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Ever since the early humans learned to walk upright, they have suffered, as an unfortunate consequence of their erect posture, from low back pain. Modern understanding on this matter dictates that low back pain, in particular, is caused due to a postural instability resulting from poor “proprioception,” which is a term for the perception of part of our body’s own position in space. In fact, our trunk and lower legs are key to maintaining postural stability due to the presence of “proprioceptors” — sensory receptors responding to position and movement — in those areas.
Elderly people suffering from low back pain tend to have poorly performing proprioceptors, which is thought to affect their “proprioceptive control strategy” — a postural control strategy in response to vibratory stimulations as proprioceptive input. Interestingly, studies have suggested that a local vibratory stimulation can, in fact, improve proprioceptive function. In previous studies by other researchers, however, its effect on postural control is still unclear. Moreover, the studies make no distinction between poor and healthy proprioceptors and do not take into account the fact that each proprioceptor has a natural vibration response frequency.
To address these issues, a team of researchers from Japan recently conducted a study in which they explored the effect of local vibratory stimulations on the proprioceptive control strategy when applied to a poor proprioceptor. Prof. Yoshifumi Morita from Nagoya Institute of Technology, Japan, who was part of the study, published in Electronics, lays down the research question: “For elderly people with low back pain, can proprioceptive function be improved? Will it cure the low back pain?”
Researchers carried out their study over a period of 3 months in which they recruited six elderly individuals, all of whom were patients with low back pain. Researchers made each participant stand on a balance board to assess their standing balance and attached fasteners with vibrators to their legs as well as both sides of their trunk. They then generated vibration signals using a PC and amplified and output them from the vibrators as mechanical vibratory stimulations. Furthermore, they allowed the frequency of stimulation to vary with time, from an initial 20 Hz (cycles/second) up to 300 Hz, to gauge the postural response as a function of the applied frequency. Finally, they compared the proprioceptive control strategy in each patient before and after applying the stimulations to an impaired proprioceptor.
Three patients showed an improvement in their proprioceptive control strategy after their impaired muscle spindles (proprioceptor detecting stretch in muscles) responded to higher frequency, an observation that suggested that low back pain could be alleviated in patients by activating impaired proprioceptors with vibratory stimulations. Furthermore, the treatment device and protocol could be used for multiple frequency ranges, allowing for the diagnosis as well as activation of a poor proprioceptor.
Given the results, the researchers look forward to conducting a clinical trial for a larger group of patients. “The clinical trial is scheduled to start in April this year and will be conducted for the next three years. We plan to verify whether the improved proprioceptive sensation can be maintained for a long time, thus relieving elderly people of low back pain,” comments an excited Prof. Morita.
The team hopes that the trial’s findings will soon lead to the commercialization of their device, which will allow elderly patients with low back pain to finally breathe a huge sigh of relief!
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On the surface, Parkinson’s disease — a neurodegenerative disorder — and melanoma — a type of skin cancer — do not appear to have much in common. However, for nearly 50 years, doctors have recognized that Parkinson’s disease patients are more likely to develop melanoma than the general population. Now, scientists report a molecular link between the two diseases in the form of protein aggregates known as amyloids.
The researchers will present their results today at the spring meeting of the American Chemical Society (ACS). 
“Several studies have shown that melanoma occurs two to six times more frequently in the Parkinson’s population than the healthy population,” says Dexter Dean, Ph.D., a postdoctoral fellow at the National Heart, Lung, and Blood Institute (NHLBI), who is presenting the work at the meeting. “What’s more, the protein involved in Parkinson’s disease, α-synuclein, is elevated in melanoma cells.”
In Parkinson’s disease, α-synuclein forms amyloid deposits that are thought to kill dopamine-producing neurons in the brain, causing symptoms such as tremor, slow movements and dementia. While intense research has focused on the effects of α-synuclein in the brain, much less is known about its presence or activities in other tissues. However, scientists have evidence that the amyloid-forming protein is expressed more in melanoma cells than in healthy skin. Furthermore, higher levels of α-synuclein in melanocytes (the skin cells that give rise to melanoma) correlate with reduced pigment, or melanin, production. Melanin protects skin from damage by the sun’s ultraviolet rays.
Jennifer Lee, Ph.D., Dean’s postdoctoral advisor at NHLBI, part of the National Institutes of Health, had previously studied another amyloid-forming protein called premelanosomal protein (Pmel). “Most people know that amyloids are involved in diseases, such as Parkinson’s and Alzheimer’s, but it’s less well-known that some amyloids, like Pmel, actually serve a useful function,” Lee says. In healthy melanocytes, Pmel forms amyloid fibrils that act as scaffolds to store melanin in melanosomes (the organelle where the pigment is produced, stored and transported). “Because both α-synuclein and Pmel are expressed in melanoma cells, we wondered if these two amyloid proteins could interact, and whether this interaction could be relevant to the correlation between Parkinson’s disease and melanoma,” Lee says.
To investigate whether α-synuclein and Pmel could interact, the researchers used microscopy and western blotting to show that the two proteins both resided in the melanosomes of human melanoma cells. When Dean added preformed α-synuclein amyloid to a test tube containing the amyloid-forming region of Pmel (known as the repeat, or RPT, domain), the α-synuclein fibrils stimulated Pmel to aggregate and form a twisted fibril structure that the protein does not normally adopt on its own.
Because α-synuclein in melanoma cells may also be found in its soluble, or non-amyloid, form, the researchers performed other in vitro experiments in which they added soluble α-synuclein to the Pmel RPT domain. In this case, α-synuclein inhibited Pmel’s ability to self-aggregate and form amyloid in a concentration-dependent manner. They traced this activity to the first 60 amino acids of α-synuclein.
“We now have preliminary data that suggest an amyloid from one protein can ‘seed’ or template amyloid from another, and in the soluble form, α-synuclein prevents Pmel aggregation.” Lee says. “Therefore, we think that both forms of α-synuclein could diminish melanin biosynthesis — the amyloid form by causing Pmel to form an unusual twisted structure, and the soluble form by stopping Pmel from aggregating like it should.” Loss of skin pigmentation could contribute to the increased melanoma risk in Parkinson’s disease patients, the researchers say.
“I think we’re just at the tip of the iceberg of appreciating what α-synuclein might be doing in melanoma,” Dean says. “In future experiments, I’m really interested in understanding more about what α-synuclein is doing to promote melanoma proliferation, in addition to this interaction with Pmel.”

A new scientific review has found there are significant gaps in our knowledge of how mammal populations are responding to climate change, particularly in regions most sensitive to climate change. The findings are published in the British Ecological Society’s Journal of Animal Ecology.
Nearly 25% of mammal species are threatened with extinction, with this risk exacerbated by climate change. But the ways climate change is impacting animals now, and projected to in the future, is known to be complex. Different environmental changes have multiple and potentially contrasting, effects on different aspects of animals’ lives, such as reproduction and survival (known as demographic rates).
A new review by a global team of researchers from 15 different institutions has found that most studies on terrestrial mammals only looked at one of these demographic rates at a time, potentially not showing the full picture of climate change impacts.
In a search of 5,728 terrestrial mammal species, the researchers found only 106 studies that looked at both survival and reproduction at the same time. This covered 87 species and constitutes less than 1% of all terrestrial mammals.
“Researchers often publish results on the effects of climate on survival or on reproduction — and not both. But only in rare cases does a climatic variable (say, temperature) consistently negatively or positively affect all studied rates of survival and reproduction.” said Dr Maria Paniw from the University of Zurich and lead author of the review.
For example, higher temperatures could decrease the number of offspring, but if the offspring have a better chance of survival because of less competition, the population size won’t necessarily be affected. On the other hand, if higher temperatures decrease both reproduction and survival, a study of only one of these could underestimate the effects on a population.

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesA Covid vaccine being manufactured in Scotland has reported a 90% immune response in early trials.Biotech company Valneva tested its vaccine on 153 people and concluded it was safe and generally well tolerated.The company will move to phase three by testing up to 5,000 people, some of whom will be recruited in Scotland.UK Health Secretary Matt Hancock said if approved, the vaccine would play an “important role” in protecting communities.Valneva, which manufactures its Covid vaccine at a plant in Livingston, said the results of their phase one/two study showed the vaccine was “highly immunogenic with more than 90% of all study participants developing significant levels of antibodies” to the Covid virus spike protein.Those who received a medium dose of the vaccine showed an 89.8% immune response, while people given a high dose showed a 100% response.The vaccine also induced T-cell responses, which help the body fend off a virus and play a role in long-lasting immunity.No safety concerns were identified by an independent data safety monitoring board.Valneva vaccine begins manufacturing in LivingstonModerna vaccine UK rollout begins in WalesHow does the Oxford-AstraZeneca vaccine work?Valneva’s chief financial officer David Lawrence told the BBC’s Good Morning Scotland programme that the results were a “major milestone” and that the company had started commercial production.He said: “I think it’s down to the design of the vaccine that we’ve made – we’re following a very tried and tested technology.”Now that we’ve got our production up and running we can tweak the production process to put in a different variant – we started working with the original Wuhan strain, but we can put in a South African strain. “All of the trials we’re doing should remind people its important for people to volunteer and participate in clinical trials.”Mr Hancock said it was “fantastic” to see Valneva’s vaccine produces a “strong immune response”.He said: “This vaccine will be made onshore in Livingston in Scotland, giving another boost to British life science, and if approved will play an important role in protecting our communities.”I look forward to seeing the results of the upcoming phase three trial.”UK Vaccines Minister Nadhim Zahawi described the results as “very promising” and said they provided renewed hope that a vaccine using a whole inactivated virus might provide strong protection against variants.AstraZeneca concernsIt comes as the UK’s medicines regulator launched an investigation into a possible link with the Oxford/AstraZeneca vaccine and rare blood clots in adults. It is expected to give an update on Wednesday along with the European medicines regulator.In the UK, 30 people have developed the clots – and seven have died as a result – out of 18 million people who have received the Oxford/AstraZeneca vaccine.On Tuesday, the trial of the Oxford vaccine on children was paused as a precaution. Prof Andrew Pollard from the University of Oxford told the BBC there were no safety concerns with the trial itself, but its scientists were waiting for further information.Meanwhile the UK has begun the rollout of its third coronavirus vaccine, the Moderna jab, in Wales.It has not been confirmed when the rest of the UK will start using the jab, but Scotland received its first batch on Monday.RULES: What are the restrictions in your area?LOCKDOWN: Six months that changed our livesCASES: Where are the latest cases in Scotland?WHO? The people who have died with Covid-19

Start-ups and tech companies are creating products to address women’s health care needs. It’s still a small segment of the market, but growing.This article is part of our new series on the Future of Health Care, which examines changes in the medical field.Women represent half of the planet’s population. Yet tech companies catering to their specific health needs represent a minute share of the global technology market.In 2019, the “femtech” industry — software and technology companies addressing women’s biological needs — generated $820.6 million in global revenue and received $592 million in venture capital investment, according to PitchBook, a financial data and research company. That same year, the ride-sharing app Uber alone raised $8.1 billion in an initial public offering. The difference in scale is staggering, especially when women spend an estimated $500 billion a year on medical expenses, according to PitchBook.Tapping into that spending power, a multitude of apps and tech companies have sprung up in the last decade to address women’s needs, including tracking menstruation and fertility, and offering solutions for pregnancy, breastfeeding and menopause. Medical start-ups also have stepped in to prevent or manage serious conditions such as cancer.“The market potential is huge,” said Michelle Tempest, a partner at the London-based health care consultancy Candesic and a psychiatrist by training. “There’s definitely an increasing appetite for anything in the world which is technology, and a realization that female consumer power has arrived — and that it’s arrived in health care.”She said one reason women-related needs had not been focused on in the field of technology was that life sciences research was overwhelmingly “tailored to the male body.” In 1977, the U.S. Food and Drug Administration excluded women of childbearing age from taking part in drug trials. . Since then, women have been underrepresented in drug trials, Dr. Tempest said, because of a belief that fluctuations caused by menstrual cycles could affect trial results, and also because if a woman got pregnant after taking a trial drug, the drug could affect the fetus. As a result, she noted, “we do lag behind men.”Ida Tin, co-founder of Clue, which offers a period and ovulation tracking app.via ClueThe term “femtech” was coined by Ida Tin, the Danish-born founder of Clue, a period and ovulation tracking app established in Germany in 2013. In an article on the company’s website, Ms. Tin recalled how she first had the idea for the app. In 2009, she found herself holding a cellphone in one hand and a small temperature-taking device in the other and wishing she could merge the two to track her fertility days, rather than manually having to note her temperature on a spreadsheet.Clue allows women to do exactly that with a few taps on their smartphone. Today, the company has a lot of competition in the period- and fertility-tracking area. And plenty of other women-specific tools have come onto the market. Elvie, a London-based company, has marketed a wearable breast pump and a pelvic exercise trainer and app, both using smart technology. Another strand of femtech known as “menotech” aims to improve women’s lifestyles as they go through menopause, providing access to telemedicine, and information and data that women can tap into.Clue’s period and ovulation app. Ms. Tin had the idea when she found herself holding a cellphone in one hand and a small temperature-taking device in the other.ClueFinally, there are medical technology companies focused on cancer that affects women, such as cervical cancer and breast cancer.According to the World Health Organization, cervical cancer is the fourth most common cause of cancer among women around the world. In 2018, about 570,000 women had it, and as many as 311,000 died. The W.H.O. in November announced a program to eradicate the disease completely by the year 2030.MobileODT, a start-up based in Tel Aviv, uses smartphones and artificial intelligence to screen for cervical cancer. A smart colposcope — a portable imaging device that’s one and a half times the size of a smartphone — is used to take a photograph of a woman’s cervix from a distance of about a meter (3 feet). The image is then transmitted to the cloud via a smartphone, where artificial intelligence is used to identify normal or abnormal cervical findings.A diagnosis is delivered in about 60 seconds — compared to the weeks it takes to receive the results of a standard smear test (which, in developing countries, extends to months.) In addition to this screening, doctors still use smear tests.The technology was recently used to screen 9,000 women during a three-month period in the Dominican Republic as part of a government-led campaign, the company announced last month. Another 50,000 women are expected be screened in the next six months.Leon Boston, the South African-born chief executive of MobileODT, said the privately owned company was selling into about 20 different countries including the United States, India, South Korea and Brazil, and is going into a fund-raising round to build on its initial seed money of $24 million.But the leading cause of cancer among women all over the world is breast cancer. One French start-up is focused on dealing with its aftermath. Lattice Medical has developed a 3-D printed hollow breast implant that allows for the regeneration of tissue and is absorbed by the body over time.How it works: Post-mastectomy, the surgeon harvests a small flap of fat from the area immediately around the woman’s breast and places it inside the 3-D-printed bioprosthesis. That piece of tissue grows inside the implant, and eventually fills it out. In the meantime, the 3-D-printed shell disappears completely 18 months later.So far, tests on animals have been encouraging, said Julien Payen, the company’s co-founder and chief executive. Clinical trials on women are expected to start in 2022, with the aim of getting the product into the market in 2025, he added.Asked why the global femtech market was so small for technology companies, Mr. Boston said it was partly because of the “high level of regulation” involved in medical technology.MobileODT, a start-up based in Tel Aviv, uses smartphones and artificial intelligence to screen for cervical cancer. MobileODT“If your technology is incorrect and comes up with the wrong result, a woman who thinks she’s not positive for cervical cancer is actually positive,” he said. As a result, “the world of medical technology is slow to move.”Still, prospects are favorable, according to Mr. Boston. “It’s very rare to have a totally barren market open for full potential, as we have today in medical technology,” he said.The data forecasts appear to back that up. According to a March 2020 report by Frost & Sullivan, a research and strategy consultancy, revenue from femtech is expected to reach $1.1 billion by 2024.Mr. Payen explained that for the femtech market to expand and develop, there have to be many more tech companies offering genuine health benefits to women, not just well-being apps crowding the market and adding little in terms of health or medical value. He cited the example of Endodiag, a French medical technology company that allows early diagnosis of endometriosis and a better management of the condition.Either way, said Mr. Payen, the industry showed promise.“Over the last 10 years, thanks to #MeToo and other movements, women are being listened to and heard more than ever before,” Mr. Payen said. And “more and more women are running companies and investment funds,” he added.“In 10 or 15 years from now, as a new generation takes over, things will have changed even more radically,” he said. “Femtech is clearly poised to grow.”

Los brotes generalizados de enfermedades tienen el potencial de sacudir a las sociedades para que adopten nuevas formas de vida.Hace cinco años, decidí escribir una novela ambientada en las secuelas de una terrible pandemia.La novela era una historia alternativa, un western revisionista ambientado en el siglo XIX, y acabé investigando en abundancia sobre todo tipo de temas, desde las marcas de ganado hasta la obstetricia. Pero me avergüenza admitir que mi investigación sobre las catástrofes sanitarias fue un tanto escasa. Básicamente, analicé una lista de brotes de gripe, elegí el que se adaptaba mejor a mi argumento (una pandemia de 1830 que podría haber empezado en China) y empecé a escribir.Pero cuando terminé el libro, sus acontecimientos chocaron con el presente. En marzo de 2020 estaba trabajando en las correcciones cuando la ciudad de Nueva York, donde vivo, empezó a cerrar. De repente, tuve mucho tiempo, y mucha motivación, para considerar lo que había acertado y lo que no sobre la devastación que la enfermedad genera en una sociedad.En muchos aspectos, mi imaginación se había alejado de la realidad. Por un lado, ninguna pandemia conocida ha sido tan mortal como la que escribí, que mata al 90 por ciento de la población estadounidense. Sin embargo, tuve un instinto que resultó ser correcto: las pandemias tienen el potencial de conmocionar a las sociedades para que adopten nuevos estilos de vida. La peste negra, por ejemplo, provocó el fin de la servidumbre feudal y el ascenso de la clase media en Inglaterra.No obstante, un brote de enfermedad también puede hacer que los gobiernos redoblen la represión y el fanatismo, como cuando Estados Unidos utilizó como chivo expiatorio a los estadounidenses de origen asiático durante las epidemias de peste del siglo XIX.Una pintura del Hospital de Viruela de San Pancracio, alrededor de la década de 1880, en un campamento provisional en Londres.Frank Collins/Buyenlarge, vía Getty ImagesLa historia no puede decirles a los políticos y activistas estadounidenses con exactitud cómo responder a la COVID-19; más bien ofrece ejemplos de lo que no se debe hacer. Sin embargo, los brotes en la Sudáfrica del siglo XX, la Inglaterra medieval, la antigua Roma y otros lugares pueden ofrecer algunas lecciones para quienes trabajan con el fin de curar los daños de la COVID y forjar una sociedad más justa tras su paso.Hace cinco años, la historia de las pandemias fue un punto de partida para mí, una inspiración, y poco más. Ahora es algo más urgente: representa lo que podemos esperar en estos tiempos oscuros, así como lo que nos espera si no actuamos. A continuación enumero algunas lecciones aprendidas.AdaptarseLa peste negra, una pandemia causada por la bacteria Yersinia pestis que se extendió por Asia, África y Europa a partir de 1346, fue “sin duda la crisis sanitaria más catastrófica de la historia”, dijo en una entrevista Mark Bailey, historiador y autor de After the Black Death: Economy, Society, and the Law in Fourteenth-Century England. En Inglaterra, la peste mató a cerca del 50 por ciento de la población en 1348 y 1349; en el conjunto de Europa, las estimaciones oscilan entre el 30 y el 60 por ciento. La magnitud de la mortandad fue un impacto enorme, aunque sus efectos fueron mucho más allá. Como dijo Monica Green, historiadora de la medicina que se ha especializado en la Europa medieval: “¿Quién va a recoger la cosecha si la mitad de la gente desapareció?”.Diversas sociedades han respondido de manera diferente. En muchas partes del noroeste de Europa, como Gran Bretaña y lo que hoy son los Países Bajos, la muerte repentina de una gran parte de los trabajadores significaba que era más fácil para los sobrevivientes conseguir trabajo y adquirir tierras. “Se produce un aumento de la riqueza per cápita y una reducción de la desigualdad de la riqueza”, explicó Bailey. Desde un punto de vista económico, al menos, “la gente corriente está mejor”. “Huida de los habitantes del pueblo al campo para escapar de la plaga”, de 1630. La plaga se representa en el extremo derecho como un esqueleto que sostiene una daga y un reloj de arena./Universal Images Group, vía Getty ImagesLo contrario ocurrió en gran parte de Europa del Este, donde los terratenientes consolidaron su poder sobre el campesinado, ahora escaso, para volver a imponer la servidumbre y obligarlos a trabajar la tierra en condiciones favorables para los poderosos. Allí, la desigualdad se estabilizó o incluso aumentó a raíz de la peste.Hay muchas explicaciones distintas pero una posibilidad es que “la peste negra tiende a acelerar las tendencias existentes”, por ejemplo, el movimiento hacia una economía menos feudal y más basada en el consumo en el norte de Europa, explicó Bailey. Pero esa región no se convirtió por arte de magia en un bastión de la igualdad después de la peste: el gobierno inglés impuso topes salariales a mediados del siglo XIV para evitar que los sueldos subieran demasiado. El resultado fue un malestar generalizado, que culminó en la Revuelta de los Campesinos de 1381, que reunió a personas de muy diversos orígenes sociales en una expresión de “frustración contenida” por la mala gestión de la economía por parte del gobierno, dijo Bailey.En general, si “la resiliencia en una pandemia es hacer frente”, continuó, “posteriormente, la resiliencia económica y social consiste en adaptarse”. La lección moderna sería: “Adaptarse a la nueva realidad, al nuevo paradigma, a las nuevas oportunidades, es la clave”.Combatir la desigualdadEl avance hacia una mayor igualdad económica en Inglaterra tras la peste puede haber sido un poco atípico: a lo largo de la historia, las epidemias tienden a intensificar las desigualdades sociales existentes.En 1901, por ejemplo, cuando una epidemia de peste azotó Sudáfrica, “miles de sudafricanos negros fueron expulsados a la fuerza de Ciudad del Cabo bajo la suposición de que su libre circulación estaba influyendo en la propagación de la peste dentro de la ciudad”, dijo Alexandre White, profesor de sociología e historia de la medicina cuyo trabajo se enfoca en la respuesta a las pandemias. Esa expulsión sentó las bases de la segregación racial de la época del apartheid.Estados Unidos también tiene un historial de políticas discriminatorias durante las epidemias, como la focalización en las comunidades asiático-estadounidenses durante los brotes de peste de principios del siglo XIX y principios del XX en Hawái y San Francisco, y la lenta respuesta federal a la epidemia de VIH cuando parecía afectar sobre todo a los estadounidenses de la comunidad LGBTQ, dijo White. Ese tipo de decisiones han ampliado no solo la desigualdad, sino que también han obstaculizado los esfuerzos para combatir la enfermedad: ignorar el VIH, por ejemplo, permitió que se extendiera por toda la población. Un científico que estudiaba la plaga en un laboratorio de San Francisco en 1961.Smith Collection/Gado/Getty ImagesY ahora, Estados Unidos se enfrenta a una pandemia que ha enfermado y matado de manera desproporcionada a los estadounidenses de color, quienes conforman buena parte de la mano de obra esencial pero tienen menos probabilidades de acceder a la atención médica. Mientras los gobiernos federales y estatales gestionan el despliegue de las vacunas, el acceso a las pruebas y al tratamiento, y los paquetes de ayuda económica, es crucial aprender del pasado y dirigir las políticas que reduzcan las desigualdades raciales y económicas que hicieron que la pandemia fuera tan devastadora.“Si los efectos del racismo y la xenofobia fueran menos sistémicos en nuestra sociedad, probablemente veríamos menos muertes como resultado de la COVID-19”, comentó White. “La intolerancia es, de manera sustancial, mala para la salud pública”.Adoptar la innovación inesperadaAunque las pandemias han reafirmado viejos prejuicios y modos de marginación, también han generado cosas nuevas, especialmente en cuanto al arte, la cultura y el entretenimiento.La antigua Roma, por ejemplo, estaba atormentada por las epidemias, que se producían cada quince o veinte años durante los siglos IV, III y II a. C., explica Caroline Wazer, escritora y editora que realizó una tesis sobre la salud pública romana. En aquella época, la principal respuesta en materia de salud pública era la religiosa, y los romanos experimentaban con nuevos ritos e incluso con nuevos dioses en un intento por detener la propagación de la enfermedad. En un caso, según Wazer, puesto que una epidemia que se prolongaba durante tres años y el público estaba cada vez más agitado, el Senado adoptó un extraño y nuevo ritual del norte de Italia que consistía en traer “actores para que se presentaran en el escenario”. Según el historiador romano Livio, “así es como los romanos tuvieron su teatro”, dijo Wazer, aunque esa idea ha sido debatida.Una respuesta espiritual a la enfermedad también provocó un cambio cultural en la Inglaterra del siglo XIV. Recordando las fosas comunes de la peste negra, los británicos temían morir sin un entierro cristiano y pasar la eternidad en el purgatorio, dijo Bailey. Así que empezaron a formar gremios, pequeños grupos religiosos que funcionaban básicamente como “clubes de seguros de entierro”, en los que recaudaban dinero para dar a sus miembros el tratamiento adecuado tras la muerte.Esas cofradías organizaban fiestas y otros eventos, y con el tiempo surgió la preocupación “por el consumo de cerveza en la iglesia y sus alrededores”, dijo Bailey. Así que los gremios comenzaron a construir sus propios salones para socializar. Luego, durante la Reforma en el siglo XVI, los gremios se disolvieron y los salones se convirtieron en algo nuevo: los pubs.De hecho, los historiadores han argumentado que el aumento del consumismo y la riqueza de la gente común después de la peste negra allanó el camino para la cultura de los pubs por la que Inglaterra sigue siendo conocida hoy en día.Sería frívolo calificar a esas innovaciones culturales como un “rayo de luz” originado por las pandemias; después de todo, han surgido muchas formas de arte y nuevos lugares sociales sin el catalizador de las muertes masivas. Sin embargo, vale la pena recordar que, incluso a raíz de los desastres de salud pública más devastadores, la vida social y la creatividad humana han resurgido de formas nuevas e inesperadas.“Las pandemias son tanto catástrofes como oportunidades”, me dijo Bailey. En los próximos años, el mundo se enfrentará a la trágica oportunidad de reconstruirse tras la COVID-19. Si aprendemos las lecciones de la historia, quizá podamos hacerlo de una manera más justa, más inclusiva e incluso más alegre que el pasado que nos hemos visto obligados a superar.Anna North es reportera sénior en Vox y autora de tres novelas, entre ellas Outlawed, la más reciente.

When life is disrupted by crisis, some people see opportunities — for change, action, introspection — they might not otherwise.This article is part of a series on resilience in troubled times — what we can learn about it from history and personal experiences.About a year ago, just as the pandemic was hitting New York City, St. John Frizell and his two partners were readying for the grand reopening of Gage & Tollner, a newly renovated, 140-year-old restaurant in Downtown Brooklyn. One day before the March 15 opening — for which the three partners had spent almost a year and a half preparing — they made the difficult decision not to open.Mr. Frizell retreated to his home in Brooklyn. “The only sounds in the street were ice cream trucks and ambulances,” he recalled. Anxious about going to the supermarket but needing groceries for himself and his son, he reached out to one of his vendors, Lancaster Farm Fresh Co-op, to see about having some food delivered. Lancaster was delivering boxes of seasonal produce, but needed an order large enough to be worth the trip. So Mr. Frizell, who suddenly had downtime, did something he hadn’t done in a while: He reached out to his neighbors.“I posted something about it in a local Red Hook group on Facebook and got a big response,” he said. “I thought, OK, I can set this up for all of us.”Mr. Frizell also owns Fort Defiance, a beloved Red Hook bar that he opened in 2009 and that also closed in March; it became the order pickup spot. Neighbors began asking about other grocery items, so Mr. Frizell added things like milk, eggs, cheese and meats. “A lot of people in the neighborhood began looking to us for their staples,” he said.By midsummer, Fort Defiance had permanently become a general store, with new signage painted over the old “Cafe & Bar.” This March, Mr. Frizell started a crowdfunding campaign to help the store move to a bigger space one block away. (Gage & Tollner, which has been open for takeout since mid-February, plans to open for indoor dining on April 15.) The whole experience made Mr. Frizell aware of how much richer his life is when he is connected to the community. “Reaching out and asking what people needed felt really good, like I was doing what I could to help,” he said. “It felt very purposeful.”Fort Defiance in 2018. Now, the business operates as a general store serving the Red Hook neighborhood of Brooklyn.Marian Carrasquero/The New York TimesWhen life is disrupted by crisis, as it has been this past year, some people see opportunities — for change, action, introspection — they might not otherwise. The pandemic has caused many to question the way they live and what is important to them. That’s because a crisis often helps us develop a wider perspective on our lives, said Amit Sood, a physician and executive director of the Global Center for Resiliency and Wellbeing in Rochester, Minn. And that allows us to reframe what we see.Of course, for many people struggling to make ends meet or lacking savings, a big life change — or even just a shift in perspective — may not be possible. But for those fortunate enough to have the psychological space and economic security, this kind of reframing can present real possibilities for change.“When people focus on what is right within what seems wrong in their life (for example, the car has a flat tire but isn’t totaled), that can lead to seeing things that present themselves as opportunities,” he said.This is not the same thing as positive thinking. Instead, said Rick Hanson, a clinical psychologist and author of “Resilient: How to Grow an Unshakable Core of Calm, Strength, and Happiness,” it’s about seeing openings in life for change and transformation, even in difficult circumstances. Mr. Hanson said that although we often think of opportunities as things that exist outside ourselves, like a new job or moving to a different city, opportunities for growth and change exist inside us, too.Justin E.H. Smith, for example, a philosopher, historian and professor at the University of Paris, made subtle but important changes this past year. Mr. Smith describes himself as an introvert with a tendency to lead a rigid life, doing the same things in the same way every day. The pandemic forced him to restructure his daily life and soften his rigidity.“I’m aware of the contingency of these new routines now,” he said, “and my power to restructure them if they don’t suit.” Mr. Smith, 48, also admitted that he used to feel too old to try anything new. But the pandemic gave the professor permission to be a novice again. “It didn’t feel shameful any longer for me to be a beginner.”So after some research, he opened an online brokerage account. He also took up guitar (and now plays every day) and in August, decided to start a paid subscription newsletter on the digital publishing platform Substack, where he writes about the philosophical dimensions of culture, science and politics, and the ways they are changed (and distorted) by technology.Absent the pandemic, Mr. Smith probably never would have considered it, but for the first time in his professional life, he thought about diversifying his income. “I’m thinking ahead in a precarious moment,” he said.Those sorts of moments often shake up all that we believe to be true about the world, and that is what leads to personal growth. “These are core beliefs we have about the world that we generally don’t question, such as how vulnerable or safe we are, how much control we have over things or what our identity is,” said Richard Tedeschi, who, along with fellow psychologist Lawrence Calhoun, coined the term “post-traumatic growth” in the 1990s, naming this phenomenon.Red Hook in November. After the pandemic hit last spring, neighborhood residents began looking to Fort Defiance for basic grocery items.Karsten Moran for The New York TimesWe use these assumptions about the world to make decisions every day and to plan for the future. When a crisis hits, we often have trouble believing and accepting what is happening because it disrupts those core beliefs. “That is what qualifies as trauma,” Dr. Tedeschi said. “And it can set in motion major changes in people’s lives.” In fact, one of the five areas where growth and change occur after a crisis is in recognizing new possibilities.That is what happened to Elaine Mazanec. In mid-2019, she was a co-owner of a public relations agency in Washington and the mother of a 2-year-old when her husband died suddenly. As someone not used to asking for help, she was forced into a position of vulnerability.“I allowed myself to be cared for in a way I hadn’t before,” Ms. Mazanec said. “I had so much support. It wasn’t comfortable for me, but it was what enabled me to find my footing after the loss.”Just as she was getting back into a normal routine, the pandemic descended. “For the first few weeks, I felt similar to when I lost my husband, like the rug got pulled out from under me,” she said. In the weeks that followed she became more reflective, appreciating the positives in her life, especially the security and support she has (and that so many others do not).“I think sometimes when we’re super busy, we don’t get a chance to zoom out and see the bigger picture,” Ms. Mazanec said. “I realized that what had felt the most meaningful for me in the last two years was having the support of others to help me through a terrible loss, to help me process it.”Ms. Mazanec decided she wanted to be a person who supports others going through difficult times, so she started looking into graduate programs in social work. Most deadlines for applying had already passed, so when she learned that the University of Maryland School of Social Work — her first choice — had extended its deadline because of the pandemic, she took it as a sign she was on the right path.Now in her second semester of the program and doing her fieldwork in an elementary school, Ms. Mazanec says she feels that the work has real purpose and is closely aligned with her values.“The loss I experienced, that tragedy, really changed me,” she said. “And then the pandemic gave me an opening. It all came together in a way I couldn’t have predicted, but I know I’m where I’m supposed to be.”Eilene Zimmerman is author of the memoir “Smacked: A Story of White-Collar Ambition, Addiction and Tragedy.”

An emerging branch of neuroscience asks a question long on the minds of researchers. Recent stimulus payments make the study more relevant.New monthly payments in the pandemic relief package have the potential to lift millions of American children out of poverty. Some scientists believe the payments could change children’s lives even more fundamentally — via their brains.Does cash aid to poor parents help their children’s long-term brain development?Karsten Moran for The New York TimesIt’s well established that growing up in poverty correlates with disparities in educational achievement, health and employment. But an emerging branch of neuroscience asks how poverty affects the developing brain.Over the past 15 years, dozens of studies have found that children raised in meager circumstances have subtle brain differences compared with children from families of higher means. On average, the surface area of the brain’s outer layer of cells is smaller, especially in areas relating to language and impulse control, as is the volume of a structure called the hippocampus, which is responsible for learning and memory.These differences don’t reflect inherited or inborn traits, research suggests, but rather the circumstances in which the children grew up. Researchers have speculated that specific aspects of poverty — subpar nutrition, elevated stress levels, low-quality education — might influence brain and cognitive development. But almost all the work to date is correlational. And although those factors may be at play to various degrees for different families, poverty is their common root. A continuing study called Baby’s First Years, started in 2018, aims to determine whether reducing poverty can itself promote healthy brain development.“None of us thinks income is the only answer,” said Dr. Kimberly Noble, a neuroscientist and pediatrician at Columbia University who is co-leading the work. “But with Baby’s First Years, we are moving past correlation to test whether reducing poverty directly causes changes in children’s cognitive, emotional and brain development.”Dr. Noble and her collaborators are examining the effects of giving poor families cash payments in amounts that wound up being comparable to those the Biden administration will distribute as part of an expanded child tax credit.The researchers randomly assigned 1,000 mothers with newborns living in poverty in New York City, New Orleans, the Twin Cities and Omaha to receive a debit card every month holding either $20 or $333 that the families could use as they wished. (The Biden plan will provide $300 monthly per child up to age 6, and $250 for children 6 through 17.) The study tracks cognitive development and brain activity in children over several years using a noninvasive tool called mobile EEG, which measures brain wave patterns using a wearable cap of 20 electrodes.The study also tracks the mothers’ financial and employment status, maternal health measures such as stress hormone levels, and child care use. In qualitative interviews, the researchers probe how the money affects the family, and with the mothers’ consent, they follow how they spend it.The study aimed to collect brain activity data from children at age 1 and age 3 in home visits, and researchers managed to obtain the first set of data for around two-thirds of the children before the pandemic struck. Because home visits are still untenable, they extended the study to age 4 and will be collecting the second set of brain data next year instead of this year.The pandemic, as well as the two stimulus payments most Americans received this past year, undoubtedly affected participating families in different ways, as will this year’s stimulus checks and the new monthly payments. But because the study is randomized, the researchers nonetheless expect to be able to assess the impact of the cash gift, Dr. Noble said.Baby’s First Years is seen as an audacious effort to prove, through a randomized trial, a causal link between poverty reduction and brain development. “It is definitely one of the first, if not the first” study in this developing field to have direct policy implications, said Martha Farah, a cognitive neuroscientist at the University of Pennsylvania and director of the Center for Neuroscience and Society who studies poverty and the brain.Professor Farah concedes, however, that social scientists and policymakers often discount the relevance of brain data. “Are there actionable insights we get by bringing neuroscience to bear, or are people just being snowed by pretty brain images and impressive-sounding words from neuroscience? It’s an important question,” she said.Skeptics abound. James Heckman, a Nobel Prize-winning economist at the University of Chicago who studies inequality and social mobility, said he didn’t see “even a hint that a policy would come out of it, other than to say, yes, there’s an imprint of a better economic life.”“And it still remains a question what the actual mechanism is” through which giving parents cash helps children’s brains, he said, adding that targeting such a mechanism directly might be both cheaper and more effective.Samuel Hammond, director of poverty and welfare policy at the Niskanen Center, who worked on a child allowance proposal by Senator Mitt Romney, agrees that tracking the source of any observed cognitive benefits is tricky. “I have trouble disentangling the interventions that actually help the most,” he said. For example, policy experts debate whether certain child care programs directly benefit a child’s brain or simply free up her caregiver to get a job and increase the family’s income, he said.Yet that is exactly why providing disadvantaged families with cash might be the most potent way to test the link to brain development, Dr. Noble said. “It’s quite possible that the particular pathways to children’s outcomes differ across families,” she said. “So by empowering families to use the money as they see fit, it doesn’t presuppose a particular pathway or mechanism that leads to differences in child development.”Neuroscience has a track record for transforming societal thinking and influencing policy. Research showing that the brain continues to mature past adolescence and into a person’s mid-20s has reshaped policies relating to juvenile justice.In another example, research on brain and cognitive development in children who grew up in Romanian orphanages from the mid-1960s into the 1990s changed policy on institutionalization and foster care, in Romania and worldwide, said Charles Nelson, a neuroscientist at Harvard and Boston Children’s Hospital who co-led that work.Those studies demonstrated that deprivation and neglect diminish IQ and hinder psychological development in children who remain institutionalized past age 2, and that institutionalization profoundly affects brain development, dampening electrical activity and reducing brain size.But that work also underscores how consumers of research, policymakers among them, are prone to give more weight to brain data than to other findings, as other studies show. When Professor Nelson presents these findings to government or development agency officials, “I think they find it the strongest ammunition to implement policy changes,” he said. “It is a very powerful visual, more so than if we said, well, they have lower IQs, or their attachment isn’t as strong.” (He is an adviser for Baby’s First Years.)The vividness of such data isn’t necessarily bad, Dr. Noble said. “If we find differences and the brain data make those differences more compelling to stakeholders, then that’s important to include,” she said. Moreover, brain data provides valuable information in its own right, particularly in infants and young children, for whom behavioral tests of cognition are often inaccurate or impossible to conduct, she said. Brain differences also tend to be detectable earlier than behavioral ones, she said.The field may simply be too young to clock its contributions to policy, Professor Farah said. But increasing understanding of how specific brain circuits are affected by poverty, along with better tools for gauging such circuits, may yield science-based interventions that get taken up at a policy level, she said.Meanwhile, Baby’s First Years hopes to address a broader question that is already relevant at the policy level: whether cash aid to parents helps their children’s brains develop in a way that helps them for a lifetime.Alla Katsnelson is a science journalist in Northampton, Mass. You can follow her on Twitter at @lalakat.

The special project “What Loss Looks Like” presents personal artifacts belonging to those who have left us and explores what they mean to those left behind.Times Insider explains who we are and what we do, and delivers behind-the-scenes insights into how our journalism comes together.As the art director of the Well desk, I’ve spent the last year looking for images to reflect the devastation of the pandemic and the grief it has wrought. As the crisis has stretched on, I’ve thought of all the people who have lost loved ones to Covid-19 — not to mention those who have lost loved ones, period — and how they were cut off from the usual ways of gathering and grieving. Watching the numbers rise every day, it was easy to lose sight of the people behind the statistics. I wanted to find a way to humanize the death toll and re-establish the visibility of those who had died.To help our readers honor the lives of those lost during the pandemic, we decided to ask them to submit photographs of objects that remind them of their loved ones. The responses were overwhelming, capturing love, heartache and remembrance. We heard from children, spouses, siblings, grandchildren and friends — people who had lost loved ones not only to Covid-19 but from all manner of causes. What united them was their inability to mourn together, in person.Dani Blum, Well’s senior news assistant, spent hours speaking with each individual by phone. “It’s the hardest reporting I’ve ever done, but I feel really honored to be able to tell these stories,” she said. “What struck me the most about listening to all of these stories was how much joy there was in remembering the people who died, even amid so much tragedy. Many of these conversations would start in tears and end with people laughing as they told me a joke the person they lost would tell, or their favorite happy memory with them.”The photographs and personal stories, published digitally as an interactive feature, was designed by Umi Syam and titled “What Loss Looks Like.” Among the stories we uncovered: A ceremonial wedding lasso acts as a symbol of the unbreakable bond between a mother and father, both lost to Covid-19 and mourned by their children. A ceramic zebra figurine reminds one woman of her best friend, who died after they said a final goodbye. A gold bracelet that belonged to a father never leaves his daughter’s wrist because she is desperate for any connection to his memory.For those who are left behind, these items are tangible daily reminders of those who have departed. These possessions hold a space and tell a story. Spend time with them and you begin to feel the weight of their importance, the impact and memory of what they represent.Museums have long showcased artifacts as a connection to the past. So has The New York Times, which published a photo essay in 2015 of objects collected from the World Trade Center and surrounding area on 9/11. As we launched this project, we heard from several artists who, in their own work, explored the connection between objects and loss.Shortly after Hurricane Sandy, Elisabeth Smolarz, an artist in Queens, began working on “The Encyclopedia of Things,” which examines loss and trauma through personal objects. Kija Lucas, a San Francisco-based artist, has been photographing artifacts for the past seven years, displaying her work in her project “The Museum of Sentimental Taxonomy.”“Saved: Objects of the Dead” is a 12-year project by the artist Jody Servon and the poet Lorene Delany-Ullman, in which photographs of personal objects from deceased loved ones are paired with prose to explore the human experience of life, death and memory. And the authors Bill Shapiro and Naomi Wax spent years interviewing hundreds of people and asking them about the most meaningful single object in their lives, gathering their stories in the book “What We Keep.”As the pandemic continues to grip the nation, the Well desk will continue to wrestle with the large-scale grief that it leaves in its wake. Other features on this topic include resources for those who are grieving, the grief that’s associated with smaller losses, and how grief affects physical and psychological health. As for “What Loss Looks Like,” we are keeping the callout open, inviting more readers to submit objects of importance, to expand and grow this virtual memorial and provide a communal grieving space.

The president pushed up his target date by two weeks, matching the timetable already being put in place by many states.WASHINGTON — President Biden on Tuesday moved up by two weeks, to April 19, his deadline for states to make every American adult eligible for coronavirus vaccination, following the lead of states around the country that are already meeting that timetable.Mr. Biden’s announcement came as Americans and their elected officials were grappling with competing and seemingly contradictory forces. The pace of vaccinations is accelerating, but worrisome new variants are spreading. The death rate is declining, but caseloads and hospitalizations are on the rise.California officials announced on Tuesday that they plan to lift all coronavirus restrictions on June 15, provided there are enough Covid-19 vaccines available for anyone age 16 or older and hospitalizations remain low and stable. Other states are already lifting restrictions, but Mr. Biden, in remarks at the White House, warned against throwing off the guardrails too soon.“The virus is spreading because we have too many people who, seeing the end in sight, think we’re at the finish line already,” the president said. “But let me be deadly earnest with you: We aren’t at the finish line. We still have a lot of work to do. We’re still in a life-and-death race against this virus.”The president also reiterated and made explicit his pledge to give surplus vaccine to other countries, once he is certain there is enough for people in the United States.Not quite a month ago, Mr. Biden set a deadline of May 1 for states to open up vaccination to all adults. A week after that, he said that by April 19, 90 percent of adults would be eligible for a shot and would be able to get one within five miles of their home.Since then, nearly every state in the nation has accelerated its vaccination program, and the vast majority are now meeting or coming in ahead of the April 19 target. On Tuesday, Oregon said those 16 or older will be eligible for vaccination on April 19.At least 530 new coronavirus deaths and 76,624 new cases were reported in the United States on Monday, according to a New York Times database. Over the past week, there has been an average of 64,855 new cases per day, an increase of 20 percent from the average two weeks earlier.That has put the country in a tenuous situation, with public health officials, including Dr. Rochelle Walensky, the director of the Centers for Disease Control and Prevention, pleading with governors not to lift restrictions and with citizens to continue to follow social distancing guidelines, wear masks and take other public health precautions. Last week, Dr. Walensky said she felt a sense of “impending doom” from a potential fourth surge of the pandemic.But in California, cases have been declining since hitting a peak early this year, with the state now averaging around 2,700 new cases a day, the lowest figure since June. The C.D.C. said that, as of Tuesday, 35 percent of the state’s total population had received at least one vaccine shot, and 18 percent were fully vaccinated.“With more than 20 million vaccines administered across the state, it is time to turn the page on our tier system and begin looking to fully reopen California’s economy,” Gov. Gavin Newsom, a Democrat, said in a statement. “We can now begin planning for our lives post-pandemic.”Many public health experts say that the nation is in a race between the vaccines and the variants and that, for the moment at least, the vaccines appear to have the upper hand. But public health officials are worried that future iterations of the virus may be more resistant.At the same time, they are watching an uptick in cases among young people, particularly those ages 18 to 24. Dr. Walensky told reporters on Monday that the C.D.C. was working with states to investigate outbreaks in young people that she said may be related to extracurricular activities or sports.Mr. Biden spoke on Tuesday after visiting a vaccination clinic at the Virginia Theological Seminary in Alexandria, Va., which is working with community health centers to offer inoculations. Making the rounds of the makeshift clinic, he showed flashes of his old self — the sunny retail politician who likes to get close to people, with a pat on the arm or a squeeze on the shoulder.“He’s gonna be hard — he’s got so much muscle mass there,” the president joked to a nurse as he squeezed the shoulder of a muscular man who was about to get his shot. “I tell you what, I could have been an All-American if I had those.”But his lightness belied the seriousness of the message he would later deliver at the White House. There, he marked a milestone: Since Mr. Biden has been in office, more than 150 million Covid-19 shots have been administered to Americans, which puts the nation on track to reach his goal of 200 million shots by his 100th day in office, at the end of this month.“We’ve vaccinated more people than any other nation on Earth,” the president said. “The vaccines have proven to be safe and effective. That should give us real hope.”But, he added, “we can’t let it make us complacent.”Jill Cowan