines but accept others.1

Dr. Sendler: Wuhan, China’s seafood wholesale market was linked to a cluster of patients who developed pneumonia in December 2019. By sequencing the entire genome of patient samples, a new coronavirus was discovered. 2 An international committee on the taxonomy of viruses dubbed it SARS-CoV-2, and the disease caused by it was dubbed coronavirus disease 2019 (COVID-19) by the World Health Organization.

After infecting and killing thousands of people in China, the virus has spread to Italy, other European countries, and the United States, with the number of confirmed new cases increasing daily. Since the disease was highly contagious and easily spread, the World Health Organization declared it a pandemic.

Much effort has gone into developing vaccines against COVID-19 in order to stave off a pandemic, and the majority of vaccine candidates are based on vaccine candidates using the S-protein from SARS-CoV-2,5.

Three vaccines have been approved and are currently recommended for the prevention of COVID-19. The United States is also conducting or planning large-scale clinical trials (phase 3) for other COVID-19 vaccines. Nos. 6 and 7

Health care workers, as well as the general population, must be vaccinated to prevent the spread of new infections.

Other studies have shown that vaccine trials for HPV and HIV vaccines in Europe and the United States have a significant impact on the willingness of people to get vaccinated.

Public trust in public health authorities, science, and medicine may vary widely from country to country, depending on the severity of the health and socioeconomic consequences of the COVID-19 crisis and the intensity of controversies.

Concerns about vaccine safety and efficacy, as well as a large segment of the population who refuses vaccinations, have contributed to many Americans’ unwillingness to be vaccinated against COVID-19.12.

Some 25% of people in five surveys in France (representative samples of 1000 adults) stated they would refuse a future vaccine against it if it were available, mainly due to safety concerns around an emergency vaccine developed in an emergency situation.

In order to better understand vaccine hesitancy during the COVID-19 pandemic and specifically vaccine hesitancy toward the COVID-19 vaccine, we conducted a narrative review.

Just 86.1 percent of participants in an Italian study (Barello et al.) chose to be vaccinated against COVID-19, which was the highest percentage of vaccine acceptance. According to Detoc et al., only 77.6 percent of the general population stated that they would accept the COVID-19 vaccine if given the opportunity. Despite the fact that each study was conducted at a different time period, the percentages remained fairly consistent.

Damian Sendler

There is a similar situation with influenza vaccine: the highest acceptance rate was reported by Grech et al. (69 percent), but only 54.3 percent of parents were favorable to vaccinate their children and 58.3 percent intended to vaccinate themselves in the only study that exclusively focused on influenza vaccine (Goldman et al.).

The review’s point-to-point analysis of factors influencing acceptance or rejection is one of its most intriguing aspects. As Williams et al. reported, despite extensive investigation into the reasons why parents choose to delay or refuse vaccinations for their children, the reasons for vaccine delay or refusal may change over time. 30

According to our findings, there was a lower acceptance rate for people of African descent. According to another study, African Americans were more skeptical and concerned about the flu vaccine than their white counterparts. 31

However, Pogue et al. found that income had no effect on attitudes toward vaccination, despite our findings. In addition, the acceptance rate was lower among participants with lower levels of education (except for the study conducted in Turkey by Salali et al.). While Danis et alstudy .’s found a correlation between vaccine hesitancy and economic hardship, no correlation was found between this correlation and vaccine refusal. Parents who were less educated than their children were more likely to refuse all vaccines, but hesitancy did not appear to be related to parental education. 32

It was not statistically significant that caregivers from households in the third or fourth quintiles were more likely than those in the other quintiles to fully immunize their children in another survey.

Damian Jacob Markiewicz Sendler: A higher level of education was found to be a protective factor against vaccine reluctance. Other studies, on the other hand, did not agree on this correlation, with some being in agreement,34, 35 or showing no significant association. 37 Select sources of information can be used by parents with higher education backgrounds who are more critical thinkers and more engaged in their children’s education. 38

We found that religiosity had a negative correlation with the vaccination of COVID-19. In other studies, it was found that some people refused vaccinations because of their religious beliefs, such as the belief that God doesn’t take medicine or that vaccines are associated with Satanism. 39

People who identified as Democrats were significantly more likely to choose vaccination over those who identified as Republicans or Libertarians, while those who did not vote or did not identify with any political party were significantly more likely to reject vaccination. In addition, those who voted for candidates from the extreme left or right of the political spectrum were significantly more likely to refuse vaccination. Previously, Kennedy et al. observed that the support for populist parties could be used as a proxy for vaccine hesitancy, at least in the Western European context, and an increase in support was a signal for public health actors to be vigilant.

Damian Jacob Sendler

Female applicants had a lower acceptance rate than male applicants in our survey. Women are more likely than men to express concerns about vaccine safety and lack confidence in the accuracy and objectivity of medical information, as evidenced by other studies. 41

As a result of our investigation, we discovered three seemingly unrelated phenomena: 1) lower vaccination willingness was associated with younger age (2) those who were highly concerned about infection were less likely to refuse vaccination (3) there was no difference observed between those who had been infected and those who had not been infected. People with low risk perception are more likely to engage in risky behaviors or reduce their efforts to prevent them, so it’s important to keep this in mind. 42 COVID-19 can spread more easily in young people (such as college students, as reported by Ding et al.) because they tend to be healthy and have mild symptoms after being infected with COVID-19. 43 According to Ding et al., it’s possible that college students may refuse vaccinations due to a lack of risk perception, so health education in various ways should be implemented in an effort to improve the risk perception of college students. 43

Contrary to popular belief, healthcare workers are more likely to accept vaccines than non-healthcare workers or students. However, studies by Dror et al. found no differences in vaccine acceptance between healthcare workers and non-healthcare workers. According to the European Centre for Disease Control, healthcare workers have expressed concerns about the risks of vaccination and a lack of trust in the health authorities, which have been extensively studied. Even some doctors and nurses were opposed to vaccination. 44

As a result of these factors, vaccine refusal was more common than vaccination acceptance. The most common reasons given for vaccine refusal were: general antipathy to vaccines, concerns about safety/thinking that a vaccine produced hastily is too dangerous, deeming the vaccine useless due to COVID-19’s harmless nature, lack of trust in general, uncertainty about vaccine effectiveness, conviction that one is already immunized, uncertainty about vaccine provenance.

Damien Sendler: There is a strong correlation between these findings and findings from other studies. People’s fear of being injected incorrectly or getting infected, as well as their fear of pain, have all been documented by Pugliese-Garcia et al in a survey they conducted. 39 In many cases, vaccine efficacy was based on misinformation about how, for whom, and how long vaccines were effective. Vaccines were viewed as a preventative measure, rather than a treatment for a specific disease, by those surveyed. 39 The most common reason for vaccine refusal, according to Alabbad et al, was the belief that vaccines had no positive effect and were unnecessary. 28

Parents and medical professionals surveyed by Krishnamoorthy et al. reported that social media rumors about the vaccine’s safety were the primary source of their concerns. However, they didn’t verify the authenticity of the message before sending it out to friends, family, and other members of the local community. However, the use of multiple media channels to spread awareness has helped to overcome these obstacles. 45

Even in some studies, some participants preferred informal, traditional, and religious methods of preventing and curing disease. In addition to beer, spirits, and local alcoholic beverages like Tujilijili, Junta, and Kachasu, some young men also drank herbs, herbal teas, and tattoed themselves, according to the participants.

Even in the midst of the COVID-19 pandemic, vaccine hesitancy persists, and the reasons for vaccine refusals are numerous. As a result of people’s growing reluctance to get immunized, coverage rates drop, which in turn increases the risk of an infectious disease outbreak. 40

Health care professionals, particularly primary care physicians and pediatricians, should play a role in helping people make informed decisions about vaccinations.

46-47% Researchers have begun to develop and evaluate interventions for vaccine-hesitant people, but the current data do not support one method of intervention as being more effective than others; therefore, further development and evaluation of interventions are required.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian Jacob

Damian Sendler, M.D. – When working in a high-risk environment like a healthcare facility, it is critical that employees have the freedom to express their thoughts and feelings without fear of being judged by others. In mental health, where recovery-oriented approaches rely on interprofessional teams to make complex decisions, psychologically safe working is particularly important. A lack of attention is paid to the practical steps that can be taken to increase the level of psychological safety in healthcare organizations across and at all levels of the organization.

Damian Jacob Sendler: Patient safety and effectiveness in mental health services are directly tied to the psychological well-being of the patients being treated. A large-scale program in psychological safety with a focus on mental health and drawing from the current literature provides concrete steps for how our current understanding of psychological safety can be implemented.

Dr. Sendler: One of the most important aspects of psychological safety at work is the shared belief that it is safe to take risks with one’s coworkers in order to learn and grow as a team. Employees should be able to freely express their concerns, errors, or problems without fear of retaliation, and should be treated fairly and compassionately when doing so. Aside from fear, they also need to feel safe and secure in their personal, professional and social relationships and their future professional and occupational advancement.

Working in high-risk environments, such as healthcare, where staff are expected to work in multidisciplinary teams where mistakes can have life-threatening consequences, psychological safety is critical [3–6]. A culture of blame and fear is still prevalent in healthcare organizations, which is detrimental to patient safety, staff morale, and organizational performance and results in unreported errors [7–10]. In countries with strict hierarchical structures, where structure and control are paramount, this culture of blame and fear may be exacerbated, with little to no opportunity for candid conversations across different levels of the organization. Countries with market cultures may prioritize competition over open discussion of failures, resulting in an environment that could be poisonous for all parties involved.

The ability of patients and their families to express their ideas, anxieties, and suggestions is a crucial component of mental health, and ensuring that people feel safe in doing so is critical. There is a recovery-oriented approach to many mental healthcare organizations, which focuses on empowering patients and their families/caregivers to build on their strengths, make educated choices, and take an active role in their own health and well-being [11].

In this paper, we’ll look at the advantages of fostering a culture of psychological safety before moving on to the more difficult task of implementing it across the entire organization. Before we address the specific challenge of enhancing psychological safety in mental health services, we first consider the challenges of cultural change of any kind. As part of our research, we outlined a number of concrete ideas for promoting a culture of psychological safety throughout an organization, as well as a number of initiatives that would work in conjunction with it. As part of the design, consideration is given to creating an ethos of psychological safety as well as specific interventions that can have a measurable and impactful effect.

It is the spirit or personality of an organization that is referred to as organizational culture. An organization’s employees’ well-being and productivity depend on it. [12] More specifically, it is a manifestation of the workplace’s shared beliefs [12], behaviors, thoughts, attitudes, and norms. To borrow a phrase from Schein, culture can be defined as the “pattern of shared basic assumption—invented, discovered or developed by a given group” [13, 14]. This interpretation is important because it takes into account the sociocognitive, interpersonal, and symbolic manifestations of culture [15]. Organizational culture acts as a collective, and it has the potential to drive wider organizational innovation and change [16].

A positive organizational culture in healthcare has proven to be difficult to implement and even more difficult to demonstrate, despite the obvious benefits. No reliable results have been found in recent systematic reviews of the impact of organizational cultural change on healthcare performance. [18] Other studies have found that many attempts fail immediately or do not last long [18]. Underlying these challenges is an ongoing discussion about whether or not culture can be influenced directly or whether it simply needs to be taken into account when planning interventions and change [19].

A shift in the healthcare industry’s culture presents additional difficulties. There has been a shift in healthcare needs and behaviors over time as a result of a wide range of patient needs and the complexity of healthcare delivery. With an executive core at the center, healthcare typically consists of nested structures, some clinical, others non-clinical. There are many different types of teams, each with its own set of responsibilities, and each one can be assigned to a different population, provide its own unique service, or be a part of a variety of distinct services [20]. Healthcare organizations have a diverse range of stakeholders with varying levels of interest, which can make it difficult to implement consistent change due to the heterogeneity of their teams. For the sake of creating a work environment where employees can feel safe and secure, all of this is especially important.

Internationally, the national culture will have a significant impact on whether or not cultural change is possible in any healthcare organization in any given country. What can be achieved in terms of cultural change depends on factors such as individualistic vs. collectivist ideologies, patriarchal vs. matriarchal cultures, and levels of tolerance for uncertainty.

Creating a culture of psychological safety not only benefits the organization’s workforce and patients, but it also lays the groundwork for future cultural shifts. Benefits in health care management and clinical practice as well as foundations for long-term innovation can be found in these technologies. In this section, we provide a brief overview of some of the most important aspects of mental health care.

When it comes to spotting mistakes and near misses, psychological safety is crucial [1, 2, 21]. In situations where there are pressures from within and outside the organization (e.g., concerns about patient safety and bed capacity), speaking up can be especially challenging.

International efforts to remove barriers in healthcare organizations have recognized the importance of speaking up [22, 23]. Some of the most common barriers across countries and cultures include concerns about the negative consequences of speaking up, as well as power and hierarchy, and leadership influence. In the United States and Europe, the majority of studies on psychological safety have been conducted, but the importance of speaking up to prevent errors has been recognized in a wide range of clinical settings [22, 24, 25] The World Health Organization curriculum guide and patient safety teaching programs both emphasize the importance of open communication within teams [26, 27].

Many clinical decisions in mental health are based on a patient’s subjective observations and therefore necessitate open and honest discussions [28, 29]. Employees should be expected to bring up mistakes, not just encouraged to do so. To that end, employees should be treated fairly, and investigations into errors should take into account all possible contributing causes (e.g., staffing levels, patient acuity). Psychologically safe organizations use error management as an opportunity to learn, to improve, and to calibrate expectations among their workforce.

Patients, caregivers, and families in mental health services need to feel comfortable raising issues they are concerned about. There are many people who are afraid to talk about their struggles with mental health issues or treatment. Caregivers and family members play an important role in community mental health care. Patients, family members, and caregivers have the opportunity and space to openly discuss their concerns and care plans are adapted to accommodate these discussions in psychologically safe organizations.

There is a correlation between psychological safety and the capacity for rapid learning and innovation in other industries [30, 31]. The ability of employees to provide feedback on areas that need attention or could be improved is critical to quality improvement and innovation. An organization’s local needs and efforts to embed change are better understood by its employees who are invested and share a sense of collective responsibility. Throughout all stages of Quality Improvement (QI), psychological safety is essential, from open discussions about problems to taking controlled risks and being free of fear of failure.

In all countries, psychological safety and its effects on Quality Improvement (QI) are critical. It’s critical for low-income countries to develop and mature a competent healthcare workforce [32]. The success of newly formed QI teams in these settings is largely dependent on two factors: psychological safety and learning behaviors [23, 32].

Many healthcare organizations have shifted away from assurance-based reporting in favor of QI in mental health. The CQC’s evaluation of mental health in the UK emphasizes the importance of Quality Improvement (QI) approaches [33].

QI projects are more likely to take place in teams that have a high level of trust and respect for one another [21, 34, 35]. The employees of a psychologically secure company know the value of failure as a learning opportunity and that, despite the challenges of organizational change, they are essential to its success.

Promoting employee well-being at work necessitates that they be able to recognize and report when they require assistance or are having difficulty meeting the demands of their current jobs. To admit that you need help is seen as a weakness by some who fear it will harm their reputation, job security, and future career prospects. This problem can worsen over time if it is not addressed, as it can lead to increased levels of work-related stress [36].] Staff in mental health facilities may find it difficult to speak up about their own well-being because they work with patients who face similar difficulties. In addition, some employees may fear that speaking out about these issues will negatively impact their ability to carry out their responsibilities at work.

Damian Sendler

In the midst of the COVID-19 pandemic, where many members of the healthcare team may suffer from post-traumatic stress disorder or other forms of moral injury, the ability of these professionals to speak up is all the more critical (i.e., feelings of guilt in not being able to cope with current work conditions [37]).

There are a number of fundamental principles that underpin any successful program for organizational change in general and culture change in particular. According to a recent review, there are a number of factors that contribute to psychological security. A holistic approach is emphasized in these principles, which take into account behavioral changes in employees who take interpersonal risks by speaking up, leadership support to serve as a model and enable these changes, and facilitation of environmental and organization-wide transformations as well. Before we get into the specifics of mapping and intervention, here are the main principles and success factors to keep in mind.

Damian Jacob Markiewicz Sendler: Every large-scale change necessitates executive leadership. The extended executive must be involved in any organization-wide program in order to simultaneously engage stakeholders from different directorates and core operations. (i.e., HR, Governance). Early executive buy-in is required by discussing research literature, options and developing a preliminary work plan with multiple streams is needed. Furthermore, it increases the likelihood of securing a sufficient amount of funding at an early stage of the business.

There are likely to be many subcultures in healthcare organizations [19]. Each subculture’s level of psychological safety varies. In some organizations, it is encouraged to speak your mind, while in others, it may not be possible. In order to keep their jobs, employees may be afraid of being punished or having their job prospects harmed. Psychological safety may be a higher priority for some teams. The opposite is also true: some people will resist change and insist on sticking with the status quo.

The success of a company-wide psychological safety program depends on the development of a flexible program that can be tailored to meet local needs. Indeed, there is a wide range of views on the importance of psychological safety in the workplace. Local manager styles and the consequences of taking an interpersonal risk by speaking up can influence these [2, 40]. Transformational leadership, inclusiveness, managerial openness, trustworthiness and behavioural integrity have been found to enhance psychological safety in the workplace [21–44]. In addition, teams may differ in terms of the operational processes they use to ensure psychological safety in the workplace (e.g., meeting structures, content and frequency).

In addition to recognizing effective leadership styles, the executive and local levels of the organization should model psychologically safe practices in their leadership values and behaviors. Instead of encouraging confrontational behavior within and amongst teams, this strategy aims to keep issues from festering and growing into much more serious problems down the road. Leadership at all levels must therefore provide opportunities for subordinates to speak up while also managing contributions in a positive and collaborative manner.. Leadership must also have the courage to limit or even halt contributions that jeopardize psychological safety. In other words, the goal of psychological safety is to encourage open, honest, and focused discussions rather than a free-for-all approach that accepts all ideas. In addition to their role in fostering psychological safety, leaders must also feel safe in their managerial duties and have HR practices that support them.

Co-production demonstrates and utilizes the value of the experience of staff, patients, and their caregivers and families in the field of health care. Health-related research frequently employs this strategy [45, 46]. In various contexts, the term “co-design/production” has a variety of meanings. It is everyone’s responsibility to contribute to innovation and change, which may lead to safer patient care, for psychological safety. Contributing ideas for improvement, experimenting and providing feedback are all examples of this. It also includes making an effort to put changes into action.

Damian Jacob Sendler

For the development of psychological safety interventions, this is critical. To begin, it gives employees a chance to participate in collaborative and co-designed interventions, allowing them to apply their knowledge of regional nuances to organizational plans and thereby maximize their chances of success [47]. For one thing, the experience of collaboration itself can foster psychological safety and convince employees that the leadership’s intentions are genuine. Co-design/production, on the other hand, increases the intrinsic motivation of employees and increases their involvement in these changes, which in turn promotes sustainability. A final consideration is the importance of involving employees in the design and production process, which gives them a voice and enables them to take an active role in promoting a climate of psychological safety.

Damien Sendler: People’s behavior, particularly that of the organization’s leaders, has a significant impact on the organization’s culture. Organizational culture is also reflected in its written documents, procedures, and symbols. Some policies would benefit from a psychologically safe focus. ” There should be psychologically safe practices embedded in whistleblowing policies so that the whistle blower, those who might be implicated, as well as the organization itself, can have an honest discussion about their concerns. The first step is to encourage employees to speak up, and it’s essential that the organization’s practices support what happens after someone has spoken up. Near miss policies should shift from being an assurance-based tool to encouraging and even rewarding employees who speak up, as well as promoting transparency, in order to show how learning and improvement are looped back into the organization. Policies enacting organizational change should adopt a similar strategy, laying out a framework for employee participation in order to take advantage of available local knowledge and secure their support.

All levels of the healthcare workforce are provided with a variety of educational opportunities, both formal and informal. Many of the induction programs include essential training on governance and information security, but other courses may focus on the various methods of caring for people. Years of formal education and multiple placements are required for some roles (e.g., nurses, allied healthcare roles, and doctors). For both local and company-wide induction training, the antecedents of psychological safety should be addressed: teamwork, voice behaviors, and respectful listening. A strong emphasis on inclusive, compassionate, and collaborative leadership is essential to creating psychological safety in the workplace [6, 31].

Knowing whether or not an effort to promote psychological safety has been a success and how to assess that success are difficult tasks. Team surveys [1] are the most common method of gauging psychological security. Individual and organizational psychological safety can be assessed using this survey (see, for example, [42, 49]).

Typically, healthcare organizations send out surveys to their employees to get feedback on various aspects of their work experiences.. If a team or service has a low score on these surveys in areas that can indicate psychological safety (perceived organizational support, perceived compassion), they may also feel unsafe psychologically. This is preferable, however, to conduct a specific survey of psychological safety at the beginning and at regular intervals throughout a major program. These surveys are short and take only a few minutes to complete, so they aren’t a burden on employees. There are ways to limit how many people are needed to complete new surveys or add new questions to existing surveys, such as using careful sampling strategies. To identify groups of people who have scored low on psychological safety or who do not feel able to complete a survey, surveys can be helpful. To build trust across the organization, executive leaders must provide extra assistance to these individuals and groups.

Future research in this area will benefit from the use of objective measures of psychological safety. The use of observational frameworks relating to the verbal and nonverbal indicators of psychologically safe and unsafe practices may be particularly useful in simulation interventions around speaking up and decision making, for example. Behavior markers provide a way to measure good or poor practice once psychological safety behaviors have been agreed upon. These frameworks are used in simulation-based education in order to measure and assess non-technical skills among medical teams [50, 51]. As a result, the use of observational frameworks for behavior provides a means of gauging psychological safety. In particular, some of the below-discussed targeted interventions will be evaluated for their psychological safety.

To improve patient safety and staff engagement in the long run, it is important to foster and enhance psychological safety. As a result, it’s difficult to determine whether or not psychological safety has any effect on these indices. Immediate consequences like more people speaking up or reporting near misses could be a more realistic target earlier on. In addition, by focusing on these areas, a connection can be made between the impact of psychological safety and other important outcomes, like the safety of patient care. An organization’s current and new employees will have to adapt to a new way of working and a new culture, which will take time and effort. Staff surveys and long-term evaluations of current practices allow for a better understanding of the long-term effects that a program like this one can have.

The idea of psychological safety is simple on the surface, but it turns out to be more nuanced than it first appears. For a variety of reasons, it can be difficult for organizations to take concrete steps to improve psychological safety. First and foremost, psychological safety is a multi-faceted issue, which necessitates a multi-faceted approach to solving it. For the first time, the majority of the workforce at all levels must be involved in the effort to improve psychological safety. Third, measuring psychological safety in terms of its impact on patient safety, healthcare improvement, and overall well-being is particularly challenging. Finally, and most importantly, it is difficult to identify what concrete steps to take to enhance psychological safety, in what order and over what timescale. Even though there are many inspiring stories of organizations that have embraced psychological safety, little research provides any kind of defined set of steps or interventions to follow. There will be a unique journey for each organization, but defining the essential components of a psychological safety program will help.

It is the goal of the majority of psychological safety interventions to affect a broad range of attitudes, values, and trust across an entire organization. Creating an atmosphere of psychological safety is what we call this strategy in general. A complementary approach is to use targeted interventions in settings and activities where psychological safety is particularly important. A person-centered organization that is also one that listens and learns should be the focus of any effort to promote a psychologically safe work environment. A patient-centered organization will enable employees to participate in the creation of an engaging workplace that emphasizes patient safety and quality. An organization that values hearing its employees’ suggestions for improvement, as well as their mistakes and blunders, is one that is committed to listening and learning from its mistakes.

Innovative practice and safe patient care can only be achieved in mental health if a healthy and engaged workforce provides it. Despite the fact that psychological safety is an easy concept to grasp, making it a reality at a large scale is extremely difficult. Two things make it relevant to mental health. In the first place, many mental health organizations focus on recovery-oriented practice, which requires a lot of involvement from patients and their families. Second, mental health decision-making is frequently based on subjective observations and necessitates input from the entire team. Safe and optimal care for mental health patients requires that all parties involved feel free to speak up and participate to their full potential.

To the best of our knowledge, this overview and proposed plan for enhancing psychological safety is only applicable to the mental healthcare system in the United Kingdom. Many aspects of this plan may not be applicable in all countries or cultures because healthcare organizations differ greatly in structure, investment, and prevailing culture. Despite these differences, many of the challenges and suggested solutions will be applicable to countries and cultures around the world. When it comes to things like the importance of speaking up when something goes wrong or when you have an idea for a better solution, the barriers are universal.

It is possible in all settings to establish a patient council and to actively encourage family/carer participation, even if it is more difficult in some cultures. So, while the plan itself may not be applicable to a variety of healthcare organizations, many of the recommendations can be applied individually or tailored to fit the needs of a particular organization.

When conducting research in non-traditional organizational settings, it is important to consider the cultural and structural differences that exist. As an example, healthcare organizations may differ in societies with a strong emphasis on collectivism or individualism.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: Diabetes is on the rise, especially in developing countries like India, where the prevalence of obesity and unhealthy habits is on the rise. In 2019, 77 million people in India were estimated to have diabetes, which is expected to rise to 134 million by 2045, according to the estimates. A whopping 57% of those affected by this disease are still unaccounted for. Microvascular and macrovascular complications can occur as a result of type 2 diabetes, which accounts for the vast majority of cases. An increase in premature morbidity and mortality among diabetics is a major contributor to decreased life expectancy as well as a significant financial and other burden on the Indian health care system. Diet and lifestyle habits, as well as genetics and a family history of the disease, all play a role in the development of diabetes. Diabetes complications can be avoided or delayed with proper blood sugar, blood pressure, and lipid levels management. An array of factors, including a lack of a multisectoral approach, surveillance data, awareness of diabetes’ risk factors and complications, as well as access to health care settings and affordable medicines, make the prevention and management of diabetes a huge challenge in India. Consequently, effective health promotion and primary prevention at both the individual and population levels are needed to reduce the diabetes epidemic in India.

Damian Jacob Sendler: Diabetes is one of the top 10 leading causes of death in the world today, along with cardiovascular disease (CVD), respiratory disease, and cancer, according to the World Health Organization.

Dr. Sendler: Noncommunicable diseases (NCDs) accounted for 74% of global deaths in 2019, with diabetes accounting for 1.6 million of those deaths, making it the ninth leading cause of death worldwide, according to the WHO. [2] Nearly 592 million people will die of diabetes by that year. [3] Before, type 2 diabetes was thought to be limited to the more affluent “Western” countries, but it has now spread throughout the world and is now a leading cause of disability and death among people in their 20s and 30s. [1] Over the past few decades, countries like China and India have seen a dramatic rise in the prevalence of diabetes. Diabetic patients’ numbers are rising fastest in countries with low and middle incomes, according to the World Health Organization. [4] Rapid socioeconomic change in conjunction with urbanization and industrialization, as well as population growth, unhealthy eating habits, and a sedentary lifestyle, play a major role in the global increase in the diabetes epidemic. [5]

Chronic diseases such as diabetes can have a devastating impact on a person’s health and well-being as well as their family, community and healthcare system. Diabetic retinopathy, nephritis, and neuropathy are all complications of uncontrolled diabetes, which increases the risk of vascular disease and contributes significantly to the burden of type 2 diabetes. [5,6]

Pacific Islanders, Asian Indians, and Native Americans all have a significantly higher risk of developing type 2 diabetes than people in other parts of the world. There has been a dramatic increase in the number of people worldwide with type 2 diabetes since 2000, which began in the 1990s. [7] Men (9.6 percent) have slightly higher rates of diabetes than women (8.8 percent), according to the International Diabetes Federation (IDF) (9.0 percent ). [1] Around 463 million people have diabetes and 374 million people have impaired glucose tolerance (IGT), a pre-diabetic state. According to current projections, the number of people living with diabetes and IGT will rise by 51% by 2045, reaching 700 million people with diabetes and 548 million people with IGT. [1]

It is estimated that there are 163 million people with diabetes in the Western Pacific region, which is the most populous of the International Diabetes Federation’s six regions, followed by 88 million people in Southeast Asia and Europe, 59 million people in the Middle East and North Africa, and 55 million people in North America and the Caribbean (47.6 million). South and Central America (36.1 million people) and Africa are currently home to the lowest population densities worldwide (19.4 million). [1] Thus, it is clear that the affluent regions of Europe and North America are not the only ones experiencing the diabetes epidemic.

For the year 2019, the International Diabetes Federation (IDF) estimates that China has 116.4 million diabetics, India has 77.0 million, and the United States has 77.0 million (31.0 million). China (with 140,5 and 147.2 million people) and India (with 101.0 and 134.2 million people) will continue to have the highest diabetes burdens in 2030 and 2045. [1] A report from the Global Burden of Disease Study found that China and India, two of the world’s most populous countries, have the highest rates of diabetes in the world. [8]

In low- and middle-income countries, diabetes prevalence is increasing faster than in high-income countries (367.8 million) (95.2 million).

Damian Sendler

[1] More than 170 countries and territories participated in the Global Burden of Disease (GBD) study, which provided a comprehensive look at trends in diabetes prevalence between 1990 and 2025. [9] The study also found that the burden of diabetes was higher in low and middle-income areas than in high-income areas. Between 1990 and 2017, the number of people diagnosed with diabetes increased from 11.3 million to 22.9 million (a 102.9 percent increase), and the number of people diagnosed with diabetes increased from 211.2 million to 476.0 million (a 129.7 percent increase). Diabetes burden was found to be largely caused by modifiable metabolic, environmental, and behavioral risk factors.

There is also a high percentage of people with undiagnosed diabetes, which currently stands at more than 50 percent. Health care systems in developing countries tend to be underdeveloped, which explains why this is more common. There are an estimated 231.9 million (one in two) adults in the world with diabetes who have not been diagnosed, according to estimates. [1] According to Fig. 1, undiagnosed diabetes is prevalent in various regions of the Israeli Defense Forces (IDF). [1] Nearly 59.7 percent of Africans with diabetes are unaware of their disease, while only 37.8 percent of North Americans and Caribbean residents with diabetes are aware of their disease, according to reports (the lowest proportion among all the regions). There are fewer people with diabetes who have not yet been diagnosed in Africa and South and Central America than in other IDF regions (11.6 and 13.3 million, respectively). [1] These figures suggest that a greater emphasis should be placed on diabetes screening in the near future. Undiagnosed diabetes can have negative consequences, including an increased risk of diabetes-related complications and increased healthcare use and associated costs, if it is not diagnosed and treated in a timely manner. [10]

Over the last three decades, the global burden of diabetes has risen steadily, with India bearing a disproportionately large share of it. While mortality from communicable and maternal, neonatal, and nutritional diseases (CMNNDs) has decreased, NCDs and injuries have markedly increased their contribution to overall disease burden and mortality in India as a result of an epidemiological shift. [11] Overall DALYs from CMNNDs accounted for 61% of India’s 1990 DALY total, followed by NCDs (30%), and injuries (9%). Due to major epidemiological changes in India, total DALYs from CMMNDs have decreased by 33 percent, while those from NCDs and injuries have increased by 55 and 12 percent, respectively, in 2016 [Fig. 2]. DALY rates for diabetes in India increased fourfold in 2016, and when looking at the leading causes of DALYs in India, most NCDs have seen an increase in rank since 1990, with diabetes showing a dramatic increase, from 35th place in 1990 to 13th position in 2016. [11]

Diabetes’ toll in India has been steadily rising since 1990, and it has accelerated dramatically since the year 2000. According to the International Diabetes Federation (IDF), diabetes prevalence in India has steadily increased over the past decade. [1,12,13,14,15,16] As of 2019, 8.9 percent of Indians had diabetes, up from 7.9 percent in 2009. Table 1 shows the diabetes burden in India in a single table. There are currently 25.2 million adults with IGT, and that number is expected to rise to 35.7 million by 2045. India is the second-largest country in the world with 77 million people suffering from diabetes. There are currently 12.1 million people over the age of 65, and this number is expected to rise to 27.5 million by 2045. An additional 43.9 million adults in India, or about 57 percent of the country’s total number of diabetics, remain undiagnosed. Diabetes is directly responsible for 1 million deaths each year and costs the average American family $92 per person per year in medical expenses.

A study on the disease burden in India’s states found a 64.3% increase in diabetes prevalence across the country’s entire population, with an age-standardized prevalence of 29.3%, between 1990 and 2016.

[11] Study collaborators on the India State-Level Disease Burden Initiative Diabetes found that in India, the prevalence and number of diabetics rose from 5.5 percent and 26.0 million in 1990 to 7.7 percent and 65.0 million in 2016. Tamil Nadu had the highest prevalence in 2016, followed by Kerala, Delhi, Punjab and Goa. Karnataka had the lowest prevalence.

According to cross-sectional surveys conducted in various parts of India, diabetes is becoming more prevalent.

[18] In a study of 18,243 people conducted in Mumbai in 1963, it was discovered that 1,5% of those tested had diabetes after testing their urine. [19] Some national studies have been done on the prevalence of diabetes, but they are few and far between. The multicenter ICMR survey, conducted between 1972 and 1975 in Ahmedabad, Calcutta, Cuttack, Delhi, Poona, and Trivandrum as well as neighboring rural areas, found a national prevalence of diabetes of 2.1%. [20] An age-standardized prevalence of 12.1% was found in the National Urban Diabetes Survey conducted in India’s six major cities in 2001,[21] while the Prevalence of Diabetes in India Study, conducted in India’s 40 urban and 37 small and rural areas in 2004, found a prevalence of 5.9% and 2.7% to be respectively. [22] Between 2003 and 2005, researchers from the WHO-ICMR NCD Risk Factor Surveillance Study monitored people in urban and rural areas across six states and found that 4.5% of those studied had self-reported diabetes. [23]

India DIABetes, the largest nationally representative epidemiological survey conducted in India on diabetes and pre-diabetes, found that the prevalence of diabetes ranged from 3.5 to 8.7 percent in rural to 5.8 to 15.5 percent urban, and the prevalence varied from 4.3 percent in Bihar to 13.6 percent in Chandigarh [Table 2].”

Damian Jacob Sendler

[24,25] In comparison to rural areas, diabetes was more common in urban areas (11,2 percent) (5.2 percent ). In rural areas, the prevalence of prediabetes ranged from 5.8 to 14.7%; in urban areas, the prevalence ranged from 7.2 to 16.2%. In most states, the prevalence of pre-diabetes was higher than the prevalence of diabetes. Many people are at risk of developing type 2 diabetes in the near future, based on this data. Compared to other ethnic groups, Asian Indians appear to progress more quickly through the pre-diabetes stage. [25,26] Diabetes was more common in states with higher GDP per capita and in people with higher socioeconomic status (SES). An epidemiological transition is clearly evident in this study, with a greater prevalence of diabetes in low socioeconomic status urban areas in more economically developed states.

Damian Jacob Markiewicz Sendler: Indian states/union territories were divided into 15 regions, with the Andaman and Nicobar Islands (26 and 14.5 percent, respectively, for males and females) having the highest prevalence of diabetes, followed by Haryana (8.2 percent) and Bihar (6.1%), respectively. Urban areas had a higher prevalence than rural areas. The prevalence of diabetes increased from 18.6 percent in 2006 to 21.9 percent in 2016 in urban areas, while it increased from 16.4 percent to 20.3 percent in small towns and from 9.2 percent to 13.4 percent in periurban villages in the recent Secular Trends in Diabetes in India study. [28]

Diabetes or pre-diabetes affects six out of every ten adults in South Asian cities, according to data from the Center for Cardio-metabolic Risk Reduction in South Asia (CARRS).

[29] 22.8 percent of the population in Chennai and 25.2 percent in Delhi were estimated to have diabetes. Karachi, Pakistan, has a diabetes prevalence of 16.3 percent, which is lower than the two Indian cities studied in this study. In the CARRS cohort, men had a 55.5% lifetime diabetes risk compared to women’s 64.6%, and both women (86.0%) and men (86.0%) were obese (86.9 percent ). In women, the risk of diabetes declines to 37.7%, while in men, the risk drops to 27.5% with increasing age (at age 60). [30] Migrant Indians have lower rates of type 2 diabetes than their Indian counterparts, according to new research. Type 2 diabetes was found to be more common in Asian Indians living in Chennai (38%) than in Asian Indians living in San Francisco and Chicago (both in the United States) (24 percent ). [31] According to these findings, the “diabetogenic” environment in India is now as bad as it is in the United States due to the country’s rapid economic and nutritional transitions.

There has been a steady increase in the number of people with diabetes in India, in addition to the rising prevalence of the disease itself. The prevalence of diabetes and prediabetes has received relatively little attention in Indian longitudinal studies. Diabetes and pre-diabetes incidence rates in the Chennai Urban Population Study cohort were reported to be 20.2 and 13.1 per 1000 person-years, respectively, in the follow-up study conducted in the Chennai Urban Rural Epidemiology Study (CURES) cohort. [33] People with normal glucose tolerance have a diabetes conversion rate of 19.4%, while those with prediabetes have a diabetes conversion rate of 58.9%. Diabetes incidence among those with pre-diabetes was reported to be 78.9 per 1000 person-years. [33]

Participants from two semiurban wards of Venmony Panchayat in Alappuzha district in Kerala were tracked for ten years as part of the Study of Life Style Diseases in Central Kerala. Type 2 diabetes and impaired fasting glucose (IFG) incidence rates were 24.5 per 1000 person-years and 45.01 per 1000 person-years, respectively, in this study. Nearly 60% of participants with baseline IFG developed type 2 diabetes during the follow-up period.

It’s no secret that diabetes has a systemic effect on a wide range of diabetes-related complications, including macro- and micro-vascular problems, as well as death. Non-traditional complications such as mental illness, cancer, physical impairment, and liver disease have also been linked to diabetes in recent years. [36] Diabetic retinopathy, the most specific complication of diabetes, has been used to set diagnostic thresholds for the disease. Adults with diabetes in urban South India are estimated to have diabetic retinopathy at a prevalence rate of 17.6 percent. [37] Diabetic retinopathy was found to be prevalent in one-third of people with type 2 diabetes who visited 14 eye-care facilities in India, and one-fifth of those patients had sight-threatening diabetic retinopathy. [38] Comparing Indian urban populations to Western populations, the CURES study found lower prevalences of eye and kidney diseases and peripheral vascular disease (CAD) but higher prevalences of heart disease (retinopathy, nephropathy, neuropathy, and atherosclerosis). [37,39,40,41,42] A comparison of rural and urban South Indian areas reveals that the burden of complications in rural areas is comparable, if not higher. [43] Complications, co-existing illnesses, inadequate health care, and high drug costs, particularly insulin, may be to blame for the high prevalence of diabetic complications in developing economies like India.

Damien Sendler: Diabetes is a leading cause of death because of the complications it can cause. As of 2019, the South East Asian region ranked second in the IDF Regions with 1.2 million deaths attributable to diabetes in adults; India accounted for more than one million of these deaths. [1] All-cause mortality and CV mortality rates were significantly higher in low- and middle-income countries among 143,567 adults with and without diabetes, according to the Prospective Urban Rural Epidemiology study involving 143,567 adults with and without diabetes from 21 countries, including India. [44] There has been an increase in the number of deaths from diabetes in India since 1990 by more than 131 percent, according to the India State-Level Disease Burden Initiative Diabetes study. [17]

As of now, there are no large-scale Indian studies on the mortality of type 2 diabetics, and the few clinical studies available show a wide range of results. Among the 234,776 inpatient admissions studied retrospectively in Srinagar[45], 16,690 people died, with diabetes accounting for 4.4% of those deaths. Infections accounted for 41% of deaths, chronic renal failure 33.6 %, CAD 16.9 %, cerebrovascular disease 13.2 %, and chronic obstructive pulmonary disease 6.9 % of deaths in the top five causes of death. People with diabetes have a mortality rate nearly four times higher than those without diabetes, according to a follow-up of the CURES cohort (27.9 per 1000 person-years vs. 8.0 per 1000 person-years). Ischemia heart disease and diabetes were found to have the highest population-attributable risk for all-cause mortality in the study cohort. [46]

It is estimated that in 1990, a tenth of the total disease burden in India was caused by a cluster of risk factors that included an unhealthy diet, being overweight or obese, high blood pressure, blood sugar, and cholesterol, all of which contributed to ischemic heart disease, stroke, and diabetes, which in 2016 increased to a quarter of the total disease burden in India. According to the Indian Centers for Disease Control and Prevention (CDC), tobacco use is a significant contributor to cardiovascular disease and diabetes, as well as cancer and other diseases. [47] Obesity, low dietary intake of fruits, nuts and seeds, and whole grains, and tobacco use are the most significant risk factors for DALYs and deaths from diabetes, according to the Global Burden of Disease Study 2016. [48]

Many people in India are concerned about rising rates of pre-diabetes, diabetes and their associated complications in urban and rural areas and among the young. India, the second-largest country in the world, has a large and diverse population, making addressing diabetes-related health issues a challenge. Diabetes prevention and management faces numerous challenges, including I a lack of strong national partnerships for multisectoral actions, (ii) a lack of robust surveillance and research data on diabetes, (iii) abysmal public awareness, (iv) a lack of access to basic prevention/management of diabetes in the primary health care setting, which includes access to affordable medicines, (v) disproportionate fund allocation.

A shift from a biomedical to a public health approach is required to effectively combat diabetes. Instead of focusing on a single risk factor, the focus should be on a group of risk factors as a whole. As a result, a multifaceted approach is essential when planning prevention and control programs. I reducing exposure to lifestyle risk factors through health promotion and primary prevention; (2) early detection and prompt treatment; (ii) surveillance to track trends in diabetes and its associated risk factors are all methods of preventing or controlling the disease. Diabetes is a growing problem in India, and it requires a multisectoral approach to combat it. There are a number of policies that may help to slow down the diabetes epidemic in India: I national food policies aimed at ensuring the availability and accessibility of healthy and nutritious foods; (ii) health policies to reduce harmful behaviors such as smoking, alcohol abuse; and (iii) policies to promote healthy eating habits. Health, information, education, and agriculture ministries must work together effectively to raise awareness of the importance of leading a healthy lifestyle among Indians.

For countries like India, where the burden of diabetes has increased significantly in recent decades and will continue to rise in the future, the picture is even more bleak than it already is. This could have a significant impact on diabetes-related morbidity and mortality in India, as well as the country’s overall healthcare costs. Early diagnosis, screening for complications, optimal treatment at all levels of care for those who have already developed diabetes, and primary prevention of diabetes in those with pre-diabetes are all necessary components of a multi-pronged approach to halting the diabetes epidemic and its associated complications.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: It has become increasingly clear that a new field of study, “theoretical psychiatry,” is necessary for the discipline’s scientific and professional maturation at the beginning of the twenty-first century. There have been a variety of ideas, orientations, and approaches to psychiatry since its beginning. Psychoanalysis, psychodynamic, and psychoanalytical psychiatry as well as social psychiatry, medical psychiatry, biological psychiatry, and psychopharmacology were among the many “schools” of psychiatry. It is possible to view mental health and illness from a variety of angles, including from a medical or disease perspective, as well as from dimensions such as cognitive, behavioral, narrative, spiritual, and systemic (see Jakovljevi et al. 2012). There are a number of different ways to look at and treat mental illness, and each of them has its own merits, but none of them have had a great deal of success. Instead, psychiatry appears to be an uncoordinated collection of theoretical concepts and practices rather than a unified field of scientific theory and standardized practice. 

Damian Jacob Sendler: The fundamental tenets and treatment principles of many of the fragmentary psychiatric schools are disrespected, aggressively criticized, and negated. However, it is clear that many of these schools share a common thread. Today’s problems force mainstream psychiatrists to broaden their disciplinary perspectives beyond what they had in the previous century (Jakovljevi 2012). Although psychiatry is full of data, theories, and stories, there is a dearth of good scientific models and theories in the field. Because clinical practice consumes so much of their time, it is rare for clinicians to find the time to think about philosophical issues like how we come to know what we know (Bartlett 2011). However, academic psychiatrists are usually occupied with academic lectures and research projects of their own design. A fragmented neurobiological paradigm has also inhibited creativity in academic psychiatry, which is defined by rigid rules that define success and failure with short cycles for evaluation of performance and follow-up (Priebe et al. 2013). 

Dr. Sendler: In the last three decades, there have been no major breakthroughs in psychiatric practice, according to Priebe (2013). In spite of major advances in fundamental research, it is claimed that new mental health medications are not clearly more effective than those that were available 30 years ago (Priebe et al. 2013). Mental disorders are classified by the international ICD-10 and DSM-V systems as descriptive and “atheoretical” tools, rather than credible practices based on comprehensive theory. Nomothetic and idiographic knowledge are once again at odds in psychiatry, resulting in a re-emergence of the old conflict between observation and empathy (Kecmanovi 2013), which is, in fact, the clash between nomothetic and idiographic knowledge. Epistemology and axiology, particularly in medical psychiatry, are not given enough respect in mainstream psychiatry. 

There are still many debates about the proper methodological, epistemo- logical, and ontological necessity of psychiatric explanations and treatments as a result. The beginning of the twenty-first century presents a major challenge for psychiatry in terms of establishing a unified transdisciplinary scientific narrative and a more theoretical foundation. A new neurophilosophy of the brain and mind, as well as “psychiatry’s Higgs boson moment” (Craddock, 2013), are both urgently required by the field (Tretter 2010).

Damian Sendler  

It can be defined as the study of hypotheses, models, and theories that describe and explain the mechanisms of mental disorders and their treatment (Tretter 2010). Sadly, there is no recognized field of “theoretical psychiatry,” but some attempts have been made to develop a theoretical perspective. No matter how fundamentally different their approaches and orientations may be, all of the major schools of psychiatry share the goal of discovering the causes, pathophysiologies, and phenomenologies of mental illnesses in order to better treat them. When it comes to psychiatry, conceptual discord can be a powerful force for good or ill. The future of psychiatry greatly depends on how this problem is resolved. For psychiatry to develop explanatory concepts and models that successfully integrate the enormous amount of data from neurosciences, mind sciences, social and spiritual sciences into a conceptual framework of mind-brain-body functions and dysfunctions, systems thinking, systems (complexity) theory, epistemology and philosophy of science are crucial (see Jakovljevi et al. 2012). We can better treat mental health issues by creatively integrating different theoretical perspectives (see Jakovljevi 2013a) and thus gain a better understanding of the complexities of mental health and mental disorders. Personal, systems-based approaches to mental disorders must incorporate a wide range of data sources, including neurobiological, psychophenomenological and environmental data and clinical information. New diagnostic and therapeutic tools should be offered in place of the traditional “one size fits all” approach to diagnosis and treatment. Examples include “the five Ps approach to case formulation,” which includes presenting problem, predisposing factors, precipitating and re-initiation of the problem, and protective/positive aspects (Macneil et al. 2012). 

Damian Jacob Markiewicz Sendler: To formulate a case, you must first develop a thorough understanding of your patients and their problems in order to guide your treatment decisions. This method integrates the patient’s lived experience with relevant clinical theory and research to create a link between diagnostic evaluation and treatment. When done correctly, case formulation allows for a shared understanding of a patient’s symptoms and difficulties in answering the classic questions: “Why this problem?” How come in this person? “And why now?” he asks. For more information, please see: (Macneil et al. 2012). The rationale and common agenda for what to target and in what order is also provided (Macneil et al. 2012). Individualized and person-centered treatment is replacing generalized pathological diagnoses and non-specific “one-size-fits-all” therapies in the field of mental health care. This approach should provide the right drug to the right patient (Jakovljevi et al. 2010, Jakovljevi 2012). 

Psychiatry’s primary goal in systems thinking is to decipher the intricate interplay between the brain and the mind that is at the root of mental illness, as well as how these systems communicate back and forth. Genome and body operate within the context of society, and society within the context of the universe, according to systems thinking. ‘Systems thinking’ (Cloninger 2004). The genotype and the environment combine to form an organism’s phenol type. Genes in the same body can compete with each other, while genes from different bodies can collaborate (Dawkins 1999). Every system is made up of various components and the relationships between them. Computational neuroscience experiments can test mathematical models that are derived from qualitative concepts. This is how we can build maps and models to better understand reality (Tretter 2010). Psychiatry that is transdisciplinary, integrative, and systems-oriented is known as systems or complexity psychiatry (see Jakovljevi 2008). 

Damien Sendler: Modern psychiatry and clinical psychopharmacology are plagued by numerous issues related to evidence-based medicine, all of which stem from misinformation, outright lies, and other forms of spin (Marshal 2004).  It is defined by Marshal (2004) as deliberate falsification of study results, while spin is an attempt to deceive that falls short of falsification. Mechanistic, formistic, reductionist, and linear thinking frequently leads to misunderstandings. Misunderstandings are exacerbated by the existence of a wide range of models, languages, and paradigms within competing, at times even hostile, schools of thought. EBPs and best practices are often used interchangeably by experts, but in reality, they have very different meanings (see Mueser& Drake 2005). Both EBPs (evidence-based practices) and best practices (evaluated by the majority) are modalities that have been scientifically proven effective. In some cases, EBPs and best practices overlap. 

Damian Jacob Sendler 

The beliefs, attitudes, and theories of opinion leaders in the field, the prejudices of guild organizations, or the successful marketing of the pharmaceutical industry may influence the best practices in their field. Reliable scientific research frequently disproves widely accepted best practices. Many RCTs and basic research findings, on the other hand, have not been confirmed in clinical practice and may lead to what is known as “science-biased” treatment practices. To put it another way, the best evidence-based (RCTs) practices are only those that are supported by evidence from the field (natu- ralistic studies, pragmatic trials). 

Distinguishing between different types of mental illnesses is a fruitless exercise in wishful thinking; modern psychiatry has yet to find a treatment that works. Treatment focuses on altering the psychopathophysiologic processes associated with specific disorders, rather than attempting to treat mental health problems in general. There is a strong emphasis on nomothetic knowledge in clinical guidelines and research on diagnostic groups that are very diverse. Research in biological psychiatry and psychopharmacology has as its primary goal the establishment of causal relationships between specific pathophysiological processes and specific mental illnesses in order to make rational treatment decisions based on this information. However, context, meaning, and reasons are often overlooked in this process. 

Psychiatry’s reliance on evidence-based practices is based in large part on RCTs, which have emerged as the gold standard in drug efficacy and effectiveness evaluations. Nomothetic knowledge is produced by them, and they are characterized by their tendency to generalize and derive laws to explain objective phenomena. The Number Needed to Treat (NNT) statistic is used to evaluate the likelihood of an intervention or drug X producing an outcome Y. The number of patients who must be treated in order to achieve a positive outcome or to prevent a negative outcome is known as the NNT (see Slade 2011). As a result, therapies with a lower NNT are more effective. At least theoretically and sometimes in practice, a deterministic flowchart can be used to express the optimal drug treatment, which is the one with the lowest NNT (Slade 2011). 

Modern clinical psychopharmacology is riddled with epistemological issues. In clinical practice, clinicians treat individuals rather than groups, and what is statistically significant may or may not have clinical significance. Instead of asking what is best for a large group of patients with the same diagnosis, clinicians must consider what is best for a single patient (see Jakovljevi 2013b) in everyday clinical practice. The overall impact of drug therapy is also affected by a wide range of intricate internal and external factors. 

Different medications have different side effects, both in terms of the medication’s pharmacodynamics and its non-specific psychological effects. Idiographic knowledge, which is defined as the ability to identify and understand the meaning of contingent, accidental, and often subjective phenomena, is essential to determining the best treatment option for a specific patient (see Slade 2013). The promotion of a psychiatric technical rationality based on nomo-thetic knowledge falls short of adequately addressing human health and disease issues. Both scientific discourse and clinical practice suffer when nomo-thetic knowledge predominates. Patients’ non-compliance with treatment and lack of cooperation may be linked to a lack of empathy and a focus on technical details. 

Focusing solely on idiographic knowledge can lead to many problems including difficulty in distinguishing what is best for an individual patient from what is best for a group of patients with the same diagnosis; harmful mistrust of professionals who use nomothetic evidence; and an oppositional discourse and blaming of problems on the part of those professionals (Slade 2011). False dichotomies, such as the nomothetic-idiographic knowledge dichotomy (see Jakovljevi 2007), can influence treatment decisions. Nomothetic and idiographic knowledge alone are not enough to ensure good clinical practice. It is essential to have both nomothetic and idiographic knowledge in order to conduct an intelligent and creative psychopharmacotherapy. 

The advancement of psychiatry’s scientific and professional standing necessitated the emergence of a new field, theoretical psychiatry, at the dawn of the twenty-first century. The theoretical psychiatry is based on systems thinking, systems (complexity) theory, epistemology, and the philosophy of science. We can gain a better understanding of mental health and mental disorders, as well as more effective treatment, by creatively combining different theological perspectives. As a result of this, new diagnostic and treatment options should be offered, rather than the traditional “one size fits all” approach. The field of psychiatry appears to be moving toward a time when treatment is tailored to the specific needs of the patient, placing an emphasis on individualized and person-centered care.

Dr. Sendler

Damian Jacob Markiewicz Sendler

Sendler Damian

Damian Sendler: The use of brain stimulation technology in the treatment of mental illness is on the rise. A therapist who uses these techniques has been referred to as an ECT practitioner, TMS provider, or somatic therapist by procedure-specific terminology. There are many ways to describe brain stimulation, yet these names fall short. It is our hope that the term “interventional psychiatrist” will serve as a means of facilitating the training and certification of people who conduct these highly specialized treatments [1] and alongside the upcoming training milestone project [2].

Damian Jacob Sendler: Using the word “interventional” does not mean that standard psychiatric therapies have no impact. For our purposes, the word interventional will be used in the same way that it is used in domains like cardiology, radiology, and neuroscience to describe procedures that need intervention. Physicians who are trained and qualified to undertake procedures that are more intrusive than those provided by regular medical care are referred to be interventional in these domains of practice.

Dr. Sendler: A minimal level of knowledge, competence, and experience is essential for an interventional psychiatrist but we believe that this level is best accomplished by working with current clinical training paradigms and the milestones project [2]. We may make use of the existing clinical training paradigms and centers of competence. The present clinical and research infrastructure can best facilitate the mobility of growing knowledge by including interventional psychiatry into resident education. This work attempts to incorporate these notions into specific milestone components [2] by briefly outlining the scope and reasoning for such training paradigms.

An electrochemical organ, the brain may be affected by chemical and electrical interventions. Interventional psychiatrists must have a solid foundation in both neuroscience and physics in order to perform electrical treatments safely and successfully. Interventional psychiatrists must also understand the circuits and native electrical characteristics of the procedures used to alter the brain, in addition to comprehending the circuits and native electrical qualities of the human brain.

Damian Sendler

Interventional psychiatry is a new area that is gaining traction. Newer approaches to classical neuromodulation have emerged in the recent half-century, as have refinements to older methods. EEG research has continued to refine treatment settings in an effort to improve outcomes and minimize adverse effects. Vagus nerve stimulation (VNS) was authorized by the Food and Drug Administration in 2005 as the first invasive neuromodulation device for the treatment of a neuropsychiatric condition (FDA). Transcranial magnetic stimulation (TMS) was licensed by the FDA in 2008 for the treatment of treatment-resistant depression. Deep brain stimulation (DBS) for obsessive-compulsive disorder was given a disputed humanitarian device exemption by the FDA as recently as 2009. (OCD). DBS is presently being explored for the treatment of numerous neuropsychiatric diseases, including as Gilles de la Tourette syndrome and depression, like many other experimental and FDA-approved stimulation treatments [5]. As with other specialities, the area of interventional psychiatry is developing and expanding in a similar way as new techniques and technology are developed [6].

As a result of the interaction between functional neuroimaging, neurophysiology and targeted brain stimulation, interventional psychiatry was established. The goal of such a discipline is to begin to understand the underlying causes of behavior [7]. [7,8] As an interventional psychiatrist, you must be able to distinguish the behavioral changes that emerge from manipulating the neural circuitry linked with mental diseases [6]. Delivering existing therapies and creating new ones both need these abilities. The interventional psychiatry field, for example, is now able to locate and control neuronal activity within malfunctioning brain circuits, and then monitor both patient response and neurophysiologic response. As a result, interventional psychiatry has the potential to uncover novel biomarkers for mental illness and develop new targets for brain stimulation.

Damian Jacob Markiewicz Sendler: Interventional subspecialties have emerged as a result of advances in diagnostics and treatments [12]. A natural progression occurs when normal medical therapies fail and individuals grow resistant to therapy. Using fluoroscopy to visualize arterial occlusions, cardiologists were the first to develop an interventional subspecialty by adapting radiology procedures. Meanwhile, cardiologists created new electrical therapies to restore healthy heart rhythms.

For patients with treatment-resistant neurologic illness, cardiology’s electrical therapies were quickly adopted. [3] The development of the interventional neurology arose, using a modified version of the toolset of cardiology and a sophisticated grasp of their patient’s functional neurologic condition. Neurology, like cardiology, discovered and exploited the brain’s electrochemical nature. TMS has evolved as a noninvasive method to explore the brain’s cortical excitability and neurophysiological activity in a targeted and noninvasive manner [13]. Medically resistant aberrant cortical synchronization may be reversed using electroconvulsive treatment (ECT), according to certain neurologists.

As a first step, implanted vagus nerve stimulation (VNS) was developed, and then responsive neurostimulation (RNS) was introduced. By using functional stereotactic neurosurgery, invasive neuromodulatory therapies such as deep brain stimulation (DBS) electrodes have been proven to alter regional brain circuitry and thereby cure neurological illness.

There were psychological side effects and advantages connected with the use of these technologies when they were first employed for neurologic purposes. Depression may be alleviated with the use of transcranial magnetic stimulation (TMS) on the prefrontal brain. It has been shown that when VNS is implanted to treat medically resistant epilepsy, it also improves depression. It has been shown that DBS may considerably diminish obsessions and compulsions if it is implanted in the limbic region [19]. Interventional psychiatry was born as a result of these neuropsychiatric therapies and the use of electroconvulsive therapy (ECT).

Damien Sendler: Interventional psychiatry is a rethinking of the work that has been done for more than a century in the field. As much as interventional psychiatric treatments have been studied in the past, it took approximately 50 years for the stigma associated with early interventions such as frontal lobotomies to be lifted [20]. There must be a formal recognition and development of the specialization known as interventional psychiatry, with significant training and awareness of the ethics of brain stimulation, in order to prevent previous errors. As an example, approximately a dozen kinds of brain stimulation for neuropsychiatric disorder are either under research or have been licensed for clinical use. Journals dedicated to the field are also available [21].

Damian Jacob Sendler

For the time being, interventional psychiatry has no established definition or training program. In spite of the recommendations of the APA Task Force on ECT, psychiatric residency training has not regularly included ECT as an option. In accordance with current ACGME psychiatric training requirements, trainees are expected to have a basic understanding of ECT but no specific degree of clinical competence is established or assessed [22]. The most recent version of the suggested milestones for psychiatry includes sub-milestone ratings for each of the five stages of professional growth and is more detailed in terms of knowledge and risks [2]. Our proposals do not contradict, but rather support a defined educational program that begins with exposure, progresses to competence, and culminates in advanced practice for residents. TMS, despite its growing popularity and substantial amount of literature, has not been required in resident education in any regular way. When it comes to invasive operations like DBS and VNS, the training disparities in psychiatry are much more severe.

There is now a basic educational framework for somatic treatments and clinical neuroscience in the form of these new milestones. There are many ways in which these notions might be included into psychiatric teaching, and this page aims to provide further details. We recommend elective track and fellowship training programs as a means to go beyond the minimum criteria and construct a route to mastery. Students in interventional psychiatry would benefit from the proposed track and one-year fellowship by having the chance to gain the skills, information, and attitudes necessary to treat their patients with therapies that are safe, ethical, and appropriate. Fellowship training approaches in recognized neurology interventional subspecialties are modified and adapted to match the emphasis of interventional psychiatry, as we suggest here [23].

However, although this appears to be changing [24], neuroimaging is still only used for limited diagnostic and prognostic purposes by psychiatrists, various structural imaging methods are used by interventional psychiatrists for stimulation localization and troubleshooting, while functional imaging methods are improving our understanding of the circuitry underlying mental disorders and may help us choose an effective treatment. Structural brain imaging helps the interventional psychiatrist detect whether a device is failing, while more advanced structural imaging, such as MRI, may assist the interventional psychiatrist find the most optimal stimulation area. With the development of functional MRI (fMRI), it is now possible to study the effects of both online and offline TMS [9]. The training of an interventional psychiatrist should include a full-time equivalent (FTE) credit in a neuroimaging rotation that includes exposure to modalities such as head radiography, CT, MRI, fMRI, diffusion imaging, PET, and SPECT.

Nearly 100 years after it was first used, ECT has improved tremendously in terms of adverse effects. It has been shown that shorter pulse widths and unilateral electrode topologies have minimized cognitive side effects of ECT, and the technique of delivering the electrical pulse has been examined. An multitude of neuropsychiatric disorders may be treated extremely well with ECT [28]. Additionally, the duration and timing of treatment, whether or not to put the patient on maintenance ECT, and what medical and neurological problems are relative contraindications are all significant aspects of training.

Electromagnetic devices are used to provide transcranial-pulsed magnetic fields of sufficient amplitude to trigger neuronal action potentials in rTMS. The symptoms of severe depressive illness may be alleviated in many individuals with daily inductions of neuronal action potentials in the prefrontal cortex (PFC) for many weeks [8]. For acute therapy of depressed patients who have failed at least one antidepressant drug, the FDA approved one rTMS device in 2008. According to research, repetitive TMS-induced neuronal action potentials over a long period of time may be sufficient to restore a functional impairment in the left prefrontal cortex, which controls deeper limbic areas, and so enhance mood [18, 33]. Interventional psychiatrists who use rTMS to treat depression must be aware of the medical and neurological conditions that would rule out a patient as a candidate for the therapy, notably the danger of producing seizures. Training in rTMS for depression is also necessary for interventional psychiatrists. Furthermore, an interventional psychiatrist must determine an exact motor threshold and a specific treatment site in order to consistently apply therapy on a variety of different patients.

The treatment of medically resistant depression with vagus nerve stimulation (VNS) has been authorized by the FDA. Patients with treatment-resistant depression (TRD) were included in the first VNS depression trial, which examined the effectiveness of the therapy in 40 percent of the patients [34]. It takes many months for VNS to attain its maximal therapeutic effects, unlike ECT and TMS. As a result, insurance companies have been hesitant to pay for VNS implants since the FDA authorized it before there was any class 1 proof of effectiveness. While this setback may have been disappointing, it does not seem to diminish the benefits of VNS.

The interventional psychiatrist must be educated on the indications for the device and be aware of the possible adverse effects induced by the device. [36] The interventional psychiatrist must know how to program the device in order to minimize these adverse effects and enhance its effectiveness. Increased exposure to VNS for interventional psychiatry residents in the epilepsy clinic may help them gain experience with the therapy, especially if the facility has few depression patients receiving VNS implantation. At least three VNS patients for depression, as well as a rotation at an epilepsy clinic where VNS patients are implanted, would be sufficient exposure.

The field of interventional psychiatry is only getting started, but it’s an area of psychiatry that’s only going to expand in importance. However, the FDA has authorized at least three types of brain stimulation therapy (ECT, VNS, and TMS) for use in the treatment of conventional psychiatric disorders. The current focus of these experimental therapies is on psychiatric patients who are resistant to therapy, but this is expected to alter in the future. The area of brain stimulation is fast becoming more clinically relevant, more widely accessible, and more sophisticated, thus it is critical to identify and support the training of interventional psychiatrists. Therapeutic-resistant individuals with mental illnesses face a critical shortage of doctors equipped to use brain stimulation as a treatment option. The fact that intrusive treatment of mental diseases is one of the most contentious topics in medicine, raising important moral, ethical, and economical difficulties, is worsened by these training inadequacies. Individual-centered care and mental health recovery paradigms need that these strategies be applied carefully and responsibly by the profession. We can avoid the mistakes and abuses of therapy from earlier generations if we work together in an ethical and procedural manner.

A noninvasive neuromodulation track as an elective in residency programs, as well as a formal interventional psychiatry fellowship, are all ideas we’d like to see implemented in order to make the most of recent advancements in invasive and noninvasive brain stimulation. We think these three approaches would be the best way to ensure that interventional psychiatry is properly trained (ABMS).

Dr. Sendler
Damian Jacob Markiewicz Sendler
Sendler Damian

Damian Sendler: A multidisciplinary strategy that is very technical and difficult, but seems to yield results that resonate, is quickly being adopted by the field of psychiatry as the current “wild west.” To assess these papers, the techniques are frequently unclear and it is difficult to identify the right reviewers. If there isn’t a clear framework for evaluating these research and fostering credibility, this problem will only become worse. To address this urgent need, our research focuses on developing a framework for evaluating complicated methodologies such that the process is done objectively, equitably and scientifically. There are three essential factors to consider when evaluating the usefulness of artificial intelligence in psychiatry: explainability, transparency and generalizabilty.. We explain how difficult it may be to define these three concerns since the phrases have diverse meanings in medical, computer science, and law. We explore how specifying these three difficulties helps to establish a framework to assure trustworthiness. To summarize, we believe it is critical to begin the conversation so that a policy can be established and that the scientific community is extra cautious when evaluating clinical uses of these models.

Damian Jacob Sendler: Artificial Intelligence (AI) and machine learning (ML) in psychiatry have recently seen a boom in popularity. In clinical decision-making, automated analysis may give additional information and identify subtle patterns that people have a hard time noticing. There is, however, a lack of knowledge of the underlying processes and how and when it should be used, even when the outcomes seem to be positive. There’s a risk that people may stop trusting human judgment in favor of computer algorithms because of this. 1,2 It is true that the mystique surrounding artificial intelligence (AI) does not promote the kind of dependability that is so important when using medical technologies.

Dr. Sendler: In several fields, including education, politics, and medical, the role of AI and ML in society has sparked heated disputes. We want to start a discussion on how to verify that ML techniques are legitimate, effective, and implemented and utilized appropriately, given that a rising number of psychiatric articles use ML methods3–9. Prior to implementing any new methods, we must first address the steps necessary to guarantee that research is of the highest quality, that findings are subjected to comprehensive and fair evaluation, and that any new findings have clinical use. Using AI in psychiatry may be possible in the near future if the following three principles can be established: (1) explainability, (2) transparency, and (3) generalizability. Psychiatry may be able to use these technologies in the near future.

Damian Sendler

Google AI’s lung cancer screening model, for example, performed on par with six radiologists in detecting the disease (10). However, IBM Watson’s choice to treat a cancer patient overlooked contraindication evidence (11). In both successes and failures, we are forced to analyze who is ultimately accountable, how to reduce mistakes in the future, and how best to continue the road of AI help. In order to answer these issues, the AI’s decision-making process must be described.

What would be helpful to physicians is an explanation of behavior (e.g., no vocal modulation in psychosis) that links it to clinical concepts (e.g., schizophrenia) (an indicator of a worsening clinical state13). As stated by DSM-V, these components are phenomenology or symptoms.14 However, the NIMH Research Domain Criteria15 recommends a more basic and granular level of characterisation, and ML-based modeling typically does not operate at this feature level (eg, frequency counts, word choice, time of task completion). Several models integrate many characteristics (hundreds or thousands) and learn how to weight them to best describe the clinical constructs.

Models may work for bogus reasons16, which in medicine can have disastrous effects since clinical judgments may be based on a poor basis, even if they don’t always correlate directly with clinical characteristics, thus understanding the classes of information the model is employing is crucial.

Each application area and ML model has its own unique explanation. Explanations from classification models may need a counterfactual example in order to explain why a certain situation is labeled differently by the model. When it comes to analyzing data, regression models are ideal since they allow you to focus on certain attributes and give weights to them. If we had more or less of a certain variable, we may infer that our result would have been different. This set of variables may not be connected in any meaningful way, but they are at least statistically significant in some way. 17,18 It is crucial to know both the statistical data used to train the model and the distributions and probabilities given to features and classes in order to get accurate results.

Damian Jacob Markiewicz Sendler: It’s also important to distinguish between models that are easy to understand (like decision trees or linear regression/classification models) and ones that are difficult to understand (eg, complex, deep neural networks). An interpretable model has a small number of characteristics, and the model learns weights for each of those features as it is built up. There are many ways to measure the quality of a person’s memory recall, but a simple example is the number of words remembered, which could be weighted at 2.0 and semantic closeness of a recall to the original tale, which could be weighted at 3.0. Often at the expense of accuracy, these basic models may give more in-depth explanations than more complicated, deep neural networks can. Tradeoff between model performance and model explainability is well-known in the industry 19 As a result, the most effective machine learning models can’t be explained. Recent breakthroughs in machine learning (ML) have made it possible for us to see inside the “black box,” yet the perspective may still be limited. While achieving explainability is a worthy objective, achieving transparency and generalizability is a more practical one.

There must be clarity in the objective of a model, how it is built and how it was trained, as well as any assumptions that were made in the process. The model’s characteristics should also be linked to the constructions of interest being analyzed, and this should be made clear.

Damian Jacob Sendler

Trust in machine learning models must meet the aforementioned standards. In contrast, a model that is promoted as a money-saver and is clear about its techniques and assumptions and presented as reliably forecasting a variable of interest would instill higher faith in the model’s claims. In order to better understand model behavior, it is important to understand common assumptions (eg, the data are independent and identically distributed, cross validation is used in training, or model choice [eg, selecting a regression classifier implies that the data are believed to be linearly separable].

A ML model’s output should be designed to complement the clinical decision-making process rather than be a final conclusion that is afterwards challenged by the scientific community. Including clinical recommendations for usage is as crucial as being open and honest about the model’s complexities. The doctor must be aware of the system’s specifics and how to utilize it effectively. Open-source code isn’t implied since it’s impossible in many circumstances, but rather that high-level functions and details are accessible.

Good science and the advancement of knowledge are built on generalizability. Because complex ML techniques tend to overgeneralize, they need huge datasets. Because of the absence of established cross-validation techniques, many research in psychiatry have been published with small and insufficient sample sizes (e.g., less than 50 training samples and less than 20 generalization sets). 9 A “matched” dataset is impossible to produce in the clinical sense because of the enormous datasets that have become the norm in machine learning. In spite of the fact that the datasets are unlikely to be matched, the benefit of ML is that it can use the diversity inherent in huge data sets to offer accurate characterizations.

Due to the biases and prejudices contained in the data used to train ML systems, they reflect past patterns of racial, economic, and gender inequality.

20–23 It is imperative that the scientific community produce big and reliable datasets that are representative of the target populations in order to evaluate algorithms without bias or generalizability difficulties. A benchmark that all models must achieve before they can be used in the actual world would guarantee that there is less discrimination against certain groups. It is essential that the database include samples from the whole desired audience. This will raise the likelihood of early and accurate detection and diagnosis by increasing the accuracy of assaying the proper measurement constructs. In order to build the next generation of ML-based solutions, it is essential to ensure that the underlying algorithms are valid across genders, ages, ethnicity, and sociodemographics.

For every product of computer science, thorough testing is required before it can be put into use in a therapeutic context. In testing, edge cases and corner cases are concepts that must be taken into account. It is important that a model be able to handle the most extreme clinical cases, which is why the first example is at the extremes of acceptable operating parameters (eg, minimum and maximum values of features) and the second example is at the extremes of expected operating parameters (eg, the combination of features at their outer limits). Breaking a machine learning model is the best technique to assure that it will behave as predicted in all circumstances..

Damien Sendler: ML integration into psychiatry faces a number of challenges, many of which may be addressed using the aforementioned paradigm. There are, however, additional long-term issues to consider. How can sensitive data be shared in a consortium-like approach with AI technologies that function best with massive datasets? It’s hard to utilize state-of-the art, publicly accessible techniques to identify patients (even if the PHI is deleted from the data, numerous sources may be triangulated to keep identity), so how can we go around this? Finally, who bears the brunt of the blame for mistakes? Ultimately, who is responsible for making sure the model is safe to use, and who is responsible for making sure the model is safe to use? These are the kinds of topics that should be debated across the board.

There is a long way to go before we can use what we’ve learned about machine learning in the field of psychiatry in therapeutic settings. We must turn our attention to make ML models as resilient as feasible so that they can be used in the real world after accuracy advances in ML models have reached a plateau. Machine learning models should not be used as final decision-makers in medicine, but should instead be used to benefit from the unique strengths of machines. We’ve laid out a framework that may be used by both researchers and clinicians who want to incorporate machine learning into their practice. ML models must be able to explain themselves, be transparent, and be able to be generalized. This framework offers the foundation for this evaluation.

Damian Jacob Markiewicz Sendler

Dr. Sendler

Damien Sendler

Sendler Damian

Damian Sendler: One of the most devastating effects of the COVID-19 epidemic on teenagers is the lockdowns and limitations that have impacted their daily lives. SARS-CoV-2 positive teenagers between the ages of 15 and 18 years old were compared to a control group in terms of health, including signs of long-term COVID.

Damian Jacob Sendler: In Denmark, LongCOVIDKidsDK was a cross-sectional research that included SARS-CoV-2-positive adolescents and matched controls. From July 20, 2021, a survey was issued to all Danish 15–18-year-olds who had tested positive for SARS-CoV-2 between January 1, 2020, and July 12, 2021, as well as a control group that was age and sex matched (1:4). In order to participate, participants had until September 15, 2021. Children with COVID-19 were asked about symptoms, school attendance, and health-related quality of life using auxiliary questions and validated questionnaires (PedsQL and CSSI-24). Descriptive statistics and logistic regression were used in the statistical analysis. NCT04786353 is the ClinicalTrials.gov identifier for this investigation.

Dr. Sendler: SARS-CoV-2 case and control participants were selected among 24 315 teenagers who tested positive for SARS-CoV-2. SARS-CoV-2 infection was suspected in 3013 of the matched controls. In the case study, there were 6630 participants (27.3 percent), whereas there were 21 640 participants (22.3%), all of whom were qualified to take part in the control group. In both groups, the median age was 17 years and 6 months (interquartile range: 16 years and 4 months to 18 years and 5 months). Of the 28 270 respondents, 16 277 (576%) were female and 11 993 (424%) were male. Case group participants were more likely than control group participants to have at least one long-term COVID symptom lasting at least two months (3159 [619%] vs 12340 [570%], odds ratio 122 [95% CI 115–130]; p00001). Mean symptom score (ie, somatic distress) of 10–7 (SD 11–4, median 7–0 [IQR 2–0–15–0]) in the case group was considerably lower than in the control group: compared to 11–9 in the control group, p=0–0001. There was a significant difference in quality of life between the two groups: physical functioning 887 versus 865 (SD 13–9, median 93–8 [IQR 83.4–96.9]; emotional functioning 77–1 (20%, 80–0) versus 71–7 (21–4, 75% [60–90%]); social functioning 93% (12%, 100–0 [90–0–100–0]; and school functioning 66–9 (22%, 65% [60–90%]) versus 88–4 (16%, 95% [80–0–100–0]. In the case group, more individuals than in the control group reported 16 or more illness days (1205 [18.2 percent] vs 2518 [11.6 percent]; p00001) and 16 or more days of school absence (695 [105 percent] vs 1777 [8.2 percent]; p=00001).

In comparison to the control group, those with SARS-CoV-2 positive tests had longer-lasting symptoms and greater sick leave, whereas those in the control group had shorter-lasting symptoms and a worse quality of life. Clinical detection and treatment of long-term COVID in adolescents is critical.

Hospitalization and fatality rates for children and adolescents with SARS-CoV-2 infection are regarded to be lower than for adults.

1, 2 The long-term effects of SARS-CoV-2 infection, such as weariness, headaches, and shortness of breath, have been made more widely known across the world (long COVID).

Damian Sendler

3, 4, and 5 As of October of 2021, WHO classified protracted COVID as symptoms that continue or fluctuate for at least two months after SARS-CoV-2 infection and that cannot be explained by any other diagnosis in adults;5 however, a criteria for children and adolescents has not yet been published. More research has been done on the symptoms of extended COVID in adults than in children and adolescents. In a recent review,10 14 papers were found but only five had a control group, with a total of just 5270 cases and 12 588 controls in total. More than a dozen Cases with SARS-CoV-2 infection were more likely than controls to have persistent symptoms, according to three of these five investigations,13, 14, 15; two studies revealed no difference between cases and controls. 10, 11 The longest period of follow-up was 12 weeks, and no laboratory confirmation of SARS-CoV-2 was found in either study. The ages of 16 and 17 Children and adolescents have been known to experience long-term symptoms following a viral infection, such as persistent coughing following an infection with the respiratory syncytial virus in infants and toddlers18 and persistent fatigue, headaches, and abdominal pain following an infection with the Epstein-Barr virus. 19 As a result, it is not surprising that teenagers have a lengthy COVID.

The LongCOVIDKidsDK cross-sectional research was conducted in Denmark. We surveyed all of the 15–18-year-olds in Denmark who had tested positive for SARS-CoV-2, as well as a group of matched peers who had not.

Damian Jacob Markiewicz Sendler: SARS-CoV-2 positive test results for all 24 315 Danish adolescents aged 15–18 years (case group) were retrieved from the Danish COVID-19 database that includes countrywide coverage of all persons with a positive SARS-CoV-2 test results in the period Jan 1, 2020, to July 12, 2021. On July 12, 2021, this accounted for 9% of the population aged 15–18 years in Denmark. One-fourth (n=97 257) of the cases in the Danish Civil Registration System did not have a positive SARS-CoV-2 test, which allowed researchers to identify a control group. 19 Teenagers who had tested negative throughout the epidemic as well as those who had never been tested made comprised the control group.

One initial invitation and two follow-up reminders were sent through e-Boks (a Nordic secure digital postbox that is used by public authorities to communicate with Danish citizens) between July 20 and September 15, 2021, for questionnaires to be answered in REDCap (a secure web application for online surveys).

SARS-CoV-2 positive cases and controls were questioned about comorbidities prior to the date of the SARS-CoV-2 positive test.

Controls who claimed to have been infected with SARS-CoV-2 at some point during the epidemic but were unable to get a test at the time were not included in this study. Survey invitations to those who were infected between July 12, 2021, when the population was extracted from the registration, and the survey invitation were sent were declined by those affected.

According to the data protection agency, this research has been authorized (P-2021-195). The Danish Health Data Authority provided access to registration data (FSEID 00005625 and 00005757). In Denmark, no further ethical permission is given for surveys. Submitting a completed electronic questionnaire in lieu of paper signed off as proof of informed consent.

In order to determine the existence of diverse somatic symptoms in children, the Children’s Somatic Symptoms Inventory-24 (CSSI-24) was created. In order to create a two-week rolling average, each item is given a Likert scale value ranging from 0 (not at all) to 4 (a lot). Somatic distress is more likely to have a higher total score. 26

Damien Sendler: Pediatric Quality of Life (PedsQL) is a 23-item general questionnaire that includes four domains of health-related quality of life in children aged 15–18 years old. The PedsQL provides a total summary score and subscores for physical functioning, emotional functioning, social functioning, and school functioning during the last month.. Healthier children had higher ratings on the Pediatric Quality of Life Scale (PedsQL). 27

For the Long COVID Kids Rapid Survey in January 2021, we used the CSSI-24 and the PedsQL, in addition to the 23 most frequent long COVID symptoms that were discovered.

In addition to 28 questions regarding height and weight to calculate BMI, there were also questions about sick leave and absence from school.

Sources of information and management

All symptoms experienced by adolescents who had been infected with SARS-CoV-2 were requested to be reported, including questions concerning their severity and duration. Participants were asked whether the symptoms had been present before to SARS-CoV-2 infection and if they considered the symptom was linked to the virus. –> Before infection, long COVID symptoms could not have been expected. A nested population was created to look for teenagers in the case group who were experiencing new symptoms that might be linked to COVID-19 (long COVID group). At least one new-onset symptom that had not been present prior to the positive SARS-CoV-2 test was found in this group of subjects.

Damian Jacob Sendler

The control group was questioned about the same symptoms and to assess the strength and duration of them. The control group was split into four equal-sized random groups using statistical tools. It was requested that each of these four groups report on the 23 lengthy COVID symptoms dating back 3, 6, 9, or 12 months.

The Long COVID Kids Rapid Survey, conducted in January 2021, yielded a list of 23 prevalent symptoms.

28 This illness manifested itself in a variety of ways: as indigestion and heartburn to headaches and fatigue to muscle and joint pain to dizziness and skin rashes to mood swings and nausea to difficulty breathing to paleness and memory loss to cold hands and feet to cough to chapped lips to dizziness and extreme paleness. There were 23 common symptoms in the case group and control group that met the WHO criterion for extended COVID: symptoms lasting at least two months or longer. Participants were questioned about the severity of symptoms—eg, “often” or “always”—rather than the length of the symptoms.

As of March 11, 2020, schools in Denmark were open from March 11 to June 21, 2021, with different periods of closure. In the early months of 2020, SARS-CoV-2 testing was only available via a doctor referral; starting in May of that year, walk-in centers would be open to the public. Denmark was not under lockdown at the time of our data collection, but the post-COVID-19 respiratory syncytial virus outbreak was in full swing.

We studied symptoms and quality of life in the Danish teenage population between the ages of 15 and 18 who were SARS-CoV-2 positive and in a sex and age matched control group in this investigation. A higher percentage of those in the case study group had long-term central COVID-19 symptoms, but they also had higher quality of life ratings and less short-term symptoms than those in the control group. The case group’s members missed more days of school due to illness and other absences than did those in the control group.

SARS-CoV-2 PCR findings for the whole population of Denmark and the Danish Civil Registration System, which allows for nationwide survey matching, are two of the study’s main strengths. National secure digital post-boxes reach all residents without delays imposed by postal mail and have a direct interface with the survey. They also provide immediate access to respondents. The research also includes a number of flaws, though. COVID-19 has been implicated with a slew of symptoms. 10 We included symptoms from two previously validated questionnaires26, 27 as well as 23 previously described symptoms, as well as information on individuals’ preexisting conditions, which may have influenced the results. 28 All relevant symptoms may not have been taken into account due to the incompleteness of the list we utilized. 23–27 percent of participants responded to our study, which is significantly lower than earlier research involving teenagers in general,30,31 but substantially higher than recent studies examining COVID-19 symptoms among adolescents.30, 31 (less than 14 percent ). 10, 13, 15, 17 There may be a non-response bias since there were more male non-responders than female non-responders. Due to the equal response rates of the two groups, sampling bias seems improbable. It is important to note that participants in the case group were asked to report on acute symptoms and whether or not they were new and connected to COVID-19, while individuals in the control group were not. Comorbidities prior to a SARS-CoV-2-positive test were questioned of participants in the case group, whereas those in the control group were asked to report on past comorbidities with no index date. This discrepancy resulted in a malfunction of the overall response mechanism. Recall bias may have resulted from a 12-month retrospective recall. Symptoms such as headache, worry, and weariness are all subjective, but this is the nature of the data. Because there are no relevant controls, case-only reporting is critical for identifying previously unknown symptoms of SARS-CoV-2 infection. The results, however, should be regarded with care.

Compared to the control group, individuals in the case group had fewer pre-existing conditions. Participants in the case group experienced a greater number of long-lasting conditions, such as chest discomfort, difficulty breathing, cough, headaches, sore throat and dizziness compared to the control group. It’s possible that these are long-term signs of COVID-19 infection. Five prior investigations of lengthy COVID in adolescents with a control group indicated a difference in persistent symptoms, with the case group having more of them, although two studies11 and 12 found no difference. Compared to the studies that found a difference in the persistence of symptoms, those that found no difference had shorter follow-up periods (15 to 3 months), fewer samples, different symptoms (e.g. sleep disruption and myalgia/arthralgia), and different techniques. In our research, individuals on the control group reported poorer results in the validated generic questionnaires for symptoms, psychological outcomes, and quality of life after 2–4 weeks of recall time compared to those in the case group, which was surprising. Despite the fact that the differences were statistically significant, the impact sizes for emotional and social outcomes were just modest enough to be clinically important. Aside from skin rashes, mood swings, dark bags under the eyes, and chapped lips, we also discovered greater reporting in the control group compared to those in the case group. At the outset, the demographic and clinical characteristics of the two groups differed, with the control group having higher comorbidity than the treatment group. It’s possible that the people in the control group were more afraid of COVID-19 and had less freedoms because they were trying to protect themselves from the virus. We have validated questionnaires with 2–4 weeks of recall, thus many people in the case group may have been free of symptoms for a long period after infection.

The idea that lockdowns and social limitations are causing pandemic symptoms has been floated10, and it’s possible that these symptoms are the result of the poor flourishing that comes as a result of them.

10 – 32 Long-term COVID symptoms may be difficult to detect in surveys because of suspected pandemic symptoms such insomnia, anxiety, and depression,22 as well as the respiratory syncytial virus and vaccination side effects.23. Many individuals suffer with the symptoms on a regular basis. Thus, any variations in the strength and duration of these symptoms may have been obscured by the study.

As the epidemic progressed, Denmark was one of the nations that tested the most, with an average of almost 10 PCR tests per individual and as many antigen tests. The observed mean symptoms differences between our case and control groups may be bigger than those experienced by the typical person who contracts a SARS-CoV-2 infection since some teenagers may have been infected with SARS-CoV-2 but remained asymptomatic.

Sick days and school absences varied widely between the two groups, as expected. It is possible that quarantine regulations may have contributed to some of the absences from school. It’s important to consider the impact of COVID-19 from a variety of angles, including the impact on the health of families, the economy, and the well-being of children.

Of the 6264 patients in the case study, 2997 (47.8%) had at least one new symptom that had not been evident before 8 weeks following infection. In previous smaller studies, the prevalence of symptoms ranged from 4% to 66% 10 based on criteria such as the number and kind of symptoms included in the study. In our research, the most common symptoms were headache, nausea, and exhaustion. However, trouble breathing was not previously described in prior studies, which have confirmed similar results with variable rates of prevalence10. However, this research offers more solid evidence of a reduction in the quantity and severity of symptoms over time. While it is possible that new-onset symptoms may have occurred in the control group, the lack of an index event in the control group makes a comprehensive comparison very challenging.

Female individuals showed higher symptoms in both the case and control groups compared to male participants. Molteni and colleagues discovered the same thing. 13 In general, female teenagers have a greater number of complaints, symptoms, and diseases to report. 34, 33 There was a greater correlation between increased anxiety, sadness, and life satisfaction among female participants during the COVID-19 pandemic than there was among male participants. 35

The conditions of social pandemic management may have affected health outcomes in teenagers when evaluating generalisability. There may also be differences in teenage body mass index and mental health across nations.

Differences were discovered between the two groups, with the SARS-CoV-2 positive group experiencing more long-term symptoms and taking more sick time, whereas the control group had more short-term symptoms and a lower quality of life.. Post-COVID-19 diagnoses, recommended medications, and health-care use should be studied further.

Damian Jacob Markiewicz Sendler

Dr. Sendler

Damien Sendler

Sendler Damian

Damian Sendler: It is difficult to define acute respiratory distress syndrome (ARDS) as a single clinical entity because of its wide range of symptoms. Lung injury causation, resolution, and healing have evolved significantly during the last several decades. ARDS mortality and morbidity are still high despite the fact that only therapy aimed at reducing ventilation-induced lung damage have shown consistent benefit to yet. Numerous potential treatments that showed promise in preclinical investigations were found to be useless in human trials, most likely as a result of the clinical and biological heterogeneity that affects ARDS patients’ treatment response. 

Damian Jacob Sendler: Patients who are most likely to benefit from certain treatments will be identified via the use of precision medicine in clinical trials, which may help account for the variability of ARDS patients’ responses. National Institutes of Health (NIH) hosted an October 2019 session of interdisciplinary specialists to discuss research potential and obstacles for speeding precision medicine in the treatment of ARDS. Preclinical ARDS models play a critical role in the creation and validation of a precision medicine strategy. 

Dr. Sendler: Cohort studies are vital for advancing precision medicine, and innovative clinical trial methodologies are needed to support this strategy. It is our hope that this Position Paper will serve as a guide for the advancement of precision medicine in ARDS. Precision therapeutics for ARDS have never been more critical than they are now because a COVID-19 pandemic has made many of the major principles, breakthroughs, and problems presented at this workshop urgently necessary. 

Damian Sendler

As much as a quarter of all critically sick patients who need mechanical ventilation develop acute respiratory distress syndrome (ARDS).

In spite of significant progress in avoiding ARDS-induced lung injury,2 ARDS is still linked with a high death rate and long-term morbidity among survivors. 

Damian Jacob Markiewicz Sendler: ARDS has yet to be successfully treated with a particular medication. Uncountable preclinical treatments have been shown to be unsuccessful in human trials because of the variability in clinical and biological characteristics of ARDS in humans. 6 In a precision medicine approach, such underlying heterogeneity is supposed to be openly addressed in order to better understand how different individuals with the same illness respond to treatment. 

Due to the inability to thoroughly identify possible causes of heterogeneity, precision medicine approaches to ARDS are not feasible. Patients with certain clinical–molecular multivariable phenotypes may respond differently to treatments that have been judged unsuccessful for the general population, according to growing evidence8, 9, 10. This gives rise to renewed optimism for the use of precision medicine in the treatment of ARDS. 

As a result of these developments, the NHLBI’s Division of Lung Diseases organized a meeting to identify research possibilities and identify possible hurdles to advancing precision medicine in ARDS treatment. The invited preclinical, human translational, and clinical ARDS trial specialists were joined by experts from outside the area of ARDS in precision medicine and adaptive trial design. Weighing existing research in ARDS and recommending strategic coordination of future research from bench to bedside, this Position Paper summarizes the group’s presentations and debates. The participants of the workshop came up with the following summaries. It’s worth noting that this workshop was held before to the COVID-19 pandemic, which was brought on by the newly discovered coronavirus SARS-CoV2. COVID-19, which has become a prevalent cause of ARDS, demonstrates the wide range of phenotypes that may arise from even a single precipitant of lung damage and the necessity for high-efficiency trials to swiftly assess potential therapeutics. This Position Paper includes a short overview of important elements of the epidemic by workshop participants, many of whom have been actively engaged in clinical research linked to COVID. 

Formulation of executive summaries and assertions of viewpoint. 

Damien Sendler: The National Institutes of Health (NHLBI) held a workshop in Bethesda, Maryland, from October 22 to 23, 2019, bringing together specialists in ARDS, precision medicine, and adaptive trial design. It was organized by CSC, BTT, and the NRA, and was themed Precision Medicine in ARDS. Through a series of pre-workshop conference calls, with input from the session moderators (including JCM, RMB, MNG, TRM, JAB, TJS, and MM), the workshop chairs organized the meeting into three sessions to discuss thematic questions that broadly defined current and future research directions for advancing precision medicine in ARDS. It was determined that three key questions needed to be addressed in order to design future clinical trials that would help advance ARDS’ precision medicine: (1) the current state of ARDS research; (2) what can be learned from other disease areas that have made precision medicine advances; and (3) pressing considerations. For the presentations, workshop chairmen and moderators divided the group into groups according to competence. 

Damian Jacob Sendler

Participants created summaries of the information to be given in advance of the workshop, and the chairs were provided with slides for comments. A series of short presentations and group discussions followed, with the goal of distilling important points for each topic. Final consensus statements were drafted by JRB and forwarded to all participants for modification following the workshop, which was done through electronic communication after the meeting to arrive at the final summary statements shown below (Panel 1, Panel 2 ). From the presentations and discussions that took place during the workshop, this Position Paper was crafted with input from all authors and represents the opinions of the interdisciplinary group of writers. 

in ARDS, precision medication is a must. 

Physicians attempt to provide treatment that is personalized to each patient’s unique needs, maximizing possible benefit and minimizing risk. Precision medicine captures this goal. The practicality of this method may be contingent on the capacity to classify patients in advance based on their likelihood of responding to therapy. In other fields, such as melanoma, BRAF inhibitors or targeting of receptors for oestrogen, progesterone, or human epidermal growth factor receptor 2 in breast cancer11, 12 or subphenotyping of severe asthma13, examples of the value of identifying and targeting treatment-responsive subgroups are provided by rigorous cohort characterisation. ARDS is, by definition, a clinical illness that may manifest itself in a variety of ways. Sub-phenotyping patients with ARDS based on molecular causes that are clinically accessible and actionable is expected to speed up therapeutic development. 

Despite this, it is rare to find techniques for measuring alveolar inflammation or barrier function that have been well verified and made freely accessible. When it comes to ARDS diagnosis, there are no strict syndromic criteria and the diagnosis is based on clinical judgment, which introduces inter-clinician variability and, as a consequence, phenotypic variation across doctors. 3 A more exact definition, on the other hand, would not eradicate ARDS’s significant clinical overt heterogeneity. 

Patients with ARDS are commonly subtyped using respiratory physiology, but with inconsistent outcomes. The lower the PaO2/FiO2 ratio, the more likely it is that diffuse alveolar damage will be seen on autopsy,14 although the ratio is altered significantly by ventilator settings15 and does not reliably discriminate therapy response. It’s unclear if patients with greater PaO2/FiO2 ratios would benefit from the same therapies as those who have lower PaO2/FiO2 ratios, however stratification of ARDS based on these ratios has shown some effectiveness in clinical trials. 

Treatment responsiveness may be affected by treatment-induced lung damage, however it is difficult to evaluate the difference between ventilator techniques on lung injury at the bedside. 

Global respiratory mechanics and ventilator support are utilized to identify individuals with ARDS on a regular basis. 19, 18 Focal or diffuse radiographic ARDS classification of lung injury indicates regional mechanical heterogeneity, correlates with biomarkers of alveolar epithelial injury, and has prognostic value, but it is unclear whether it has value in predicting treatment response and is not consistently characterised in practice.

For example, pneumonia, aspiration, and other risk factors for ARDS have been classified as direct (pulmonary) or indirect (extrapulmonary) based on whether the damaging risk factor originated in the lungs or somewhere else (eg, abdominal sepsis, pancreatitis, transfusion-related). It has been shown that indirect ARDS has a lower probability of development to fibrosis and more alveolar epithelial damage than direct ARDS. Numbers 23 and 24 Direct and indirect ARDS may have different clinical predictors of death. 25 However, pinpointing the exact cause of a lung damage is difficult due to the wide range of possible explanations. Direct and indirect injuries can occur simultaneously in patients with no known risk factors.26 1 The categorization of harmful stimuli by direct or indirect precipitant does not take into account whether the stimulus is temporary (e.g., transfusion, trauma, aspiration) or prolonged (e.g., days) (eg, infection, pancreatitis). 

ARDS may be influenced by other clinically overt variables, which might affect the disease’s progression and the efficacy of treatment. Additional clinical variability, such as the use of various hydration management and sedation strategies, might have an impact on patient outcomes and the responsiveness of treatment. Twenty-seven and a half blockers and agonists, statins, and inhaled and systemic corticosteroids8, 29, 30 may have a direct impact on the host response to lung damage when administered to treat underlying illnesses. Smoking, drinking alcohol, and poor air quality all have the potential to alter the body’s response to pulmonary assaults. 32, 33, and 32 A variety of pathogen species and strains may cause lung damage in patients with infection-associated ARDS via various virulence mechanisms and pathogen–host interactions. 34 Ventilation-induced lung damage may be targeted with treatments that take advantage of the variation in respiratory mechanics, while medicines aimed at other routes of ARDS etiology have had less success using clinically evident heterogeneity. 

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

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Damian Sendler: In 2022, the sky will be illuminated by total lunar eclipses, many meteor showers, and supermoons. There are a lot of celestial events to look forward to in the new year. Inevitably, the International Space Station will pass directly above at some point. Check out The Old Farmer’s Almanac’s list of visible planets if you ever need to know what planets are visible in the morning or evening sky. Here are some of the most anticipated celestial occurrences for the year 2022, so get out your binoculars and telescopes.

Damian Jacob Sendler: A total of two full moons in 2022 qualify as supermoons, with a total number of 12 full moons. In general, a supermoon is a full moon that is brighter and closer to the Earth than usual, making it look bigger in the night sky. However, specific definitions do exist. When the moon is near 90 percent of its closest approach to Earth in orbit, some astronomers believe that the event happens. Both the June and July full moons are considered supermoons under this criterion.

According to The Old Farmer’s Almanac, there will be two complete lunar eclipses and two partial solar eclipses in 2022.

On April 30, individuals in southern South America, the southern Pacific Ocean, and the Antarctic Peninsula will be able to observe a partial solar eclipse. Another one will be visible on October 25th from Greenland, Iceland and Europe to the northeast of Africa, the Middle East, western Asia, India and western China, as well as Europe. Neither of the two partial solar eclipses will be seen in the United States or Canada.

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Only a full moon can produce a lunar eclipse because the sun, Earth, and moon all line up just so for the moon to enter Earth’s shadow. During a lunar eclipse, Earth throws two shadows on the moon. There are two types of shadows: the penumbra and the umbra.

Full moons migrate into Earth’s shadow and get darker, yet they remain visible. “Blood moons” are the result of sunlight flowing through Earth’s atmosphere and illuminating the moon in a spectacular way, making it crimson.

It might seem rusty, brick-colored, or even blood red, depending on the local climate.

Red light is the most prominent hue emphasized when sunlight travels through our atmosphere and casts it on the moon. This occurs because blue light suffers more from atmospheric dispersion.

This year’s second complete lunar eclipse will take place on November 8 at 3:01 a.m. Eastern Time and last until 8:58 a.m. Eastern Time, however the moon will be setting for people in eastern North America.

Quadrantid meteor shower peaks the first week of January, bringing new year’s eve to a close.

The Lyrid meteor shower, which will peak in April, is the next in a series of 12 that will occur throughout the year.

Consider driving to a region that is not overshadowed by lights from the city, so you can get a clearer view of the night sky. From late evening till dawn, meteors may be seen every few of minutes if you can locate a spot free of light pollution.

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

According to NASA, the explosion from a meteor that sparked a tremendous bang in western Pennsylvania on New Year’s Day was 30 tons of TNT.

After a few minutes of silence, the noises became audible. According to a post on NASA’s Meteor Watch Facebook page, the fireball would have been clearly visible in the sky had it not been overcast. In a rough estimate, NASA claimed the explosion was nearly 100 times brighter than the moon at full moon.
NASA was able to determine the meteor’s energy output because to data gathered from an infrasound station nearby.

It is possible to estimate the meteor’s size and mass at around a yard in diameter, with a mass close to half a ton, according to NASA’s estimations.

According to the county’s Twitter account, the Pittsburgh neighborhood of South Hills got 911 calls reporting a loud boom and shaking on Saturday. At first, it was thought that the only likely causes were an earthquake and thunder and lightning.

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Had there not been a haze, the exploding fireball would have been clearly visible throughout the day.

Sonic booms, which sound like an explosion or thunderclap, occur when an item moves through the atmosphere faster than the speed of sound, such as a meteor or a supersonic aircraft.

NASA has said that supersonic objects cause air to behave like a fluid. Shock waves, or sonic booms, are created when flying objects push away molecules in the air they pass through.

One of Russia’s own aging satellites was destroyed on November 15, 2021, by a missile fired from the Earth’s surface. This action produced an enormous amount of debris and put numerous space assets, including humans in orbit, in danger.

These events occurred barely two weeks after the UN General Assembly’s First Committee acknowledged the critical role played by the universe’s resources and the dangers military actions in space pose to the improvement of human life on the planet.

The First Committee of the United Nations works with disarmament, global issues, and threats to peace. It passed a resolution on Nov. 1 that establishes an open-ended committee.

Assessment of present and future space dangers, determination of when action may be regarded irresponsible and “contribution to the drafting of legally enforceable instruments,” including a convention to avoid “an arms race in space,” are the group’s main objectives.

Damian Jacob Markiewicz Sendler: The commercial space industry and space law are our areas of expertise. In addition, we serve as the head and vice head of the National Space Society, a non-profit organization dedicated to space exploration. To have the United Nations recognise that peace in space is still a fragile state is a welcome change of pace. Since operations in space are becoming more vital and tensions are rising, this resolution has been adopted in a timely manner.

The 1967 Outer Space Treaty, which has been ratified by 111 countries, governs space activities. There were only two countries with space capabilities at the time of the treaty’s negotiation, Soviet Union and the United States.
As a general guide, the Outer Space Treaty does not provide any specific “rules of the road” for governments. The pact essentially guarantees the right to explore and utilize space for all human beings. Two cautions are all that are needed here, and a number of holes are readily apparent.

Damien Sendler: The moon and other heavenly bodies must only be utilized for peaceful purposes, according to the first caveat. Because of this broad ban, the rest of the world is excluded. A “common interest” in the “development of the exploration and use of space for peaceful purposes” is acknowledged in the preamble of the treaty. With respect to “the equivalent interests of all States Parties to the Treaty,” the second caution states that anyone undertaking space operations must do so with “due attention.”

The lack of definitions for “peaceful aims” and “due regard,” respectively, in the treaty constitutes a significant obstacle.

Even while the Outer Space Treaty explicitly prohibits the placement of nuclear arms or weapons of mass destruction anywhere in space, it does not ban the deployment of conventional weapons in space or the use of ground-based weapons against assets in space. A last ambiguity concerns the treaty’s restriction on certain weapons, such as China’s new nuclear-capable parabolic hypersonic missile.

The treaty’s ambiguous military restrictions offer opportunity for interpretation that might lead to confrontation.

In 1942, Germany launched its first V2 rocket for military objectives.
It should come as no surprise that many of the first satellites, as well as GPS and the Soviet Space Station, were designed or have been utilized for military objectives.

The distinction between military and civilian usage of space is becoming less and less blurred as commercialization expands. Agricultural yields may be increased and human rights abuses can be monitored thanks to satellites’ ability to provide weather predictions, climate monitoring, and internet access.

A new space economy built on Earth and lunar activities shows that humanity’s reliance on outer space as a source of revenue will only grow in the future.

However, satellites that deliver advantages to the earth’s surface may — and in some cases, do — also be used for military purposes. We are left with no choice but to conclude that the distinctions between military and civilian applications are still blurry enough to increase the likelihood of a confrontation. The expansion of commercial activities will also lead to conflicts over operating zones, which might lead to military reactions from the government.

While there has been no direct military confrontation in space, there has been an increase in the number of countries attempting to demonstrate their military might in and near space. The most recent example is Russia’s latest nuclear test. An anti-satellite weapon was tested by China in 2007 and caused a massive debris cloud that is still generating difficulties. Even as late as Nov. 10, 2021, the International Space Station had to avoid a portion of the Chinese test.
There was significantly less devastation caused by similar rallies in the US and India, but the world community did not welcome them any less.

Since 1959, the United Nations Committee on the Peaceful Uses of Outer Space has been addressing space activities.

This committee’s primary goal is to encourage international collaboration and investigate legal issues associated with space exploration. Neither can it implement the 1967 Outer Space Treaty’s concepts and rules, nor can it compel parties to discussions.

A United Nations resolution passed in November 2021 mandates that the newly formed working group meet twice a year for the next two years, starting in 2022 and continuing through 2023. Despite the slow pace of commercial space development, this is a significant milestone in global space policy.

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

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Damian Sendler: The Smithsonian National Zoo was surprised when an Asian water dragon emerged out of an egg. Why? Her mother had never had sex with a male water dragon in her whole life. Genetic tests revealed that the freshly hatched female, born on August 24, 2016, was the result of a reproductive mode known as parthenogenesis, which was identified by zoo experts.

As the Greek term for “virgin creation,” parthenogenesis refers to the asexual generation of females. In spite of the prevalent misconception that parthenogenesis may only be found in science fiction or religious writings, parthenogenesis can be found in a wide range of creatures, including plants and insects as well as fish and reptiles. Because mammals, including humans, need sperm to carry specific genes, parthenogenesis is impossible for mammals.

Damian Jacob Sendler: Sexual reproduction requires a female and a male, each contributing genetic material in the form of eggs or sperm, to generate a unique child. All of the genetic material needed to make offspring is found in eggs laid by females of just a few species, while the great majority of animal species reproduce via mating or mating-related means. Some wasps, crabs, and lizards reproduce only by parthenogenesis, and these females are referred to as “obligate parthenogens” because of this.

In zoo animals like the Asian water dragon at the National Zoo or the blacktip shark at the Virginia Aquarium, several species undergo spontaneous parthenogenesis. The majority of the time, spontaneous parthenogens reproduce by sexual means, although they are capable of producing eggs that are developmentally mature on occasion.

In recent years, researchers have discovered that spontaneous parthenogenesis may be a heritable feature, meaning that women who unexpectedly undergo parthenogenesis may produce daughters who are more likely to be able to perform the same thing themselves.

A series of cellular activities must take place before parthenogenesis may occur. Women must be capable of producing eggs without being stimulated by sperm or mating in order to reproduce. As a second step, a developing embryo must be formed from the eggs laid by females. To conclude, it is necessary that the eggs hatch.

Each stage of this process may easily fail, notably step two, which needs the chromosomes of DNA within the egg to double, assuring a complete complement of genes for the growing kid. This may be done by using leftover cells from the egg formation process known as polar bodies to “fake fertilize” the egg The amount of genetic resemblance between the mother and her child will be determined by the procedure used to start the embryo’s growth.

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Parthenogenesis seems to be triggered by changes in the environment, but this is not entirely clear. Stressors like overcrowding and predation may lead female aphids to transition from parthenogenesis to sexual reproduction, but not the other way around in species capable of both sex and parthenogenesis. Among freshwater plankton, excessive salinity is thought to have a role.

Spontaneous parthenogenesis is very uncommon, but it has significant advantages for the female who is able to pull it off. When it comes to mating partners, females may be able to create their own.

All parthenogenetic children are born with a sexe that is determined in the same manner as all other members of the species. A parthenogenetic female in an organism where the gender is determined by chromosomes, such as certain insects, fish, and reptiles that have XX female and XY male chromosomes, can only give birth to XX female children. When a female has sex chromosome ZW, every live children generated will either be ZZ (male) or WW (female) (such as in snakes and birds).

The Phoenix Zoo’s checkered gartersnake gave birth to two male pups between 1997 and 1999. Both males lived to maturity. Inbreeding would occur if a woman married with her son, a parthenogenetically created offspring. While inbreeding may cause a slew of genetic issues, it is preferable than having no children at all from an evolutionary standpoint. It seems possible that parthenogenesis, the process by which females generate male children, is more widespread in nature than scientists thought.

In the long term, scientists have noticed that species requiring parthenogeny are susceptible to illness, parasitism, and changes in environment. Parthenogenetic organisms’ fast evolutionary timelines may be a result of the inbreeding that is a characteristic of these species.
Parthenogenesis research is now focused on figuring out why certain species are able to reproduce both sexily and parthenogenetically, and whether this is adequate for a species’ long-term survival.

Damian Jacob Markiewicz Sendler: Scientists in Egypt have digitally unwrapped the mummified bones of Egyptian pharaoh Amenhotep I for the first time since its discovery in 1881, revealing intriguing facts about the king’s life and death. The body was so delicate that scientists had never risked exposing the bones, making it the only royal Egyptian mummy discovered in the 19th and 20th centuries that had never been opened for investigation.

Three-dimensional computed tomography (CT) scanning has been utilized by Egyptian scientists to unwrap and analyse the 3,500-year-old mummy’s innards using noninvasive digital procedures.

Damian Jacob Sendler

Dr. Sahar Saleem, professor of radiology and radiologist of the Egyptian Mummy Project, said in a press release that “we could study this well-preserved pharaoh in unprecedented detail” by digitally unwrapping the mummy and “peeling off” its virtual layers—the facemask, the bandages, and the mummy itself—in unprecedented detail.

Amenhotep I was roughly 35 years old and 169 centimeters (5.5 feet) tall when he died, according to Saleem and her colleagues. In addition to his good teeth and circumcision, he was in excellent health. Within the wrappings, researchers discovered 30 amulets and a one-of-a-kind gold girdle.

Saleem stated the pharaoh had a curly beard, curly hair, and slightly projecting upper teeth in addition to his narrow chin and short, narrow nose.

Their investigation did not identify any injuries or deformities that would explain how he died.

Between 1525 and 1504 BC, Amenhotep I governed Egypt for nearly 21 years. King Tse-tung II of the 18th Dynasty ruled in relative tranquility and constructed several temples.

Damien Sendler: Mummy had several postmortem wounds, perhaps caused by ancient tomb-robbers, which, according to hieroglyphic inscriptions from the 21st Dynasty, priests and embalmers attempted to treat more than four centuries after he was initially buried and mummified.

Preliminary research led Saleem to believe that the priests and embalmers indicated in the inscriptions had opened the body in order to repurpose things like amulets for future pharaohs. She insisted, however, that this was not the case.

According to Saleem, “We demonstrate that the priests of the 21st dynasty painstakingly repaired the damage done by the tomb thieves, restored his mummy’s former brilliance, and kept the fine jewelry and amulets.”

Frontiers in Medicine, a peer-reviewed journal, released the findings on Tuesday.

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

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Damian Sendler: At-home COVID-19 tests have been ranked by an independent patient safety body for the first time based on how straightforward they are for consumers to use. 

Damian Jacob Sendler: Seven no-prescription fast antigen tests were assessed by ECRI, a nonprofit organization that is likewise concerned with health care quality and cost-effectiveness. The over-the-counter tests were evaluated based on factors that a customer could care about, such as how easy they are to use, how easy it is to understand and interpret the findings. 

Many people in the United States are looking for easy-to-use, dependable testing, and this is intended to help them narrow down their possibilities. 

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In the words of ECRI CEO Marcus Schabacker, “We have no horse in this race — we want to make sure customers have the greatest possible access. “There are some that are simple to use, others that are complicated, and some that fall somewhere in the middle.” 

As part of ECRI’s evaluation process, 12 staff engineers were assigned to evaluate tests using a decades-old, industry-standard scale. 

BD Veritor’s On/Go antigen test had the lowest score of 51.8 out of a possible 100 points. Neither the judges nor the participants found any of the tests to be outstanding or poor. 

In addition to On/Go, CareStart and FlowFlex fast antigen tests are among the most user-friendly. Third-tier antigen tests Abbott Laboratories’ BinaxNow, Quidel’s QuickVue, and InteliSwab all earned comparable grades from reviewers. 

A person who is incapacitated or suffers from tremors may have difficulty doing tasks like removing a cap or putting droplets to the testing strip, according to the research. 

Numerous coronavirus tests have been approved for use in laboratories, physicians’ offices, and even households by the Food and Drug Administration since the start of the COVID-19 epidemic. Customers may mail a saliva or nasal sample for testing to a lab using several home tests. eMed, a telehealth startup, delivers tests to customers’ homes overnight, observes them remotely while they complete the exam, and validates findings that could be needed by an airline or a workplace. 

Damien Sendler: Thirty-two businesses have been given emergency use license by the FDA to offer fast antigen home testing at retail outlets in the United States. Non-prescription tests like these may be purchased online or from stores like CVS, Walgreens, and Amazon. 

As demand for the more infectious omicron version soars, kits have become scarce for many buyers. There are seven tests selected by ECRI that may be purchased from Amazon or other merchants, and which are the same as those that customers looking for retail testing can most likely buy themselves.

Additionally, ECRI’s analysis did not examine whether or not the applications included those that automatically reported data to federal and state public health organizations, such as accuracy and affordability. FlowFlex costs $17 on Amazon, whereas BD Veritor costs $34. 

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In an effort to alleviate the shortfall, President Joe Biden plans to provide 500 million free home testing kits to the United States’ citizens. Those who want the kits will be able to request them online and they will be shipped to their homes, potentially within the next several weeks. Countries like the United Kingdom and Germany have already made large purchases and given free tests to their citizens. 

A group of experts who were not involved in the survey emphasized the importance of providing clear and understandable instructions. A person who misplaces their nose swab may not be able to acquire a sufficient sample for testing. There are other possibilities, such as skipping the step of applying a chemical solution to the test card. 

Dr. Emily Volk, president of the College of American Pathologists, stated, “I have a propensity, as a customer, to simply open up the box and start swabbing.” Following the instructions exactly will help you avoid receiving a false negative or positive result. 

Damian Jacob Markiewicz Sendler: Consumers who get favorable results from the ECRI-evaluated home tests should still tell their doctor, even if they are not required to have a physician’s supervision. Antivirals and monoclonal antibodies might be recommended and connected to a patient at risk of difficulties by a clinician. 

Since the average consumer is unlikely to submit a positive test on their own, physicians and other medical professionals will also notify state and local health agencies. 

I doubt most individuals would want to contact their public health agency and inform them that they have tested positive for COVID at home,” Volk added. 

Instead of providing step-by-step instructions, BD Veritor directs users to an app that provides videos for each test phase. Repeating these processes for many exams “would be annoying and make the test take longer than required,” according to the reviewers. 

It was the most difficult exam to use for two-thirds of evaluators. 

At-home COVID- There are 19 tests that can be used to stop the virus’s spread and keep populations safe. 

Spokesman Troy Kirkpatrick said in an email that Becton Dickinson, the firm that manufactures BD Veritor, sought advice from focus groups and studies to overcome problems inherent to these kinds of testing. 

the findings of the test are shown and explained in step-by-step video instructions,” said Kirkpatrick of the smartphone-based test. the results of the test are automatically reported to the federal and state public health authorities, he said. Because many home tests lack this capability, customers are forced to record their own findings. 

A straightforward design, well-written instructions, and an optional app earned On/Go a great rating from reviewers. In addition, the program lets users skip forward if they already know how to complete a certain task. 

Animated instructional videos and other humorous touches were used to make the On/Go test more user-friendly, according to Intrivo CEO Ron Gutman. 

Gutman claimed that during testing, “people who are not acquainted with medical technology are terrified and anxious.” “You need to make things as simple as possible.”

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

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Damian Sendler: Argentina is home to the biggest dinosaur ever discovered by paleontologists. Comparing these enormous reptiles, on the other hand, may be tricky. 

Much though we may have discovered the biggest dinosaur, we’re still seeing sauropods with even more girth.

Damian Jacob Sendler: Dinosaurs continue to set new marks. Paleontologists say that the “Biggest Yet” distinction may be in jeopardy every now and then. Since 1993, Argentinosaurus had been the probable record-holder, but in 2017, the about 120-foot-long, 57-ton Patagotitan was replaced. Paleontologists in Argentina’s Neuquén Province discovered another another sauropod, this one maybe much bigger, in an unexpected development this year. 

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In a Cretaceous Research report published in June, paleontologist Alejandro Otero of Facultad de Ciencias Naturales y Museo in Buenos Aries revealed the newly discovered dinosaur’s bones. It’s estimated that this 98-million-year-old mammal left behind roughly two dozen vertebrae as well as hip and shoulder bones. Fossils show that the species was a titanosaur, a long-necked, herbivorous dinosaur that was either the same weight as or somewhat heavier than its nearest rivals, Argentinosaurus and Patagotitan. 

However, it’s impossible to estimate the exact size of this dino. Every “Biggest Yet” contender’s remnants are fragmentary, and their sizes can only be calculated. “The periodic media struggle over the biggest sauropod is fuelled virtually completely by fragmentary remains,” says Cary Woodruff, a paleontologist at the Great Plains Dinosaur Museum. He goes on to say that some dinosaurs had not yet reached their maximum size when they perished, making it impossible to draw any meaningful comparisons between them. In addition to species variation, paleontologists must take into account individual variance. 

Damien Sendler: Finding additional fossils, including as limb bones that may aid estimate overall body mass, will play a significant role in the resolution of the dino dimensions challenge. It’s still too early to say whether or whether there will be any bigger species of sauropod found, but Otero says he’s looking forward to seeing some massive, full sauropod bones. The fact that all of the opponents looked to be of the same size raises the issue of how such giants have developed so many times before.

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

Damian Sendler: According to a new report, global insurance losses due to extreme weather exacerbated by climate change will reach $100 billion in 2021, marking the fourth time in the previous five years that this threshold has been crossed. 

Damian Jacob Sendler: In the United States, Hurricane Ida was the most costly disaster, causing $65 billion in damage, according to a research issued Monday by Christian Aid, a British NGO. It was followed by the European floods, which cost $43 billion. 

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Floods that swept across the continent in July caused $43 billion worth of insurance claims, along with Hurricane Ida’s arrival in Louisiana on Aug. 29 as a Category 4 storm and her subsequent trail of damage across the eastern United States. There were $23 billion in losses from a Texas winter storm that shut down much of the state’s electricity grid in February, and $17.6 billion in damages from a devastating flood in China’s Henan region in July. The November floods in British Columbia, Canada, that resulted from record-setting rainfall totaled $7.5 billion in damages in 2021, rounding out the top five highest extreme weather insurance losses of the year. 

Researchers have found a correlation between the increasing power and speed of storms as a result of global warming in both the oceans and the atmosphere. As a result of climate change, polar vortexes like the one that devastated Texas have been unleashed, according to studies. Studies have also indicated that the planet’s atmosphere contains an additional 7% more moisture for every degree Celsius of warming, increasing the likelihood of extreme downpour events. 

Swiss Re, a Zurich-based insurance company, released a report earlier this month stating that big extreme weather losses are becoming more and more prevalent. 

Natural disaster losses insured in 2021 above the previous ten-year average, maintaining the trend of an annual 5–6 percent increase in losses recorded in recent decades. An executive at Swiss Re warned in a statement that “at least one secondary peril event like a severe flooding or winter storm or wildfire, each year results losses in excess of USD 10 billion,” he said. However, Hurricane Ida serves as an ominous warning of the danger and financial losses associated with peak risks.” Losses from even a single large-scale incident in an area with a high concentration of people can be substantial. 

Damian Jacob Markiewicz Sendler: Extreme weather occurrences will recur alarmingly in 2021 in heavily populated places. Scientists say that the impacts of greenhouse gas emissions will continue to rise as civilization continues to pump them into the atmosphere, causing global temperatures to rise. 

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As a result, the Christian Aid analysis warns that if the globe continues on its current warming trajectory, annual insurance losses surpassing $100 billion are all but certain. 

Damien Sendler: Disasters like this are likely to worsen unless the world takes swift action to reduce emissions. This will be the sixth time that worldwide natural disasters have surpassed the $100 billion insured loss threshold, according to Aon’s head of catastrophe insight, Steve Bowen. In the five years since 2011, all six have occurred, and 2021 will be the fourth time in that span.

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

Damian Sendler: Scientists term these high levels of arousal “arousal” because it causes the heart rate to quicken, blood pressure to rise, breathing to become shallow, and “bad” decisions to be made. Researchers at Mount Sinai’s Icahn School of Medicine evaluated data from a prior research of non-human primates to better understand how these moods affect the brain’s decision-making processes. 

Damian Jacob Sendler: Two of the brain’s decision-making centers have neurons that appear to monitor the body’s internal movements, according to a new study. Some decision-making neurons appeared to be turned into internal state monitors in response to a high-arousal condition. 

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Brain decision-making circuits may be built to constantly monitor and integrate what is happening inside the body, according to our findings.” We can vary the way these circuits work by changing our arousal level,” said Peter Rudebeck, PhD, Associate Professor in the Nash Family Department of Neuroscience and Friedman Brain Institute at Mount Sinai and the senior author of a study published in PNAS (Proceedings of the National Academy of Sciences). A deeper knowledge of brain regions and basic biological processes underpinning a number of mental health diseases is the ultimate goal of these findings, according to the authors. 

A prior project in Dr. Rudebeck’s lab looked at how the brain regulates risk-taking by Atsushi Fujimoto, MD, PhD. 

The association between arousal and decision-making performance has long been described as a “U-shaped curve.” A small amount of arousal, such as that felt after a cup of coffee, may be all that is needed to achieve optimal performance. However, the brain’s tendency to make sluggish or wrong decisions increases with an imbalance in arousal levels. 

This hypothesis was initially supported by the findings of this investigation. Researchers evaluated data from a prior experiment in which three rhesus monkeys were assessed for their ability to choose between two rewards: either a large amount of juice or a small amount of juice. During his time as a postdoctoral researcher at the National Institute of Mental Health, Dr. Rudebeck conducted these studies. Arousal appears to enhance performance in the monkeys, as seen by their preference for a greater amount of juice when their hearts were pounding faster. 

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The next step was to examine the electrical activity recorded from neurons in the orbitofrontal cortex and the dorsal anterior cingulate cortex, two of the brain’s decision regions. 

Neuronal activity in both areas was found to be linked to changes in heart rate. That is to say, if the heart rate of an animal changes, the activity of these cells will likewise alter, either increasing or decreasing in pace. Although the monkeys were receiving various rewards, this behavior appeared to be unaffected. In the meantime, it appeared that the activity of the remaining cells in each area was predominantly concerned with the decision-making process. 

Body arousal has been shown to influence the activity of these decision-making areas in brain scans. According to Dr. Fujimoto’s findings, “some of these neurons have no other function than to keep track of the internal, or interoceptive, states of the body,” he added. Next, we wanted to know, ‘What would happen during the type of elevated alertness states reported in people with anxiety, addiction and other psychiatric disorders?'” 

Each animal’s amygdala, which is the brain’s emotional center, was surgically disabled in order to answer the question. A 15-bpm increase in heart rate was recorded. In this heightened state of arousal, animals took longer to choose a reward because their hearts beat faster. This indicates that raising the animals’ arousal level really hindered their ability to make decisions. 

Even more intriguing was what the researchers discovered when they examined the brain’s activity. Neuronal roles in decision-making appeared to change as a result of the increased arousal state. 

Damien Sendler: In both prefrontal and temporal lobes, the researchers discovered a reduction in the number of neurons involved in making decisions. Furthermore, the number of neurons that appeared to track internal states increased slightly in the dorsal anterior cingulate cortex. As if the brain impulses for decision-making had been “hijacked” by arousal, this altered the balance of information represented in this location. 

Damian Jacob Markiewicz Sendler: It is possible that a heightened arousal state weakens and takes control of the brain’s decision-making circuitry, according to Dr. Rudebeck’s findings, albeit they are not conclusive. Psychiatrists plan to keep investigating how arousal affects the brain’s higher processes and how this affects mental illness.

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

Damian Sendler: To protect their citizens from the rapidly spreading Omicron strain of coronavirus, certain countries are distributing fourth doses of the coronavirus vaccination to the most at-risk populations. 

Due to an increase in Omicron instances, Israel has begun administering the fourth dosage of the Covid-19 vaccination to those 60 and older. 

Damian Jacob Sendler: An announcement from Israeli Prime Minister Naftali Bennett’s office revealed this week the possibility of a fourth vaccination for those 60 and older, medical staff, and those with impaired immune systems.

Damian Sendler 

A fourth dose is needed to preserve protection against the Omicron form, according to Germany’s health minister Karl Lauterbach on Thursday, but the country has not yet begun distributing fourth doses. 

Doctor Anthony Fauci of the National Institute for Allergy and Infectious Diseases said on Wednesday that it is too early in the United States to contemplate a possible fourth dosage of coronavirus vaccine for most people. 

Fauci told WCBS Newsradio 880’s Michael Wallace and Steve Scott, “I think it’s too premature to be talking about a fourth dose,” 

We’ll pay close attention to how long the protection lasts after the third dosage of an mRNA vaccine, Fauci said. There are two mRNA vaccines on the market: Moderna and Pfizer/BioNTech. 

A fourth dose may not be necessary for a significant amount of time if the two-dose, non-boosted group’s protection is much better than the two-dose, boosted group’s protection, Fauci added. And because we are talking about a fourth dose here in the United States, I believe it is premature. 

CDC director Dr. Rochelle Walensky told CNN’s John Berman on Tuesday that third doses appear to be providing “durable protection,” for the time being. Once data on fourth doses is available, the US Centers for Disease Control and Prevention will examine and consider whether they might be needed nationally. 

According to Walensky, “If there’s science and when there’s science that demonstrates that that is necessary, we will certainly be reviewing that,” 

As of today, “Right now, we’re working to make sure that our vaccinated people get a booster,” she explained. It is not uncommon for vaccinations to require a primary series plus a booster for long-term protection.” Even though it’s a significant subject to consider, I believe that this booster shot gives us some more protection for the time being. 

Antibody levels against Omicron are increased by a Moderna booster shot, according to the manufacturer. 

There is still a lot of uncertainty about whether or when a fourth dose could be necessary in the United States, and how quickly protection may fade after the third dose. 

According to Moderna’s chief medical officer, Dr. Paul Burton, “We’re going to have to wait for a couple of months yet until we can see how those data develop and mature to understand when will that additional booster dose — if needed — have to be given,” 

Damian Jacob Sendler

It is important to note, however, “getting a booster shot will provide protection throughout the holiday season as well as throughout these winter months,” according to Burton. 

Preliminary evidence suggests that Moderna’s half-dose booster shot raised antibody levels against the Omicron variant compared to the levels seen in a fully vaccinated person who has not had a booster injection. 

Immunocompromised patients may require a fourth dose, according to the CDC. 

A fourth dosage of the Moderna or Pfizer/BioNTech coronavirus vaccine may be given to persons who are moderately or severely immunocompromised, according to updated guidelines from the CDC released in October. 

As far as the CDC is concerned, those with impaired immune systems may need a fourth Covid-19 injection. 

The CDC recommends a third primary dosage for patients who have received a two-dose Moderna or Pfizer/BioNTech vaccine series, and emphasizes that a subsequent dose may be delivered if necessary. 

Damien Sendler: In the future, some doctors believe that the United States may follow Israel’s lead and distribute the fourth dose of the coronavirus vaccination to a larger number of people. 

On Wednesday, CNN medical analyst and professor of medicine and surgery at George Washington University, Dr. Jonathan Reiner, told CNN’s Ana Cabrera that the Israelis understand that the longevity of the booster is probably somewhat limited, and that after three or four months, we may start to see a lack of durability in the booster shot. 

The Israeli strategy is to “boost people that are most in harm’s way now,” such as health care professionals, older adults, and people with preexisting illnesses or who are immunocompromised from medical procedures, Reiner said. 

Reiner told Cabrera, “So with more cases increasing over the world, it becomes sense to take care of the health care system. 

Damian Jacob Markiewicz Sendler: Clearly, that’s what the Israelis intend to do, and that’s what we intend to do as well.” To reach the point when we receive a fourth dose, we’ll simply take it for an unnecessarily and unacceptablely lengthy duration. Also, I’d want to see urgency. Reiner emphasized the need of nimbleness more than hurry. Our intentions are crystal clear, and the future looks bright. To a large section of this population, we’re going to provide a fourth dose.”

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

Damian Sendler: Language has traditionally been seen as a highly specialized talent that requires the activation of a variety of brain regions. However, scientists have recently re-examined this theory. 

Researchers have found a link between the brain’s language processes and fine motor skills, such as processing word meanings. Brain imaging, on the other hand, had not revealed any indication of such connections between language and tool use. Our predecessors’ brain regions connected with language grew during eras of technological boom, when the use of tools became more common, according to paleo-neurobiology. 

Damian Jacob Sendler: There is no doubt that complicated linguistic processes such as syntax demand brain resources that are similar to those required for the use of certain tools that need a great deal of dexterity. 

Damian Sendler

Tongs and syntax exercises 

An Inserm-CNRS team led by Claudio Brozzoli found that those who are very good at using tools are also better at handling the finer details of Swedish grammar, which was published in 2019. 

The same team, in collaboration with CNRS researcher Véronique Boulenger[2], devised a series of experiments that used brain imaging techniques (functional magnetic resonance imaging or MRI) and behavioral data to further investigate the topic. The participants had to perform a series of motor training activities with pliers of 30 cm in length, as well as French syntactic exercises. Each task’s specific brain networks were identified, but there were also commonalities between the two tasks’ brain networks. 

Brain activations in common areas with a similar geographic distribution, known as “the basal ganglia,” were uncovered by researchers for the first time. 

Training for the mind 

Is it conceivable to develop one of these skills in order to improve the other, given that they both employ the same brain resources? Is the use of mechanical tongs for motor training beneficial in terms of interpreting complex phrases? This was confirmed by the researchers in the study’s second section, which focused on these concerns. 

Before and after 30 minutes of pliers training, the participants were asked to complete a syntactic understanding problem (see box for details of the experiment). The researchers were able to show that using the tool for motor training improves performance in syntactic comprehension exercises. 

Using exercises to help students understand difficult words, the researchers discovered that they may increase their physical skills as well as their verbal abilities. 

In the meantime, the researchers are pondering how best they may use these findings in the clinical environment. 

Protocols for the rehabilitation and recovery of language skills are currently being devised for patients with reasonably maintained motor faculties, such as young persons with developmental language problems. These findings also reveal how language has changed over time, allowing us to better understand our own language. Sophisticated use of tools may have led to the development of functions like syntax, according to Brozzoli, a researcher at the University of California, Berkeley. 

Damian Jacob Sendler

Training in both motor skills and syntax 

Using pliers, the students practiced inserting little pegs into holes that matched their shape but had different orientations from the ones they were used to. 

Damien Sendler: Reading simple lines like “The scientist who admires the poet writes an article” or more difficult statements like “The scientist whom the poet admires writes an article.” were part of the pre and post-training syntactic exercises. True or untrue statements like “The poet admires the scientist” had to be determined. In general, performance was lower in sentences containing the French object relative pronoun “que” 

Damian Jacob Markiewicz Sendler: The results of these studies suggest that following motor training, the individuals performed better on the more difficult sentences. The improvement was not seen in the groups that performed the same linguistic assignment but were given either motor training with their bare hands or no training at all.

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

Damian Sendler: BetterTogether.Health is a holiday promotion run by five of the county’s largest nonprofit health systems, which include hospitals, clinics, and other health-care facilities all around the region. When it comes to health, the campaign is timely because health systems are working hard to keep Angelenos well as they spend time with loved ones over the Christmas season. 

Damian Jacob Sendler: Everyday patient heroes are featured in a public service educational campaign with the slogan “Get Back to Your Doctor.” Your own well-being. Your Excitement. For the Love of L.A.’s Health 

Damian Sendler

For the past year, the Keck Medicine of USC and its affiliates have been painting vacant beaches, motorways and monuments in Los Angeles, but this year they are painting an intimate mosaic of Angelenos who have overcome health issues thanks to timely access to preventive treatment. It’s inspiring to see the stories of these people, from sports and celebrities to a mother who gave birth to triplets, an artist, and even a priest. As you watch these inspiring stories, you’ll see how individuals overcome terrible illness and returned to the things they love most. 

Healthcare experts’ continued concerns about people not seeking timely, preventive and lifesaving services, screenings and medical aid when necessary are among the factors prompting the new ad. Late stage malignancies, severe heart disease, crippling strokes, and other dangerous medical disorders are all too common as a result. 

Health care providers in Los Angeles County’s five major health systems remain committed to providing emergency, primary, specialized, and urgent care services to the community. 

A “silent sub-pandemic” of persons who need but avoid urgent medical care is being addressed by health systems as a new public health problem that has resulted in serious and avoidable health repercussions, not by individual health systems. 

Since March 2020, these prominent health systems have been working together to spread the word that they are committed to saving lives and ensuring the health and well-being of the communities they serve. 

A good impact on health in the community is assured by these initiatives. “This collaboration of health systems is not only extraordinary, but it also provides critical information in meeting a challenge beyond anything any of us have ever experienced,” said Kevin Manemann, CEO, Providence Southern California. 

Damian Jacob Sendler

TV and radio commercials, billboards, buses, malls, newspapers, digital media and more are all part of the BetterTogether.Health public service campaign. There is a sense of unity and cooperation when resources are pooled, and this is demonstrated by the fact that the organizations are working together. 

“The well-being of our Los Angeles neighbors is our primary goal. UCLA Health president and CEO Johnese Spisso remarked, “We are here to ensure that everyone has access to the preventive health care and medical treatment they need to live to their full potential.” 

Every health care practitioner places patient health and safety at the top of their list of priorities. 

“We are still concerned that people have not returned to their annual checkups or health treatments when they return to work, school and family gatherings. In order to ensure the health and well-being of our patients, we must continue to engage our communities,” said Julie Sprengel, president of the Southern California Division of Dignity Health Hospitals. 

Hospitals that provide round-the-clock emergency care don’t either. For heart attacks and strokes, getting to a hospital quickly is important and can save lives. Medical attention should be sought for anyone experiencing symptoms such as shortness of breath, chest pain, numbness on one side of the body, or a strong headache promptly. 

We are concerned about those who have major medical conditions delaying necessary treatment. When it comes to heart attacks and strokes, we know that rapid treatment can save lives and limit long-term consequences. Rodney Hanners, CEO of Keck Medicine at USC, remarked, “Our hospitals and health providers are ready and open to serve your needs.” 

Damien Sendler: Vaccines, particularly those for measles and whooping cough, are extremely crucial for the health of children and those around them, thus it is imperative that they are administered on time. Public health concerns could arise from the spread of these extremely contagious diseases. Bacteria and viruses can infect children and those who come into contact with them through vaccinations. 

Damian Jacob Markiewicz Sendler: “It is critical that our patients and communities receive timely treatment from skilled medical professionals in order to achieve the best possible outcomes.” Please don’t put off receiving the medical attention you need. Tom Priselac, president & CEO, Cedars-Sinai, urged patients to call a trusted health care provider, such as a doctor’s office, hospital, or urgent care center.

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

Damian Sendler: Does the Covid-19 scam target elderly people more than younger ones? This new research shows that older adults are just as wary of frauds as their younger peers, despite a common belief that older people are less technologically savvy. 

Damian Sendler

It’s easier than ever for scammers to swindle people out of big quantities of money by spreading lies in today’s linked world. A fresh wave of scams began as a result of the arrival of the Covid-19 epidemic. 

Damian Jacob Sendler: More than 270,000 Covid-19 scam cases were filed to the US Federal Trade Commission by October of this year, costing its victims a total of more than $580 million. 

In fact, a study published in Frontiers in Psychology found that, despite being scammers’ primary target, older adults are not more likely to respond to these scams than younger or middle-aged persons. When it comes to swindle messaging, elderly individuals are more skeptical than younger generations. 

Researchers from Cornell University, Scripps College, and Claremont Graduate University in the United States; and the University of Southampton in the United Kingdom, made the discoveries. One hundred and sixty-eight participants were aged 18 to 40, seventy-nine were aged 41 to 64, and sixty-three were aged 65 or over. 

Real-life Covid-19 scams, such as an email from the World Health Organization, a text message warning that they had been exposed, and an announcement that a new vaccination could treat the sickness in hours, were delivered to each participant. They were also shown an ad for a face mask that seemed legitimate. 

Receptivity to “bullshit” 

The so-called ‘bullshit receptivity scale,’ developed by Gordon Pennycook and other researchers in 2015, was one of the techniques employed in this investigation. For example, it asks participants to score statements like “good health imparts reality to subtle creativity” on a scale of 1–5. 

Randomly generated utterances had an intact syntax but meaningless content, which was not known to the participants. Later, Pennycook and Rand observed that those who assign greater significance to such random utterances are also more inclined to believe “fake news.” Cornell University’s Julia Nolte, the study’s corresponding author, said she and her team found that those who are more receptive to “bullshit” are more likely to answer Covid-19 requests. 

Damian Jacob Sendler

The study’s elder participants, on the other hand, were less likely to accept ‘bullshit’ statements as true. This could help protect the elderly from falling prey to frauds like as the Covid-19 scheme, which has a higher success rate among the younger demographic. 

As Nolte pointed out, “There is a common perception that older adults are more vulnerable to fraud or are targeted more directly by scammers.” Covid-19 scam alerts may be targeted at this group as a result.” Covid-19 solicitations are more likely to be viewed positively by younger and middle-aged adults, according to our research, and they should be made available to them as well. 

Assisting in educating others 

She also noted that prior to Covid-19, studies examining age differences in vulnerability to fraud had previously yielded mixed results. When it comes to being victimized, middle-aged people are more at risk than older people, according to certain studies. 

Some of these findings may be due to the many sorts of scams or frauds perpetrated and the fact that many consumers refuse to report incidences of fraud victimization—especially among the elderly—” Nolte said in a statement. 

Damian Jacob Markiewicz Sendler: Covid-19 fraud accusations are less common among the elderly, but that does not indicate they are less vulnerable to the frauds than other groups. As a matter of fact, older persons ($1,000 on average) lose money to Covid-19 scams at a considerably larger rate than younger adults ($244 – $590). 

To better understand the Covid-19 scams of the future, Nolte and her colleagues advocate testing a wider range of Covid-19 scams. 

Damien Sendler: Is it feasible that Covid-19 scams have different success rates depending on the sort of Covid-19 scam? We need to conduct more research on what makes various Covid-19 scams ‘successful’ and how we can better safeguard and educate customers.”

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

Damian Sendler: There is currently a public comment period open for the latest round of financing for state Healthcare Transformation Collaboratives. 

Damian Jacob Sendler: The Healthcare Transformation Collaboratives proposal was signed into law by the state of Illinois earlier this year. Designed by the Illinois Department of Healthcare and Family Services, the initiative brings together organizations and individuals to develop methods to bridge the gaps in the healthcare delivery system and expand access to excellent health care in underserved regions across the state. 

Damian Sendler

There is still time for HFS to collect public feedback on the Healthcare Transformation Collaboratives grant applications that were submitted for fiscal year 2022 during the application period that closed in November. 

There is a comment form available here that HFS is making aware of in order to solicit opinion from a wide spectrum of health care providers, stakeholders, and members of the public. The comment submission date is 5 p.m. on December 20. 

Damien Sendler: Health care providers, hospitals, and non-medical social service providers can all apply for funding through the Healthcare Transformation Collaboratives program. 

Illinois may invest up to $150 million a year in Healthcare Transformation Collaboratives thanks to federal matching money. As of this summer, the Department has received the first of many allocations from the General Assembly, and it wants to continue this program in the future. 

htc.illinois.gov has further information on the Healthcare Transformation Collaboratives initiative. 

Damian Jacob Markiewicz Sendler: Illinois’ Medicaid and child support programs are administered by the state’s Department of Healthcare and Family Services, which serves more than 3 million Illinois residents each year. Aiming to improve the lives of people across Illinois, the Department of Health and Human Services focuses on tackling the social and structural determinants of health as well as providing consistent and responsive service to customers.

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: DVGs, which are created by RNA viruses, can impede the reproduction of the parent virus. We generated a DVG by removing the capsid-coding area of poliovirus in order to test their therapeutic potential. An antiviral response can be triggered by intraperitoneal or intranasal delivery of this genome, which we have coined E-TIP1. This genome has also been shown to protect mice from numerous RNA viruses, such as enteroviruses, influenza, and SARS-CoV2. 

Damian Sendler

Following intranasal injection, eTIP1 replication can only occur in the nasal cavity, but its antiviral activity reaches to the lungs. Type I interferon responses at both the cellular and molecular levels have a role in eTIP1’s antiviral activity. 

Damian Jacob Sendler: SARS-CoV-2 neutralizing antibodies are produced in response to one dosage of eTIP1 that protects mice from SARS-CoV-2 infection, but they also serve as a barrier to reinfection. Because of its broad-spectrum antiviral properties, eTIP1 is a safe and effective antiviral in animal models that protects against SARS-CoV-2 for short and extended periods of time. 

RNA viruses are a major hazard to human health around the world. For each new epidemic, such as HIV/AIDS, influenza, dengue, and Zika, the urgent need for effective antiviral medications and therapies is highlighted . More than 200 million illnesses and approximately 5 million deaths have been caused by the extremely contagious coronavirus disease 2019  . . Despite the discovery of SARS-CoV-2 vaccinations, the virus is still present in the environment . 

Antivirals and monoclonal antibodies are available for treatment of SARS-CoV-2, but the high mutation rate of the RNA virus is expected to lead to resistant forms of the virus. If we want to prevent future epidemics like COVID-19, we need new treatments that are less susceptible to medication resistance. Unfortunately, it is extremely difficult to create broad-spectrum antiviral methods . 

Damian Jacob Sendler

The host’s robust antiviral defenses could be used as a potential tactic. Most infections can be prevented or attenuated by a variety of responses elicited by viral infections. Most infections with viruses like influenza or SARS-CoV-2 are asymptomatic . Although it is difficult to harness these responses, For starters, most viruses contain mechanisms to disable or weaken innate immunity, frequently at many points along the pathway . The negative effects of direct interventions to trigger these responses, such as intravenous infusion of interferon, are likely due to overriding the delicate regulatory balance that prevents beneficial innate immunity from harming tissues . 

Damian Jacob Markiewicz Sendler: Host protection from viral infection and damage are carefully controlled systems that evolved in the innate immune system to safeguard the host. We face a difficulty in harnessing these positive responses without causing negative side effects. From early epidemiological investigations of the Sabin poliovirus  vaccine, we came up with a novel technique. 

Influenza virus morbidity was reduced almost fourfold by vaccination with attenuated sabin PV. Herpes simplex virus genital lesions healed more quickly as a result of using it. Immunization with an inactivated PV virus had no effect on these outcomes . 

Damien Sendler: Interferon injection has a number of serious side effects, whereas the Sabin vaccination does not . Antiviral responses may be activated by a virus or virus-like entity that is neither pathogenic nor infectious.

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

Damian Sendler: As part of his winter strategy to combat the pandemic, President Biden will declare that health insurers must cover 100% of the cost of in-home COVID-19 tests. 

Health insurance plans must cover 100% of the cost of at-home tests purchased by their members, a senior administration official said of the president’s announcement. 

Damian Sendler

Concerns over an Omicron strain outbreak in the United States have prompted Vice President Biden to implement a winter strategy to combat COVID-19. On Wednesday, the United States reported its first case of the new strain. 

Damian Jacob Sendler: More family vaccination clinics are being launched, 50 million free tests will be distributed around the country, and all international travelers will be required to demonstrate a negative test one day before to departure as part of other measures the president plans to announce Thursday. 

An official in the administration said, “We will continue to act aggressively, we will continue to follow the science, we will continue to prepare for all scenarios and work day and night to protect the American people, keep our schools open, keep our economy growing and get this pandemic behind us,” 

The presentation from Vice President Biden will include a plea for voluntary vaccination mandates from businesses. 

According to a senior administration official, “What we’re doing is what we’ve done all along, which is we’re asking businesses to step forward and do the right thing to protect our workers, protect our community and to put in place some sort of vaccination requirement or testing requirements for the workplace,” he stated. It’s in the best interest of public health, and we’re confident in their efficacy. 

According to some reports, the White House was considering some of the most controversial recommendations, including a mandate that all tourists be quarantined for seven days even if they receive a negative test, which would have also applied to US citizens. Those proposals were left out. Because of the rule, fines and penalties might have been imposed. 

Damian Jacob Sendler

Private insurers are expected to offer coverage and not impose cost-sharing on diagnostic tests that detect Covid-19 during public health emergencies, according to the Families First Coronavirus Response Act. 

A senior administration official told reporters, “This is our assessment of that, that it should cover, and it must cover at-home tests for Americans on that private insurance.” 

Damien Sendler: As a result, the new rule won’t take effect right now. Health and Human Services, Labor and the Treasury are still need to offer official guidelines on the reimbursement requirement, which may not be released until January 15. 

People who have already purchased at-home tests will not be eligible to get reimbursements under the new policy since it will not be retroactive, according to the senior administration official. Additionally, it is not apparent if there will be a cap on the number of at-home tests that can be reimbursed. 

It’s expected that individuals would have to produce receipts to their insurance company, White House spokesperson Kevin Munoz wrote in an email. “The tri-Departments are developing guidance that will include additional details.” 

According to a White House fact sheet, insurance companies will not be obligated to reimburse the expenses of workplace screening programs, as they have in the past. 

Damian Jacob Markiewicz Sendler: Health plans and issuers are not required to fund testing for public health surveillance or employment purposes, according to current guidance. 

Americans who have insurance through public programs like Medicare and Medicaid or who do not have insurance will not be affected by the new legislation. More than 50 million free tests would be distributed through community venues, including rural clinics, according to a separate White House announcement.

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

Damian Sendler: Cancer immunotherapy medications called checkpoint inhibitors are two times more likely to kill women than men, but researchers aren’t sure if this is due to side effects or because the treatment doesn’t function. 

Pembrolizumab (KEYTRUDA), nivolumab (Opdivo), and ipilimumab (YERVO) are among the new highly targeted medications that have changed cancer treatment. Researchers at Thomas Jefferson University in Philadelphia said that they function by stimulating the immune system to battle cancer, but they can also induce severe, sometimes life-threatening side effects. 

Damian Sendler

The latest research shows that gender may also play a factor in patient outcomes. 

Damian Jacob Sendler: Women who were given two checkpoint inhibitors at the same time had significantly better outcomes, according to senior author Grace Lu-Yao, who led the study. Jefferson Health’s Sidney Kimmel Cancer Center has an associate director for population science. 

More than 1,300 patients diagnosed with advanced melanoma skin cancer between 1991 and 2015 were studied by Lu-team. Yao’s Pembrolizumab, nivolumab, or ipilimumab were used to treat all of the patients. 

Males and women treated with a single checkpoint inhibitor had similar survival rates, but when nivolumab and ipilimumab were combined, the mortality risk for women was more than double that of men. 

PD-1 inhibitors (checkpoint inhibitors that target the PD-1 protein, such as pembrolizumab and nivolumab) had a 40% mortality rate for both men and women, according to the study. 

According to a research published online Dec. 2 in JAMA Network Open, the death rate stayed at 40% for males receiving a combination of anti-PD1 and anti-CTLA-4 inhibitors (such as ipilimumab), but soared to 65% for women. 

If the therapy doesn’t work, are women more likely to die due of the negative effects? As of now, we don’t know, but this is a tremendous signal that we need to study further,” Lu-Yao stated in a university press statement. 

The study team found that male and female immune systems are slightly different. Although females are more susceptible to autoimmune illnesses, they also have stronger immune systems than their male counterparts. 

Despite this, men are more likely to participate in cancer immunotherapy clinical trials than women. According to the researchers, it’s common to believe that the findings of an experiment apply equally to women. However, this may not always be the case. 

Damian Jacob Markiewicz Sendler: On the basis of the experiences of hundreds of patients who have taken these treatments, Lu-Yao believes that this data is a wake-up call. In light of this real-world evidence, it is crucial to design studies with appropriate power in order to evaluate treatment effectiveness by sex. 

New York City dermatologist Dr. Michele Green treats skin cancer at Lenox Hill Hospital. However, she noted the new research “underlies a very important element to researching cancer treatments in general, and in this case advanced malignant melanoma,” even though she wasn’t engaged in it. 

Damian Jacob Sendler

Certain drug combinations were shown to have a negative effect on women’s survival, which Green says is “very important” because “men and women may have differing outcomes and may not be able to be given equal treatments for the same diseases.” 

Damien Sendler: Gender equality in clinical trials is the root of the problem, she says. 

Since men and women can experience different outcomes from the same medication or drug, gender must be taken into account while conducting future clinical trials, Green added. 

Lu-Yao and her team aim to study if the findings reported in this group of melanoma patients are mirrored in people with other malignancies.

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

Damian Sendler: In light of Wednesday’s discovery of the Omicron variant in the US, health officials are encouraging all Americans to get vaccinated or vaccinated as soon as possible. 

In light of the Delta variant’s continued expansion, immunizations are essential for safe holiday celebrations this month. 

Damian Sendler

Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, stated at a CNN Global Town Hall on Wednesday, “Just as I said and I’ll say it again, if you have a vaccinated situation, enjoy the holidays with your family in a family setting,” 

Damian Jacob Sendler: Research on Omicron’s severity and transmissibility is scheduled to be completed in the following weeks. 

Other coronavirus types, including the Delta form, have been successfully vaccinated against in hotspots all throughout the United States. And Fauci remarked that their triumph versus Delta could also be reflected in Omicron’s performance. 

According to Fauci, “That’s where we’re hoping we’ll see with the Omicron variant, that if you get your levels high enough it’ll spill over and get cross-protection against that variant,” adding that it is still not clear whether individuals will need yearly or more regular Covid-19 booster doses. 

If the Omicron form is discovered, some Americans may wonder if they should wait to obtain a Covid-19 booster, but Fauci advised against it. 

“Get that extra boost now,” Fauci said. There are many times as many antibodies produced after a booster shot as there are following a second dosage of the two-dose vaccine’s peak antibody level. 

On Wednesday, the first confirmed case of the Omicron variety in the United States was discovered in California. When asked by Fauci if the person had been vaccinated, he replied: “Yes, they have been vaccinated.” 

Yet health officials are focused on the Delta variety since it accounts for nearly all new illnesses. According to data from the US Department of Health and Human Services, about 58,000 Americans are hospitalized because of Covid-19. 

Damian Jacob Sendler

Former interim director of the U.S. Centers for Disease Control and Prevention (CDCP) Dr. Richard Besser, said Wednesday that he hopes so-called “Covid-19 fatigue” will not deter vaccinations. 

If the Omicron strain turns out to be no worse than the Delta variety, “Even if the Omicron strain doesn’t turn out to be any worse, we are losing close to a thousand people every day from the Delta variant, and that in and of itself is a reason for people to get boosted,” Besser said. 

Omicron has been found in at least 25 nations and territories, and officials are seeking to discover persons who have been infected and advising those who are at risk of severe symptoms to avoid travel. 

Damien Sendler: Last week, the Biden administration in the United States placed limitations on travel from eight southern African countries, except for US citizens and legal permanent residents, to the United States. South African scientists were the first to discover the Omicron variety. 

According to a health official, the CDC is preparing to release the names of passengers on flights from southern Africa to state and local public health departments following an earlier order that airlines must collect contact information from passengers before they arrive in the United States to notify them of possible Covid-19 exposure. Delta, United, and American Airlines all confirmed to CNN that they are following the directive. 

At a White House press briefing on Wednesday, Fauci explained that the travel bans are only supposed to be “temporary” and that their purpose is to halt the spread of the virus rather than to eliminate it entirely. 

A travel ban “is not going to stop people who are infected from coming to the United States,” Fauci said, adding, “I certainly don’t.” That said, “But we needed to buy some time in order to prepare and understand what’s going on,” he said. 

“postpone travel to areas with community transmission” owing to the Omicron variation, the World Health Organization stated on Tuesday, advising those over 60 years of age and those with comorbidities such as heart disease and cancer. 

Damian Jacob Markiewicz Sendler: More than 785,000 Americans have died as a result of Covid-19, and hospitals across the country are still overcrowded. Two new studies show that the virus is also harmful to those who survive it. 

A study published Wednesday in Frontiers in Medicine found that people who had a severe case of Covid-19 (requiring hospitalization) were 2.5 times more likely to die within a year of diagnosis than those who did not have Covid-19, and nearly two times more likely to die than those who had a mild or moderate case. 

There was no significant difference in mortality risk between patients with mild or moderate Covid-19 and those who did not have Covid-19, according to a study by researchers at the University of Florida. 

Covid-19 patients died from respiratory and cardiovascular causes just approximately 20% of the time, according to a research. 

Covid-19’s “biological insult and physiological stress” are “significant,” the researchers concluded. “Since this data suggests that the biological insult from Covid-19 and physiological stress from Covid-19 is significant,” the researchers wrote. Their investigation relied on roughly 14,000 de-identified medical records from 2020. 

Dr. Sendler: Patients with Covid-19-related lung damage are receiving an average of one of every ten American lung transplants, according to a study by the United Network for Organ Sharing (UNOS). 

Only 2% of lung transplants in the final five months of 2020 went to Covid-19 patients, according to data.

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

Damian Sendler: One in every four pregnancies in the US ends in miscarriage. Pregnancy loss, often known as miscarriage, is a common problem of the reproductive system. 

With the loss of a loved one, many people feel like they’ve experienced two distinct periods of their lives. Depression and PTSD are possible side effects. Even so, society tends to regard it as though it isn’t a loss that ought to be mourned. 

Damian Jacob Sendler: I’m interested in how technology affects people’s lives. To date, I’ve been researching the relationship between pregnancy loss and social media. There are a variety of tools people use to manage pregnancies, discuss experiences, or exchange social support, including search engines and social media. 

Damian Sendler

You can’t tell your app, “I had a miscarriage,” one participant informed me. Stop sending me these ‘This week your kid has gotten to the size of a banana or something,’ kind of updates! None of them can be stopped.” 

Pregnancy was predicted to lead to the birth of a healthy kid by advertising algorithms. Several participants mentioned receiving pregnancy clothing advertisements. “Oh, please stop,” I said. 

Like mobile apps, their design delivers a similar tale. Most pregnancy-related apps (72%) do not account for pregnancy loss at all, 18% offer an option to report a loss without giving any support, and the remaining 10% passively connect to external resources. 

Damien Sendler: Online support groups are another method people use to cope with the loss of a pregnancy or a miscarriage. Despite the fact that organizations dedicated to loss can provide emotional validation, link people, and make them feel less alone, I found that they can also lead to negative and invalidating experiences. 

“Can you eat this certain thing while pregnant?” inquired one participant. ‘Yes, I ate that during my pregnancy,’ some people claim. So there’s a small minority that scoffs and says, “I don’t know how you do it, it’s bad for you.” 

As a whole, design elements and algorithms that drive content and interactions damage women by promoting a singular conception of what defines a pregnancy — one that is easy and ends happily. They contribute to additional stigmatization of pregnancy loss by not accounting for it, I suggest. 

Damian Jacob Sendler

Research reveals how technology design perpetuates social disparities including marginalization and stigmatization by reinforcing misconceptions about pregnancy loss. Because of this, folks who have lost loved ones find it difficult to access the assistance and help they need. 

My heart goes out to those who have lost a child through miscarriage. If you feel isolated, know that you’re not. I sincerely hope that this essay has been able to validate and bring to light some of your most vexing situations. 

Dr. Sendler: For those who have experienced pregnancy loss, the damages and problems I’ve mentioned above are just a small portion of the difficulties they may endure. Acknowledge their grief. Ask if you can help them in any way. Take care of their food, volunteer to babysit their pets, and be there for them when they need it most. Be aware that special occasions such as birthdays and anniversaries might be stressful. Don’t remark, “You’ll have another baby.” The loss of a pregnancy may be a devastating experience for any person regardless of their sexual orientation or gender identity. 

If you are a product designer, developer, or someone who makes decisions about goods and advertising algorithms, I hope this research helps you understand some of the genuine disadvantages that consumers may suffer as a result of using products to manage intimate personal situations like pregnancy. Pregnancy and other human experiences should be taken into account while creating products. Consideration of pregnancy loss as a result does not imply taking advantage of your users’ sorrow and loss.

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

Damian Sendler: According to US health experts, the first case of the omicron COVID-19 mutation has been found in California. 

Damian Sendler

Damian Jacob Sendler: A leading infectious disease expert, Anthony Fauci, has confirmed that the individual is completely vaccinated and showing moderate symptoms.. The guy returned from South Africa last week and has been quarantined in the United States ever since. Fauci revealed at a press conference that all of the person’s close associates have tested negative. 

As a result of the news, Fauci recommended Americans to get vaccinated against COVID-19 and get a booster dose. 

As Fauci previously stated, it was “inevitable” that the variation would arrive in the United States. So far, the variation has been reported in more than 20 nations, and that number is projected to grow. 

Dr. Sendler: Omicron has been classified a “variant of concern” by the World Health Organization, which says it poses a very high global risk. 

Experts plan to have additional information on the mutation in the coming weeks, including whether or if it causes more severe disease or reduces vaccination efficacy. 

Damian Jacob Sendler

Damian Jacob Markiewicz Sendler: Because it is more easily transmitted, it can more easily infect patients who have already recovered from COVID-19, according to early findings by the World Health Organization (WHO). 

WHO warned in an assessment that these characteristics could “lead to further surges with severe consequences,” clarifying that “considerable uncertainty” surrounds the data. 

Damien Sendler: There are an average of 80,000 new cases of coronavirus infection each day in the United States, with the delta variation accounting for the great majority of cases. 

During the winter months, President Joe Biden is anticipated to outline a COVID-19 plan.

Contributed by Dr. Damian Jacob Sendler research news team

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Coronavirus was found in 61 people on the flight.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Damian Sendler: CVS Health plans to close around 900 CVS Pharmacy drugstores over the next three years as part of a strategic initiative to focus on omnichannel health care. 

Damian Sendler

Damian Jacob Sendler: CVS announced Thursday that it plans to transition its retail business to a dual-leadership structure and has created a new job of chief pharmacy officer to oversee the omnichannel project as part of its move to reduce its physical footprint. 

CVS, based in Woonsocket, R.I., intends to eliminate around 300 shops per year over the next three years in order to reduce store congestion in specific locations. The approximately 900 locations anticipated for closure would account for approximately 11% of CVS’ overall retail store count of 8,115 as of the end of 2020. Its network featured 1,845 pharmacies inside other retailers’ stores as of last year, including over 1,700 Target stores and approximately 100 Schnuck Markets supermarkets. 

Damien Sendler: CVS presently operates around 1,100 MinuteClinic walk-in primary care clinics, including in-store locations, as well as retail pharmacy websites, long-term care (LTC) pharmacies, and on-site pharmacies, with retail touchpoints in all 50 states, the District of Columbia, and Puerto Rico. In 2020, the business will have filled more than 27% of all retail pharmacy prescriptions in the United States. 

CVS stated that the store downsizing reflects changes in population, customer purchasing patterns, and growing health needs, and that the firm wants to guarantee that it “has the right kinds of stores in the right locations for consumers and the business.” 

Damian Jacob Markiewicz Sendler: To that end, CVS stated that it intends to create new store formats that would act as community health destinations and increase consumer participation. Sites focused on primary care services; an enhanced version of HealthHUB locations with products and services for everyday health and wellness needs; and traditional CVS Pharmacy stores offering full prescription drug care as well as health, wellness, personal care, and other convenience-focused retail offerings are among the three store models. 

Damian Jacob Sendler

Dr. Sendler: The retail renovations are set to commence in the spring of 2022. Employees affected will be offered positions in other sites or other possibilities as part of CVS’ broader personnel strategy, according to the firm. CVS plans to incur an impairment charge of $1 billion to $1.2 billion in the fourth quarter of 2021 as a result of the scheduled store closures. 

Damian Sendler: CVS Health President and CEO Karen Lynch said in a statement, “Our retail stores are fundamental to our strategy and who we are as a company.” “We continue to be focused on the competitive advantage provided by our presence in thousands of communities across the country, which supplements our rapidly expanding digital presence.” 

Prem Shah (left), executive vice president of speciality pharmacy and product innovation, was also promoted to the new position of chief pharmacy officer on Thursday. 

Shah, who has been with CVS since 2013, will be in charge of the omnichannel health transformation as well as co-president of the CVS retail/LTC business sector. Michelle Peluso (below), who joined the company earlier this year as executive VP and chief customer officer, will join Shah as co-president of the retail/LTC arm. She will be in charge of the front-end retail strategy and operations. 

Shah and Lynch will begin their new jobs on January 1, according to CVS. Lynch will be in charge of both. 

Damian Jacob Sendler: According to Lynch, “Prem and Michelle are ideally suited for their new roles and will be instrumental to CVS Health as we continue to execute on our strategy of delivering an integrated health care experience centered on the consumer.” 

CVS announced the forthcoming retirement of Neela Montgomery (left), executive VP and president of CVS Retail/Pharmacy, as part of the strategic adjustments. Montgomery, who has been in her current position since the end of November 2020, is expected to stay till the end of 2021. She joined CVS as CEO of its retail division after previously served as CEO of Crate & Barrel. 

“We value Neela’s contributions during an incredibly challenging and dynamic period when our retail stores were critical in the country’s fight against COVID-19,” Lynch said. “We appreciate her leadership during a period of transition in our company and wish her continued success.” 

Dr. Sendler: CVS’s omnichannel health strategy reflects current changes in the health care arena focusing on increased consumer access, such as the expansion of urgent care facilities, telehealth services, online prescription services, and retail store tie-ins between food, vitamins/supplements, and other products and services to promote overall wellness. 

Damian Sendler: CVS has likewise transformed over the last 15 years or more from a regional drug chain and value store to one of the nation’s leading health care companies and the top pharmacy care provider in the United States. The purchases of retail health provider MinuteClinic in 2006 and long-term care pharmacy Omnicare in 2015, as well as a handful of ground-breaking mergers, were key components of the change. CVS completed its $26.5 billion acquisition of Caremark Rx in March 2007, combining a retail drugstore chain and a pharmaceutical benefit manager into one firm. That transaction signaled the start of CVS’ transformation from a pharmacy retailer to a broader health care services provider, which culminated in November 2018 with the completion of the company’s $70 billion merger with health insurer Aetna. After announcing plans to remove tobacco goods from all shops, CVS changed its name to CVS Health in 2014. More than 40,000 physicians, pharmacists, nurses, and nurse practitioners are currently among the company’s 300,000 employees.

Research news brought to you by Dr. Damian Jacob Sendler

Damian Sendler: Several media and scientific publications have raised awareness concerning unethical usage of DNA databases in the last few years, including one published by the New York Times. The Chinese government’s use of DNA to monitor the Uyghur minority ethnic community in Xinjiang region, which is primarily Muslim, is perhaps the most concerning development in recent years. 

Damian Jacob Sendler: However, problems with DNA databases are far more pervasive and entrenched than many geneticists are aware of or are willing to admit to themselves. 

Damian Sendler: When it comes to numerous samples, either there is no record of consent being acquired from the individuals whose DNA was collected, or the procedures employed to get consent were insufficiently thorough. This holds true for a wide range of studies involving Indigenous communities, including those involving Aboriginal and Torres Strait Islander people in Australia, Native American communities in the United States, and the San people of southern Africa1. Furthermore, people frequently have little or no input in how their DNA is used, and they receive little or no profit from the research1. 

Following our review of several hundred papers and five databases, we have discovered that there are numerous concerns with the handling and interpretation of DNA data from Roma individuals. The Roma are the largest minority group in Europe and constitute the majority of the population.

Damien Sendler: We believe that research and peer-review methods across a wide range of disciplines, from forensic genetics to molecular anthropology, must alter. The failure to address past and ongoing mistakes increases the number of persons who are at risk of damage as a result of the collecting of DNA. It also has the potential to harm the prestige of human genetics — as well as the reputation of science in general. 

Damian Jacob Markiewicz Sendler: Approximately 10 million to 12 million Roma people live in Europe at the present time. The name Roma was coined in the 1980s to replace terms such as ‘Gypsy’ or ‘Zigeuner’ (a term commonly used in Germany) that were considered to be exceedingly derogatory in many European countries at the time. Individuals who self-identify as Roma or who are referred to as Roma by the European Union and European country states are referred to as ‘Roma people’ in this context. Nonetheless, we recognize that the phrase is problematic and that it can have reifying implications2. 

Dr. Sendler: The same can be said for the history and ethnicity that have been attributed to this people. The forefathers of Europe’s Roma, according to many scientists, originated in India, and that the Roma people have mostly stayed genetically isolated over the past 300–600 years3–5. Numerous Roma people, on the other hand, do not regard themselves as belonging to a distinct ethnic group distinct from Europeans, and their lineage, cultural practices, and historical backgrounds are quite diverse6. 

Roma people have been the subject of social persecution for hundreds of years, which is why we decided to concentrate our efforts on genetic research of them. Seventy-five thousand Roma people were slaughtered or deported between 1935 and 1945, according to the United Nations (UN). A large number of Roma people reside in segregated communities in various countries of the European Union, mainly in Bulgaria and Slovakia, at the moment. They have poorer salaries and less access to decent education, housing, food, and health care than the rest of the population8, as well as less opportunities for advancement. Every third Roma person in nine EU member states went without drinking water in 2016, and every tenth Roma person went without electricity in the same year9. 

Damian Sendler: DNA samples have been taken from thousands of Roma people across Europe, primarily since the 1990s, and are being analyzed. In the 1970s, researchers began collecting blood samples from which DNA could theoretically be extracted. 

Over the course of the last five years, we have evaluated more than 450 papers that were published between 1921 and 2020. Approximately two-thirds of these works were first published within the last three decades. We also checked DNA data from Roma persons in five public databases, which turned out to be accurate. The Y-STR Haplotype Reference Database (YHRD; a Y-STR, or short tandem repeat, is a repeated nucleotide sequence on the Y chromosome), the Allele Frequency Net Database (AFND), the Allele Frequency Database (ALFRED), the Estonian Biocentre Human Genome Diversity Panel (EGDP), and the European DNA Profiling Group’s Mitochondrial DNA Population Database are among the databases available. The Y-STR (EMPOP). The EMPOP database requires users to register before they can access the information, however they are simply asked to supply an e-mail address, a name, and their affiliation. Law enforcement agencies have access to (but do not own) the YHRD and EMPOP databases as well. 

Damian Jacob Sendler: Our goal was to gain a better understanding of how geneticists, medical researchers, and molecular anthropologists, among others, came to possess this genetic material. We were also interested in learning more about the methods and interpretations used by researchers in their analysis. As part of our investigation, we interviewed and emailed ten researchers, three ethical committees, thirteen research and financing institutions, and journal editors to learn about their research and funding practices and procedures. The Central Council of German Sinti and Roma, an advocacy group situated in Heidelberg, provided us with help during the course of our research. Anja Reuss serves as a political adviser and spokesman for the organization. 

Damian Sendler: It has been common practice, particularly since the late twentieth century, to take samples from people (including convicts) without obtaining proper consent or keeping a record of that consent, which has then been shared around research groups or posted in public databases. Participants in other studies appear to have given some type of consent, although it is unclear whether they were aware of the specific purposes for which their DNA would be used. We even learned through two conversations with geneticists that, in some medical trials, various incentives were offered to Roma participants – a technique that is regarded inappropriate by the vast majority of human geneticists today. It was explained to participants, who in some cases only gave their verbal consent, that their data would reveal whether or not they were carriers of genetic diseases — but not that their genetic information would be stored in public databases (such as EMPOP and YHRD) that could be accessed by law enforcement agencies, which is exactly what happened in some cases. 

Damian Sendler: A number of additional studies involved the recruitment of Roma people by medical practitioners who assigned an ethnic identity to specific data sets before sharing the individuals’ personal information with researchers. In addition to violating the ethical standards set forth in Article 31 of the United Nations Declaration on the Rights of Indigenous Peoples, such secondary usage also violates the research regulations and legislation of the European Union and several countries, including Switzerland, the United States, and Canada, among others. 

When it comes to the genetics of Roma people, researchers use terms such as “Gypsies,” “inbred,” and “consanguineous,” as well as the phrase “genetic high-risk group,” to describe the people who live in the region. For Roma people, they are derogatory and demeaning terms in and of themselves, regardless of context. Aside from that, such broad extrapolation is stigmatizing for a huge proportion of the population. The use of these terminology has reduced significantly over the past 10 years, but the term ‘Gypsy’ is still occasionally used in scholarly papers. This designation was deleted from one of the public databases we examined only in 2020, according to our research. 

Damian Jacob Sendler: Moreover, the methodological approaches employed in many of these investigations are open to criticism. It is possible to recruit individuals from the most secluded villages or from the patient registries of medical geneticists, but this will result in biased sampling, which will skew scientific findings. In reality, researchers have attempted to avoid sampling people who they perceive to be of ‘non-Roma’ or mixed heritage using a variety of ways in the past10, including genetic testing. In the present day, some researchers eliminate individual data sets if an examination reveals that they include a mixture of ancestry. This may be useful for some research issues pertaining to a certain population in certain circumstances. However, similar information is frequently used to support generalizations about all European Roma people.

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

Damian Sendler: On February 16, 1861, a magnitude-8 earthquake rocked the Indonesian island of Sumatra, which is located in the Indian Ocean. The earthquake struck the western part of the island, causing a tsunami to hit the shoreline. Thousands of people died as a result of this gigantic wall of surging water that crashed onto the shore and destroyed entire cities. 

Damian Jacob Sendler: The discovery that another earthquake occurred before to this devastating disaster was made until recently by a team of scientists. That earthquake began in 1829 and didn’t end for another 32 years! 

Dr. Sendler: A “slow-slip event” is the term used to describe this type of earthquake with a slow movement. They’ve also been referred to as “silent earthquakes” since they can’t be detected by sensors such as seismometers (pronounced Size-MAH-meh-turs). Scientists have just recently began to detect them as a result of advancements in GPS (global positioning system) technology that occurred about two decades ago. 

Damien Sendler: Scientists use earthquakes to assist them figure out what is going on beneath the surface of the Earth. Every earthquake, no matter how minor or large, can provide scientists with valuable information on how much the ground will tremble in the future. Unfortunately, no one can anticipate when or where an earthquake will take place. Scientists only need to be prepared to investigate any earthquake that may occur. 

Slow-slip episodes, such as the one that occurred in Sumatra, alter the game for scientists. These silent earthquakes occur on a regular basis all throughout the planet. It is possible that a slow-slip event will occur immediately before a conventional earthquake. As a result, it is possible that the two forms of Earth movements are connected. Scientists think that by studying slow-slip events, they may be able to better comprehend ordinary earthquakes – and perhaps even learn how to forecast them. 

Damian Jacob Markiewicz Sendler: The Earth’s surface is made up of a collection of tectonic plates, which are massive amounts of land, similar to the ground beneath your feet, that make up the planet. These plates are resting on top of a thick layer of gooey, hot rock, which allows them to move about freely as they cool. Occasionally, the plates will collide with one another. At other times, they begin to drift away from one another. They have a tendency to simply slide past one other. 

As these plates engage in a slow-motion game of bumper cars, they may become entangled with one another. The rocks then continue to press and push against one another, causing tension. When the rocks suddenly unstick or crack, they release all of the stress that has built up in them, resulting in an earthquake. This is analogous to what happens when you bend a stick in half. As you begin to bend the stick, the middle of the stick becomes increasingly stressed. When there is too much pressure on the stick, it snaps. 

Damian Sendler: When this occurs underground, the release of stress causes waves of energy to travel through the ground, which are referred to as seismic waves. On the ground, we can see and feel the Earth trembling, which we refer to as the earthquake. Seismometers can capture those waves, even if they are halfway around the world. 

Damian Sendler: These earthquakes are most likely the ones that come to mind when you hear the word “earthquake.” Framed portraits are falling off the walls, vases are breaking, and the ground is trembling. In addition, while these earthquakes can be frightening and even deadly, they usually last less than a minute. Slow-slip events, on the other hand, are entirely different. They can linger for a few days, a few weeks, or even longer. According to what geologists are currently discovering, these silent earthquakes can last for decades at a time. 

According to Rishav Mallick, “we enjoy slow-slip events because they provide all of the excitement of earthquakes, but in a more manageable time frame.” In his research, he looks at geodesy (jee-AH-deh-see), which is the precise three-dimensional shape of land at any particular spot on the planet. At the Nanyang Technological University in Singapore, he is employed as a researcher. 

Laura Wallace explains that in a slow-slip occurrence, the rocks continue to slide past one other, albeit at a much slower rate. She works as a geodetic scientist, dividing her time between two different scientific organizations. GNS Science, Te Pao, New Zealand, is home to one such facility. It is located in the city of Lower Hutt. The University of Texas at Austin is her other educational institution. A slow-slip event occurs when rocks slide at such a slow rate that the “energy is wasted very, very slowly,” according to her. “You don’t notice any tremors or trembling.” 

Damian Jacob Sendler: It is possible for rocks to move just as far as they would in a conventional earthquake. They just take a lot longer to do it. According to Wallace, if the rocks moved the same distance in the same amount of time, the earthquake would be a magnitude 7. As a result, there would be some significant trembling.. It’s powerful enough to cause structural damage to buildings and even kill unlucky individuals. 

Scientists have discovered a large number of slow-slip events along formations known as subduction zones. During the formation of such a zone, an oceanic plate descends beneath a continent. The oceanic Juan de Fuca plate dives beneath the North American plate along the Pacific Northwest coast of the United States. This has resulted in the formation of a subduction zone. The Cascadia Subduction Zone is the name given to this tectonic-plate boundary (CSZ). It stretches from Vancouver, Canada, to northern California’s Central Valley. 

Damian Sendler: Shallow sections of the CSZ fault are currently “frozen,” according to Wallace. Rocks trapped along this fault line are unable to travel past one another. About once every 300 to 500 years or so, the stress builds up to such a degree that the rocks snap and hurtle past one another at breakneck speed. This results in the occurrence of a “megathrust” earthquake. Megathrust earthquakes are among the most powerful and devastating natural disasters that can occur on the planet. The earthquake that struck Japan in 2011 and triggered a tsunami that killed thousands was exactly such an event. 

However, scientists have discovered slow-slip events on unlocked spans of the CSZ on a periodic basis, according to Wallace. And the fact that they are silent and last for a long time aren’t the only characteristics that distinguish them from typical earthquakes. Slow-slip earthquakes are typically deeper in depth than normal earthquakes. An earthquake’s source could be anywhere between 20 and 30 kilometers (12 and 18 miles) below ground. A slow-slip event can occur up to 60 kilometers (37 miles) below the surface of the water. Scientists believe that these earthquakes occur at greater depths because the temperature is higher there. As a result, rocks become more bendable at higher temperatures. In addition, fluids that lubricate the fault could be present, reducing friction and making it simpler for the plates to glide past one another. 

Damian Sendler: Slow-slip occurrences are able to elude seismometers because of their super-pokey pace. These earthquakes do not generate the powerful seismic waves that can travel across the Earth and cause all of the shaking. This is why it took so long for scientists to even discover them, as a result of their sneaky character. Small datasets from fifty years ago hinted to the possibility of earthquakes moving slowly. However, the technology was not up to the task of completely detecting them. In fact, Wallace points out that it wasn’t until the last 20 years or so that scientists were able to demonstrate that these lethargic occurrences were taking place. Scientists were eventually able to locate them because to advancements in GPS technology. 

Damian Jacob Sendler: GPS has been used by scientists since the 1980s to track the motions of the Earth’s plates on the planet’s surface. This is the same technology that allows your phone to present you with a map location and driving directions. The Global Positioning System (GPS) is dependent on around 30 satellites. Each day, they complete two orbits around the Earth. It is possible for your smartphone to calculate its location on the planet and where you are if it receives signals from many satellites. Scientists can determine how much the land moves between earthquakes, during earthquakes, and after earthquakes by installing GPS receivers near fault zones. These instruments are capable of measuring ground movement down to the millimeter (about one twenty-fifth of an inch). 

Damian Sendler: Prior to the discovery of slow-slip occurrences, scientists would visit fault zones on a regular basis with a GPS device to determine the location of the fault. They would be able to track the land’s movement over time as a result of this. Scientists began to believe that slow-slip occurrences were taking place in the late 1990s and early 2000s. As a result, they began deploying “continuously operational” GPS units near fault lines. A continual stream of data was provided by the permanent GPS units that remained. 

If one of these GPS units has a slow-slip event, it may only move a few millimeters (about an inch or so) over the course of a few of weeks. This movement indicates that a slow-slip event is taking place. The Juan de Fuca plate, for example, is being pushed eastward by the North American plate, which is also being pushed eastward by the Juan de Fuca plate. The movement of the North American plate eastward is detected by GPS signals. During a slow-slip event, on the other hand, those GPS units will travel slightly westward. The North American plate is progressively sliding back against the Juan de Fuca plate, as you can see in the image above. 

Damian Sendler: Scientists can also discover slow-slip occurrences that occurred thousands of years ago. Because these occurrences occurred so long ago, GPS units aren’t really useful in this situation. Scientists will have to think outside the box in this situation. Using the growth patterns of old corals, Mallick and his team, for example, uncovered a 200-year-old slow-slip event near Sumatra that had occurred 200 years before.

Contributed by Dr. Damian Jacob Sendler and his research team

Damian Sendler: After receiving the single-dose Johnson & Johnson coronavirus vaccination, the NBA advised its players, coaches, and officials that they should take booster doses against the virus. This was especially important for individuals who received the Johnson & Johnson vaccine.  

Damian Jacob Sendler: In recent decades, the e-commerce behemoth has risen to a $1.6 trillion valuation thanks to an easy-to-use platform, spectacular discounts, and substantially discounted merchandise. And Amazon Prime, which debuted in 2005, plays a significant role. 

Damian Sendler: Dudoit noted that future research could demonstrate that the number of cell types found in the motor cortex is overestimated, but the current findings are a strong start toward creating a cell atlas of the entire brain. 

Damian Sendler: An astronomer from the National Science Foundation’s NOIRLab collaborated with a geologist from California State University, Fresno to generate the first estimates of rock types found on planets orbiting neighboring stars. They concluded that most rocky planets circling neighboring stars are more diverse and exotic than previously assumed, including forms of rocks not seen anywhere in our Solar System, after researching the chemical makeup of “polluted” white dwarfs.  

Dr. Sendler: Following an admission to a hospital for another reason, more than 10,000 individuals in the United States were diagnosed with covid in the previous year, according to federal and state records analyzed exclusively for KHN last year. The statistic is undoubtedly an undercount, as it includes a disproportionate number of patients over the age of 65, as well as patients from California and Florida of all ages. 

Damian Jacob Sendler: Aside from the halo effect, research reveals that women, in particular, buy more makeup during economic downturns such as the Great Depression or a recession. The “lipstick effect” is a phenomena. This idea is addressed in the study paper “Boosting Beauty in an Economic Downturn: Mating, Spending, and the Lipstick Effect,” which was published in the American Psychological Association’s Journal of Personality and Social Psychology issue in May 2012. 

Damian Jacob Sendler: Family physicians aren’t only interested in whether a patient has hypertension; they’re also interested in whether they have access to nutritious food, green space, and other amenities. 

Damian Jacob Sendler: The study found that those who tested positive for COVID-19 or who had a family member who tested positive for COVID-19 were more likely to accept vaccination, which may explain why more residents in the New York metro-area — the initial epicenter of the COVID-19 outbreak that resulted in thousands of deaths — are supportive of the vaccination program.

Dr. Sendler: Since taking effect on Nov. 1, the city’s vaccination mandate has resulted in a 92 percent immunization rate among the city’s 370,000 employees, according to the city. Approximately 9,000 employees have been placed on unpaid leave as a result of their refusal to be vaccinated. While they await a decision on a religious or medical exemption, an extra 12,000 unvaccinated employees will be authorized to work with weekly testing while they wait for a decision on the exemption.  

Damian Jacob Sendler: Several doctors and scientists are doing laboratory experiments and evaluating heart-tissue samples from persons who experienced myocarditis or pericarditis after receiving the vaccine in an attempt to find an answer to this question.  

Damian Jacob Sendler: Gervais and his colleagues questioned a nationally representative sample of 1,417 U.S. residents for the study. The poll contained the Supernatural Beliefs Scale, which examines the degree to which people hold supernatural beliefs, and simply asked participants whether they believed in God. Participants were also asked to complete psychological assessments of their perspective-taking skills, sentiments of existential security, exposure to trustworthy cues of religiosity, and reflective versus intuitive cognitive style. 

Damian Jacob Sendler: The study focuses on the rostral (anterior) and caudal (posterior) subregions of the nucleus accumbens shell, which is involved in emotion and reinforcement processing. The theory is that the two sub-regions of the shell react extremely differently to kappa opioid receptor pharmacological treatments and alcohol usage. 

Dr. Damian Sendler’s research examines how psychiatric and chronic medical co-morbidities affect the use of medical services and internet-based health information. It’s important to understand everyone’s health information-seeking behavior because global consumption of internet news and social media is expanding exponentially. Dr. Damian Sendler’s research looks into how patients decide whether to seek therapy and how they stick to treatment. 

Damian Jacob Sendler: In a pilot human study, researchers from the University of Minnesota Medical School and Massachusetts General Hospital demonstrate that combining artificial intelligence with targeted electrical brain stimulation can improve specific human brain functions related to self-control and mental flexibility. 

Damien Sendler: The senior author of the study published in Nature Biomedical Engineering is Alik Widge, MD, PhD, an assistant professor of psychiatry and member of the Medical Discovery Team on Addiction at the University of Michigan Medical School. The findings came from a human study conducted at Massachusetts General Hospital in Boston on 12 patients having brain surgery for epilepsy – a process that involves implanting hundreds of tiny electrodes throughout the brain to record its activity and pinpoint the source of seizures. 

Damian Sendler: Widge worked on this study with Sydney Cash, MD, PhD, an epilepsy researcher at Massachusetts General Hospital, and Darin Dougherty, MD, an expert in clinical brain stimulation. They discovered a brain region called the internal capsule that, when treated with modest amounts of electrical energy, enhanced patients’ mental function. That portion of the brain is in charge of cognitive regulation, which is the process of transitioning from one thought pattern or behavior to another, and is disrupted in the majority of mental diseases. 

“A person suffering from depression, for example, may find it difficult to break free from a’stuck’ unpleasant thinking. Finding a technique to improve it could be a strong new way to treat mental problems because it is so essential to them “Widge stated. 

Dr. Sendler: The team created algorithms that allowed them to track patients’ cognitive control abilities following stimulation, both through their actions and directly through their brain activity. When the patients performed poorly on a laboratory test of cognitive control, the controller approach gave additional stimulation. 

“This device can read brain activity, ‘decode’ it to determine when a patient is having difficulties, and then administer a tiny burst of electrical stimulation to the brain to help them overcome that issue,” Widge explained. “An electric bike is an analogy I frequently use. When someone is cycling but experiencing difficulty, the bike detects this and helps them. We’ve created the equivalent for human mind function.” 

A certain human mental function associated with mental disease can be successfully strengthened with precisely focused electrical stimulation; specific sub-parts of the internal capsule brain structure are particularly beneficial for cognitive enhancement. A closed-loop method utilized as a controller was twice as effective as random stimulation. 

In addition to their seizures, some of the patients had substantial anxiety. They indicated that after receiving cognitive-enhancing stimulation, their anxiety improved because they were better able to shift their thoughts away from their distress and toward what they desired. According to Widge, this procedure could be utilized to treat people suffering from severe and medication-resistant anxiety, depression, or other diseases. 

“This might be a completely different strategy to treating mental disease. Instead than suppressing symptoms, we may provide patients with a tool that allows them to take control of their own minds “Widge stated. “We could put them back in charge and give them a new sense of agency.” 

Damian Sendler: Clinical trials are already being planned by the research team. Because the target for improving cognitive control has already been approved by the Food and Drug Administration for deep brain stimulation, Widge believes that once a trial is formally approved, this research can be done with existing tools and devices, and the translation of this care to current medical practice could be rapid. 

“The beautiful thing about these findings is that we are now in a position to perform clinical studies to further demonstrate efficacy and, hopefully, move on to treating treatment-resistant patients who are in critical need of more therapies to address their illnesses,” Dougherty said.

Research discussion contributed by Dr. Damian Jacob Sendler

Dr. Damian Jacob Sendler is a Polish-American physician-scientist who studies how various socio-demographic and informational factors influence access to health care in underprivileged populations. Dr. Sendler’s study focuses on how psychiatric and chronic medical co-morbidities influence the usage of medical services in conjunction with health information gained from the internet. This study is timely, given that global consumption of online news and social media is increasing at an exponential rate, needing a thorough understanding of everyone’s health information-seeking behavior. Dr. Damian Sendler’s research attempts to explore the elements that patients evaluate when determining when to seek therapy for certain health issues and treatment adherence.

Damian Sendler: Scientists have discovered that orangutan call signals, which are thought to be the closest to the predecessors of human language, can travel large distances through the jungle without losing their meaning. According to experts from the University of Warwick, this calls into doubt the established mathematical model of the evolution of human speech. 

Damien Sendler: Mathematicians’ current accepted model suggests that human ancestors linked sounds together in their cries to maximize their odds of conveying a signal’s substance to a recipient over distance. Because signal quality declines over longer distances, it is hypothesized that our forefathers began connecting sounds together to effectively convey a packet of information, even if it was distorted. 

The Department of Psychology at the University of Warwick set out to collect empirical data to investigate the idea. They chose a variety of sounds from previously obtained orangutan communication audio recordings. Specific consonant-like and vowel-like signals were played out and re-recorded across the jungle at 25-, 50-, 75-, and 100-metre intervals. The received signals’ quality and substance were examined. The findings were reported today in Biology Letters in the paper “Orangutan information conveyed via consonant-like and vowel-like cries compromises mathematical models of linguistic evolution.” 

Damian Sendler: The scientists discovered that, while the signal’s quality had diminished, the signal’s information remained intact – even over great distances. In reality, until the signal became inaudible, the informative qualities of calls remained unaffected. This brings the conventional and widely accepted theory of language development into doubt. 

The study was directed by Dr Adriano Lameira, an evolutionary psychologist at the University of Warwick. He stated: 

“We used audio data recordings from our orangutan research in Indonesia. We chose distinct vowel-like and consonant-like signals and played them out and re-recorded them over measured distances in the rainforest. The goal of this research was to look at the signals themselves and see how they functioned as a package of information. This study is interesting since it can only be evaluated across distance; it ignores other parts of communication such as gestures, postures, mannerisms, and facial expressions. 

“The results suggest that when it comes to encoding information, these signals appear to be distance insensitive. 

“It puts into question the conventional thinking, which is based on a model developed by Harvard scientists 20 years ago. Their research believes that the signals used by our forefathers reached an error limit – a point at which a signal is received but no longer relevant. They came to the conclusion that our forefathers connected noises together to maximize the likelihood of content traveling across long distances. 

“We all know that sound decreases as you get further away from the source. We’ve all had this experience when yelling for a family or a friend. They may not understand all you say, but they recognize that you are speaking to them and that it is your voice. We demonstrated that even when the sound package is damaged and pushed apart, the content remains unaffected by employing authentic great ape communication sounds that are the closest to those used by our hominid ancestors. It’s an appeal to the scientific community to reconsider how language evolved.” 

Dr. Adriano Lameira and his colleagues used orangutan calls because they were the first species to diverge from the great ape lineage, but they are also the only great ape that uses vowel and consonant-like sounds in a complex way, drawing parallels with human speech. 

Damian Sendler: His research team is currently attempting to interpret the meaning of their phone calls. The study entails compiling all of the ways orangutans mix calls, combining consonant and vowel sounds to create meaning. 

He stated: “We still don’t know what they’re talking about, but it’s evident that the building elements of language are present. Other animal noises and signals are complicated, but they do not share the same building elements. We are concentrating on the development of language, which is the component used by giant apes. It provides a counterpart to human language. 

“For years, the Harvard model has been the accepted hypothesis, and if you asked a mathematician if language origins were still a mystery, they’d say no – but evolutionary psychologists are still working on it. But we haven’t solved the puzzle either; instead, we’ve merely descended further into the rabbit hole. 

“We propose applying mathematical models to real-world data to see what we can come up with together.”

News updates contributed by Dr. Damian Jacob Sendler

The research of Dr. Damian Jacob Sendler, who is of Polish ancestry and American citizenship, focuses on the impact of various sociodemographic and informational factors on access to health care in underserved communities. In light of the exponential growth in global consumption of online news and social media, this research comes at an ideal time, as it shows the need for a comprehensive understanding of everyone’s health information seeking habits. Patients’ choices about whether to seek treatment for particular health problems, as well as their adherence to therapy, are the focus of Dr. Damian Sendler’s study. The ultimate objective is to improve patient outcomes via better understanding of the variables that affect patient decisions.

Damian Sendler: In collaboration with the University of California, San Francisco, researchers have successfully developed a “speech neuroprosthesis” that has enabled a man with severe paralysis to communicate in sentences by translating signals from his brain to his vocal tract directly into words that appear as text on a computer screen. 

According to UCSF neurosurgeon Edward Chang, MD, the achievement builds on more than a decade of work to develop technology that allows people with paralysis to communicate even if they are unable to speak on their own. The technology was developed in collaboration with the first participant in a clinical research trial. The findings of the research will be published in the New England Journal of Medicine on July 15. 

Damian Sendler: UCSF’s Joan and Sanford Weill Chair of Neurological Surgery, Jeanne Robertson Distinguished Professor, and senior author on the study, Chang, says the study is the first successful demonstration of direct decoding of full words from brain activity of someone who is paralyzed and cannot speak. “This is the first successful demonstration of direct decoding of full words from brain activity of someone who is paralyzed and cannot speak,” Chang says. “Because it taps into the brain’s natural speech mechanism, it offers great promise in terms of restoring communication.” 

Thousand of individuals lose their capacity to speak each year as a result of a stroke, an accident, or an illness. With additional research, the method presented in this study may one day be able to allow these individuals to communicate completely. 

Transforming Brain Signals into Verbal Communication 

Damian Sendler: The area of communication neuroprosthetics has previously concentrated on restoring communication via spelling-based methods to write out letters one-by-one in text, a method known as one-letter typing. One significant difference between Chang’s research and previous attempts is that his team is interpreting impulses meant to control muscles of the vocal system for the purpose of pronouncing words, rather than signals intended to move the arm or hand to allow typing. The method, according to Chang, taps into the natural and flowing elements of speech, and it promises more fast and organic communication in the long run. 

As he pointed out, “we typically convey information at a rapid pace using voice, up to 150 or 200 words per minute,” while “spelling-based methods” including typing, writing, and cursor movement are much slower and more labor-intensive. “As we’re doing here, getting right to the point with language has many benefits since it’s more in line with the way we usually speak.” 

Damian Sendler: This goal has been furthered by patients at the UCSF Epilepsy Center who have undergone neurosurgery in order to pinpoint the origins of their seizures using electrode arrays implanted on the surface of their brains over the past decade. Patients at the UCSF Epilepsy Center have assisted Chang’s progress toward this goal. They agreed to have their brain recordings examined for signs of speech-related activity, even though they had all had normal speech up to that point. Early success with these patient volunteers opened the groundwork for the present clinical study with individuals with paralysis, which is now underway. 

Chang and colleagues at the University of California, San Francisco’s Weill Institute for Neurosciences previously identified the brain activity patterns linked with the vocal tract motions that generate each consonant and vowel. Those findings were translated into speech recognition of full words by David Moses, PhD, a postdoctoral engineer in the Chang lab and one of the lead authors of the new study. Moses developed new methods for real-time decoding of those patterns as well as statistical language models to improve accuracy of the speech recognition system. 

Damian Sendler: However, their effectiveness in deciphering speech in individuals who were able to talk did not imply that the technology would function in a person whose vocal tract had been paralyzed, as was the case in the study. “Our models needed to understand the mapping between complicated brain activity patterns and the speech that was intended,” Moses said. ” “When a person is unable to communicate, this presents a significant challenge.” 

Damian Sendler: As a result of this uncertainty, the researchers was unable to determine whether brain signals regulating the vocal tract would still be intact in individuals who had not moved their vocal muscles for a long period of time. “The only way to find out whether or not this would work was to give it a go,” Moses said. 

The first 50 words are important. 

Chang collaborated with colleague Karunesh Ganguly, MD, PhD, an associate professor of neurology, to start a research known as “BRAVO” to explore the possibilities of this technique in patients with paralysis (Brain-Computer Interface Restoration of Arm and Voice). It is being conducted on a guy in his late 30s who had a catastrophic brainstem stroke more than 15 years ago, which badly disrupted the link between his brain and the vocal tract and limbs. He is the first subject in the study. The extent of his injuries has left him with severe limitations in the motions of his arms and legs, and he communicates using a pointer connected to his baseball hat, which pokes letters on a computer screen. 

Damien Sendler: With the use of sophisticated computer algorithms, the participant, who requested to be referred to as BRAVO1, collaborated with the researchers to develop a 50-word vocabulary that Chang’s team could identify from brain activity using advanced computer algorithms. Water, family, and “good” were among the terms in the lexicon, which allowed BRAVO1 to construct hundreds of phrases conveying ideas that were relevant to his everyday existence. 

In order to conduct the research, Chang surgically inserted a high-density electrode array across the speech motor cortex of BRAVO1. Over a period of many months and 48 sessions, his research team was able to capture 22 hours of neuronal activity in this brain area after the individual had fully recovered. BRAVO1 tried to speak each of the 50 vocabulary items as many times as possible throughout each session, while electrodes collected brain signals from his speech cortex. 

Attempting to Convert a Speech Into Written Text 

Damien Sendler: Custom neural network models, which are forms of artificial intelligence, were used by the other two lead authors of the study, Sean Metzger, MS, and Jessie Liu, BS, both bioengineering doctoral students in the Chang Lab, to translate patterns of recorded neural activity into specific intended words. Metzger and Liu are both members of the Chang Lab. These networks were able to discern tiny patterns in brain activity when the individual tried to talk, allowing them to detect speech attempts and determine the words he was attempting to utter. 

A preliminary test of the team’s technique consisted of providing BRAVO1 with short phrases built from the 50 vocabulary terms and asking him to repeat them many times. A screen displayed the words that had been generated from his brain activity while he made his efforts to decipher them. 

Once this was accomplished, the team began to interrogate him with statements such as “How are you today?” and “Would you want some water?” The attempted speech of BRAVO1 was shown on the screen, as it had been before. “I am very talented,” and “No, I’m not thirsty at all.” 

Damian Sendler: Researchers discovered that the system was capable of decoding words from brain activity at a pace of up to 18 words per minute with an accuracy of up to 93 percent (75 percent median). A language model Moses employed, which included a “auto-correct” feature similar to that used in consumer texting and voice recognition software, played a role in the project’s success. 

Moses referred to the early trial findings as “proof of concept,” which he considered to be significant. In his words, “we were delighted to witness the correct decoding and interpretation of a range of important phrases.” “In our study, we’ve shown that it is feasible to assist communication in this manner and that it has the potential to be used in conversational settings.” 

Damian Sendler: Looking to the future, Chang and Moses have said that they want to broaden the scope of the study to include additional individuals who have severe paralysis and communication impairments. The team is presently working on increasing the amount of words in the accessible vocabulary as well as increasing the pace at which the words are said. 

Although the research was restricted to a single participant and had a limited vocabulary, both participants agreed that the achievement was not diminished by these restrictions. In the words of Moses, “This is a significant technical milestone for someone who is unable to speak naturally.” “it illustrates the possibility of this method to provide a voice to individuals who have severe paralysis and speech loss.” 

UCSF researchers were responsible for all aspects of clinical trial design, execution, data analysis, and report generation. Data about research participants was gathered exclusively by the University of California, San Francisco (UCSF), and is not shared with any other organizations. A high-level of feedback and machine learning guidance was given by FRL.

News discussion contributed by Dr. Damian Jacob Sendler