High temperatures can make us miserable. Research shows they also make us aggressive, impulsive and dumb.In July 2016, a heat wave hit Boston, with daytime temperatures averaging 92 degrees for five days in a row. Some local university students who were staying in town for the summer got lucky and were living in dorms with central air-conditioning. Other students, not so much — they were stuck in older dorms without A.C.Jose Guillermo Cedeño Laurent, a Harvard researcher at the time, decided to take advantage of this natural experiment to see how heat, and especially heat at night, affected the young adults’ cognitive performance. He had 44 students perform math and self-control tests five days before the temperature rose, every day during the heat wave, and two days after.“Many of us think that we are immune to heat,” said Dr. Cedeño, now an assistant professor of environmental and occupational health and justice at Rutgers University. “So something that I wanted to test was whether that was really true.”It turns out even young, healthy college students are affected by high temperatures. During the hottest days, the students in the un-air-conditioned dorms, where nighttime temperatures averaged 79 degrees, performed significantly worse on the tests they took every morning than the students with A.C., whose rooms stayed a pleasant 71 degrees.A heat wave is once again blanketing the Northeast, South and Midwest. High temperatures can have an alarming effect on our bodies, raising the risk for heart attacks, heat stroke and death, particularly among older adults and people with chronic diseases. But heat also takes a toll on our brains, impairing cognition and making us irritable, impulsive and aggressive.How heat makes us dumbNumerous studies in lab settings have produced similar results to Dr. Cedeño’s research, with scores on cognitive tests falling as scientists raised the temperature in the room. One investigation found that just a four-degree increase — which participants described as still feeling comfortable — led to a 10 percent average drop in performance across tests of memory, reaction time and executive functioning.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Neck cracks and spine adjustments have become a potent social media trend, but some chiropractors fear the videos send the wrong message about the profession.Videos of chiropractic adjustments have become a popular genre on TikTok.Snap. Crack. Pop. These sounds, once used to sell a popular breakfast cereal, are now enticing people to visit the doctor thanks to a wave of chiropractic videos sweeping social media.The most popular videos follow a familiar template: A patient enters with a debilitating condition. A chiropractor maneuvers the patient’s limbs and joints in horrifying ways, producing a series of snaps and crunches. And the patient is relieved of years of pain — all within a matter of minutes.For viewers, the clips can be both cringeworthy and satisfying A.S.M.R. (Autonomous Sensory Meridian Response) content. For the chiropractors, they are valuable marketing, helping to build business.But not everyone in the chiropractic industry is thrilled about the videos. Some doctors say they are misleading, potentially leading patients to think miracle cures are available with one pop of the spine — or even to try the procedures themselves.Easy and free advertising for chiropractorsAlex Tubio has become a sensation in the world of medical content creation. He owns chiropractic clinics in Houston and Orange County, Calif., and sees about 100 patients a week.Mr. Tubio says he owes all of his business to social media, which he started using in 2019 to promote his work. He has more than one million followers on TikTok, over one million subscribers on YouTube, and his appointment calendar is booked until August.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Secret documents show a scramble to safeguard critical public services from the potential collapse of tech giant Atos, which works with billions of pounds worth of government contracts.

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Some scientists who study youth mental health say the evidence does not support the notion that social media is harmful per se.When the U.S. surgeon general, Dr. Vivek Murthy, announced on Monday that he was planning to push for a mental health warning label on social media platforms, he was met with cheers from many parents and teachers, who described a long, lonely struggle to wrench children away from a habit that was hurting them.He got a cooler reaction, however, from some scientists who study the relationship between social media and mental health. In interviews, several researchers said the blanket warning Dr. Murthy has proposed — “social media is associated with significant mental health harms for adolescents” — stretches and oversimplifies the scientific evidence.For many years, researchers have tried to determine whether the amount of time a child spent on social media contributed to poor mental health, and “the results have been really mixed, with probably the consensus being that no, it’s not related,” said Dr. Mitch Prinstein, the chief science officer at the American Psychological Association.What seems to matter more, he said, is what they are doing when they are online — content about self-harm, for example, has been shown to increase self-harming behavior.“It’s kind of like saying, ‘Is the number of calories that you eat good for you or bad for you?’” said Dr. Prinstein, who testified before the Senate on the subject last year. “It depends. Is it candy, or is it vegetables? If your child is spending all day on social media following The New York Times feed and talking about it with their friends, that’s probably fine, you know?”Like other scientists interviewed, Dr. Prinstein applauded Dr. Murthy for drawing attention to the mental health crisis. He said he was very optimistic about policy changes that might follow, to keep social media use from interfering with school, sleep and physical activity. After Dr. Murthy’s announcement, Gov. Gavin Newsom of California called for a statewide ban on smartphone use in California schools.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The shortage highlights a widening gulf in the standard of care for people with diabetes, most of whom live in low-income countries.South Africa’s public health care system has run out of the human insulin pens that it provides to people with diabetes, as the pharmaceutical industry shifts production priorities to blockbuster weight-loss drugs that use a similar device for delivery.Novo Nordisk, the company that has supplied South Africa with human insulin in pens for a decade, opted not to renew its contract, which expired last month. No other company has bid on the contract — to supply 14 million pens for the next three years, at about $2 per pen.“Current manufacturing capacity limitations mean that patients in some countries, including South Africa, may have limited access to our human insulins in pens,” said Ambre James-Brown, a spokeswoman for Novo Nordisk. The company did not reply to questions about which other countries are affected.Novo Nordisk’s drugs Ozempic and Wegovy, which are widely prescribed in the U.S. for weight loss, are sold in single-use pens produced by many of the same contracted manufacturers who make the multidose insulin pens. A month’s supply of Ozempic in the United States costs about $1,000, far more than insulin.Novo Nordisk dominates the global market for insulin in pens and has supplied South Africa since 2014. Eli Lilly, the other major producer, has indicated in recent months that it is struggling to keep up with the significant demand for its weight-loss drug Zepbound.“This is because of the global demand for Ozempic and these drugs,” said Khadija Jamaloodien, the director of sector-wide procurement for South Africa’s health service. “They’re shifting the focus on the more profitable line.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Cyclodextrins (CDs) are complicated carbohydrates, a term that describes the natural, sugar-based, starchy material that makes up much of fruits, vegetables and grains.
Their unique chemical properties make them ideal for all sorts of uses, including air fresheners, medications and cosmetics. Scientists also are exploring their potential to treat cardiovascular diseases caused by atherosclerotic plaques.
Now, more than 130 years after CDs were first discovered and reported, a University of Texas at Arlington team of scientists has created chemical mirror images of these complex carbohydrates in the laboratory. This discovery may revolutionize how medications are delivered to patients.
Daniel W. Armstrong, the Robert A. Welch Distinguished University Chair in Chemistry, has co-authored a new peer-reviewed publication in Nature Synthesis describing mirror-image cyclodextrins for the first time along with his former graduate student Saba Aslani.
“This discovery is exciting, as it may make it easier to formulate and deliver complex medications to patients,” Armstrong said. “This missing piece of the puzzle definitely paves the way for additional gains in treating and curing disease.”
Other authors on the paper are from Northwestern University; University of Hong Kong; University of Wyoming; ZJU-Hangzhou Global Scientific and Technological Innovation Center in China; National University of Singapore; Universite d’Angers in France; Zhejiang University in China; and University of New South Wales in Australia.
After creating these mirror-image CDs in the lab, researchers were able to confirm their discovery using X-ray crystallography and binding studies of other mirror-image molecules.
“In the pharmaceutical industry, it is common and even mandated to synthesize and test such mirror-image drug entities, as they may have different medicinal properties and toxicities,” Armstrong said. “Based on how popular CDs are already for delivering medications, this newly discovered mirror image may have even more biomedical uses. Plus, we know that such mirror-images carbohydrates are more resistant to biological degradation than their natural counterparts.”

Coffee drinking is a heritable habit, and one that carries a certain amount of genetic baggage.
Caffeinated coffee is a psychoactive substance, notes Sandra Sanchez-Roige, Ph.D., an associate professor in the University of California San Diego School of Medicine Department of Psychiatry. She is one of an international group of researchers that compared coffee-consumption characteristics from a 23andMe database with an even larger set of records in the United Kingdom. She is the corresponding author of a study recently published in the journal Neuropsychopharmacology.
Hayley H. A. Thorpe, Ph.D., is the lead author on the paper. Thorpe, of the Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry at Western University in Ontario, explained that the team collected genetic data as well as self-reported coffee-consumption numbers to assemble a genome-wide association study (GWAS). The idea was to make connections between the genes that were known to be associated with coffee consumption and the traits or conditions related to health.
“We used this data to identify regions on the genome associated with whether somebody is more or less likely to consume coffee,” Thorpe explained. “And then identify the genes and biology that could underlie coffee intake.”
Abraham Palmer, Ph.D., is also a lead researcher on the paper and a professor in the UC San Diego School of Medicine Department of Psychiatry. He said that most people are surprised that there is a genetic influence on coffee consumption. “We had good reason to suspect from earlier papers that there were genes that influence how much coffee someone consumes,” he said. “And so, we weren’t surprised to find that in both of the cohorts we examined there was statistical evidence that this is a heritable trait. In other words, the particular gene variants that you inherit from your parents influence how much coffee you’re likely to consume.”
Sanchez-Roige said the genetic influence on coffee consumption was the first of two questions the researchers wanted to address.
“The second is something that coffee lovers are really keen on learning,” Sanchez-Roige said. “Is drinking coffee good or bad? Is it associated with positive health outcomes or not?”
The answer is not definitive. The group’s genome-wide association study of 130,153 U.S.-based 23andMe research participants was compared with a similar UK Biobank database of 334,649 Britons, revealing consistent positive genetic associations between coffee and harmful health outcomes such as obesity and substance use. A positive genetic association is a connection between a specific gene variant (the genotype) and a specific condition (the phenotype). Conversely, a negative genetic association is an apparent protective quality discouraging the development of a condition. The findings get more complicated when it comes to psychiatric conditions.

“Look at the genetics of anxiety, for instance, or bipolar and depression: In the 23andMe data set, they tend to be positively genetically correlated with coffee intake genetics,” Thorpe said. “But then, in the UK Biobank, you see the opposite pattern, where they’re negatively genetically correlated. This is not what we expected.”
She said there were other instances in which the 23andMe set didn’t align with the UK Biobank, but the greatest disagreement was in psychiatric conditions.
“It’s common to combine similar datasets in this field to increase study power. This information paints a fairly clear picture that combining these two datasets was really not a wise idea. And we didn’t end up doing that,” Thorpe said. She explained that melding the databases might mask effects, leading researchers toward incorrect conclusions — or even cancelling each other out.
Sanchez-Roige says the researchers have some ideas about how the differences in results arose. To begin with, there was an apples-and-oranges aspect to the surveys. For instance, the 23andMe survey asked, “How many 5-ounce (cup-sized) servings of caffeinated coffee do you consume each day?” Compare it to the UK Biobank’s “How many cups of coffee do you drink each day? (Include decaffeinated coffee)”
Beyond serving size and the caffeinated/decaf divide, the surveys made no accommodation for the various ways coffee is served. “We know that in the U.K., they have generally higher preference for instant coffee, whereas ground coffee is more preferred in the U.S.,” Thorpe said.
“And then there’s the frappuccinos,” Sanchez-Roige added, citing the American trend of taking coffee loaded with sugary additives. Palmer mentioned other caffeinated drinks and especially in the context of the UK Biobank, tea, none of which were included in the GWAS, which addressed only coffee. Palmer added that the GWAS demonstrates the relationship between genotype and phenotype is more different than the relationship between coffee and tea.

“Genetics influences lots of things. For instance, it influences how tall you might be,” he said. “And those kinds of things probably would play out very similarly, whether you lived in the U.S. or the U.K. But coffee is a decision that people make.”
Sanchez-Roige pointed out that coffee comes in a variety of forms, from instant to frappuccino, and is consumed amid cultural norms that differ from place to place. A person with a given genotype might end up having quite a different phenotype living in the U.K. versus the U.S.
“And that’s really what the data are telling us,” she said. “Because unlike height, where your behavior doesn’t really have much to do with it, your behavior and the choices you’re making in your environment play out in various ways. So the interaction between genotype and environment complicates the picture.”
The collaborators stressed the need for more investigation to unravel the relationships between genetics and the environment, focusing not only on coffee/caffeine intake but also other substance-use issues.
In addition to the researchers noted above, co-authors on the paper from UC San Diego are: Benjamin K. Pham, John J. Meredith, Mariela V. Jennings, Natasia S. Courchesne-Krak and Sevim B. Bianchi, all of the Department of Psychiatry. Other co-authors are Pierre Fontanillas, of 23andMe, Inc.; Laura Vilar-Ribó, of the Universitat Autònoma de Barcelona, Spain; Julian Mutz, of King’s College London, U.K.; Sarah L. Elson and Jibran Y. Khokhar, of the University of Guelph, Canada; Abdel Abdellaoui, of the University of Amsterdam, The Netherlands; Lea K. Davis, of Vanderbilt University Medical Center; and the 23andMe Research Team.
Mariela V. Jennings, Sevim B. Bianchi and Sandra Sanchez-Roige are supported by funds from the California Tobacco-Related Disease Research Program (TRDRP; Grant Number T29KT0526 and T32IR5226). Sevim B. Bianchi and Abraham Palmer were also supported by P50DA037844. BKP, Julian Mutz, and Sandra Sanchez-Roige are supported by NIH/NIDA DP1DA054394. Hayley H. A .Thorpe is funded through a Natural Science and Engineering Research Council PGS-D scholarship and Canadian Institutes of Health Research (CIHR) Fellowship. Jibran Y. Khokhar is supported by a CIHR Canada Research Chair in Translational Neuropsychopharmacology. Lea K. Davis is supported by R01 MH113362. Natasia S. Courchesne-Krak is funded through an Interdisciplinary Research Fellowship in NeuroAIDs (Grant Number R25MH081482). Julian Mutz is funded by the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London.

Researchers at the Johns Hopkins Kimmel Cancer Center’s Sol Goldman Pancreatic Cancer Research Center have developed a 3D genomic profiling technique to identify small precancerous lesions in the pancreas — called pancreatic intraepithelial neoplasias (PanINs) — that lead to one of the most aggressive, deadly pancreatic cancers.
Published May1 in Nature, the results provide the most detailed 3D map of precancerous lesions in the human pancreas to date, laying a foundation for future early detection of pancreatic ductal adenocarcinoma (PDAC) and other types of pancreatic cancer.
“Not many people actually develop pancreatic cancer, so we were shocked to find a lot of precancer, or PanINs, within the normal regions of the pancreas,” says Laura Wood, M.D., Ph.D., associate professor of pathology and oncology at the Kimmel Cancer Center and the Johns Hopkins University School of Medicine and one of the study’s senior authors. “This research highlights what we don’t yet know about normal aging and raises fundamental questions about how cancer arises in the human pancreas.”
The research was co-led by Alicia Braxton, D.V.M., Ph.D., a postdoctoral fellow at the Johns Hopkins University School of Medicine, and Ashley Kiemen, Ph.D., an assistant professor of pathology at the medical school.
Because of their small size, PanINs are challenging to detect and cannot be identified by a typical radiology examination. In the clinic, this often means that by the time patients are diagnosed with cancer, such as PDAC, the cancer already has reached an advanced stage and metastasized to other organs.
Existing 2D histological staining methods, during which tissue is thinly sliced, stained and examined under a microscope, provide only a limited view of PanINs, leaving researchers in the dark about their origins and how they lead to cancer. To better characterize PanINs, the researchers developed a 3D approach.
After thinly slicing and staining tissue from 38 normal pancreatic samples onto hundreds of sequential 2D slides, the researchers developed CODA, a machine-learning pipeline, to analyze and reconstruct the slide images into digital 3D images.

The 3D reconstructions revealed complex networks of interconnected PanINs with an average overall burden of 13 PanINs per cubic centimeter, and a range of from 1 to 31 PanINs per cubic centimeter. Patients with PDAC in other regions of their pancreas seemed to have a higher PanIN burden than those with nonductal disease, although it was not statistically significant.
The researchers further investigated eight of the samples via 3D-guided microdissection and DNA sequencing of specific PanINs. Genomic analysis revealed that the networks were made up of genetically distinct PanINs driven by different gene mutations, such as mutations in the cancer-causing gene Kirsten rat sarcoma virus (KRAS), which is found in most pancreatic cancers.
The finding that multiple precancerous lesions arose from independent mutations is something that hasn’t yet been seen in other organs, says Wood, “but now that we know that PanINs are there, we can work on targeting them, such as through KRAS.”
Although CODA is not yet usable in a diagnostic setting, among its advantages is that it can be applied to any tissue, disease or model organism, says Kiemen.
“This is just the beginning,” she says. “We want to continue to investigate what this means in the context of other organ tissues. If normal tissue has thousands of PanINs, then how do we identify which ones are clinically relevant to disease and which ones are not?”
“One of the ways we can make a difference for the largest number of people with cancer is through prevention, and better understanding the early precursors to cancer through detailed and anatomic molecular maps is the first step,” adds Wood. “Until you look in 3D, you don’t know what you’re missing.”
The study’s other co-authors include Mia Grahn, André Forjaz, Jeeun Parksong, Jaanvi Mahesh Babu, Jiaying Lai, Lily Zheng, Noushin Niknafs, Rebecca Reichel, Sarah Graham, Alexander Damanakis, Catherine Fischer, Stephanie Mou, Cameron Metz, Julie Granger, Xiao-Ding Liu, Niklas Bachmann, Yutong Zhu, YunZhou Liu, Cristina Almagro-Pérez, Ann Chenyu Jiang, Jeonghyun Yoo, Bridgette Kim, Scott Du, Eli Foster, Jocelyn Hsu, Paula Andreu Rivera, Linda Chu, Fengze Liu, Elliot Fishman, Alan Yuille, Nicholas Roberts, Elizabeth Thompson, Robert Scharpf, Rachel Karchin, Ralph Hruban, Pei-Hsun Wu, and Denis Wirtz of Johns Hopkins.

Other authors were from the Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, and the Institute of Cancer Research at the Henan Academy of Innovations in Medical Science in Zhengzhou, China.
The work was supported by multiple grants from the National Cancer Institute at the National Institutes of Health, the Sol Goldman Pancreatic Cancer Research Center, Lustgarten Foundation, Break Through Cancer, the Buffone Family Gastrointestinal Cancer Research Fund, the Allegheny Health Network — Johns Hopkins Cancer Research Fund, the American Association for Cancer Research (AACR)-Bristol Myers Squibb Midcareer Female Investigator Grant, the Rolfe Pancreatic Cancer Foundation, the Joseph C. Monastra Foundation for Pancreatic Cancer Research, the Gerald O Mann Charitable Foundation (trustees Harriet and Allan Wulfstat), S. Wojcicki and D. Troper, the Lustgarten Foundation-AACR Career Development Award for Pancreatic Cancer Research (in honor of Ruth Bader Ginsburg) and the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2021-I2M-1-067 and 2021-1-I2M-018).
Kiemen, Hruban, Wu, Wirtz and Wood filed a patent June 24, 2022, for the 3D genomic profiling technique. This relationship is managed by The Johns Hopkins University in accordance with its conflict-of-interest policies.

Black patients who leave hospice care and patients with short stays in hospice care are at increased risks for being admitted to a hospital after being discharged from hospice, according to Rutgers Health researchers.
Their study, published in JAMA Network Open, examined patient outcomes after hospice care discharges to determine what factors contribute to transitions that lead to negative health implications.
“Hospice care teams may want to pay particular attention to the discharge planning needs of patients of racial and ethnic minority groups and patients with more complicated needs,” said Elizabeth Luth, the lead author of the study and a core faculty member of the Center for Healthy Aging Research at the Rutgers Institute for Health, Health Care Policy and Aging Research.
About 15 percent of patients leave hospice care before death for a number of reasons, including unplanned hospitalization, seeking treatment for a terminal condition, transferring hospice services or condition stabilization. Often, the transition to a different care setting is burdensome for the health of the patient. According to researchers, the factors that contribute to the risk of burdensome transitions out of hospice care are understudied, but important for clinicians and policymakers to better understand.
Using Medicare data from more than 115,000 patients from 2014 to 2019, researchers looked at different types of burdensome transitions out of hospice care, including patients admitted to a hospital after leaving care and patients who died while hospitalized. They sought to assess what individual patient, health care services and hospice organizational factors are associated with the different types of transition outcomes.
Researchers found that Black patients who had shorter hospice stays and received care from a for-profit hospice service had higher odds of a burdensome transition after they were discharged. About 42 percent of hospice patients who were discharged die within six months, “suggesting that uninterrupted hospice care may be appropriate for many individuals who were discharged,” the researchers found.
Inequitable access to health care services, as well as institutionalized racism, are important factors in racial and ethnic disparities in health outcomes, according to previous research published in The New England Journal of Medicine and The Lancet.
Researchers also found that inpatient respite (services providing short-term relief for family caregivers) and general inpatient care (short-term hospital care for symptom management) were associated with lower odds of hospitalization and hospice readmission.
“Policymakers may want to consider making inpatient respite and general inpatient care more widely available and accessible to families with members in hospice with complex needs to support better outcomes if they are discharged,” said Luth, who is an assistant professor in the Department of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School.
Coauthors of the study include Caitlin Brennan and Susan Hurley of Care Dimensions, a hospice and palliative care facility in Massachusetts, Veerawat Phongtankuel, Holly Prigerson, and Yongkang Zhang of Weill Cornell Medicine, Miriam Ryvicker of VNS Health, a nonprofit, community-based health care organization in New York City, and Hui Shao of Emory University.