Publisher Health

It’s the most contagious form of the coronavirus so far. Here’s what you need to know before traveling.With vaccinations on the rise and mortality rates related to Covid-19 going down in Europe and other parts of the world, many people are making plans to travel this summer and beyond. But experts say the quickly circulating Delta variant is a new concern for travelers, particularly those who are unvaccinated.The European Union said on June 18 that the United States would be added to its “safe list” of countries, a decision that should allow even unvaccinated visitors from the U.S. (who can provide proof of a negative coronavirus test) to enter its 27 member states for nonessential travel. These countries, however, can impose their own restrictions and requirements for entry.The E.U. decision comes the same week that the Centers for Disease Control and Prevention elevated the Delta variant of the coronavirus to a “variant of concern” as it appears to spread more quickly and may affect people more severely than earlier forms of the virus.If you’re wondering how the variant will affect your travel plans, here is everything you need to know before booking a flight.Where is the Delta variant spreading?So far, the variant, first identified in India, has spread to more than 80 countries as of June 16, according to the World Health Organization. In a news conference on June 10, Dr. Hans Kluge, W.H.O.’s regional director for Europe, said that the variant was “poised to take hold” in Europe.Jennifer Nuzzo, an epidemiologist at Johns Hopkins Bloomberg School of Public Health, said this will probably be the case in other countries, as well.“If you’re out and about this summer, chances that you’re going to encounter the Delta variant, either in the U.S. or in Europe or other parts of the world, are pretty high,” she said.The Delta variant currently makes up between six and 10 percent of cases in the United States, said Dr. Ashish Jha, the dean of Brown University’s School of Public Health, adding that it will probably will be the dominant strain in the United States by August.If you are fully vaccinated, particularly with a two-dose vaccine, “don’t worry about the Delta variant,” Dr. Jha said.Millions of Americans have received either Pfizer-BioNTech or Moderna vaccines; both are two-dose vaccines. Studies have shown their efficacy drops only slightly when encountering variants.“People who have been vaccinated still do quite well against this variant,” Dr. Jha said, “but it is one where you need a high degree of immunity to ward off, so you really need to have both of your doses of your vaccine.”52 Places to Love in 2021We asked readers to tell us about the spots that have delighted, inspired and comforted them in a dark year. Here, 52 of the more than 2,000 suggestions we received, to remind us that the world still awaits.Where can I find vaccination or infection rates for the places I want to travel?The C.D.C. has a global variant map that shows the countries where different variants have been identified, though it does not list infection rates. It also lists the risk level by country.Using information from government sources compiled by the Our World in Data project at the University of Oxford, The New York Times has been tracking global vaccinations, showing the percentage of people vaccinated in individual countries.You may also look online to the national health department websites for the country you are planning to visit to get more specific data.In Britain, for instance, where the Delta variant is already the most widespread strain, the National Health Service publishes information on the spread of the variant and vaccination rates in the country.Unequal access to the vaccine across the world has meant that poorer countries are less adequately protected, with cases continuing to rise in parts of South America, Southeast Asia and Africa. According to the W.H.O., 75 percent of vaccine doses have gone to just 10 nations.Dr. Jha said it’s important to look at not just vaccination rates for the country, but also the vaccine that is being used there. Brazil, Turkey and other countries are relying on one or both of the two main vaccines manufactured by Chinese companies to inoculate their citizens. “We don’t have data that the Chinese vaccines, for instance, are quite as good in general, and particularly around the Delta variant,” Dr. Jha said.I’m fully vaccinated. What would it mean if I traveled to a place that had low vaccination numbers?A recent study by the C.D.C. shows that the Pfizer-BioNTech or Moderna vaccines reduce the risk of infection from any form of the virus by 91 percent for fully vaccinated people. The single-dose Johnson & Johnson vaccine is about 66 percent effective at preventing infection.“Is it complete? No,” Dr. Nuzzo said. “But is it pretty darn good to the point that I personally would relax? Yes.”It’s possible for vaccinated people to still be infected, she said, but the cases of this happening are quite low, and even if they get infected, they are unlikely to become ill. She added that those who have symptoms are more likely to spread the virus, so “if the vaccines did a good job at keeping you without symptoms, the likelihood that you’re going to spread it is quite low.”If you want to further improve your odds of not getting infected, she recommends continuing to follow safety protocols like wearing a mask, social distancing and avoiding crowded, poorly ventilated indoor spaces.If you are vaccinated but your immune system is compromised, because of a medical condition or because of certain medications you take, you should heed caution. You may not be fully protected, she said.What if I’m unvaccinated?“If you’re an unvaccinated person, that, I think, makes your travel prospects much riskier,” Dr. Nuzzo said. “I really would not advise people traveling in an era of the increasing spread of these, not only more transmissible but possibly more severe, forms of the virus.”Dr. Jha adds that “the simple answer” for protecting yourself as a traveler is to get vaccinated. This, he said, makes the prospect of encountering the Delta virus much less risky.“But if you are unvaccinated or with unvaccinated people, then it really does pose a substantial risk,” he said.He adds that travelers can use other safety measures to protect themselves, like wearing masks or social distancing, “but if you’re going to be vacationing this summer, that’s a less fun way to vacation.”Dr. Nuzzo suggests thinking about vaccination and safety measures as different layers of protection against the virus. “Each layer adds something,” she said. “Vaccination is the thickest layer of protection against all forms of the virus.”What about my children?If your kids are over 12, get them vaccinated, said Dr. Jha. But for children under 12, who cannot yet get vaccinated in the United States, he suggests continuing to follow mask-wearing and social distancing rules. He also said that getting vaccinated yourself can help protect your children.“The single biggest thing we can do to protect kids under 12 is to make sure everybody around them, all the adults, are vaccinated,” he said. “There’s very good evidence that when adults are vaccinated, kid infection numbers go down.”He said that he plans to travel with his children this summer, one of whom is too young to be vaccinated.Dr. Nuzzo, who has two young unvaccinated children, said she will, as well. “We are in a phase where we have to gauge the risks and benefits of everything that we do,” she said. “Everybody’s going to make those calculations differently.”How is the variant affecting travel restrictions?When the initial version of the coronavirus swept the globe last spring, much of the world hunkered down, restricting domestic movement, and many countries shut their borders to nonessential travel.Now, many nations are opening up, but concern remains about the virus, particularly about the Delta variant. Some countries are making specific changes to their entry decisions because of the variant, while others are ordering emergency lockdowns.On June 18, Italy’s health minister said that the nation would require a mandatory five-day quarantine and testing for people coming from Britain, even if they are vaccinated, over concerns about the Delta variant. It also extended the ban on arrivals from India, Bangladesh and Sri Lanka.On the same day, Portugal ordered a weekend lockdown for the capital region of Lisbon, as a way to curb a surging number of virus cases. Roughly half of the reported cases stem from the Delta variant.Rules around testing and requirements to enter another country are evolving and can change quickly from one day to the next. Make sure to check the requirements for your destination country before booking your flight, but also in the days before to you travel make sure you are following the most updated rules.THE WORLD IS REOPENING. LET’S GO, SAFELY. 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A new study paves the way for the development of next generation therapeutics for the prevention and treatment of Clostridioides difficile infection (CDI), the most frequent cause of healthcare-acquired gastrointestinal infections and death in developed countries.
Published today in Nature Communications, the study reveals the first 3D structure of the Clostridioides difficile toxin B (TcdB) in complex with chondroitin sulfate proteoglycan 4 (CSPG4), a human receptor. The study was co-led by senior author Rongsheng Jin, PhD, a professor in the Department of Physiology & Biophysics at the University of California, Irvine, School of Medicine, and Min Dong, PhD, an associate professor at Harvard Medical School.
“TcdB is one of two homologous C. difficile exotoxins, which are major virulence factors responsible for the spread of C. difficile infections,” explained Jin. “TcdB alone is capable of causing the full-spectrum of diseases associated with CDI in humans.”
Previous studies had identified CSPG4 as a potential receptor for TcdB, however the pathophysiological relevance and molecular details were unknown. Results from this new study reveal a unique binding site involving TcdB and CSPG4, and also show that CSPG4-binding residues are highly conserved across most TcdB variants known to date.
CDI has become the most common cause of antibiotic-associated diarrhea and gastroenteritis-associated death in developed countries, accounting for approximately 223,900 infections, 12,800 deaths, and $1 billion in healthcare costs in the United States in 2017. It is classified as one of the top five “urgent threats” by CDC. There is also growing global concern surrounding the emergence of rapidly spreading hypervirulent C. difficile strains, reminiscent of the current COVID pandemic.
“What these new findings tell us is that a rationally designed CSPG4-mimicking decoy could neutralize major TcdB variants, providing a unique therapeutic avenue for combating some of the hypervirulent C. difficile strains,” said Jin. In contrast, researchers also revealed that the therapeutic mechanism for bezlotoxumab, the only FDA approved anti-TcdB antibody, is sensitive to escaping mutations in some bacterial strains.
The current standard of care for CDI involves treatments using broad spectrum antibiotics, which often lead to frequent disease recurrence. While bezlotoxumab could reduce the recurrence rate of CDI in some patients, results from this and some earlier studies indicate it has weaker potency against some TcdB variants.
“We have designed a CSPG4-mimicking decoy based on the 3D structure we observed, which could neutralize major TcdB variants and is superior to bezlotoxumab on a major TcdB variant from a hypervirulent strain (TcdB2) in our studies. As a highly conserved cellular receptor of TcdB, a CSPG4 decoy molecule would be difficult for TcdB to escape, since any mutations that disrupt toxin binding to the decoy would also disrupt binding to its native receptors,” said Jin.
The team of researchers has also developed a family of recombinant protein therapeutics based on these new findings, as well as on an earlier discovery on how TcdB recognizes another human receptor Frizzled (FZD).
“We are now examining the therapeutic features of these novel antitoxin molecules, and we believe they could provide broad-spectrum protection and neutralization against most known TcdB variants, thus improving existing antibody therapeutics for CDI,” said Jin, whose team has filed a patent on these neutralizing molecules.

Identifying the causes of human neurodegenerative diseases is a global research priority, warranting frequent reviews of the accumulating knowledge. In doing just that, biologists from the Plant Physiology Laboratory at the University of Guam and neuroscientists from the Experimental Medicine Program at The University of British Columbia have published an update on the reputed environmental toxins that have been suspected of being involved in mammal neurodegeneration. Their summary was published in April in the book Spectrums of Amyotrophic Lateral Sclerosis, which is available online from the publisher Wiley Blackwell.
A decades-long search for a dementia-causing toxin
Interest in the correlations between environmental toxins and neurodegeneration focused the world’s magnifying glass on the island of Guam in the 1950s due to an unexpected increase in cases of neurodegenerative cases among the indigenous CHamoru population. The specific condition that temporarily affected Guam is known as amyotrophic lateral sclerosis-parkinsonism dementia (ALS-PDC) and known locally by the CHamoru term lytico-bodig.
A focus on this isolated cluster of cases led to decades of pursuit of causal toxins found in seeds of Guam’s native cycad tree. These seeds were components of the local cuisine at the time, and increased reliance on this form of food starch during World War II was a plausible hypothesis to explain the increase in neurodegeneration cases shortly after the war.
Several factors likely coalesce
An ebb and flow of sequential disappointments has evolved since the 1950s because the identification of a single causal cycad toxin remains elusive.

A research group including Professor MATSUDA Tetsuya of Tamagawa University’s Brain Science Institute (Machida City, Tokyo; Director: SAKAGAMI Masamichi) and Assistant Professor ISHIHARA Toru from Kobe University’s Graduate School of Human Development and Environment has illuminated the changes in the brain’s neural network and cortex structure that underlie the positive association between childhood exercise and the maintenance and promotion of cognitive function in later life.
These results were published in the academic journal NeuroImage on May 23, 2021.
Main Points The researchers showed that people who are physically active during childhood (up to 12 years of age) have higher cognitive functions in later life. However, they could not find a correlation between cognitive function and post-childhood physical activity. The positive association between childhood exercise and cognitive function was evident in the modular (*1) segregation of brain networks, strengthened inter-hemispheric connectivity, greater cortical thickness, lower levels of dendritic arborization and decreased density. During childhood, the formation of the brain’s network is susceptible to environmental and experience-related factors. It is thought that exercise during this period optimizes brain network development and is linked to the maintenance and promotion of cognitive function in later life.Research Background
Research over the previous decade has shown that exercise during childhood affects the development of cognitive functions. Recent findings have indicated that these benefits of childhood exercise extend to the maintenance and promotion of cognitive functions in middle age and later life. However, the changes in brain functionality and structure related to this positive association have yet to be illuminated. This research study investigated the relationship between physical activity in childhood and cognitive function in later life, using MRI (magnetic resonance imaging) to illuminate the structural and functional changes in the brain that are behind this relationship.
Experiment Method
The research group conducted a study on 214 participants ranging in age from 26 to 69 in order to investigate the relationship between childhood exercise and cognitive function, and the underlying functional and structural neural networks and cortical structure. Childhood exercise was assessed via questionnaire. One aspect of cognitive function, response inhibition (the ability to suppress inappropriate behaviors), was measured using a Go/No-go task. The image data from the MRI was analyzed and the following were calculated: structural and functional connectivity (*2), cortical thickness, myelination, the degree of neurite orientation dispersion and density index. The brain was divided into 360 areas in accordance with the Human Connectome Project (*3), and functional and structural parameters were obtained for each area. In the statistical analysis, information obtained through the questionnaire was used as confounders. This included each participant’s educational background, parents’ educational background, number of siblings and exercise during adulthood.

Scientists have developed a new technique that could revolutionise medical imaging procedures using light.
A team of physicists, led by Dr David Phillips from the University of Exeter, have pioneered a new way in which to control light that has been scrambled by passage through a single hair-thin strand of optical fibre. These ultra-thin fibres hold much promise for the next generation of medical endoscopes — enabling high-resolution imaging deep inside the body at the tip of a needle.
Conventional endoscopes are millimetres wide and have limited resolution — so cannot be used to inspect individual cells. Single optical fibres are approximately 10x narrower and can enable much higher-resolution imaging — enough to examine the features of individual cells directly inside living tissue. It is normally only possible to view cells once they have been taken outside the body and placed in a microscope.
The catch is that we can’t directly look through optical fibres, as they scramble the light sent through them. This problem can be solved by first calibrating an optical fibre to understand how it blurs images, and then using this calibration information as a key to decipher images from the scrambled light. Earlier this year, Dr Phillips’ group developed a way to measure this key extremely rapidly, in collaboration with researchers from Boston University in the USA, and the Liebniz Institute of Photonic Technologies in Germany [paper: Compressively sampling the optical transmission matrix of a multimode fibre, published in Light: Science and Applications, April 21st 2021].
However, the measured key is very fragile, and easily changes if the fibre bends or twists, rendering deployment of this technology in real clinical settings currently very challenging. To overcome this problem, the Exeter based team have now developed a new way to keep track of how the image unscrambling key changes while the fibre is in use. This provides a way to maintain high resolution imaging even as a single fibre based micro-endoscope flexes. The researchers achieved this by borrowing a concept used in astronomy to see through atmospheric turbulence and applying it to look through optical fibres. The method relies on a ‘guide-star’ — which in their case is a small brightly fluorescing particle on the end of the fibre. Light from the guide-star encodes how the key changes when the fibre bends, thus ensuring imaging is not disrupted.
This is a key advance for the development of flexible ultra-thin endoscopes. Such imaging devices could be used to guide biopsy needles to the right place, and help identify diseased cells within the body.
Dr Phillips, an Associate Professor in the Physics and Astronomy department at the University of Exeter, said: “We hope that our work brings the visualisation of sub-cellular processes deep inside the body a step closer to reality — and helps to translate this technology from the lab to the clinic.”
The latest work is in collaboration with researchers at the Liebniz Institute of Photonic Technologies in Germany, and the Brno Insititute of Scientific Instruments in the Czech Republic. The project was made possible with funding from the Royal Academy of Engineering and the Royal Society in the UK, the European Research Council, and the Chinese Scholarship Council.
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Materials provided by University of Exeter. Note: Content may be edited for style and length.

Two recent studies led by researchers from the University of Minnesota Medical School add new evidence to the impact of how drug price increases affect U.S. patients and the overall cost of health care.
The first study, published today in the JAMA Network Open, provides new data on how dramatic increases in anti-infective drug prices altered the overall cost of outpatient health care and decreased patient access to appropriate drug treatment. The study protocol was reviewed by the U.S. Centers for Disease Control and Prevention and scanned more than 100 million de-identified patient records to find roughly 89,000 cases of interest between 2010 and 2018. The results showed that: A standard-of-care (SOC) drug to treat hookworm increased from $32.77 to $1,660, which correlated with a decrease in patients receiving an appropriate drug from 43 percent to 28 percent. A SOC drug to treat pinworm increased from $14.81 to $130, which correlated with a decrease in patients receiving an appropriate drug from 81 percent to 28 percent. A SOC drug to treat Clostridioides difficile (a control with little price change) remained mostly stable, increasing from $53 to $68, which correlated with an increase in patients receiving an appropriate drug from 69 percent to 77 percent.”Our study shows that dramatic drug price increases lead to much higher outpatient costs and decrease appropriate drug treatment due to access issues and health care professionals switching to a substandard drug,” said co-first author of the study, William Stauffer, MD, MSPH, FASTMH, who is a professor of medicine at the U of M Medical School. “More studies need to be done to confirm these findings, but this should increase policymakers attention as they consider solutions to extreme drug pricing.”
The second study looked at state legislative action on the issue so far. Published in the Journal of General Internal Medicine, the research team reviewed all U.S. state laws enacted since 2015 to address drug price increases, as well as state bills being considered in 2020, and found several shortcomings. The study has two recommendations: Transparency laws were the most common type of legislative action, however, many of the transparency bills considered in 2020 don’t require transparency until after the price increases occur — some up to one year after. The study recommends requiring transparency before price increases occur, so that vulnerable patients have time to seek alternative treatment options. Of those states that created affordability review bills, only 22 percent specify OPOE (off-patent, off-exclusivity) brand-name drugs, which are cheaper than patent-protected, brand-name drugs and more prone to price hikes — as demonstrated by this team’s 2020 study. The study recommends creating separate review thresholds for OPOE drugs to ensure they are not misclassified as brand-name drugs, which are allowed higher price increase thresholds.”Prescription drug price increases inflate national health spending and are disproportionately felt by patients who are uninsured or have high deductibles,” said Arman Shahriar, a U of M Medical School student and first author of the study. “Despite prescription drug price increases being a known problem for years, little has been done at the federal level, and states have not been unified in their approach. We want to make state lawmakers aware of the current landscape and future directions of this legislation.”
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Materials provided by University of Minnesota Medical School. Original written by Angel Mendez. Note: Content may be edited for style and length.

University of Minnesota Medical School researchers determined that the common blood pressure medication, losartan, is not effective in reducing hospitalization for mildly-ill COVID-19 outpatients.
In the multicenter, randomized, double-blinded clinical trial, non-hospitalized patients recently diagnosed with COVID-19 were given either losartan or a placebo and monitored for 15 days. The study’s results, which were published in EClinicalMedicine, showed that although losartan does not reduce the likelihood of hospitalization, the medication does not appear to worsen symptoms of COVID-19 or have any significant or harmful side effects on patients with mild COVID-19.
“Based on our results, there is no benefit to starting losartan for newly diagnosed outpatients with COVID-19, but those who are already taking the medication for pre-existing health conditions should feel safe continuing it,” said Michael Puskarich, MD, an associate professor in the Department of Emergency Medicine at the U of M Medical School and co-principal investigator of this study. He is also an emergency physician at Hennepin Healthcare.
Conflicting hypotheses since the start of the pandemic led this research team to investigate losartan as a potential treatment option. While some experts believed drugs like losartan may reduce inflammation and help those infected recover, others worried that the drug could worsen COVID-19 symptoms.
“Given SARS-CoV-2 binding with ACE2 there has been significant research interest into the utility of ACE and AT1R blocking agents to combat COVID-19. This study provides insight that for patients with mild COVID-19, who do not require hospital admission, that there is no benefit or harm from such agents,” said co-principal investigator Christopher Tignanelli, MD, MS, an assistant professor in the Department of Surgery at the U of M Medical School and critical care surgeon with M Health Fairview.
The same team has been working on another trial for inpatients to evaluate if losartan prevents lung injury in hospitalized patients with COVID-19 pneumonia. They have completed enrollment and are currently analyzing the data.
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Materials provided by University of Minnesota Medical School. Original written by Kelly Glynn. Note: Content may be edited for style and length.

Researchers from The University of Texas Health Science Center at San Antonio (UT Health San Antonio) and colleagues worldwide describe a new science-based intervention for hiccups in a research letter published June 18 in the journal JAMA Network Open.
In the publication, the scientists coined a new term for the intervention: the “forced inspiratory suction and swallow tool,” or FISST. The team also reported the results of a survey of 249 users who were asked whether it is superior to hiccup home remedies such as breathing into a paper bag.
The need
“Hiccups are occasionally annoying for some people, but for others they significantly impact quality of life,” said Ali Seifi, MD, associate professor of neurosurgery in UT Health San Antonio’s Joe R. and Teresa Lozano Long School of Medicine. “This includes many patients with brain and stroke injury, and cancer patients. We had a couple of cancer patients in this study. Some chemotherapies cause hiccups.”
Simple tool
FISST is a rigid drinking tube with an inlet valve that requires forceful suction to draw water from a cup into the mouth. The suction and swallow simultaneously stimulate two nerves, the phrenic and vagus nerves, to relieve hiccups.

A hydrogel that forms a barrier to keep heart tissue from adhering to surrounding tissue after surgery was developed and successfully tested in rodents by a team of University of California San Diego researchers. The team of engineers, scientists and physicians also conducted a pilot study on porcine hearts, with promising results.
They describe their work in the June 18, 2021 issue of Nature Communications.
In rats, the hydrogel prevented the formation of adhesions altogether. In a small pilot study, porcine hearts treated with the hydrogel experienced less severe adhesions that were easier to remove. In addition, the hydrogel did not appear to cause chronic inflammation.
Adhesions — organ tissue sticking to surrounding tissue — are a relatively common problem when surgeons need to operate again at the same site, which happens in 20 percent of cases every year in cardiac surgery. Re-operations are particularly common when the patients are children suffering from cardiac malformations — as the child’s heart grows, additional interventions are needed.
Adhesions form within the first 30 days post-op and can complicate operations and increase the risk of mortality during interventions. In some cases, they can also interfere with proper heart function or completely prevent a repeat surgery. One of the paper’s senior authors, UC San Diego bioengineering professor Karen Christman, experienced this when one of her uncles couldn’t have a heart valve repaired because of severe adhesions.
“Our work is an engineering solution driven by a medical problem,” said Christman, who co-founded a company, Karios Technologies, to bring the hydrogel into the clinic. “And now it’s poised to significantly improve cardiac surgery, both for adults and children.”
The work brought together not only bioengineers and physicians, but also chemists and materials scientists.