Publisher Health

A new artificial-intelligence technology for heart imaging can potentially improve care for patients, allowing doctors to examine their hearts for scar tissue while eliminating the need for contrast injections required for traditional cardiovascular magnetic resonance imaging (CMR).
A team of researchers who developed the technology, including doctors at UVA Health, reports the success of the approach in a new article in the scientific journal Circulation. The team compared its AI approach, known as Virtual Native Enhancement (VNE), with contrast-enhanced CMR scans now used to monitor hypertrophic cardiomyopathy, the most common genetic heart condition. The researchers found that VNE produced higher-quality images and better captured evidence of scar in the heart, all without the need for injecting the standard contrast agent required for CMR.
“This is a potentially important advance, especially if it can be expanded to other patient groups,” said researcher Christopher Kramer, MD, the chief of the Division of Cardiovascular Medicine at UVA Health, Virginia’s only designated Center of Excellence by the Hypertrophic Cardiomyopathy Association. “Being able to identify scar in the heart, an important contributor to progression to heart failure and sudden cardiac death, without contrast, would be highly significant. CMR scans would be done without contrast, saving cost and any risk, albeit low, from the contrast agent.”
Imaging Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy is the most common inheritable heart disease, and the most common cause of sudden cardiac death in young athletes. It causes the heart muscle to thicken and stiffen, reducing its ability to pump blood and requiring close monitoring by doctors.
The new VNE technology will allow doctors to image the heart more often and more quickly, the researchers say. It also may help doctors detect subtle changes in the heart earlier, though more testing is needed to confirm that.
The technology also would benefit patients who are allergic to the contrast agent injected for CMR, as well as patients with severely failing kidneys, a group that avoids the use of the agent.
The new approach works by using artificial intelligence to enhance “T1-maps” of the heart tissue created by magnetic resonance imaging (MRI). These maps are combined with enhanced MRI “cines,” which are like movies of moving tissue — in this case, the beating heart. Overlaying the two types of images creates the artificial VNE image
Based on these inputs, the technology can produce something virtually identical to the traditional contrast-enhanced CMR heart scans doctors are accustomed to reading — only better, the researchers conclude. “Avoiding the use of contrast and improving image quality in CMR would only help both patients and physicians down the line,” Kramer said.
While the new research examined VNE’s potential in patients with hypertrophic cardiomyopathy, the technology’s creators envision it being used for many other heart conditions as well.
“While currently validated in the HCM population, there is a clear pathway to extend the technology to a wider range of myocardial pathologies,” they write. “VNE has enormous potential to significantly improve clinical practice, reduce scan time and costs, and expand the reach of CMR in the near future.”

New research from North Carolina State University demonstrates that genes are capable of identifying and responding to coded information in light signals, as well as filtering out some signals entirely. The study shows how a single mechanism can trigger different behaviors from the same gene — and has applications in the biotechnology sector.
“The fundamental idea here is that you can encode information in the dynamics of a signal that a gene is receiving,” says Albert Keung, corresponding author of a paper on the work and an assistant professor of chemical and biomolecular engineering at NC State. “So, rather than a signal simply being present or absent, the way in which the signal is being presented matters.”
For this study, researchers modified a yeast cell so that it has a gene that produces fluorescent proteins when the cell is exposed to blue light.
Here’s how that works. A region of the gene called the promoter is responsible for controlling the gene’s activity. In the modified yeast cells, a specific protein binds to the promoter region of the gene. When researchers shine blue light on that protein, it becomes receptive to a second protein. When the second protein binds to the first protein, the gene becomes active. And that’s easy to detect, since the activated gene produces proteins that glow in the dark.
The researchers then exposed these yeast cells to 119 different light patterns. Each light pattern differed in terms of the intensity of the light, how long each pulse of light was, and how frequently the pulses occurred. The researchers then mapped out the amount of fluorescent protein that the cells produced in response to each light pattern.
People talk about genes being turned on or off, but it’s less like a light switch and more like a dimmer switch — a gene can be activated a little bit, a lot, or anywhere in between. If a given light pattern led to the production of a lot of fluorescent protein, that means the light pattern made the gene very active. If the light pattern led to the production of just a little fluorescent protein, that means the pattern only triggered mild activity of the gene.

Idiopathic pulmonary fibrosis (IPF) is the most common and severe form of lung disease characterized by relentless scarring leading to death within an average of four years from the time of diagnosis. The poorly understood pathogenesis of IPF, in part due to the lack of human disease models, has been a major hurdle in developing effective therapies.
Now, a team of regenerative medicine researchers at Boston University and the University of Pennsylvania has created a model (using pluripotent stem cells) to show how dysfunction of a highly specialized cell of the air sacs, the type 2 pneumocyte, initiates the fibrotic cascade that characterizes a number of adult and pediatric lung diseases, including IPF and childhood interstitial lung disease (chILD).
“Understanding how dysfunction of the highly specialized cells of the air sacs initiates the fibrotic cascade can result in development of novel targeted therapies for this devastating disease. Furthermore, this model has the potential to serve as a platform for testing new therapeutics,” explains first author, Kontantinos Alysandratos, MD, PhD, assistant professor of medicine at Boston University School of Medicine (BUSM).
The researchers used two groups of patient-specific cells. The first group had an altered gene that made them dysfunctional. The second group consisted of normal cells which were engineered by gene editing to correct the altered gene. When both sets of cells were examined using a number of different methods, the cells with the altered gene displayed abnormal proliferation, aberrant recycling of unnecessary cellular components, altered metabolic profiles, and inflammatory activation. When both sets of cells were exposed to hydroxychloroquine, a medication commonly used in pediatric patients carrying this altered gene, aggravation of the observed disturbances occurred in the cells with the altered gene, while no changes were seen in the normal cells.
According to the researchers, studying lung diseases in children, particularly those diseases that affect the air sac cells that reside deep in the lung, is very difficult since it is hard to access those cells for biological studies. “Generating stem cell-based in vitro models of lung disease, using easily accessible blood or skin cells from these children that are then reprogrammed into induced pluripotent stem cells, remains a very attractive approach for studying pediatric lung disease because it avoids risky biopsies of the deep lung, yet provides a simulation in the laboratory dish of the same processes that we think are occurring in the in vivo lung tissue itself,” says corresponding author Darrell Kotton, MD, the David C. Seldin Professor of Medicine at BUSM and Director of the BU/Boston Medical Center’s Center for Regenerative Medicine (CReM).
The researchers believe it should now be possible to take similar approaches to study many other types of interstitial lung diseases that arise from dysfunction in the air sacs and affect both children and adults. “In this way, these in vitro models should really expand drug development efforts to treat these diseases that until now have suffered from a lack of access to living cells from patients,” Alysandratos says. The work was led by co-senior authors, Kotton and Michael F. Beers, MD, the Robert L. Mayock and David A. Cooper Professor in Pulmonary Medicine at the University of Pennsylvania Perelman School of Medicine.
These findings appear online in the journal Cell Reports.
This work was supported by the I.M. Rosenzweig Junior Investigator Award from The Pulmonary Fibrosis Foundation to K.D.A.; NIH grants U01HL148692, U01HL134745, U01HL134766 and R01HL095993, and an IDEAL Consortium Grant from Celgene/Bristol Myers Squibb to D.N.K.; the Albert M. Rose Established Investigator Award from the Pulmonary Fibrosis Foundation, Department of Veterans Affairs Merit Review 1I01BX001176 and NIH grants RO1 HL119436 to M.F.B.; NIH grant K24HL143281 to L.R.Y.; AE acknowledges generous startup funding to the operations of the CNSB from Boston University.
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Materials provided by Boston University School of Medicine. Note: Content may be edited for style and length.

As several Republican-controlled states confront their worst outbreaks yet, their leaders — following the base — have doubled down on resisting vaccine and mask requirements.As a new coronavirus wave accelerated by the Delta variant spreads across the United States, many Republican governors have taken sweeping action to combat what they see as an even more urgent danger posed by the pandemic: the threat to personal freedom.In Florida, Ron DeSantis has prevented local governments and school districts from enacting mask mandates and battled in court over compliance. In Texas, Greg Abbott has followed a similar playbook, renewing an order last week to ban vaccine mandates.And in South Dakota, Kristi Noem, who like Mr. DeSantis and Mr. Abbott is a potential 2024 candidate for president, has made her blanket opposition to lockdowns and mandates a key selling point. Arriving by horseback and carrying the American flag, she advertised the state’s recent Sturgis Motorcycle Rally, which drew half a million people, as a beacon of liberty.Ms. Noem brushed aside criticism from Democrats and public health experts about the gathering, which was followed by a local Covid spike, saying on Fox News that the left was “accusing us of embracing death when we’re just allowing people to make personal choices.”The actions of Republican governors, some of the leading stewards of the country’s response to the virus, reveal how the politics of the party’s base have hardened when it comes to curbing Covid. As some Republican-led states, including Florida, confront their most serious outbreaks yet, even rising death totals are being treated as less politically damaging than imposing coronavirus mandates of almost any stripe.“Freedom is good policy and good politics,” Senator Ted Cruz, a Texas Republican and ally of Mr. Abbott’s who has introduced federal legislation to end mask decrees and to forbid federal vaccine passports, said in an interview.Mr. DeSantis has become a symbolic face of the battle, as President Biden has urged Republican governors opposed to mandates to at least “get out of the way.” This week, Mr. DeSantis’s education commissioner withheld funds from two school districts that made masks mandatory.Most top Republicans, including every Republican governor, have been vaccinated and have encouraged others to do so. But most have also stopped short of supporting inoculation requirements and have opposed masking requirements.In many ways, Republican leaders are simply following Republican voters.Skepticism about masks, vaccines and the rules governing them is increasingly intertwined with the cultural issues that dominate the modern Republican Party. The fear over losing “medical freedom” has become part of the broader worry that “cancel culture” is coming for conservatives’ way of life.And while opposing pandemic edicts is a limited-government stance, the forceful approach of governors is at odds with the long-held principle of local control, making it the latest Republican Party orthodoxy to be cast aside since the beginning of the Trump era, along with free trade and limited spending.Gov. Ron DeSantis of Florida wants to open antibody treatment sites for those who contract the coronavirus.Andrew West/The News-Press, via Associated PressThe intensifying conservative mistrust of the news media and opposition to the directives of elite institutions and experts — Dr. Anthony S. Fauci is now so reviled by some that Mr. DeSantis sold merchandise saying “Don’t Fauci My Florida” — have cleaved the country into two factions guided by alternative sets of beliefs.One outlier among Republican governors is Larry Hogan, a moderate who leads Democratic-dominated Maryland. He recently required that hospital and nursing home employees be vaccinated.“Frankly, it’s confusing to me as to why some of my colleagues are mandating why you can’t wear masks, or mandating that businesses can’t make their own decisions about vaccines, or mandating that school systems can’t make decisions for themselves,” Mr. Hogan said in an interview. “And then they’re talking about freedom? It just doesn’t make sense to me.”The pandemic, public health officials say, is now largely one of the unvaccinated, and the virus is raging particularly in conservative states with far lower inoculation rates and more relaxed attitudes toward group gatherings. Of the 10 states with the most cases per capita in recent days, nine voted Republican in last year’s presidential race and nine are led by Republican governors, according to The New York Times coronavirus database.Republican leaders’ posture, particularly on keeping schools from requiring masks, does not appear popular across the wider electorate. In Florida, a Quinnipiac poll released last week found that 60 percent of residents supported compulsory masks in schools.But among Republicans, that figure was inverted: 72 percent of Mr. DeSantis’s party said they opposed universal masking requirements in schools. The poll showed that a plurality of Republicans in the state also opposed a mask requirement for health care workers, a measure that is popular among independents.“Many Republicans are out on an island by themselves,” said Whit Ayres, a veteran G.O.P. pollster. “It may be a safe political place for some primary electorates at the moment. But ultimately you have to win a general election.”Governors nationwide almost uniformly reject the idea that political considerations have shaped their Covid policies. “Politics have played no role,” said Ian Fury, a spokesman for Ms. Noem.Gov. Kristi Noem of South Dakota attended the recent Sturgis Motorcycle Rally, which drew half a million people and was followed by a spike in local Covid cases.Scott Olson/Getty ImagesThe offices of Mr. DeSantis, Mr. Abbott, Ms. Noem and other Republican governors did not make them available for comment. But advisers to multiple Republican governors said the widespread distribution of vaccines had changed the governing calculus when it came to masks and shutdowns. Both Mr. DeSantis and Mr. Abbott have focused on opening antibody treatment sites for those who contract the virus.As Florida became the first state to reach a new peak in deaths since vaccines became freely available, Mr. DeSantis has remained steadfast in keeping schools from requiring masks without a parental opt-out.“We say unequivocally no to lockdowns, no to school closures, no to restrictions and no to mandates,” Mr. DeSantis said at a conservative conference in July.These choices by governors carry a range of risks.One Republican strategist privately lamented, only half-jokingly, that the party was going to kill off part of its own base with its vaccine hesitancy. Former President Donald J. Trump recently told donors at a New York Republican Party fund-raiser that he hoped his supporters would get vaccinated because “we need our people,” according to two attendees.Even Mr. Trump is not immune from blowback, however. He received a rare rebuke from his base at an August rally in Alabama after he urged people to get vaccinated. “Take the vaccines,” he said. “I did it. It’s good.”Some in the crowd began to jeer; Mr. Trump appeared to soften his stance.“That’s OK, that’s all right,” he said. “You got your freedoms, but I happened to take the vaccine.”Mr. Trump’s political operation has clearly assessed where his base stands. “FREEDOM PASSPORTS > VACCINE PASSPORTS,” read one recent fund-raising text, selling $45 American flag shirts that declare, “This is my freedom passport.”.css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}In Arkansas, Gov. Asa Hutchinson, a Republican, saw his party’s pushback firsthand on a 16-stop tour to promote vaccination.Mr. Hutchinson signed a law this spring banning mask mandates, but with cases rising again this month, he said he regretted it. In Siloam Springs, he was pelted with questions from frustrated constituents, including one woman who told him that she had been “praying that God himself will step in so that Christians are not forced by their employers and a mandate to get the vaccine.”“Yet even if God does not, I will not bow,” she said to raucous cheers.Gov. Asa Hutchinson of Arkansas spoke about the state’s high hospitalization rates during a news conference in late July.Andrew Demillo/Associated PressThen there is Ms. Noem, who last month accused other Republican governors of “pretending they didn’t shut down their states, that they didn’t close their regions, that they didn’t mandate masks.” The remarks were widely interpreted to be aimed at potential 2024 rivals.Mr. Cruz, who ran for president in 2016 and could again in 2024, predicted a reckoning for politicians, including Republicans, who had embraced pandemic edicts. “There’s a range of politicians in terms of how long they shut things down,” he said. “In my view, the shorter the better. But that will certainly be a legitimate topic for discussion and debate.”Mr. Ayres, the Republican pollster, said that governors trying to control the virus policies of schools, employers and local officials were breaking with years of tradition on free enterprise and local control.“Liberty has never meant the freedom to threaten the health” of others, Mr. Ayres said. “That is a perversion of the definition of liberty and freedom.”Some governors who imposed mandates and lockdowns last year have even been targeted by state legislators who want to trim their powers.In Ohio, the G.O.P.-controlled Legislature overrode a veto by Gov. Mike DeWine, a fellow Republican, of legislation that reined in his administration’s emergency powers to manage the pandemic. After requiring masks to be worn last year in schools, he has not renewed the order this fall.Mr. DeWine, who drew national attention for his fast and forceful response to Covid in early 2020, now faces a 2022 primary challenge fromJim Renacci, a former congressman. Mr. Renacci said the governor’s handling of the virus was “a big part” of his bid.He said Mr. DeWine had now “gone quiet” on mandates because “he realizes what he did the first time did not make Republicans happy.”A spokesman for Mr. DeWine said the need for mandates had changed since vaccines became freely available.The most severe Covid outbreaks have been most concentrated in the South, and the Republican governors of Alabama and Mississippi have largely embraced the no-mandate ethos even as cases have climbed to new heights.Gov. Tate Reeves of Mississippi renewed an emergency declaration in mid-August but set clear boundaries: “There will be no lockdowns and there will be no statewide mandates,” he said.The same week, two field hospitals were installed in the parking lots of Mississippi medical centers.Jennifer Medina contributed reporting.

Cells in the human body constantly receive substances from the outside via a process called endocytosis. One important endocytosis pathway involves the formation of a protrusion within the cell membrane, pointing to the inside of the cell, triggered when a molecule needing to get in reaches the membrane. The protrusion wraps and closes around the molecule, after which it is cut off, leaving the wrapped molecule (a so-called vesicle) inside the cell. A key role in the cutting-off mechanism is played by dynamin, a protein that can locally ‘constrict’ cell membranes, and chop off bits. The precise constriction mechanism is not completely understood, however. Now, by combining experiments and simulations probing the dynamics of dynamin, Alexander Mikhailov from Kanazawa University and colleagues show that the workings of such a ‘nanomuscle’ resembles that of a ratchet motor.
Dynamin consists of helical filaments, which coil around the neck of a vesicle forming within a membrane. In the presence of GTP (a molecule that can be thought of as a biochemical ‘fuel’, as it provides energy) these filaments start to slide, and in doing so constrict the vesicle neck. In order to gain detailed insights into the constriction mechanism, Mikhailov and colleagues used a technique called single molecule fluorescence resonance energy transfer (smFRET), which enables measuring distances in biomolecules. The obtained data revealed that different conformations of dynamin’s filaments occur, depending on whether or not they are bound to GTP and its products. These various configurations result in the formation of differently oriented molecular ‘bridges’ between neighboring coil turns. Supplying GTP and hydrolyzing it induces power strokes in the cross-bridges and generates a filament torque.
The scientists then designed a computable model of a set of dynamin filaments wrapped around a membrane protrusion, capturing the structural changes and their timescales as observed in the smFRET measurements. The membrane was modelled as a deformable cylindrical tube, and the filaments as strings of beads connected to active cross-bridges powered by GTP. The simulations showed that the combined motion of cross-bridges provides a force large enough to cut a membrane tube.
The work of Mikhalov and colleagues confirms, in a quantitative way, the constriction-by-ratchet model of the dynamin nanomuscle — nature’s strongest torque-generating motor. Quoting the researchers: “Our experimental and computational study provides an example of how collective motor action in megadalton molecular assemblies can be approached and explicitly resolved.”
Background
Dynamin
Dynamin refers to a family of biomolecules. Classical dynamin is a protein playing a key role in endocytosis (the process through which particles are brought into a cell); the molecule is involved in the scission of vesicles formed from a cell membrane. Other molecules from the dynamin family are relevant for various biological processes including the division of organelles and cytokinesis (cell division). Alexander Mikhailov from Kanazawa University and colleagues have now studied the scission of vesicles by dynamin in detail, and confirmed that when dynamin wraps around a tubular cell membrane fragment, it can constrict it, which results in scission.
smFRET
Single molecule fluorescence resonance energy transfer (smFRET) is a method used for measuring distances in the nanometer range in single molecules — typically biomolecules. smFRET is the application of FRET within a single molecule; FRET is the process of energy transfer between two chromophores (molecules that are sensitive to light). The efficiency of the energy transfer is inversely proportional to the sixth power of the distance between the chromophoric parts, making the FRET technique very sensitive to changes in distance.
Mikhailov and colleagues used smFRET to obtain information on the structure and conformational changes of dynamin, which was an important step in unraveling the constriction mechanism with which dynamin can cut off vesicles from a cell membrane.
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Telemedicine appointments combined with in-person visits significantly reduced the risk of further illness for children with medically complex cases, according to results of a new study by researchers with The University of Texas Health Science Center at Houston (UTHealth).
The study was published today in Pediatrics.
Children with medically complex cases require intense care supervision for conditions like genetic diseases, feeding difficulties, and developmental delays. These children often rely on technology such as feeding tubes or tracheostomies — a tube inserted in the throat to help provide air in the lungs.
“In the beginning, we were concerned about seeing the children through telemedicine instead of in the clinic,” said Ricardo Mosquera, MD, associate professor of pulmonary medicine at McGovern Medical School at UTHealth and corresponding author on the study. “Most of these patients have feeding tubes or tracheostomies, so we didn’t know how it would go. But, I think what we found is promising. I think providers can feel comfortable knowing that telemedicine appointments are just as effective. They don’t always have to bring high-risk patients in to the clinic.”
Using a randomized approach, researchers assessed 422 patients between 2018 and 2020. Half of the patients in the study received traditional care and the other half received comprehensive care plus telemedicine visits.
Patients who received both telemedicine and comprehensive care were 99% less likely to need additional care for serious illness outside of their home compared to those who just received traditional care.
Mosquera, a pediatric pulmonologist at UT Physicians High Risk Children’s Clinic, says reducing exposures to high-risk children is especially important during the current COVID-19 pandemic and other outbreaks of contagious and seasonal illnesses.
“Children with medically complex cases are at a higher risk of becoming severely ill. So, being able to assess these patients from their home, where they are less likely to be exposed to public areas or other critically ill patients, is important in reducing their risk. With telemedicine, we are able to provide care a lot faster. We are more proactive with prescribing medication right then and there. If a patient needs a quick telemedicine appointment Friday afternoon, I will assess them and they don’t have to wait the weekend to be seen, and there is no delay in getting the medication they need,” he said.
Mosquera says telemedicine should not replace critical in-person visits.
“Some appointments will still need to be in person. But this assures providers and even parents that they can do both in person and telemedicine. Patients don’t have to be seen solely in person to have good results. The results will be the same or even better because they are less likely to have further illnesses when they do both,” Mosquera said.
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Materials provided by University of Texas Health Science Center at Houston. Original written by Jeannette Sanchez. Note: Content may be edited for style and length.

El deterioro cerebral puede comenzar años antes de la aparición de síntomas. El comportamiento cotidiano puede arrojar advertencias.Para saber cuáles son las probabilidades de padecer demencia en algún momento —una inquietud apremiante para muchas personas, sobre todo para quienes tienen antecedentes familiares— es necesario realizar pruebas médicas y consultar con los especialistas. Pero ¿qué tal si el comportamiento cotidiano, como omitir un par de pagos de la tarjeta de crédito o frenar a menudo al conducir, pudieran predecir ese riesgo?Actualmente se llevan a cabo varios experimentos para explorar esa posibilidad, lo que refleja la creciente concientización de que las patologías vinculadas a la demencia pueden comenzar años o incluso décadas antes de que aparezcan los síntomas.“La detección temprana es muy importante para poder actuar, justo en la etapa en la que podría resultar más eficaz”, señaló Sayeh Bayat, autora principal de un estudio sobre la conducta al volante financiado por los Institutos Nacionales de Salud y realizado en la Universidad de Washington en San Luis.Según los investigadores, dichos trabajos podrían ayudar a identificar a posibles voluntarios para las pruebas clínicas y ayudar a proteger a la gente mayor de la explotación económica y de otros peligros.En los últimos años, muchos medicamentos que se consideraban prometedores para tratar la demencia, sobre todo la enfermedad de Alzheimer, han fracasado en los ensayos. Según los investigadores, tal vez una razón sea que ya se administran demasiado tarde para ser de utilidad. Detectar los riesgos cuando el cerebro aún no ha sufrido tanto daño, podría proporcionarnos una reserva de posibles participantes que tuvieran la enfermedad de Alzheimer en una fase preclínica con los cuales se podrían poner a prueba tratamientos preventivos.Es posible que esto también mejore la vida cotidiana. “Se podría aumentar la capacidad de las personas para que conduzcan durante más tiempo y que las calles fueran más seguras para todos”, mencionó Bayat como ejemplo.Por el momento, la búsqueda de personas mayores con probabilidades de desarrollar alzhéimer o algún otro tipo de demencia tiene lugar principalmente en los contextos de investigación, donde los pacientes se enteran de su nivel de riesgo gracias a una combinación de pruebas genéticas, punciones lumbares o tomografías por emisión de positrones (PET, por su sigla en inglés) que detectan la sustancia amiloide en el cerebro, así como mediante cuestionarios relacionados con los antecedentes familiares..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}“La idea es hallar a las personas lo suficientemente rápido como para tomar cartas en el asunto y evitar o retrasar la aparición de la enfermedad”, comentó Emily Largent, especialista en ética médica e investigadora en política sanitaria en el Centro de Investigación sobre la Memoria de Pensilvania, en Filadelfia, en el cual se realizan muchos estudios de ese tipo.Se vislumbran otros tipos de pruebas de predicción, como los análisis de sangre sin prescripción médica que detecten la proteína Tau, otro biomarcador del alzhéimer, pero todavía faltan muchos años para que sean una realidad, dijo Largent.Eso nos deja solo las técnicas invasivas, como las punciones lumbares, o las que son costosas, como las tomografías PET. No es posible usar estos métodos para estudiar a grupos de muchas personas. “No están disponibles en todas partes”, explicó Bayat. “No están muy accesibles ni son muy adaptables”.Sin embargo, un dispositivo GPS en el auto podría monitorear de manera casi continua y a bajo costo el comportamiento al volante, lo cual proporcionaría los llamados biomarcadores digitales. “Los estudios han demostrado que las personas que padecen alzhéimer sintomático cambian su manera de conducir”, comentó Bayat. “Pero algunos cambios se presentan incluso antes”.El estudio de la Universidad de Washington reclutó a 64 adultos mayores con alzhéimer en fase preclínica, según se determinó por medio de punciones lumbares (los participantes no recibieron los resultados) y 75 cuyo nivel cognitivo se consideró normal.A lo largo de un año, los investigadores estudiaron el comportamiento de ambos grupos al volante —con qué frecuencia aceleraban o frenaban de manera repentina, si excedían el límite de velocidad o manejaban muy por debajo de él, si hacían movimientos bruscos— y su “perfil de conducción” (cantidad de recorridos, distancia promedio, destinos inusuales, recorridos en la noche). “Solo ahora, porque contamos con esta tecnología, podemos hacer este tipo de investigaciones”, señaló Bayat.En el estudio se descubrió que el comportamiento al volante y la edad podrían predecir el alzhéimer en fase preclínica un 88 por ciento del tiempo. Es posible que esos hallazgos incentiven reclutamientos para pruebas clínicas y permitan que se pueda hacer algo —como hacer sonar alguna alarma cuando el auto se desvía— a fin de ayudar a que los conductores se mantengan en su camino. En áreas en las que no hay un buen transporte público (la mayoría), eso podría contribuir con la independencia de las personas mayores.Jason Karlawish, geriatra y codirector del Centro de Investigación sobre la Memoria de Pensilvania, calificó ese estudio como “provocativo” y bien diseñado. “Los resultados indican que monitorear un comportamiento importante a nivel cognitivo en el mundo real puede ayudar a detectar las señales más tempranas y sutiles de un deterioro cognitivo incipiente”, escribió en un correo electrónico.De manera similar, en un estudio en el que se analizan los antecedentes clínicos y los informes crediticios de más de 80.000 beneficiarios de Medicare se demostró que era mucho más probable que las personas mayores que en algún momento eran diagnosticadas con alzhéimer se retrasaran en sus pagos de tarjetas de crédito que quienes pertenecían a una población parecida, pero que nunca recibieron ese diagnóstico. También era más probable que tuvieran evaluaciones crediticias de alto riesgo.“Nos motivaron las anécdotas en las que las personas descubren la demencia de algún familiar mediante un acontecimiento financiero catastrófico, como el embargo de la casa”, comentó Lauren Nicholas, la autora principal y economista sanitaria en la Escuela de Salud Pública de la Universidad de Colorado. “Esta podría ser una manera de identificar a los pacientes que están en riesgo”.Los problemas se presentaron antes, cuando omitieron al menos dos pagos consecutivos hasta seis años antes del diagnóstico y obtuvieron un crédito de alto riesgo de incumplimiento dos años y medio antes. Aunque estudios más pequeños ya han señalado la relación entre una mala gestión financiera autonotificada y la demencia, este es el más grande y el primero en usar información financiera verídica, añadió Nicholas.En Japón, los científicos han desarrollado una herramienta de aprendizaje automático que analiza las conversaciones telefónicas para detectar señales de alzhéimer en fase preclínica. Mediante el uso de archivos de audio grabados el año pasado durante algunas entrevistas, compararon las características vocales de los pacientes sanos —tono, intensidad, intervalos de silencio— con las de los de pacientes con alzhéimer y descubrieron que estos modelos podían predecir el nivel cognitivo.Los investigadores de IBM han captado un riesgo elevado en pruebas de escritura y han descubierto que los patrones y el uso de las palabras pronosticaron un diagnóstico posterior de alzhéimer. Algún día se podría usar cualquiera de estos hallazgos para realizar un diagnóstico temprano.Sin embargo, estos métodos plantean problemas sobre la privacidad. “¿A la gente no le incomoda que su banco o el seguro de su auto tenga esa información y la comparta?”, cuestionó Largent. “Llega a ser información médica que pasa a manos de personas que no son médicos”.En el Centro de Investigación sobre la Memoria de Pensilvania, donde la información realmente está en las manos de los profesionales de la salud, “después de las pruebas en la clínica, algunas personas con deterioro cognitivo expresan que les gustaría que las monitorearan”, afirmó. “Otras consideran que eso es algo en verdad intrusivo”.Durante años, los especialistas en bioética han abordado el tema de informar a los pacientes sobre los riesgos elevados de padecer alguna enfermedad aterradora para la cual aún no existe un tratamiento eficaz. Los estudios han demostrado que, en contextos de investigación, se pueden compartir los resultados de manera segura y eficaz. Sin embargo, sigue existiendo el temor de sentirse discriminados y estigmatizados.Incluso utilizando biomarcadores establecidos, como el amiloide en las tomografías PET, estos hallazgos anticipados no son definitivos, lo que los investigadores se esfuerzan en señalar a los pacientes. “No es necesario ni suficiente tener estos factores de riesgo”, explicó Largent. Las personas con amiloide elevado tienen un mayor riesgo, pero pueden no evolucionar hacia el deterioro cognitivo; las personas que no lo tienen pueden, sin embargo, desarrollar demencia.Aun así, dijo Largent, “en general creo que tener esa información puede ser útil para la gente”.En muchos estudios, Largent ha analizado lo que sucede cuando se les revela a los pacientes y a sus familiares las posibilidades de padecer demencia y descubrió que alrededor de una tercera parte de los pacientes reaccionan modificando su comportamiento referente a la salud, realizan algunas planeaciones legales y financieras o toman otras medidas de preparación. “Hacen cosas como actualizar su testamento, redactar instrucciones de previsión, practicar más ejercicio, quizás mudarse a vivir más cerca de algún hijo adulto”, mencionó.Paul Gondek, de 68 años, que vive en Filadelfia y enseña psicología social en la Universidad de Drexel, decidió conocer su estado de riesgo hace dos años, participando como voluntario en varios estudios del Penn Memory Center. El alzhéimer tiende a ser hereditario y, tras observar el lento declive de su madre a causa de la enfermedad, sabía que tenía más posibilidades de desarrollarla.Para alivio de Gondek, la tomografía PET mostró que no tenía cantidades elevadas de amiloide en su cerebro. Y una puntuación de riesgo calculada mostró que sus probabilidades de padecer alzhéimer a la edad de 85 años eran de aproximadamente un 19 por ciento, más alto que el 11 por ciento de riesgo de la población general, pero más bajo de lo que había temido.Si se dispusiera de otros indicadores tempranos a través de los registros de conducción o financieros u otros comportamientos y fueran confiables, dijo, “me gustaría usarlos. Preferiría saberlo antes que no”.

A single glass of wine can quickly — significantly — raise the drinker’s risk for atrial fibrillation, according to new research by UC San Francisco.
The study provides the first evidence that alcohol consumption substantially increases the chance of the heart rhythm condition occurring within a few hours. The findings might run counter to a prevailing perception that alcohol can be “cardioprotective,” say the authors, suggesting that reducing or avoiding alcohol might help mitigate harmful effects.
The paper is published August 30, 2021 in Annals of Internal Medicine.
“Contrary to a common belief that atrial fibrillation is associated with heavy alcohol consumption, it appears that even one alcohol drink may be enough to increase the risk,” said Gregory Marcus, MD, MAS, professor of medicine in the Division of Cardiology at UCSF.
“Our results show that the occurrence of atrial fibrillation might be neither random nor unpredictable,” he said. “Instead, there may be identifiable and modifiable ways of preventing an acute heart arrhythmia episode.”
Atrial fibrillation (AF) is the most common heart arrhythmia seen clinically, but until now research has largely focused on risk factors for developing the disease and therapies to treat it, rather than factors that determine when and where an episode might occur. AF can lead to loss of quality of life, significant health care costs, stroke, and death.

A buildup of coronavirus in the lungs is likely behind the steep mortality rates seen in the pandemic, a new study finds. The results contrast with previous suspicions that simultaneous infections, such as bacterial pneumonia or overreaction of the body’s immune defense system, played major roles in heightened risk of death, the investigators say.
Led by researchers at NYU Grossman School of Medicine, the new study showed that people who died of COVID-19 had on average 10 times the amount of virus, or viral load, in their lower airways as did severely ill patients who survived their illness. Meanwhile, the investigators found no evidence implicating a secondary bacterial infection as the cause of the deaths, although they cautioned that this may be due to the frequent course of antibiotics given to critically ill patients.
“Our findings suggest that the body’s failure to cope with the large numbers of virus infecting the lungs is largely responsible for COVID-19 deaths in the pandemic,” says study lead author Imran Sulaiman, MD, PhD, an adjunct professor in the Department of Medicine at NYU Langone Health.
Current guidelines from the Centers for Disease Control and Prevention, he notes, do not encourage use of antivirals such as remdesivir for severely ill patients on mechanical ventilation. But Sulaiman says the NYU Langone study results suggest that these medications may still remain a valuable tool in treating these patients.
Despite previous concerns that the virus may prompt the immune system to attack the body’s own lung tissue and lead to dangerous levels of inflammation, the investigators found no evidence that this was a major contributor to COVID-19 deaths in the group studied. In fact, Sulaiman notes that the strength of the immune response appeared proportionate to the amount of virus in the lungs.
The coronavirus has so far killed over 4 million people worldwide, researchers say. Those placed on mechanical ventilators in order to breathe fare particularly poorly, with 70 percent nationwide succumbing to the illness. Notably, experts attribute the high mortality seen in other viral pandemics such as the Spanish flu in 1918 and swine flu in 2009 to a secondary bacterial infection. However, it remained unclear whether a similar issue afflicted people with COVID-19.

The evidence for their sleep-inducing benefits is thin, but experts say that in some cases there’s no harm in giving them a try.Magnesium is often touted as an antidote to poor sleep. But while some doctors say it is fine to take it in supplemental form for certain sleep disruptions, like those caused by restless legs syndrome, the evidence for its sleep-inducing benefits is thin.Magnesium, an abundant mineral in the body, plays a critical role in many physiological functions. It helps support immune health, blood sugar regulation, and nerve and muscle function. Some scientists suspect that magnesium deficiencies can contribute to poor sleep by disrupting nerve signaling and altering levels of sleep-inducing hormones such as melatonin.But most people have sufficient levels of magnesium, since the mineral is easy to get if you follow a relatively healthy diet. It’s found in a variety of plant and animal foods like nuts, greens, seeds, beans, yogurt and fish. And although many people fall short of the federal government’s recommended daily intake, true magnesium deficiencies are rare.Over the years, studies have looked at whether supplementing with the mineral can improve sleep. Most of the studies have been small or poorly designed, making it difficult to draw firm conclusions. One systematic review published in April looked at three clinical trials that studied magnesium supplementation for insomnia in 151 older adults and concluded that they generally provided “low to very low quality of evidence.”In one study published in 2012, researchers recruited 46 older adults with chronic insomnia and split them into two groups. One was assigned to take 500 milligrams of magnesium every day for eight weeks, and the other was given placebo. At the end of the study, the researchers found that compared with the placebo group, the people taking magnesium were more likely to report improvements in “subjective” measures of insomnia, such as how quickly they fell asleep each night and the number of times they reported waking up in the early morning hours. But those taking magnesium did not show any difference in their total sleep time, the researchers reported.In general, magnesium seems to have minimal side effects, and taking low doses is unlikely to cause much harm. According to the Institute of Medicine, healthy adults can safely take up to 350 milligrams of supplemental magnesium daily. Anything at or below that level is unlikely to cause any adverse health effects. But at higher doses, magnesium can cause gastrointestinal issues like diarrhea, said Dr. Colleen Lance, the medical director for the Sleep Disorders Center at Cleveland Clinic Hillcrest Hospital in Ohio. Dr. Lance said that while the evidence that magnesium can help with insomnia is weak, she does not necessarily discourage people from trying it.“I tell patients you can give it a try and see if it helps,” she said. “It may not help, but it’s probably not going to hurt.”.css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-rqynmc{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.9375rem;line-height:1.25rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-rqynmc{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-rqynmc strong{font-weight:600;}.css-rqynmc em{font-style:italic;}.css-yoay6m{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}@media (min-width:740px){.css-yoay6m{font-size:1.25rem;line-height:1.4375rem;}}.css-1dg6kl4{margin-top:5px;margin-bottom:15px;}#masthead-bar-one{display:none;}#masthead-bar-one{display:none;}.css-1pxllx6 header h4{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:500;font-size:1.25rem;line-height:1.5625rem;margin-bottom:5px;}@media (min-width:740px){.css-1pxllx6 header h4{font-size:1.5625rem;line-height:1.875rem;}}.css-1pd7fgo{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-1pd7fgo{padding:20px;width:100%;}}.css-1pd7fgo:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-1pd7fgo{border:none;padding:20px 0 0;border-top:1px solid #121212;}.css-1pd7fgo[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-1pd7fgo[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-1pd7fgo[data-truncated] .css-5gimkt:after{content:’See more’;}.css-1pd7fgo[data-truncated] .css-6mllg9{opacity:1;}.css-1rh1sk1{margin:0 auto;overflow:hidden;}.css-1rh1sk1 strong{font-weight:700;}.css-1rh1sk1 em{font-style:italic;}.css-1rh1sk1 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#ccd9e3;text-decoration-color:#ccd9e3;}.css-1rh1sk1 a:visited{color:#333;-webkit-text-decoration-color:#ccc;text-decoration-color:#ccc;}.css-1rh1sk1 a:hover{-webkit-text-decoration:none;text-decoration:none;}One instance where she does recommend magnesium is for patients who have restless legs syndrome, a nervous system disorder that causes people to have irresistible urges to move their limbs, usually at night, which can be highly disruptive to sleep. Dr. Lance said that magnesium could, in theory, make a difference because it helps nerves properly relay electrical signals, though evidence of its benefits for restless legs is still limited and mixed, and it may not work for everyone.At least one small study from 1998 found that people who had the disorder had fewer sleep disruptions after taking magnesium. However, a more recent systematic review of studies concluded that it was “not clear” whether magnesium could alleviate restless legs syndrome. More research is needed, but Dr. Lance said that she tells patients with R.L.S. that it may be worth trying to see if it makes any difference. “We tell patients that they can try some magnesium in the evening hours to see if that calms things down,” Dr. Lance added.Chronic insomnia, however, is not usually something that can be fixed with a pill. When Dr. Lance meets patients who complain of insomnia, she typically does an evaluation to figure out the root causes of their sleepless nights. Often, she finds that a patient might be having trouble falling or staying asleep because of an undiagnosed sleep disorder, like sleep apnea or restless legs syndrome. Many women have sleep problems related to menopause. Some people cannot sleep soundly because their environment is too noisy — they could have a spouse who snores, for example, or a dog that barks through the night. Others may be struggling to sleep because of anxiety related to the pandemic, their work, their finances or some other stressful situation in their lives.One of the most effective treatments for insomnia is cognitive behavioral therapy, or C.B.T., which helps people address the underlying behaviors that are disrupting their sleep. Therapies like continuous positive airway pressure, or CPAP, can help people with sleep apnea. Medications, including supplements like melatonin, may also be helpful in some cases, but a pill alone is not going to cure insomnia, Dr. Lance said.“We see a lot of people who have some underlying issue and yet they’re looking for a pill to sleep through the problem,” she said. “Whereas what we try to do instead is find and address the underlying problem.”