Publisher Health

The Supreme Court will hear from two convicted pill mill doctors in cases that could have significant implications for physicians’ latitude to prescribe addictive painkillers.For years, Dr. Xiulu Ruan was one of the nation’s top prescribers of quick-release fentanyl drugs. The medicines were approved only for severe breakthrough pain in cancer patients, but Dr. Ruan dispensed them almost exclusively for more common ailments: neck aches, back and joint pain. According to the Department of Justice, he and his partner wrote almost 300,000 prescriptions for controlled substances from 2011 to 2015, filled through the doctors’ own pharmacy in Mobile, Ala. Dr. Ruan often signed prescriptions without seeing patients, prosecutors said.Dr. Ruan has been serving a 21-year sentence in federal prison, convicted in 2017 for illegally prescribing opioids and related financial crimes. To collect millions of dollars in fines, the government seized houses, beach condos and bank accounts belonging to him and his business partner, as well as 23 luxury cars, such as Bentleys, Lamborghinis and Ferraris.On Tuesday, lawyers both for Dr. Ruan and for Dr. Shakeel Kahn, who is serving 25 years on charges related to pill mill clinics in Arizona and Wyoming will argue before the Supreme Court of the United States that the criminal standard the physicians faced is applied inconsistently among the federal circuits. In asking that the doctors’ convictions be overturned, they want the court to establish a uniform standard that permits doctors to raise a “good faith” defense. Juries could then consider whether doctors subjectively believed they were using their best medical judgment.The likelihood of these two doctors being set free is small, legal experts believe, but the court’s decision on the broader legal questions could have significant implications for the latitude doctors can take in prescribing potentially addictive painkillers and other restricted medications.The cases confront an uneasy relationship between law and medicine. In an era when overdose deaths are soaring, how should the law balance letting physicians exercise their best judgment with stopping egregious outliers?At issue is the reading of the language of the Controlled Substances Act of 1970. The act permits doctors and pharmacists to dispense certain drugs such as opioids and amphetamines, categorized by their potential for abuse and medical value, even as it prohibits everyone else from doing so. It says that a prescription for one of these medications “must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice.”Prosecutors, through the office of the U.S. Solicitor General, argue that the criminal standard in the act is straightforward and well-established, with a baked-in good-faith defense that affords doctors ample leeway. Even if the Supreme Court were to adopt a new framework and order that the doctors be retried, they argue, a jury could not conclude that the doctors were relying on their good-faith medical judgment.The evidence, they wrote, “overwhelmingly demonstrated that petitioners acted as drug dealers disguised as medical professionals, dispensing addictive drugs that endangered their patients simply to line their own pockets.”Lawyers for the government and the doctors declined to comment or did not respond to requests to do so.For many in medicine, the case is not about whether Drs. Ruan and Kahn were bad doctors.“It’s about all the other doctors in the country who intend to do the right thing, but are dealing with difficult cases,” said Dr. Stefan Kertesz, a professor of medicine at the Heersink School of Medicine at the University of Alabama at Birmingham and an addiction researcher. “Are we all at risk of criminal investigation based on making decisions that involve difficult medical trade-offs?”Some legal experts say they presume that the court picked two cases from different circuits in order to examine legal distinctions and disjunctions, and that it may well emerge with a clarifying rule. But it is difficult to predict how the justices will rule, they say, because the issues do not fit tidily into liberal and conservative boxes.The cases are being argued during a period when investigations of prescribing habits have increased, in an effort to curb the rise in overdose deaths that began more than 20 years ago, as prescription painkillers became readily available. Authorities saw doctors as a significant source of the problem.State regulators imposed an array of punishments for excessive prescribing, such as fines, license revocation and imprisonment. In recent years, the prescribing of opioids fell sharply. Even so, overdoses and deaths hit a record last year. A majority of those deaths were not from prescribed opioids but from illegal ones.Dr. Shakeel Kahn was sentenced to 25 years in prison in 2019.Tom Morton, K2radio.comDr. Xiulu Ruan has been serving a 21-year sentence, convicted in 2017 for illegally prescribing opioids and related financial crimes.Dr. Xiulu RuanSome studies see a connection between the drop in prescriptions and the rise in overdose deaths. An article published recently in The New England Journal of Medicine reported that high-dose chronic pain patients who were abruptly dismissed from doctors’ practices have experienced surges in emergency room visits, addiction to illegal drugs and even suicide.To what extent has the increased surveillance of doctors led to an overcorrection in prescribing? A 2019 survey in the journal Pain of 452 primary care clinics in nine states found that nearly half would not prescribe opioids to new primary care patients who said they were already being prescribed the painkillers.Dr. Samer Narouze, president of the American Society of Regional Anesthesia and Pain Medicine, said that he knew of doctors who had lost licenses or were jailed, and that it could be hard to understand the basis on which different sanctions were meted out. In the current risk-averse, litigious climate, his hospital’s opioid oversight committee has, on occasion, sought legal counsel before making decisions in difficult cases involving the drugs, said Dr. Narouze, chairman of the Center for Pain Medicine at Western Reserve Hospital in Cuyahoga Falls, Ohio.The outcome of the Supreme Court cases is also being closely monitored by representatives of chronic pain patients.“We definitely want to catch doctors who are behaving like large-scale drug pushers,” said Kate Nicholson, executive director of the National Pain Advocacy Center, which filed a brief arguing that fear of criminal prosecution deterred doctors from using good medical judgment to treat pain.“Our issue is the chilling effect the current standards have on good doctors, who fear that even when they are exercising their best medical judgment, they will be subjected to oversight and enforcement,” said Ms. Nicholson, a former government disability rights lawyer who was bedridden for 18 years and relied on high-dose opioids.Some years ago, she moved to Colorado to start post-surgical rehabilitation and needed to find a doctor to help her safely wean off opioids. But her new doctor, she said, told her that he had stopped prescribing opioids and that “you won’t find anyone else in this area willing to, either.”Yet other patients, whose opioid addictions were initiated by doctors’ prescriptions, still want to see prescribers more tightly reined in and punished. Dr. Kahn based his rates on the number of pills prescribed; his brother, the office manager, would meet patients in parking lots to exchange the doctor’s signed prescriptions for cash, prosecutors said. Two days after a young patient paid him $1250, she died of an overdose of oxycodone.The Supreme Court’s analysis of the Ruan and Kahn cases will likely involve a close reading of Congress’s text and a discussion about canons of criminal law.In the last 15 years, as federal agents raided pill mills and prosecutions increased, the language around “legitimate medical purpose” and “professional practice” has been interpreted differently by different federal appellate courts. Those readings direct how a judge instructs a jury on what it must find to convict or acquit the prescriber.In a brief asking for a clear legal standard, health-law and policy professors argue that several appeals courts — including the U. S. Court of Appeals for the 11th Circuit, which upheld Dr. Ruan’s conviction, and the U. S. Court of Appeals for the 10th Circuit, which upheld Dr. Kahn’s — permit doctors to be convicted if they deviate from accepted medical practice, without a jury also having to find that the doctor did so “without a legitimate medical purpose.” That standard, they say, lacks a critical component of criminal law: intent.That element, the professors wrote, distinguishes well-meaning, possibly negligent doctors from criminal ones. Without the requirement of intent, the Controlled Substances Act “has been weaponized against practitioners in reaction to the overdose crisis,” they said. Prosecutions have increased, they said, while the standards for conviction have “steadily eroded.”The professors argue that this broad standard can ensnare doctors who determine that an individual patient requires a prescription of opioids that exceeds conventional limits. Doctors who prescribe medications off-label, a common practice, could also fall under that standard.Conversely, other circuits require that prosecutors prove beyond a reasonable doubt that doctors knew not only that they were deviating from accepted medical practice but also, and crucially, that they were prescribing without a legitimate purpose.But how far can a good-faith defense be stretched? Does it suffice for doctors to simply argue that they believed the prescriptions served a legitimate medical purpose?“Good faith,” then, would seem to be a subjective standard; “legitimate medical purpose,” an objective one. If so, the two would inherently be in conflict.Prosecutors argue that at the very least, doctors must show they made reasonable efforts to learn the medical norms upon which they based their good-faith judgment. A mistake in understanding those norms, they say, would not rise to the level of criminal conduct.Recently, the Centers for Disease Control and Prevention took steps to give physicians more leeway in prescribing opioids. In a draft of the new recommendations, the agency bluntly states that prescribers should almost always seek alternative pain therapies rather than opioids. But it also says that doctors can rely on their best medical judgment, especially when treating “legacy” patients — typically, chronic pain patients who are already on high opioid doses.The good-faith argument shouldn’t be read as a “get out of jail free” card, said Kelly Dineen, who teaches health law at Creighton University School of Law in Nebraska and who is a co-author of the health-law professors’ brief. “The jury still has to assess their credibility,” she said. “But doctors should be allowed to bring that defense.”Sheelagh McNeill

SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesA new pregnancy screening tool cuts the risk of baby loss among women from black, Asian and ethnic minority backgrounds to the same level as white women, research suggests.The app calculates a woman’s individual risk of pregnancy problems.In a study of 20,000 pregnant women, baby death rates in ethnic groups were three times lower than normal when the tool was used.Experts say the new approach can help reduce health inequalities.The screening tool is already in use at St George’s Hospital in London and is being tried out at three other maternity units in England, with hopes it could be rolled out to 20 centres within two years.In the UK, pregnancy risks are much higher for women from ethnic minority backgrounds.They have two to three times higher rates of stillbirth and perinatal death – when babies die after 24 weeks of pregnancy or within a month of birth – than white women.Black women also have a 40% higher risk of miscarriage – during the first 23 weeks of pregnancy – than white women.A taskforce was recently set up to tackle the issue. Personalised careResearchers from Tommy’s National Centre for Maternity Improvement, led by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives, developed the new tool and have published their study of how it works in a journal.Professor Basky Thilaganathan, who led the research team at St George’s Hospital, said the new approach could “almost eliminate a large source of the healthcare inequality facing black, Asian and minority ethnic pregnant women”.”We can personalise care for you and reduce the chances of having a small baby, pre-eclampsia and losing your baby,” he said.The current system of a tick-box checklist to assess pregnancy risk has been around for 70 years, and is limited.Miscarriage: ‘I was in pain – they did not listen’Stillbirths high for black and Asian babies in UKNHS to tackle ‘unfair’ maternity outcomesThe new digital tool, which uses an algorithm to calculate a woman’s personal risk, can detect high-risk women more accurately and prevent complications in pregnancy, the researchers say.Both pregnant women and maternity staff can upload information on their pregnancy and how they are feeling to the app during antenatal appointments and at other times. In the study, there were nearly eight baby deaths per 1,000 births among mothers from ethnic minority backgrounds, compared with 2.63 deaths per 1,000 births among white mothers, when the current checklist was used to assess risk.But in pregnant women using the algorithm tool, there was no difference in baby death rates between white and non-white ethnic groups, because three out of four deaths linked to placenta problems had been avoided.Safest approachDr Edward Morris, president of the Royal College of Obstetricians and Gynaecologists, said it was “unacceptable” that black, Asian and minority ethnic women faced huge inequalities on maternity outcomes.”The digital tool provides a practical way to support women with personalised care during pregnancy and make informed decisions about birth. “What’s clear is the current way of risk assessing women isn’t providing the safest approach, and it’s vital both clinicians and health policymakers work to update it.”Gill Walton, chief executive of the Royal College of Midwives, said the new tool was already making “a tangible difference”.”All of this great work and effort must continue to be supported with the right levels of funding and resources to enable it to be implemented effectively,” she added.More on this storyMiscarriage: ‘I was in pain – they did not listen’Miscarriage 40% higher in black women, study showsStillbirths high for black and Asian babies in UKMiscarriage – NHSTommy’s National Centre for Maternity Improvement – Tommy’sThe BBC is not responsible for the content of external sites.

The Centers for Disease Control and Prevention on Friday offered a new strategy to help communities across the country live with the coronavirus and get back to some version of normal life.The new guidelines suggest that 70 percent of Americans can now stop wearing masks, and no longer need to social distance or avoid crowded indoor spaces.The recommendations no longer rely only on the number of cases in a community to determine the need for restrictions such as mask wearing. Instead, they direct counties to consider three measures to assess risk of the virus: new Covid-related hospital admissions over the previous week and the percentage of hospital beds occupied by Covid patients, as well as new coronavirus cases per 100,000 people over the previous week.

Our cross-country drive last winter from New York to Lake Tahoe was going to be eventful enough, with a pandemic, blizzards and the cancellation of salads at McDonald’s. But by Omaha, when the lanes on Interstate 80 seemed to be bouncing around before my very eyes, we entered unexpected territory.“Are you practicing your slalom turns at 80 miles an hour?” my wife asked.Road conditions were normal. Our S.U.V. had new tires. But the lanes often seemed to blur together. Sometimes the melding of lanes occurred late in the day, sometimes early. Sometimes in blinding sun, sometimes in fog. If I closed one eye, the lanes became separate again.What was happening? I’d worn glasses for nearsightedness since fifth grade; I’d seen my eye doctor within the year; my prescription was current.When we reached Tahoe, I went to an optometrist before even unpacking my skis. She said my eyes were fine, but advised an M.R.I. to rule out a brain bleed or a tumor. Days later, it did.She also told me to see a neuro-ophthalmologist, an increasingly rare subspecialty. Nationally, there are only about 600 of them, and because many do academic research or have general ophthalmic practices, just 250 of them are full-time clinicians. In six states, there are none practicing, according to a paper in the Journal of Neuro-Ophthalmology last year.The Tahoe optometrist warned it could take months to obtain an appointment with one of the few practitioners in the area. But my brother, a surgeon at Stanford, helped me get an appointment at Stanford Medical Center, four hours away, in Palo Alto, Ca., the following week. Dr. Heather Moss conducted the 90-minute examination, taking measurements that included the degree to which my eyes were properly centered.My diagnosis: esotropia, which means inward turning of either or both eyes.When Dr. Moss positioned a bar of triangular plastic in front of either eye, the bouncing stopped. The piece of plastic was a set of prisms, differing in strength from top to bottom. She alternated prisms until we got it right.Wayward eyes can turn outward or upward or downward. All are forms of strabismus, and double vision is the chief symptom in adults whose brains are used to receiving two slightly differing images. (Without those, you wouldn’t have depth perception or be able to see in 3-D.) Somebody with symptomatic strabismus gets the two images. But they’re out of whack because the eyes are misaligned, and the brain doesn’t compensate for the anatomical-mechanical defect.Typically congenital, it is most often diagnosed in children, whose symptoms present themselves in a “lazy eye,” because the brain suppresses images from the weak eye. Some children wear an eye patch over the strong eye, to retrain the lazy eye. Many children undergo surgery to reposition the muscles controlling the weak eye.Strabismus is derived from strabos, the Greek word for “squint,” which aptly describes the reaction by adults who compensate for the defect by closing either eye. Doing so vanquishes the conflicting binocular images from both eyes, which the brain can’t overcome.About 4 percent of adults have it, according to the journal Ophthamology. But it often goes undiagnosed and people unwittingly live with imperfect vision. “Most regular ophthalmologists are just looking at the eyes — not eye movement,” said Dr. Marc Dinkin, a neuro-ophthalmologist at Weill Cornell Medicine in New York.Larry Frohman, a professor at Rutgers New Jersey Medical School and executive vice president of the North American Neuro-Ophthalmology Society, said the specialized field attracts fewer doctors because it requires an additional year of formal training beyond neurology or ophthalmology.While surgery is sometimes the solution to this misalignment in adults, prisms are the common remedy. They can be permanently ground into lenses, displace light and shift the position of what an eye sees, tricking the brain into interpreting images from both eyes into proper alignment.Choosing the right degree of correction can prove difficult. Prisms range in strength from 1 to 40 diopters (1 is weakest), though they rarely are prescribed beyond 15 because of the distortion they can create.David Kaplan underwent testing on his eyes.David KaplanDr. Moss recommended that I try temporary Fresnel press-on vinyl lenses, which use water to attach to the inside of glasses. These one-millimeter-thick lenses allow patients to experiment with different strengths. The hassle is that they can fall off, and the plastic, which contains thin etched lines on the surface, isn’t as clear as ground-in prisms. I tried a 1-diopter lens and then a 2-diopter, before settling on 3-diopters for the next three months.Driving was no longer harrowing, but my vision was far from perfect, and even seemed to regress a bit. When I returned to the East Coast, Dr. Dinkin at Weill Cornell took over my care. In his examining chair, I finally experienced double vision.When a large “A” was displayed on the wall and I removed the Fresnel lens on my glasses, I saw two A’s. When I looked through his hand-held prism, the A’s magically merged. What I had described as bouncing images on Interstate 80 were really separate images that my brain was trying to fuse. I didn’t think it was double vision at the time because the middle driving lane looked pretty much the same as the left lane. In fact, I was seeing two left lanes.Dr. Dinkin increased the strength of my prism to 10 diopters. He divided the prisms into lenses for both eyes — 5 and 5 (with light being deflected in different directions). By late spring, Dr. Dinkin said it was time to put the correction in a pair of permanent lenses.The new glasses worked well, though another issue arose. Lenses with permanent prisms are thicker along the edges, with the resulting distortion producing the effect of a fun house mirror. It’s especially problematic walking down stairs. So I got another pair of glasses, with slightly weaker prisms — 4 and 4 diopters. I’m trying to use those most of the time, reserving the 5-and-5 glasses for driving or when I otherwise need a vision boost.How did I wind up with a diagnosis of strabismus in adulthood? Dr. Dinkin and Dr. Moss agreed I have probably had it all or most of my life, although the misalignment of my left eye is almost imperceptible. No doctor had detected the problem before because nobody had been looking for it, and I had voiced no complaints. My eyes themselves had not shifted in position. The symptoms of this condition had emerged with age and fatigue.My vision misadventure was just another of the perils of getting older. Near the end of our stay in Tahoe, I had my first serious ski fall in 20 years, resulting in sprains to my left thumb and right shoulder. No big deal — those get better with ice, rest, a splint and 15 weeks. But together with my eyes, I began to wonder about my long-term odds. It’s a good thing I’m not a racehorse.

The agency issued a new set of recommendations intended to help communities live with the virus and get back to normal life.The Centers for Disease Control and Prevention on Friday offered a new strategy to help communities across the country live with the coronavirus and get back to some version of normal life.The new guidelines suggest that 70 percent of Americans can now stop wearing masks, and no longer need to social distance or avoid crowded indoor spaces.The recommendations no longer rely only on the number of cases in a community to determine the need for restrictions such as mask wearing. Instead, they direct counties to consider three measures to assess risk of the virus: new Covid-related hospital admissions over the previous week and the percentage of hospital beds occupied by Covid patients, as well as new coronavirus cases per 100,000 people over the previous week.Based on these three factors, counties can calculate whether the risk to their residents is low, medium or high, according to the agency, and only areas of high risk should require everyone to wear a mask. But unvaccinated people should wear masks even in low-risk areas, the agency said.The agency had endorsed universal masking in schools since July, regardless of virus levels in the community, but the new guidelines recommend masking in schools only in counties at high risk.The new guidelines are being released as the coronavirus is in retreat across the country. Case numbers have dropped to levels not seen before the surge of the Omicron variant, and hospitalizations have been plummeting. About 58,000 people are hospitalized with Covid nationwide, but those numbers have fallen by about 44 percent in the past two weeks.Several experts said the new guidelines were appropriate for the country’s current situation. Although the number of cases nationwide is still high, “we’re well past the surge,” said Linsey Marr, an aerosol scientist at Virginia Tech. “We don’t need to be operating in emergency mode anymore.”But many places have already shed pandemic restrictions. Most states have eased rules for mask-wearing, and some, like New Jersey, have announced plans to lift mandates even in schools. Others are poised to end indoor mask mandates in the coming weeks. An official recommendation from the C.D.C. may hold some sway in districts that have been more cautious.Under the C.D.C.’s previous criteria, 95 percent of the counties in the United States were considered high risk. Using the new criteria, fewer than 30 percent of Americans are living in areas with a high level of risk, the agency said.The new set of guidelines gives people a framework for adapting precautions as virus levels change, Dr. Rochelle Walensky, the C.D.C.’s director, told reporters on Friday.“We want to give people a break from things like masking when our levels are low, and then have the ability to reach for them again should things get worse in the future,” she said. “We need to be prepared and we need to be ready for whatever comes next.”Those who are particularly vulnerable because of their age, health status or occupation may choose to take extra precautions, regardless of the risk level in their community, she added.The availability of high-quality masks such as N95 respirators allows individuals at high risk to continue to protect themselves even if others around them are not taking precautions, Dr. Marr said.She added that it was good that the agency would continue to monitor cases because hospital rates can lag by two to three weeks. “By the time hospitals are overwhelmed, it’s too late,” she said.But Dr. Walensky said C.D.C. scientists tested models with data from previous surges to confirm that the new method of calculating risk would have detected the surges early.The Omicron surge made it clear that because so many Americans have some immunity to the virus through vaccinations or prior infection, counties may see high numbers of cases and yet comparatively few that involve serious illness. The new guidelines nod to that reality, and allow for a more sustainable approach to living with the virus, public health experts said.“It just looked wrong that the whole country was a single shade of red,” said Jennifer Nuzzo, an epidemiologist at Johns Hopkins University’s Bloomberg School of Public Health.Though a growing number of political leaders, public health experts and ordinary citizens now support the easing of restrictions — at least temporarily, others are still wary. They note that millions of people in the United States — including children under 5 — and billions around the world remain unvaccinated, making the emergence of a dangerous new variant not just possible but likely.The Coronavirus Pandemic: Key Things to KnowCard 1 of 4A new C.D.C. framework.

Many people with Omicron infections may still be contagious beyond five days of isolation, a new report suggests.More than half of people who took a rapid antigen test five to nine days after first testing positive for the coronavirus or after developing Covid-19 symptoms tested positive on the antigen test, according to a new study from the Centers for Disease Control and Prevention.The finding raises more concerns about the agency’s revised isolation guidelines, which say that many people with Covid can end their isolation periods after five days, without a negative coronavirus test.A C.D.C. scientist who was an author of the study said that he did not believe the agency’s isolation guidelines needed to change. But the results suggest that many people with the virus may still be infectious during this period, scientists said.The study “demonstrates what a lot of people have suspected: that five days is insufficient for a substantial number of people,” Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan, said in an email. “The bottom line,” she added, “is that this absolutely should lead to a change in isolation guidance.”The research was conducted after Omicron became the dominant variant in the United States and as cases were surging nationwide. Cases have since fallen precipitously, reducing the risk of infection and the number of Americans who are in isolation.The C.D.C. shortened the isolation period to five days from 10 in December as the Omicron variant spread. Many public health experts criticized the move, noting that people might still be infectious after five days and that allowing them to end isolation without testing might help the new variant spread faster.Dr. Ian Plumb, a medical epidemiologist at the C.D.C. and an author of the new study, said that he believed the study “basically supported” the agency’s current isolation guidance, which asks people to continue taking precautions — including wearing masks and refraining from travel — until 10 full days have passed.“I honestly don’t think that it means that the current guidance needs to” change, he said.Instead, he said, the study supports the idea that antigen tests can be successfully integrated into isolation guidelines.“I think the biggest takeaway is that it’s possible to incorporate antigen tests into the guidance for isolation because they provide additional information about someone’s risk of being potentially infectious,” he said.The new study was based on people whose coronavirus infections were reported to the Yukon-Kuskokwim Health Corporation, which provides health care for rural communities in southwestern Alaska, from Jan. 1 to Feb. 9.The Coronavirus Pandemic: Key Things to KnowCard 1 of 3Vaccines for kids.

Imagine dropping a tennis ball onto a bedroom mattress. The tennis ball will bend the mattress a bit, but not permanently — pick the ball back up, and the mattress returns to its original position and strength. Scientists call this an elastic state.
On the other hand, if you drop something heavy — like a refrigerator — the force pushes the mattress into what scientists call a plastic state. The plastic state, in this sense, is not the same as the plastic milk jug in your refrigerator, but rather a permanent rearrangement of the atomic structure of a material. When you remove the refrigerator, the mattress will be compressed and, well, uncomfortable, to say the least.
But a material’s elastic-plastic shift concerns more than mattress comfort. Understanding what happens to a material at the atomic level when it transitions from elastic to plastic under high pressures could allow scientists to design stronger materials for spacecraft and nuclear fusion experiments.
Up to now, scientists have struggled to capture clear images of a material’s transformation into plasticity, leaving them in the dark about what exactly tiny atoms are doing when they decide to leave their cozy elastic state and venture into the plastic world.
Now for the first time, scientists from the Department of Energy’s SLAC National Accelerator Laboratory have captured high-resolution images of a tiny aluminum single-crystal sample as it transitioned from elastic to plastic state. The images will allow scientists to predict how a material behaves as it undergoes plastic transformation within five trillionths of a second of the phenomena occurring. The team published their results today in Nature Communications.
A crystal’s last gasp
To capture images of the aluminum crystal sample, scientists needed to apply a force, and a refrigerator was obviously too large. So instead, they used a high-energy laser, which hammered the crystal hard enough to push it from elastic to plastic.

The Omicron variant of the coronavirus has been so contagious that it may have seemed a foregone conclusion that if one person in a household became ill, other people living there would catch the virus, too.But that turns out to be less certain: A small study of households by the Centers for Disease Control and Prevention released on Friday found that when the first person infected wore a mask and stayed in a separate room at least part of the time, the risk of other household members contracting the virus became markedly lower.Vaccinated people who became infected were also considerably less likely than unvaccinated people to spread the virus to other members of their households.Still, the study highlighted just how aggressively the Omicron variant had spread within a home, especially among people living with children under 5 who tested positive. Those children, who are not yet eligible for vaccines and often need to be in closer contact with their parents or relatives, spread the virus to 72 percent of household contacts identified in the study — the highest rate of any age group, the C.D.C. said.“These findings further highlight young children’s potential contribution to household transmission,” C.D.C. scientists wrote in the report.Federal regulators are waiting for data on how well three doses of the Pfizer-BioNTech coronavirus vaccine work in children under 5 before deciding whether to authorize the vaccine for that age group.The C.D.C. study was based on 183 households across four states where someone became infected with the Omicron variant from November to early February. After interviewing members of the households about their vaccination and infection histories, any precautionary measures in the home and whether they had tested positive or become ill, C.D.C. scientists determined that the variant had spread in roughly two-thirds of the households they identified.But when the first infected person was fully vaccinated, only about 44 percent of household members developed Covid, compared with 64 percent when the infected person was unvaccinated, the study said.And when the original infected household member stayed in a room alone at least some of the time, only 41 percent of other members of the household became infected, compared with 68 percent in situations without isolation. Masking by the infected person helped, too, reducing the likelihood of transmission to 40 percent from 69 percent.Determining the precise risk of the virus spreading in a home was difficult, the study’s authors noted. They excluded situations where it was unclear who had first developed Covid, and did not do the genetic sequencing necessary to know for certain that people had caught the virus from the infected person in their home rather than at other gatherings.

The world has relied on adherence to non-pharmaceutical interventions, such as ventilation, mask-wearing and physical distancing, to keep us safe throughout the ongoing pandemic. With vaccines completing the toolbox, these measures and the accompanying public health messaging continue to play an important role.
Now a new study has shown that it is possible to test the effectiveness of interventions designed to foster safer behaviour in order to slow the spread of a virus.
The study, led by the Max Planck Institute for Human Development, Germany, with collaborators at the University of Plymouth, UK, and the IESE Business School, Spain, found that the most effective approach was a message that directly appealed to the public, contained moral reason, and was clear and consistent.
The research, published in Science Advances, asked seven groups of 100 people each in a cross section of the US population to take part in games designed to emulate virus transmission.
How did the game work?
The game was presented in a neutral framing, replacing terms associated with pandemics by references to neutral colours. Blue players represented healthy individuals, and purple players infected individuals.

The Centers for Disease Control and Prevention is expected to loosen its guidelines for when and where Americans should wear masks to prevent the spread of the coronavirus, allowing most people to go without them in public indoor spaces, according to two federal officials familiar with the matter.The policy is expected to be announced on Friday afternoon, according to an administration official. The Associated Press first reported the change on Thursday.Under the current guidelines, the agency recommends that anyone living in areas with substantial or high transmission of the coronavirus, as defined by case counts, should wear masks in public indoor spaces like gyms, movie theaters and full-capacity houses of worship. That means that people living in 95 percent of the counties in the United States should continue wearing masks indoors. The country is recording an average of about 76,000 new cases per day, a roughly 66 percent drop from two weeks ago.The forthcoming recommendations are expected to hinge on newly defined metrics to determine whether people in a particular geographical area are at high risk from the virus. They will place less emphasis on case counts and give more weight to hospitalizations as a key measure of risk, according to a federal official who is familiar with the plans but was not authorized to speak about them.The guidelines are likely to factor in the capacity of hospitals in a local area as an important indicator of the level of risk. With hospitalizations declining across the nation, that may allow the great majority of Americans to drop their masks. About 60,000 people are hospitalized with Covid nationwide, but those numbers have dropped by about 44 percent in the past two weeks.Most states have already eased rules for mask-wearing, and some, like New Jersey, have announced plans to lift mandates even in schools. Others are poised to end indoor mask mandates in the coming weeks. But an official recommendation from the C.D.C. may hold some sway in districts that have been more cautious.Many businesses have shifted to requiring only proof of vaccinations. But masks are currently required on public transportation, including airplanes. The current mandate is scheduled to remain in force through March 18, and may be extended. Last year, the C.D.C. was sharply criticized for lifting mask restrictions too soon, only to have the Delta variant of the virus surge throughout the nation. This time, however, many public health experts support the easing of mask guidelines.Recent polls have indicated that the public’s patience with Covid restrictions is waning. Nearly half of Americans surveyed thought the nation should “learn to live with” the pandemic “and get back to normal,” according to a recent Yahoo News/YouGov survey. About 70 percent of Americans believe “it’s time we accept Covid is here to stay and we just need to get on with our lives,” according to a recent poll by Monmouth University.