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Regenstrief Institute, Indiana University School of Medicine and Mayo Clinic researcher-clinicians are conducting a multi-site study to establish that music intervention can reduce the likelihood of critically ill, mechanically ventilated older adults in a hospital intensive care unit (ICU) developing delirium and can also improve their post-ICU brain health. The study is one of the first to measure dosage of music exposure as the researchers continue their pioneering exploration of the potential of music to decrease or even prevent delirium.
One million adults in the U.S. receive mechanical ventilation in a hospital ICU annually. While in the ICU, as many as 80 percent of these individuals experience delirium, a syndrome of acute brain dysfunction. Delirium predisposes patients to longer ICU and hospital stays and increased risk of death. Delirium is also associated with long-term complications including cognitive impairment and dementia.
Individuals with delirium experience a sudden change in mental status, often acting confused, disoriented or distracted. Individuals experiencing delirium could become overactive, agitated and restless. They may have rapid emotional changes, have trouble concentrating and often experience hallucinations or anxiety.
“No effective drug for delirium exists so there is great need for nonpharmacological therapies to prevent or manage delirium,” said study co-principal investigator Babar Khan, M.D., M.S., of Regenstrief Institute and IU School of Medicine. “We are conducting this study to firmly establish that music reduces delirium in ICU patients who are mechanically ventilated, with the goal of music listening as anti-delirium therapy becoming the standard of care for patients in ICUs across the country.”
A past president of the American Delirium Society, Dr. Khan is the developer of the CAM-ICU-7, an easy-to-use delirium severity evaluation tool. CAM-ICU-7 is being used in the study to score delirium on a zero (no delirium) to 7 (severe) scale to provide objectivity to brain failure assessment. This information is vital not only for current and future brain health management by clinicians, but also for use in future clinical studies by researchers. He has also developed the post-critical care model for ICU survivors.
In the current music to decrease delirium study, 160 mechanically ventilated adults, 50 years of age or older, are being randomized to one of two groups within 72 hours of ICU admission. Those in the music arm of the study receive a dose of slow tempo (60 to 80 beats per minute) instrumental music through noise-canceling headphones for one hour twice daily for seven days. The other arm receives a placebo consisting of a silent audio track administered in the same manner and duration. In addition to twice daily delirium assessments, pain and anxiety will be evaluated daily.
The primary outcome of improving delirium is measured by the number of days patients are alive, not comatose and free of delirium during the seven days of exposure to music or silence.
For both groups a specially designed computer application (app), which has been pilot tested by the Regenstrief, IU and Mayo researchers, tracks the length and frequency of listening sessions. For those in the music arm of the study, the app also gathers data about music selection from an extensive playlist.
Three months after hospital discharge, the effects of exposure to music on cognition, as measured by memory, attention, information processing, speed and executive cognitive function of recipients of music versus silent track will be assessed as well as study participants’ mood and anxiety.
“As a secondary outcome of the study, we are exploring the downstream effects of relaxing, slow-tempo music on brain health outcomes that matter to ICU survivors,” said study co-investigator Sikandar Khan, D.O. He is co-program director of the COVID-19 Recovery Program for Older Adults at Regenstrief Institute and director of the Indiana University Health Intensive Care Unit (ICU) Survivor Center.
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Materials provided by Regenstrief Institute. Note: Content may be edited for style and length.

This article is part of the I Want to Thank You series. We asked readers to tell us about who helped get them through the pandemic; these are a selection of their stories about their families and friends. Future articles will focus on health care workers and inspirational figures.Many Americans hunkered down with family members when the pandemic hit. Others relied on friends for support, emotional and otherwise. As the country moves on, some are emerging with deeper relationships and renewed appreciation for the loved ones who helped them get through an uncertain time.Among the stories: a married couple facing cancer; a new widow and her kayaking support group; a fearful actress and her childhood friend; a stroke survivor and her daughter; a septuagenarian and her 43-year-old travel buddy; and two sisters, one of them pregnant.From left, Martha Fagg, Susanne Skyrm, Elizabeth Smith and Jo Pasqualucci on Ms. Smith’s porch in Vermillion, S.D. (The group also includes Lana Svien, not pictured.) Arin Yoon for The New York TimesThank You for Helping Me Deal With DeathOn the morning of June 25, 2020, something compelled Elizabeth Smith awake at 5:30. She walked to the hospice bed of her husband, Larry, and held his hand. His breathing had become uneven. Then it slowed.“And then it became erratic,” Ms. Smith, 72, said, her voice softening. “And then he squeezed my hand really, really hard. He took one last breath, and he died.”Mr. Smith’s death, at 71, left her heartbroken and even more lonely during the early days of the pandemic. The couple had moved from Connecticut, where Mr. Smith had been a police captain, to Vermillion, S.D., in 1999. He was forced to retire after being diagnosed with Parkinson’s disease — he no longer qualified to carry a gun — and so Ms. Smith accepted a tenured professorship in the University of South Dakota’s political science department. Mr. Smith opened a bakery that, according to Oprah.com, baked “the best bread in the world.”The day after his death, Ms. Smith brought her husband’s ashes to a friend’s front lawn for a socially distanced gathering of friends, namely four women — Lana Svien, Jo Pasqualucci, Susanne Skyrm and Martha Fagg. As the summer wore on, the quintet — all single, retired and around the same age — often hung out on Ms. Smith’s lawn to share laughs and meals. When temperatures chilled they moved the lawn chairs to Ms. Smith’s open garage, which they outfitted with space heaters and dubbed “Cafe Covid.” Ms. Smith and her friends also share a love of the outdoors. She spent much of her first weeks without her husband kayaking the Missouri River, often with at least one of the self-described “Usual Suspects.”“I could send out a message in the morning, saying ‘Anyone want to kayak today?’ and get some responses,” she said.On Ms. Smith’s first Thanksgiving after her husband’s death, they gathered on her front porch for a potluck meal. And this past July a group of them headed to Oakwood Lakes State Park — some in Ms. Smith’s camping van, nicknamed “Van-essa” — for what was supposed to be a couple days of kayaking.Instead the trip got cut short, thanks to a pileup of bad luck. Ms. Smith said the group couldn’t stop laughing about the comedy of errors.“Having each other has been really a gift,” she said.Mahira Kakkar, left, and Shubhani Sarkar at Albert’s Garden, a community garden space in New York.Jasmine Clarke for The New York TimesThank You for Helping Me Get OutsideOn a summer afternoon in 2020, sitting on a bench in Central Park, Mahira Kakkar took off her mask and, for the first time in months, took a breath of fresh air.Read More on the Coronavirus PandemicEducational Declines: Test results show the pandemic’s effect on U.S. students: The math and reading scores of 9-year-olds dropped steeply, erasing two decades of progress.Heavy Toll: The average life expectancy of Americans fell precipitously in 2020 and 2021. The decline, largely driven by the pandemic, was particularly pronounced among Indigenous communities.Boosters: An influential panel of expert advisers to the Centers for Disease Control and Prevention recommended updated coronavirus booster shots to the vast majority of Americans, clearing the way for health workers to begin giving people the redesigned shots within days.Paxlovid Study: The Covid-19 medication Paxlovid reduced hospitalizations and deaths in older patients, but made no difference for patients under 65, new research from Israel found.Ms. Kakkar, an actress who has worked on TV and in film, had hardly left her apartment since that March, and she probably wouldn’t have gone to Central Park had it not been for Shubhani Sarkar.The two women had been friends while growing up in Kolkata, India. And they reconnected when they both moved to New York in the early 2000s, Ms. Kakkar to continue her education and Ms. Sarkar to begin her career as a graphic designer. But as the pandemic wore on and Ms. Kakkar felt burned out, she stopped answering Ms. Sarkar’s messages. “We were sad and lonely,” Ms. Kakkar said of herself and her husband. “But we were lucky to be sad and lonely. One of my other friends is an E.R. doctor, and sometimes she would just share her feelings. And it was horrible.”Eventually Ms. Kakkar responded to Ms. Sarkar, who’d texted that she missed her friend. “I miss you too,” Ms. Kakkar wrote back.Ms. Sarkar sent Ms. Kakkar pictures of the signs at subway stops, urging riders to maintain six feet of distance, and eventually persuaded her to join on a walk. Ms. Kakkar prayed during her entire ride.Taking off her mask in Central Park “felt like such a huge deal,” Mr. Kakkar said, and over several more walks, her friendship with Ms. Sarkar deepened. Ms. Kakkar also joined Ms. Sarkar’s cooking classes, where she would guide the group through Indian recipes via Zoom.“It was very nice to have someone else with a common background share similar anecdotes and stories, as people kind of listened in and cooked along,” Ms. Sarkar said of her friend.Ms. Kakkar said that Ms. Sarkar was surprised upon learning how much her outreach had helped Ms. Kakkar through the pandemic: “She was like, ‘I just missed you.’”“She knew better what I needed than I did,” Jon Ellis said of his wife, Rita, who he credits for helping him get through cancer.Cig Harvey for The New York TimesThe couple at Lermond Pond with their dog, Ginger.Cig Harvey for The New York TimesThank You for Getting Me Through CancerJon Ellis had never been afraid to die. And he still wasn’t. But it was becoming more difficult to live through the pain.Pancreatic cancer, with which he was diagnosed not long after the pandemic hit, and chemotherapy rendered him a stranger in his own body. As a pilot for 50 years, Mr. Ellis knew how tenuous life really is. But at least in the sky he was free. Down in his 1,500-square-foot home in Maine, Mr. Ellis, 75, could hardly pull himself off the couch.Mr. Ellis probably wouldn’t have survived, he said, if not for his wife.Rita Ellis would drive him to chemotherapy appointments, then shepherd him home and make sure he drank his smoothies. “She knew better what I needed than I did,” he said.Mrs. Ellis, 72, refused to complain, even when, on top of everything else, the Ellises’ daughter became ill and was diagnosed with Type 1 diabetes.The Ellises had moved to Maine from Memphis about five years earlier, in part to be closer to their children living in the Northeast. Now, forced to spend time with each other more than ever, the couple spoke about what Mrs. Ellis’s future might look like in practical terms: She would have to move, they agreed, to a less rural part of town, if Mr. Ellis were to die.“I was ready to hear that I wasn’t going to make it for another year,” Mr. Ellis said. “We had some really good heart-to-heart talks about our longevity on this planet. In our case, at least, it made us very much closer. I’m grateful for that.”Mrs. Ellis didn’t need to move. Mr. Ellis’s final chemotherapy treatment was in March 2021, and his cancer remains undetectable.Mr. Ellis sometimes loses his train of thought when speaking — “chemo brain,” he calls it — but in discussing his wife, Mr. Ellis’s feelings are clear.“I’ve fallen in love with her all over again,” he said.Cheryl Pearlman and her daughter, Deanna Otero, at Ms. Pearlman’s home in Brooklyn, N.Y. Vincent Tullo for The New York TimesThank You for Helping My RecoveryIt was no coincidence, Cheryl Pearlman believes, that the first time she walked without the assistance of a walker since suffering a stroke during the pandemic was in the presence of her daughter, Deanna Otero.Last autumn, Ms. Pearlman was in her home with Ms. Otero and without thinking walked to the dining room table.Ms. Otero had “really, I think, believed I would recover. I wasn’t always so sure,” Ms. Pearlman, 74, said. “It was so moving that she was there to witness it — and notice it — when I didn’t.”Earlier in the year, Ms. Pearlman started taking medication for hypertrophic cardiomyopathy, a condition which makes heart muscles thicken, causing the heart to work harder. She soon started experiencing shortness of breath and underwent surgery. When Ms. Pearlman woke up, she learned that she had suffered a stroke and was paralyzed from the shoulder down on the left side of her body.During Ms. Pearlman’s two weeks in rehab, Ms. Otero, 36, redesigned her mother’s home to make it easier to navigate. She also had the bathroom painted yellow and the dining room white.“She thought my house was too dark,” Ms. Pearlman said.Ms. Pearlman, who works as a psychotherapist, is almost back to her old self, she said. “I made it very clear to her that 90 percent of my recovery was because of her,” Ms. Pearlman said of her daughter.Drew Johnson and Victoria Bernuth began taking socially distanced walks together in Eugene, Ore., during the pandemic.Joseph Haeberle for The New York TimesThank You for Your FriendshipVictoria Bernuth didn’t have to worry about groceries during the worst months of the pandemic.Ms. Bernuth, 74, never left her Pleasant Hill, Ore., farm, but she found a lifeline in Drew Johnson, 43, whom she had met at a local meeting for humanists before Covid hit. Mr. Johnson, a former youth pastor, would drop off her groceries, then the two would take long walks along the country roads near Ms. Bernuth’s farm.As they walked and talked 15 feet apart, bonding in part over their shared atheism, Ms. Bernuth’s loneliness lifted.“We’re not romantic,” Ms. Bernuth said. “But we just have a deep affection for each other and caring for each other.”Ms. Bernuth and Mr. Johnson had taken several road trips before the pandemic, and after Ms. Bernuth got her first Covid vaccine in March 2021 he floated an idea: “C’mon, let’s go to the beach.”Ms. Bernuth teared up on the car ride to Beverly Beach, about two hours away; it was her first time being physically close to a person in almost a year. The trip was calming; they worked on crossword puzzles, looked out on the ocean and went on long walks.“He is the joy and light of my life,” Ms. Bernuth said.Rebecca Spigelman, right, helped her sister, Sarah Richter, when she was pregnant during the pandemic.Tess Ayano for The New York TimesThank You for Helping Me Through My PregnancyRebecca Spigelman did not hug her sister, Sarah Richter, for six months during the first wave of the pandemic. Ms. Richter was pregnant and anxious about how contracting Covid could impact her pregnancy.But nearly every day Ms. Spigelman walked 33 street blocks and three avenues — public transportation didn’t feel safe at the time — to Ms. Richter’s apartment to help with household chores: She washed produce, entertained her sister’s then-4-year-old son and brought Ms. Richter ginger ale when she felt nauseous.Ms. Richter was working remotely, but with her husband, a physician, spending long hours at the hospital, Ms. Spigelman’s assistance made all the difference, Ms. Richter, 38, said.“People who have the capacity to give and love like she does, they don’t think of it as a unique quality,” Ms. Richter said. “But of course, it is.”After Ms. Richter gave birth, Ms. Spigelman moved in for about three weeks, washing dishes and waking up in the middle of the night to comfort her sister’s newborn, as Ms. Richter pumped breast milk.But the highlight came the day after Ms. Richter’s baby was born: For the first time since March, the sisters hugged.“People who have the capacity to give and love like she does, they don’t think of it as a unique quality,” Ms. Richter said of her sister. “But of course, it is.”Tess Ayano for The New York Times

While the situation has improved since mid-July, many families are still scrambling to find popular brands that remain out of stock.More than six months after one of the largest infant formula manufacturing plants in the United States issued a recall and was then shut down because of contamination concerns, a newborn staple remains in short supply.In parts of the country, parents and their families are scrambling to locate precious containers of formula for their babies and many large retailers remain out of stock of popular brands. Some companies like Walmart and Target are limiting the number of containers that can be purchased at one time.While the situation has improved since mid-July, the out-of-stock figures for powder formula on store shelves in late August remained at 23 percent, still above the 10 percent it was before the recall and shutdown, according to the Chicago-based market research firm IRI.“It all depends on geography and the retailer,” said Brian Dittmeier, the senior director of public policy at the National WIC Association, a nonprofit organization. The WIC program provides nutritional assistance for women, infants and children, and accounts for about half the formula use in the country. “There are some locations,” Mr. Dittmeier said, “where the supply of infant formula is healthy and others where it is not.”But even as the scarcity subsides, parents and caregivers say that the federal Food and Drug Administration, which regulates the formula industry, is not doing enough to address systemic problems exposed by the February shutdown of the Abbott Nutrition manufacturing plant in Sturgis, Mich., that set off the nationwide shortages.The shutdown occurred after reports of infections in four babies — two of them fatal — who had consumed formula manufactured at the plant. On Feb. 17, two days after the shutdown, Abbott recalled batches of three powdered formulas over complaints of serious bacterial contamination. (Abbott has said that there is no “conclusive evidence” to link the company’s formulas to the illnesses.) That disruption made it clear just how dependent Americans were on a few formula manufacturers, and the Biden administration found itself scrambling to figure out how to make more product available.Pallets of Kendamil formula from the British company Kendal Nutricare being unloaded at Dulles International Airport in June. The company spent three years trying to get U.S. approval for its formula.Jim Lo Scalzo/EPA, via ShutterstockThe F.D.A. said it was now receiving weekly updates from domestic manufacturers and has arranged for nearly 18.9 million cans of formula to be brought in from abroad. “Is there enough formula to go around? The answer is yes, there already is enough formula here,” said Dr. Robert M. Califf, the commissioner of the F.D.A. “We just have to continue to work to get the distribution improved.” He noted, however, that it would take another couple of months before consumers see the broad array of formulas on store shelves that were available at the beginning of the year.While the two other domestic manufacturers, Reckitt Benckiser, which makes the popular Enfamil brand of formula, and Perrigo, which manufactures generic formula for retailers, ramped up production at their factories, the F.D.A. also relaxed some of the restrictions on imports. The result was an avalanche of applications from manufacturers all over the world.The U.S. market, estimated at $2 billion to $4 billion annually, has been notoriously tough for foreign formula companies to crack, owing to regulatory hurdles and tariffs.While the foreign formula is only supposed to be allowed into the United States on a temporary basis, ending around Nov. 14, the F.D.A. said it would release guidance this month on how the new companies can continue to sell in the United States past this fall.“Parents in the U.S. have been looking for a better product than what they were being offered,” said Will McMahon, one of the members of the family who owns the British baby formula Kendamil. The company has spent the last three years working through the formal process, including clinical trials, necessary to get its organic infant formula approved by the F.D.A.Kendamil was one of the earliest formulas to get its application approved by the F.D.A. in the wake of the Sturgis plant shutdown, and the company has begun sending two million cans of formula to the United States. When the formula shortage was at a crisis point in May, Christine Robinson started a Facebook group connecting parents around the country.Mark Makela for The New York TimesBut some parents say relying on foreign manufacturers is not a long-term solution. “It boggles my mind that the supply chain was so fragile and could be broken in such a major way,” said Christine Robinson, whose 8-month-old son is fed with formula.Ms. Robinson said she worried that relying on non-U.S. brands could lead to issues for babies whose sensitive digestive systems do not adapt easily to change once the U.S. suppliers are able to ramp up production and the foreign formulas are phased out.Ms. Robinson, who lives in Bucks County, Pa., said she would prefer that the F.D.A. streamline approvals for new American-made formula brands to diversify the market. The F.D.A. has allowed more than a dozen non-U.S. companies to ship more than 18 million cans of formula into the United States, a mix of established manufacturers like Danone and Nestle in Europe but also smaller, lesser-known companies like Global Kosher, based in the United Kingdom, and Care A2+, an Australian company that started operations in October 2020.But other larger global manufacturers that had formula available to ship were left on the sidelines. Some, like Organic-Family GmbH, a unit of the Swiss company Holle, said it had not gotten an update from the F.D.A. on its application. Thorben Nilewski, a managing director at GmbH, said in an email, “It feels like our offer or opinion isn’t really of interest at this point.” And the stock of the Australian formula manufacturer A2 Milk Company dropped in early August after it said the F.D.A. had notified it that it was “deferring further consideration” of its application to import formula into the United States.The Abbott Nutrition manufacturing plant in Sturgis, Mich., was shut down in February, setting off nationwide baby formula shortages.Jeff Kowalsky/AFP, via Getty ImagesIn an emailed statement, the F.D.A. said the letters sent to firms did not mean that their formulas were unsafe, but rather that there were issues that would probably not be quickly resolved.“There are a variety of reasons why certain infant formulas may not have been moved forward,” Dr. Susan Mayne, director of the Center for Food Safety and Applied Nutrition at the F.D.A., said in an interview. “The key criteria for us was whether the manufacturer had formula available immediately as our goals were to get formula on the shelves as rapidly as possible.”Priority was also given to applications from manufacturers that could provide medical and specialty formulas, she added. She said the agency was still reviewing applications.In late August, Abbott said it was set to resume manufacturing of Similac formulas at its plant in Sturgis.The company also said that it increased production at other U.S.-based manufacturing plants and one in Ireland, and that it would supply the United States with more than eight million pounds of formula in August, an increase from the year before. But it noted it would take six weeks for the Similac product from the Sturgis plant to start to hit store shelves.But some industry experts say it will take time for Abbott to gain back the market share it once had. “To be frank, there is a lot of consumer mistrust around Similac right now,” said Mr. Dittmeier of the W.I.C. program.That could be a boon for Reckitt Benckiser, which has been running its formula manufacturing plants at full tilt all summer, hoping to hold on to the market share it has gained at Abbott’s expense. Its market share has climbed to nearly 60 percent from 35 percent before the recall, said Robert Cleveland, who oversees the Mead Johnson nutrition business at Reckitt.“We remain committed to making as much formula as we can,” Mr. Cleveland said. “We continue to maximize our domestic manufacturing, running overtime and going 24/7.” He added that the company had received approval to bring in formula from its plants in Singapore and specialty formula from its facilities in Mexico.Still, in late August, when Lori Sharp, a first-time mother in Port Hueneme, Calif., realized she was down to one container of Reckitt’s Enfamil Sensitive infant formula for her 3-month-old daughter, the formula was out of stock on Walmart.com.Panicking, she scoured more websites and widened her geographic search. She eventually discovered a container of formula at a Target 40 minutes away in Moorpark, Calif. “I went into the store and they actually had four more, but their shelves were so bare,” Ms. Sharp said. “I bought all of them.”In Georgia, some of the most acute shortages are in rural areas. Jennifer Kelly, who is the family services manager at the early Head Start program in Swainsboro, which is between Macon and Savannah, said trying to find formula earlier this summer had become a “daily chore.”Jennifer Kelly, who runs the infant program at the early Head Start program in Swainsboro, said trying to find formula earlier this summer had become a “daily chore.”Dylan Wilson for The New York TimesThe 14 babies she watches drink seven different kinds of formula. She and her staff were often driving to Walmart, Walgreens or a local grocery chain or scouring Amazon for some of the more obscure brands.“It’s not like it was a few months ago when the shelves were bare,” Ms. Kelly said. “I am hoping we are on the other side of this dilemma.”When the formula shortage was at a crisis point in May, Ms. Robinson of Bucks County, Pa., created a Facebook group that connected parents around the country. The group, called Formula Hunters, does not exchange money to keep out profiteers who have been hoarding formula and seeking to resell it at a markup.The group operates on the notion that a parent who buys a hard-to-find formula brand and sends it to another parent in the group will eventually be repaid when others do the same for them.Formula Hunters now has 1,500 members, who are still actively helping each other locate formula. “This has been going on for so many months,” Ms. Robinson said. “The frustration has been high.”

High-income countries snapped up vaccines when the disease hit them, leaving none for countries that have battled the virus for years, in an echo of the Covid response.For the past month, a couple of patients a day have sat across from Dr. Alberto Mendoza at the H.I.V. clinic where he works in Lima, Peru, to hear him confirm what they had feared: They have monkeypox. The men are tormented by the painful lesions the virus causes. They’re also afraid, because the visible sores mark them as men who have sex with men, a dangerous identity in Peru, where there is intense discrimination against homosexuality.But Dr. Mendoza, an infectious disease specialist, has little to offer. “I have no options,” he said in an interview. Neither the antiviral drug nor the vaccine being used against monkeypox in the United States and Europe is available in Peru. “We have nothing, even though we are the country with one of the highest numbers of cases by population,” said Dr. Mendoza, who works with the medical charity Partners in Health.Neighboring Brazil, which, according to the World Health Organization, has close to 10 percent of global monkeypox cases, currently has no vaccine or treatment either. Nor do the countries in West and Central Africa that have struggled with monkeypox outbreaks for decades.The scramble for monkeypox vaccines and treatments has been centered in the United States and Europe, where supplies of shots have stretched thin or nearly run out. But more than 100 countries are now reporting monkeypox cases, and a vast majority of those have had no vaccine or treatments at all.They have been shut out by the prohibitive cost and by wealthy nations who bought up most of the available doses. The United States already controlled most of the vaccine, which was originally developed for smallpox, as part of its bioweapons strategy after the terrorist attacks of Sept. 11, 2001. Some public health groups are also criticizing the W.H.O. for not doing more to ensure swift movement on equitable access to tests, treatments and vaccines, after it declared monkeypox a public health emergency of international concern on July 23. They say the issues echo those seen with Covid, but without any of the mechanisms that were developed to try to right the balance during the coronavirus pandemic.A tent for screening monkeypox patients outside the Arzobispo Loayza Hospital in Lima.Ernesto Benavides/Agence France-Presse — Getty ImagesIt is difficult to even know the number of people who have monkeypox in developing nations because many lack capacity for diagnosing the disease, which is done with a P.C.R. test. Most of the testing in countries that have had outbreaks for years is done at the surveillance level, testing only a sampling of the population to find the overall incidence of the disease. Testing to diagnose individual patients, many of whom live in isolated rural areas, is rare or nonexistent.“We don’t have access to testing in Africa so we don’t know where cases are, so you can’t use that as a basis for decisions on the use of resources,” said Dr. Boghuma Titanji, an assistant professor of medicine at Emory University who responded to a monkeypox outbreak in 2018 in her native Cameroon.Most people who die from monkeypox are Africans. There are two different strains of the disease, a more lethal one circulating in the Democratic Republic of Congo and neighboring countries, and a less virulent version in West Africa, which is the one now being seen in high-income countries. Though deaths from monkeypox are rare, the risk of a fatal case is greatest in children and pregnant women, and the disease is excruciatingly painful for anyone infected.What to Know About the Monkeypox VirusCard 1 of 7What is monkeypox?

Published3 hours agoSharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesResidents under Covid lockdowns in areas across China are complaining of shortages of food and essential items.Tens of millions of people in at least 30 regions have been ordered to stay at home under partial or full lockdowns.”It’s been 15 days, we are out of flour, rice, eggs. From days ago, we run out of milk for kids,” said one resident in western Xinjiang.Authorities are scrambling to contain local outbreaks ahead of the Communist party’s congress in October.China’s zero-Covid policy requires strict lockdowns – even if just a handful of cases are reported. On Monday China recorded 949 new Covid cases across the entire country.The policy has prompted rare public dissent from citizens and has also been accused of stifling economic growth.In Xinjiang a weeks-long lockdown in the Ili Kazakh Autonomous Prefecture near the border with Kazakhstan has seen desperate residents appeal for help on social media.One post showed a video of an Uyghur man overcome with emotion, saying his three children had not eaten for three days.In Yining city, the capital of Ili, a shared online document with over 300 urgent requests for food, medicine and sanitary pads was widely circulated.”I’m out of money to buy supplies. My wife is pregnant and we have two kids. We are running out of gas. My wife needs a medical check,” said another resident.The region has a mixed population of Han Chinese, Kazakh and Uyghur residents.Earlier this month a long-awaited UN report accused China of “serious human rights violations” against Uyghurs and other mainly Muslim minorities in Xinjiang. Rights groups say that more than a million Uyghurs had been detained against their will. Beijing says its network of camps are a tool to fight terrorism.In south-western Guizhou province, authorities locked down an area of the provincial capital Guiyang without warning, stranding 500,000 residents at home without any chance to prepare.Lifts were switched off in buildings to stop people leaving, the Guardian newspaper reported.”We can’t buy stuff online as they don’t deliver and supermarkets are closed. Is the government treating us like animals, or do they just want us to die?” asked one user on the Weibo microblogging platform, quoted by the Guardian.Meanwhile Chengdu, the capital of Sichuan province, is the largest city to come under lockdown since Shanghai suffered two months of restrictions earlier this year. Its 21 million people have been banned from entering or leaving the city, with only residents able to show evidence of a negative Covid test allowed out to buy necessities.It follows a major heatwave in the region and an earthquake earlier this month which saw residents trying to flee their homes confronted by locked exits.City officials say they are planning to lift restrictions in five areas of the city starting on Monday.The multiple extended lockdowns come ahead of the National Party Congress in mid-October – a once-in-five-years event that will see top political members gather for the first time since the pandemic struck. Party officials are under immense pressure to makes sure the event runs smoothly, and even small clusters of Covid are seen as a threat.On Monday Chinese media said small numbers of cases were being detected on university campuses in Beijing as students returned from other provinces.It is the world’s last major economy attempting to entirely stamp out Covid outbreaks, claiming this is necessary to prevent wider surges of the virus which could overwhelm hospitals.China has officially recorded fewer than 15,000 deaths since the pandemic began, according to Johns Hopkins University.You may also be interested in: This video can not be playedTo play this video you need to enable JavaScript in your browser.More on this storyAnger over China lockdown during earthquake6 days agoChinese city of 21m locked down over Covid cases1 SeptemberViral videos show anger and desperation in Shanghai. Video, 00:01:57Viral videos show anger and desperation in Shanghai15 April1:57

Alcohol taxes have been stagnant for years. But after the pandemic sent alcohol-related deaths soaring, activists in Oregon said higher taxes could save lives.Oregon is a drinker’s paradise. The state boasts more craft distilleries than Kentucky and is second only to California in the number of wineries. Some call Portland “beervana” for its bevy of breweries.But Oregon also has among the highest prevalence of problem drinking in the country. Last year, 2,153 residents died of causes attributed to alcohol, according to the Oregon Health Authority — more than twice the number of people killed by methamphetamines, heroin and fentanyl combined.Sonja Grove, a retiree in Portland whose adult son drank himself to death in April 2020, feels the toll is overlooked compared with those of other drugs. “Alcoholism has sort of taken a back seat.”In 2021, confronted by these conflicting trends, as the pandemic raged on, Oregon lawmakers made it easier to drink. They permanently legalized the sale of to-go cocktails, which the Distilled Spirits Council of the United States called a “lifeline,” and increased the number of cases that wineries could ship directly to consumers.Reginald Richardson, director of the state’s Alcohol and Drug Policy Commission, described the policies as incongruent. “We obviously want to create an environment that’s pro-business, that helps the state to develop, but we’ve got this other thing,” he said.That disconnect is typical: Before Covid lockdowns, no state permitted bars or restaurants to deliver liquor to customers at home, according to a trade association. Now, 28 have relaxed the rules.In contrast, policies that experts consider most effective at curbing excessive drinking have been ignored. For example, even as alcohol-related deaths soared to record highs in the last few years, alcohol taxes have fallen to the lowest rates in a generation.The Economics of AlcoholCeleste Noche for The New York TimesAmericans drank more during the pandemic, but national data on the change have only recently become available. Alcohol tax revenues collected by the U.S. Treasury Department rose by eight percent in the fiscal year that ended on Sept. 30, 2021, compared with the previous year, and remain well above pre-pandemic levels.Deaths caused by drinking also rose during the pandemic, spiking 25 percent in 2020 over the previous year. But the deaths — which have topped 140,000 nationwide — have been rising for decades in every state. Few places have seen a greater uptick than Oregon, where the rate of alcohol-induced deaths grew 2.5 times from 1999 to 2020, after adjusting for the state’s changing age distribution.Ms. Grove’s only son, Jonathon, had begun drinking excessively in college, she said, but managed to work as a pharmacy tech for years at Oregon Health Sciences University despite his worsening addiction. Cheap beer and white wine were his weaknesses. “He always thought that he wasn’t drinking hard alcohol, so he wasn’t really an alcoholic,” Ms. Grove said. He died in a cheap hotel, surrounded by empty cans and containers.Various studies in recent years have suggested that even moderate drinking poses a health risk, including to the heart. The Centers for Disease Control and Prevention recommends that men consume no more than two drinks a day and women no more than one.Dr. Eric Roth, chief of emergency medicine at Kaiser Permanente’s two hospitals in the Portland area, estimated that 10 percent to 30 percent of his patients had illnesses or injuries at least partly linked to drinking. “It’s always been a big problem,” he said, “and it’s getting to be an increasingly big problem.”To address substance abuse, Oregon has emphasized education and treatment to address substance use. A ballot measure passed in 2020 that decriminalized possession of small amounts of all drugs also diverted hundreds of millions of tax dollars from marijuana to recovery services, including for alcohol. This summer, Oregon sponsored a campaign to “Rethink the Drink.”Dr. Tim Naimi, director of the Canadian Institute for Substance Use Research at the University of Victoria, labeled educational campaigns a “fig leaf” and said that treatment, while helpful, was akin to parking an ambulance beneath a cliff rather than fencing the precipice to prevent people from falling. Measures to prevent excessive drinking are less costly and more effective, he said. “If you want to talk prevention, you’ve got to talk policies.”.The U.S. Community Preventive Services Task Force, an independent group of experts, has endorsed measures to deter excess drinking, including raising the price of alcohol. And alcohol has never been more affordable: As a share of average household income, a can of Budweiser in 2010 cost one-fifth of what it did in 1950 after adjusting for inflation, one study calculated, and the cheapest available liquor cost one-fifteenth the price.Sonja Grove’s son, Jon. Celeste Noche for The New York TimesOne way that governments can influence the price of alcohol is by taxing its producers or sellers, who pass the cost on to consumers. This is comparable to taxes on tobacco, which scores of studies show to be a powerful tool for reducing smoking. A large body of evidence shows that higher alcohol taxes are associated with less excessive drinking and lower rates of disease and injury deaths. After Illinois and Maryland raised alcohol taxes, the states reported reductions in binge drinking and car crashes involving intoxication.Alex Wagenaar, a professor emeritus at the University of Florida College of Medicine, said studies across diverse places and populations were consistent. “There’s just no question that the tax rate affects how much people drink, and the effect then ripples through to a really wide range of alcohol-related problems,” he said.But Oregon, which has no sales tax, has long curried favor with the wine and beer industries by keeping alcohol taxes low — less than 3 cents per glass of wine and not even a penny per a 12-ounce beer. For years, sporadic efforts to raise rates have sputtered.Max Williams, who as a state legislator between 1999 and 2003 pressed unsuccessfully for an increase, noted that wine taxes have not changed since 1983, nor have beer taxes since 1977. “I was a seventh grader at Cascade Junior High the last time that happened,” he said.Furthermore, leaving tax rates unchanged has the practical effect of reducing them. As in much of the country, Oregon sets alcohol taxes by the volume of the beverage rather than as a percentage of its price so when inflation pushes up prices, it effectively erodes the tax rate. Over the last 45 years, Oregon’s beer tax has lost 80 percent of its value.Christina LaRue, executive director of the Oregon Brewers Guild, acknowledged that the state’s tax rates were among the lowest in the country. But she questioned the evidence linking that fact with alcohol-related illnesses and injuries and whether local breweries were implicated.Both her parents drank heavily and died young, Ms. LaRue said, adding it made her an impassioned supporter of mental health services. She noted that her mother consumed cheap whiskey, not craft IPAs. “If a person has a drinking problem,” she said, “they’re going to find a way.”A Movement by the AfflictedCeleste Noche for The New York TimesLast year, Oregon Recovers, a nonprofit advocacy organization, renewed the push for a tax increase. Its executive director, Mike Marshall, an electoral strategist who has worked on campaigns for marriage equality and a race for governor, is 14 years sober.In contrast with Alcoholics Anonymous, which has a foundational tradition of avoiding politics, Oregon Recovers has proved an effective if polarizing force.The group approached State Representative Tawna Sanchez to sponsor the bill. Ms. Sanchez, who is Shoshone-Bannock and one of the few Native American members of the legislature, is open about her own struggle with drinking and said she was motivated in part to address addiction in her community.“The beer and wine industries have fought tooth and nail — and have won thus far — to keep their taxes from going up,” she said. “And I don’t think that’s fair to everyone else.”Mr. Marshall said the proposed increase — $0.21 on a 12-ounce beer and $0.40 on a glass of wine — was proportionate to Oregon’s alcohol problems, and the state’s Health Authority supported the bill. But the alcohol industry branded it as extreme, labeling it “a 2,700-percent increase” from the state’s rates.The bill never made it out of its first legislative committee.The Oregon Beverage Political Action Committee, which opposed the bill, has given more than $500,000 in campaign contributions to local politicians since 2020. Danelle Romain, its treasurer, said the measure’s demise was a bellwether for public support of such policies. “I don’t think Oregonians think alcohol is evil,” she said. “I just don’t think that message resonates.”Politics vs. Public HealthCeleste Noche for The New York TimesViews about alcohol policies do not necessarily cleave along familiar partisan lines. Mr. Williams was a Republican when he pushed for a tax increase, although he has since given up his party affiliation. “This is one of those issues that I think is way less politicized by party and more politicized by ideology,” he said.Since 2013, Democrats have held Oregon’s governor’s office and majorities in both legislative chambers. But the state’s prominent progressives do not connect the lax regulatory environment with alcohol’s widening harms.Last year, Senator Ron Wyden, Democrat of Oregon, and supporter of better mental health care, led successful efforts to permanently lower federal alcohol taxes. An industry group named him a “Beer Champion” of the year.Some experts say that the Biden administration has also favored alcohol producers over consumers. In February, the Treasury Department released a report on the market for beer, wine and spirits that mainly advanced recommendations for “boosting opportunity for small businesses.”David Jernigan, a professor at Boston University School of Public Health and an expert on alcohol, said the report “entirely ignored” public health in its push to reduce regulatory barriers and to foster more competition in alcohol production. “That’s all well and good for dish soap,” he said. “It has really different consequences for alcohol.”Major philanthropies have not invested significantly in initiatives aimed at reducing alcohol-related health risks and advocates are scarce. The U.S. Alcohol Policy Alliance is one of the only nonprofits focused on reducing alcohol-related harms nationwide and it is tiny. According to Nicole Holt, its chairperson, it has an annual budget of less than $50,000 and a single paid staff member. In the wake of the pandemic, the torrent of state laws deregulating alcohol sales occurred faster than the group could respond. “We have been on our heels,” she said.Efforts to raise alcohol taxes are rare. Since 2020, public health advocates in Hawaii have promoted a bill to increase rates there, but the measure did not gain traction this year. In New Mexico, where an attempt to raise alcohol taxes in 2017 failed, the issue has resurfaced.In Oregon, Mr. Marshall was not dissuaded by the long odds. “I am a gay man with a wedding band on my finger,” he said. “My life experience tells me it absolutely can happen.”Ms. Grove remains one of the group’s volunteers, although she took time off to undergo breast cancer treatment. “The chemo knocked me down, but you know, after you go through the death of a child, nothing can be as horrible as that,” she said.Ms. Sanchez, who now heads a legislative committee overseeing state budget policy, said she was not cowed either. Last year’s bill started a conversation that she feels compelled to pursue, especially because of her experience in recovery.“Should we continue to be anonymous about this?” she asked. “Should we continue to keep it all quiet? I think we need to start talking about it.”

Published2 days agoSharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesResearchers say they have cracked how air pollution leads to cancer, in a discovery that completely transforms our understanding of how tumours arise. The team at the Francis Crick Institute in London showed that rather than causing damage, air pollution was waking up old damaged cells.One of the world’s leading experts, Prof Charles Swanton, said the breakthrough marked a “new era”.And it may now be possible to develop drugs that stop cancers forming. The findings could explain how hundreds of cancer-causing substances act on the body.The classical view of cancer starts with a healthy cell. It acquires more and more mutations in its genetic code, or DNA, until it reaches a tipping point. Then it becomes a cancer and grows uncontrollably. But there are problems with this idea: cancerous mutations are found in seemingly healthy tissue, and many substances known to cause cancer – including air pollution – don’t seem to damage people’s DNA.So what is going on?The researchers who also work at University College London, have produced evidence of a different idea. The damage is already there in our cell’s DNA, picked up as we grow and age, but something needs to pull the trigger that actually makes it cancerous. The discovery came from exploring why non-smokers get lung cancer. The overwhelming majority of lung cancers are caused by smoking but still, one in 10 cases in the UK is down to air pollution.The Crick scientists focused on a form of pollution called particulate matter 2.5 (known as PM2.5), which is far smaller than the diameter of a human hair. Through a series of detailed human and animal experiments they showed:Places with higher levels of air pollution had more lung cancers not caused by smokingBreathing in PM2.5 leads to the release of a chemical alarm – interleukin-1-beta – in the lungsThis causes inflammation and activates cells in the lungs to help repair any damageBut around one in every 600,000 cells in the lungs of a 50-year-old already contains potentially cancerous mutationsThese are acquired as we age but appear completely healthy until they are activated by the chemical alarm and become cancerousCrucially, the researchers were able to stop cancers forming in mice exposed to air pollution by using a drug that blocks the alarm signal. The results are a double breakthrough, both for understanding the impact of air pollution and the fundamentals of how we get cancer. Dr Emilia Lim, one of the Crick researchers, said people who had never smoked but developed lung cancer often had no idea why. “To give them some clues about how this might work is really, really important,” she said.”It’s super-important – 99% of people in the world live in places where air pollution exceeds the WHO guidelines so it really impacts all of us.”Image source, Getty ImagesRethinking cancerBut the results also showed mutations alone are not always enough to cause cancer. It can need an extra element. Prof Swanton said this was the most exciting finding his lab had come across, as it “actually rethinks our understanding of how tumours are initiated”. He said it would lead to a “new era” of molecular cancer prevention.The idea of taking a cancer-blocking pill if you live in a heavily polluted area is not completely fanciful. Doctors have already trialled an interleukin-1-beta drug in cardiovascular disease and found, by complete accident, they cut the risk of lung cancer. The latest findings are being presented to scientists at a conference of the European Society for Medical Oncology.Speaking to the BBC from the conference, Prof Swanton said: “Pollution is a lovely example, but there are going to be 200 other examples of this over the next 10 years.”And he said we needed to rethink how even smoking causes cancer – is it just the known DNA damage caused by the chemicals in tobacco or is the smoke causing inflammation, too?Curiously, the idea that mutated DNA is not enough and cancers need another trigger to grow was first proposed by scientist Isaac Berenblum in 1947.”Philosophically, it’s fascinating. These incredible biologists have done this work 75 years ago and it’s largely been ignored,” said Dr Lim.Michelle Mitchell, chief executive of Cancer Research UK, stressed that “smoking remains the biggest cause of lung cancer”.But she added: “Science, which takes years of painstaking work, is changing our thinking around how cancer develops. We now have a much better understanding of the driving forces behind lung cancer.”Follow James on Twitter.

The immune system is equipped to respond not just to external invaders — think viruses, bacteria, and parasites — but also to internal threats, namely, cancer. Yet, frequently, malignancies overcome the immune system’s defenses and evade detection.
In a new study, researchers led by Serge Y. Fuchs of the School of Veterinary Medicine, have uncovered a detailed mechanism by which tumors can skirt both the immune system and cancer therapies that leverage its power, such as genetically engineered CAR T cells.
Their investigation, published in the journal Cell Metabolism, revealed how tumor-derived factors stimulate trogocytosis — a process derived from the Greek word trogo, which means “to gnaw” or “to chew.” When T cells interact with cancer cells, they can sometimes “nibble” a piece of the cancer cell membrane. When that membrane segment includes an antigen, a molecule specific to the cancer, the T cells may then begin expressing that antigen on their own cell surface, making it appear to other T cells like a cancer cell.
Trogocytosis can affect a patient’s own T cells and those modified to become CAR T cells, an approach in which a patient’s T cells are genetically engineered to specifically target cancer cells, grown in a lab, and then delivered back to the patient.
“Trogocytosis can lead to three different things, and all three are bad for a person with a tumor,” says Fuchs, the senior author on the work. “First of all, the tumor cell did not get killed and has lost an antigen, which may mean that even if another, better equipped T cell comes along, it will not recognize it, giving cancer cells a window of opportunity to grow unchecked. The second problem is, for reasons we still don’t understand, once a T cell takes a piece of the tumor cell membrane, it becomes much less active. And the third problem is very ironic. Because now, a T cell that displays tumor antigen, this ‘sheep in wolf’s clothing,’ may then become victim to ‘fratricide,’ killed by another T cell.” Overall, the result is a decline in killer T cell numbers and activity and a bump in opportunities for the cancer cells to escape detection and grow.
“What we see is that only a small number of cells undergo trogocytosis and then they disappear quickly because they’re killed. So we’re studying a vanishing act. It is hard to do — very expensive and very tedious — but it appears to be very important,” says Fuchs.

While no definitive statistics exist, doctors say he was likely the longest-surviving intubated Covid patient.As the Covid-19 pandemic swept across the country in March 2020, the family of Marc Lewitinn, their 74-year-old patriarch, urged him to stay indoors. He had survived lung cancer and a stroke that left him unable to speak, and doctors were already warning that older people with his sort of medical history were especially vulnerable to the virus.He complied, more or less. But he soon felt cooped up, and one day he ventured into a crowded Starbucks near his home in Cliffside Park, N.J. By March 25, he was feeling lethargic. A pulse oximeter showed his blood oxygen level at just 85 percent.His son Albert, a TV producer, took him to the emergency room at Weill Cornell Medicine in Manhattan. The hospital was inundated with patients and doctors in hazmat suits, and it took hours for someone to see him. He tested positive for Covid that night. Six days later, with his oxygen level falling further, doctors decided to intubate him and induce a coma.They told the Lewitinn family that Marc, a retired Manhattan shopkeeper, would likely die within a few days; in the early months of the pandemic especially, the survival rate for intubated Covid patients was about 50 percent, and that included people who were younger and healthier than Mr. Lewitinn.“They stepped outside with the iPad to ask us if we wanted to just give him morphine and let him pass away naturally,” Albert Lewitinn said in an email. “On a group FaceTime, we urged my father to fight. We didn’t say goodbye; we said, ‘Keep fighting, Dad, you’re going to be fine.’”Mr. Lewitinn stabilized and recovered from Covid, but he remained too weakened to come off the ventilator. After six months he was brought out of his coma and eventually moved to another hospital, closer to his New Jersey home.After 850 days on the ventilator, Mr. Lewitinn died of a heart attack on July 23 at Palisades Medical Center in North Bergen, N.J. He was 76. His son Albert confirmed the death.While there are no comprehensive statistics for how long Covid patients have survived on ventilation, medical experts say Mr. Lewitinn may hold the record. The literature around the pandemic notes a few patients who have lasted more than three months; a patient in Alabama made headlines in 2021 when he came off a respirator after 187 days.None of those come close to Mr. Lewitinn’s streak, a combination, doctors say, of his physical and mental strength and the swiftness with which the medical establishment developed protocols for long-term Covid care.“He had a long and difficult course,” Dr. Abraham Sanders, one of his physicians at Weill Cornell, wrote in an email. “He was a strong man and was the beneficiary of sophisticated medical care.”Marco Albert Lewitinn was born on March 12, 1946, to a Jewish family in Cairo. His father, Albert Lewitinn, was a medical engineer, and his mother, Sarah (Amiga) Lewitinn, a homemaker. He grew up speaking Arabic and later learned English, French and Spanish.Egypt had a thriving Jewish community of 75,000 people, but they faced worsening conditions after the Arab nationalist revolution in 1952 and the Suez Crisis in 1956, which pitted the country against Israel, France and Britain. The government took over the elder Mr. Lewitinn’s business and, after being briefly detained, he and his family were expelled in 1958.They settled in Baltimore, where Albert Lewitinn was hired by Johns Hopkins University to work on organ transplant technology.As a young man Marc lived in New York City and Los Angeles, where he briefly attended college, then Paris, where he met Ondine Green, the sister of a childhood friend from Cairo. They married in 1968.The Lewitinns settled in the New York City area, first in Brooklyn and later in Tenafly, N.J. He opened a business on the Upper West Side that operated as a sort of everything store for the neighborhood: pawn shop, film processing, electronics repair, jeweler. It became a local fixture; John Lennon, who lived nearby, came in occasionally, and Mr. Lewitinn hung a picture of himself with Lennon on a wall at the store.He sold the business in 1981, after which he bought and sold real estate and later traded in art online.Mr. Lewitinn was an ardent supporter of Israel and Jewish causes. He raised money for Ethiopian Jews fleeing their country as refugees, and won praise from the Nazi hunters Simon Wiesenthal and Charles Kremer for helping to persuade the U.S. government to deport Archbishop Valerian Trifa, a Romanian cleric and fascist collaborator who had moved to the United States after World War II.In 1995, Mr. Lewitinn sued the Egyptian government to win the release of several Torah scrolls, prayer books and other religious items seized from the country’s Jewish community in the late 1950s. He later dropped the case.Along with his son Albert, he is survived by his wife; another son, Lawrence, a real-estate investor; his daughter, Sarah, a record producer and D.J. who performs under the name Ultragrrrl; his sisters Fortunee Yeh and Rachel Algazi; his brothers Solomon, Michael and Nessim; and two grandchildren.

Feeling jittery about math — and altogether avoiding it — “is a serious handicap” that often affected women, she wrote in Ms. magazine in 1976, followed by a book on the subject.When Sheila Tobias finished her freshman year at Radcliffe College in 1954, her professor in a natural sciences course congratulated her on her performance. But for many years she was troubled that he had not encouraged her to take more science classes. When she finally asked him, he said that her limited science background had already made her ineligible for a science career.“I think everything I have done since then originated in the thrill of that course and in the door closing through no fault of my own,” she told Physics Today magazine in 2020. “I had to become a feminist and meet women like myself who were thwarted in their careers.”That experience inspired her two decades later to explore what she called “math anxiety”: the jitters that made smart students, mostly females, avoid mathematics as it became increasingly difficult. She wrote about the concept in 1976 in Ms. magazine in an article that Gloria Steinem, a leader of the women’s movement and a founder of the publication, considered “one of the most important pieces we’ve ever published,” as she put it in an interview with the Arizona newspaper The Tucson Citizen in 2007.“She described for the first time that there is no more a math mind than there is a history mind,” Ms. Steinem was quoted as saying. “It is just that people learn in different ways.”In the Ms. article, Ms. Tobias wrote: “Math anxiety is a serious handicap. It is handed down from mother to daughter with father’s amused indulgence. (‘Your mother could never balance a checkbook,’ he says fondly.) Then, when a colleague recognizes it in an employee, she can be barred from any endeavor or new assignment by the threat that the new job will involve some work with ‘data or tables or functions.’”Ms. Tobias, who expanded the article into a book, “Overcoming Math Anxiety” (1978), died on July 6, 2021, in a nursing home in Tucson. She was 86. Her death was not widely reported at the time; it was recently brought to the attention of The New York Times by the author and journalist Clara Bingham, who learned of it while seeking to interview Ms. Tobias for an oral history project about the women’s liberation movement.Ms. Tobias expanded a 1976 article in Ms. magazine into a 1978 book. “Math anxiety is a serious handicap,” she wrote. “It is handed down from mother to daughter with father’s amused indulgence.”Ms. Tobias’s stepdaughter, Mari Tomizuka, said the cause was complications of a subdural hematoma resulting from a fall.Ms. Tobias is also survived by her stepsons Frank, David and John Tomizuka and 13 step-grandchildren. Her marriage to Carl Tomizuka, a physicist, ended with his death in 2017. Together they wrote “Breaking the Science Barrier: How to Explore and Understand the Sciences” (1992). A previous marriage, to Carlos Stern, ended in divorce.Ms. Tobias became an associate provost at Wesleyan University in 1970, the year women were admitted to its freshman class for the first time since 1909. Soon after, she began studying the transcripts of female students and noticed a disturbing pattern: They were avoiding math, or any other major that required a knowledge of math, like physics, chemistry or economics.“Smart, ambitious college girls were just ‘sliding off the quantitative,’” she told Physics Today.In 1975, Ms. Tobias opened a clinic to deal with math anxiety at Wesleyan and recalled writing math symbols on a blackboard and asking students, “Do these look hostile to you?”Although math anxiety affected men as well, Ms. Tobias found, she framed it as a feminist issue at a time when the women’s movement was in the forefront.“I was talking about math as an example of the feminist term ‘learned helplessness,’” she told Physics Today, “and how men were keeping us out of power because the learned helplessness disabled us from competing at full tilt.”Sheila Tobias was born on April 26, 1935, in Brooklyn to Paul and Rose (Steinberger) Tobias.After receiving a bachelor’s degree in history and literature at Radcliffe in 1957, she worked as a journalist in Germany. She received her master’s in history from Columbia University in 1961 and worked in print and television journalism. Cornell University appointed her assistant to the vice president of academic affairs in 1967.That same year she helped organize a Cornell conference on women that was attended by Betty Friedan, author of “The Feminine Mystique” (1963). Ms. Tobias also taught a women’s studies course, believed to be one of the first in the country.She left Cornell to join Wesleyan in 1970 and stayed there for eight years. She also became a consultant to math departments at colleges and an author (with Peter Goudinoff, Stefan Leader and Shelah Leader) of a book about that sought to demystify the military: “What Kinds of Guns Are They Buying for Your Butter? A Guide to Defense, Weaponry and Military Spending” (1982).“The appeal is to sweet reason, not to fear, outrage, anger or chauvinism,” Judith Stiehm wrote about the book in the journal Quarterly Report on Women and the Military. “With the publication of this volume, all of us have lost our excuses; each of us can be easily armed for debate.”In her research on math anxiety Ms. Tobias discovered that many college students had a similar fear of science. That led to the book “They’re Not Dumb, They’re Different: Stalking the Second Tier” (1990), written while she worked for the Research Corporation in Tucson. The book explored why students abandon science for other subjects. As part of her research, she paid liberal arts graduate students to take first-year chemistry and physics courses at the University of Arizona and the University of Nebraska and to take notes on their experiences.“What they found was that most courses remain unapologetically competitive, selective and intimidating,” she told The Hartford Courant in 1991, and “there was little attempt to create a sense of community among average students of science.”She found that some students — men and women — were turned off by science because, they said, too much time was spent studying formulas without knowing why they were learning them. Others said science courses failed to connect what they were learning with the larger world.Ms. Tobias in 2015. At Cornell, she taught what was believed to be one of the first women’s studies course in the country.Balfour WalkerMs. Tobias lectured on war and peace studies at the University of Southern California; on women’s studies at the University of California, San Diego; and on history at the City College of New York. She wrote several more books about science as well as “Faces of Feminism: An Activist’s Reflection on the Women’s Movement” (1997). She was also a top official of the organization Veteran Feminists of America.“She was very strong and forthright,” Alison Hughes, a former director of the Center for Rural Health at the University of Arizona, said in a phone interview. “She had a brilliant mind — she challenged everything.”Muriel Fox, a founder of the National Organization for Women, called Ms. Tobias “a leading thinker in our movement.”“She was always looking for new ways to think,” Ms. Fox said. “She was a rebel.”