Publisher Health

Campaigns in some countries have reduced the practice, but it remains widespread in those with high rates of population growth.More than 230 million women and girls around the world have undergone female genital cutting, according to a new analysis byUNICEF, an increase of 30 million since the organization’s last global estimate in 2016.While the data shows that in some countries a new generation of parents have chosen to forgo the practice, in other countries laws and campaigns against it have had no impact. In Burkina Faso, the share of girls aged 15 to 19 years who have undergone cutting has fallen to 39 percent from 82 percent over the past three decades. But in Somalia, where an estimated 99 percent of women have had their clitoris excised, the level of cutting has not changed.Because the countries where the practice is most prevalent are also those with the highest rates of population growth, the overall number of girls who are subject to cutting is growing each year.“The total number of women and girls is 15 percent higher than the last estimate,” said Claudia Cappa, an expert on global trends in female genital cutting with UNICEF. “The progress that has been made is too slow compared to the growth of the population of girls who are born each day in the countries that are most affected.”The United Nations has set the goal of eliminating female genital cutting by 2030, but change would need to be occurring 27 times faster than the current rate to meet that goal, she said. In Sierra Leone, Kadiatu Bangora used to perform cutting as part of traditional community rituals. But she gave up the practice and refused to allow it for her daughters.Finbarr O’Reilly for The New York TimesWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Landmark study contradicts misinformation about brain development and conditions like autism in children.
The COVID vaccine is safe to administer during pregnancy, reports UC San Francisco in an important finding on the safety of the vaccine in infants — despite widespread fear and misinformation.
The study, published in JAMA Pediatrics, is the first scientific inquiry into whether infants are at increased risk of neurodevelopmental impairments as a result of maternal vaccination.
The landmark study of more than 2,200 infants from across the country found that in utero exposure to the vaccine caused no abnormal delays when the infants were tested at 12 months and again at 18 months.
“This is a very reassuring finding — pregnant women have been facing unanswered questions around COVID vaccinations for several years,” said first author Eleni Jaswa, MD, MSc, a reproductive endocrinologist and fertility specialist at UCSF Health, noting the investigation started in April 2020. She is also an assistant professor in the UCSF Department of Obstetrics, Gynecology & Reproductive Sciences.
First meaningful evidence of maternal vaccination safety during pregnancy
Although pregnant women are considered at increased risk of severe illness with COVID-19, some chose not to get the COVID vaccine due to safety concerns around potential risks to their unborn children.

Some 34% of the participants in the study were vaccinated in the first trimester, about 45% in the second trimester, and nearly 21% in the third trimester. They were asked to complete a 30-item questionnaire assessing whether their infants performed expected milestones.
After adjusting for such factors as maternal age, race, ethnicity, education, income and maternal depression, the researchers found no difference in the risk of infant neurodevelopment at either 12 months or 18 months. They noted an increased risk of delay among male infants at 12 months but the difference was not observed at 18 months.
The study is ongoing.
“Understandably, there’s been concern about the potential impact of maternal vaccination on offspring,” said senior author Heather Huddleston, MD, a UCSF Health reproductive endocrinologist and director of the UCSF Polycystic Ovary Syndrome Clinic (PCOS).
“Despite early safety data as well as recommendations from physicians and health organizations, vaccine hesitancy is still preventing universal use,” she said. “To this day, misinformation continues to abound. People are concerned about such issues as brain development and conditions like autism in children. This is the first meaningful evidence into the safety of vaccination from the standpoint of early offspring neurodevelopment.”
Co-authors: All from UCSF, the paper’s co-authors are Marcelle Cedars, MD; Karla Lindquist, PhD; Somer Bishop, PhD; Young-Shin Kim, MD, MPH, PhD; Amy Kaing, MD; Mary Prahl, MD; Stephanie Gaw, MD, PhD; Jamie Corley, BS; Elena Hoskin, MS; Yoon Jae Cho, MD; and Elizabeth Rogers, MD.

Retinoic acid, the active state of Vitamin A, appears to regulate how stem cells enter and exit a transient state central to their role in wound repair.
When a child falls off her bike and scrapes her knee, skin stem cells rush to the rescue, growing new epidermis to cover the wound. But only some of the stem cells that will ultimately patch her up are normally dedicated to replenishing the epidermis that protects her body. Others are former hair follicle stem cells, which usually promote hair growth but respond to the more urgent needs of the moment, morphing into epidermal stem cells to bolster local ranks and repair efforts. To do that, these hair follicle stem cells first enter a pliable state in which they temporarily express the transcription factors of both types of stem cells, hair and epidermis.
Now, new research demonstrates that once stem cells have entered this state, known as lineage plasticity, they cannot function effectively in either role until they choose a definitive fate. In a screen to identify key regulators of this process, retinoic acid, the biologically active form of Vitamin A, surfaced as a surprising rheostat. The findings shed light on lineage plasticity, with potential clinical implications.
“Our goal was to understand this state well enough to learn how to dial it up or down,” says Rockefeller’s Elaine Fuchs. “We now have a better understanding of skin and hair disorders, as well as a path toward preventing lineage plasticity from contributing to tumor growth.”
Indecisive stem cells
Lineage plasticity has been observed in multiple tissues as a natural response to wounding and an unnatural feature of cancer. But minor skin injuries are the best place to study the phenomenon, because the skin’s outer layers are subject to perpetual abuse. And when the scratches or abrasions damage the epidermis, hair follicle stem cells are the first responders.
Fuchs and colleagues began to look more closely at lineage plasticity because it, “can act as a double edged sword,” explains Matthew Tierney, lead author on the paper and an NIH K99 “pathway to independence” postdoctoral awardee in the Fuchs lab. “The process is necessary to redirect stem cells to parts of the tissue most in need but, if left unchecked, it can leave those same tissues vulnerable to chronic states of repair and even some types of cancer.”
To better understand how the body regulates this process, Fuchs and her team screened small molecules for their ability to resolve lineage plasticity in cultured mouse hair follicle stem cells, under conditions that mimicked a wound state. They were surprised to find that retinoic acid, a biologically active form of vitamin A, was essential for these stem cells to exit lineage plasticity and then be coaxed to differentiate into hair cells or epidermal cells in vitro.

“Through our studies, first in vitro and then in vivo, we discovered a previously unknown function for vitamin A, a molecule that has long been known to have potent but often puzzling effects on skin and many other organs,” Fuchs says. The team found that genetic, dietary, and topical interventions that boosted or removed retinoic acid from mice all confirmed its role in balancing how stem cells respond to skin injuries and hair regrowth. Interestingly, retinoids did not operate on their own: their interplay with signaling molecules such as BMP and WNT influenced whether the stem cells should maintain quiescence or actively engage in regrowing hair.
The nuance did not stop there. Fuchs and colleagues also demonstrated that retinoic acid levels must fall for hair follicle stem cells to participate in wound repair — if levels are too high, they fail to enter lineage plasticity and can’t repair wounds — but if the levels are too low, the stem cells focus too heavily on wound repair, to the expense of hair regeneration.
“This may be why vitamin A’s effects on tissue biology have been so elusive,” Fuchs says.
Vitamin A takes center stage
One result of retinol biology remaining obscure for so long is that retinoid and vitamin A applications have long produced confusing results. Topical retinoids are known to stimulate hair growth in wounds, but excessive retinoids have been shown to prevent hair cycling and cause alopecia; both positive and negative effects of retinoids on epidermal repair have been documented through various studies. The present study bringd greater clarity by casting retinoids in a more central role — at the helm of regulating both hair follicle and epidermal stem cells.
“By defining the minimal requirements needed to form mature hair cell types from stem cells outside the body, this work has the potential to transform the way we approach the study of hair biology,” Tierney says.

How retinoids impact other tissues remains to be seen. “When you eat a carrot, vitamin A gets stored in the liver as retinol where it is sent to various tissues,” Fuchs says. “Many tissues that receive retinol and convert it to retinoic acid need wound repair and use lineage plasticity, so it will be interesting to see how broad the implications of our findings in skin will be.”
The Fuchs lab is also interested in how retinoids impact lineage plasticity in cancer, particularly squamous and basal cell carcinoma. “Cancer stem cells never make the right choice — they are always doing something off-beat,” Fuchs says. “As we were studying this state in many types of stem cells, we began to realize that, when lineage plasticity goes unchecked, it’s a key contributor to cancer.”
Basal cell carcinomas have relatively little lineage plasticity and are far less aggressive than squamous cell carcinomas. If future studies demonstrate that suppressing lineage plasticity is key to controlling tumor growth and improving outcomes, retinoids may have a key role to play in treating these cancers.
“It’s possible that suppressing lineage plasticity can improve prognoses,” Fuchs says. “This hasn’t been on the radar until now. It’s an exciting front to now investigate.”

A widespread bacteria called Wolbachia and a virus that it carries can cause sterility in male insects by hijacking their sperm, preventing them from fertilizing eggs of females that do not have the same combination of bacteria and virus. A new study led by microbiome researchers at Penn State has uncovered how this microbial combination manipulates sperm, which could lead to refined techniques to control populations of agricultural pests and insects that carry diseases like Zika and dengue to humans.
The study is published in the March 8 issue of the journal Science.
“Wolbachia is the most widespread bacteria in animals and lives symbiotically within the reproductive tissues of about 50% of insect species, including some mosquitos and flies,” said Seth Bordenstein, professor of biology and entomology, director of the One Health Microbiome Center at Penn State, and one of the leaders of the research team. “Wolbachia has genes from a virus called prophage WO integrated into its genome. These genes — cifA and cifB — allow the bacteria to remarkably manipulate sperm and quickly spread through an insect population for their own good.”
When a male and female insect that both have Wolbachia mate, they successfully reproduce and pass on the bacteria. But when a male with Wolbachia mates with a female with no Wolbachia, the sperm are rendered lethal to the fertilized eggs, succumbing them to death. This system cunningly increases the proportion of offspring with Wolbachia and the virus in the next generation, because females with the bacteria successfully reproduce more frequently than females without.
This system is being used in several ongoing pilot studies across the world to control insect pests and the harmful viral diseases they carry. For example, to control a population of agricultural or human pests that do not have the bacteria, scientists release males with Wolbachia in order to crash the population.
“One of Wolbachia’s superpowers is that it blocks pathogenic RNA viruses such as Zika, dengue and chikungunya virus, so mosquitos with Wolbachia do not pass these viruses on to people when they bite,” Bordenstein said. “So, releases of both male and female mosquitos with Wolbachia in an area where it isn’t already present leads to replacement of the population with mosquitos that can no longer pass on a viral disease. The World Mosquito Program is now using Wolbachia to control viruses in 11 countries. With this study, we reveal the underlying mechanics of how this process works so we can fine-tune the technique to expand its scope in vector control measures.”
Wolbachia’s prophage WO genes code for proteins that interfere with normal development of sperm cells. These proteins impact a critical transformation during sperm development, when the sperm’s genome is repackaged and the sperm changes from a canoe-shape into a more refined needle-like shape.

“This shape change is incredibly important to the success of sperm, and any interference can impact the sperm’s ability to travel in the female reproductive tract and successfully fertilize the egg,” said Rupinder Kaur, assistant research professor of biology and entomology at Penn State and the other leader of the research team. “The transition is highly conserved in almost everything from insects to humans. Defects in this process can also cause male sterility in humans.”
According to the researchers, sperm is particularly prone to DNA damage and repair during this transition. In this study, they found that sperm exposed to Wolbachia, or the Cif proteins alone, had an elevated level of DNA damage at this stage. The DNA damage, if not repaired in a timely fashion, can result in abnormal sperm genome packaging, male infertility and embryonic inviability.
“These results confirmed the impact of Wolbachia and Cif proteins at this stage of sperm development, but we still wanted to know what was happening at earlier stages to trigger these changes,” Kaur said. “We conducted a series of tests to explore the structure and biochemical function of the Cif proteins and found that they can cleave messenger molecules called long non-coding RNA, which sets the stage to interfere with downstream development and function of the sperm.”
The researchers used fruit flies with Wolbachia to test the potential link between the bacteria and long non-coding RNA. They found that Wolbachia — or the Cif proteins alone — reduced the amount of these RNAs. Additionally, mutant flies with reduced expression of these RNAs in conjunction with Wolbachia had elevated levels of embryonic inviability because it augmented the defective transition process of sperm development. So, Kaur explained, the virus proteins control sperm by depleting the long non-coding RNAs required for a normal sperm function.
“Long non-coding RNAs do not make any proteins themselves, but they can have profound impacts on regulating the function of other genes required for sperm development,” Bordenstein said. “By altering this non-coding part of the genome, we found that Cif proteins start impacting sperm right from the earliest stages of development. Wolbachia’s prophage WO genes act like master puppeteers, manipulating sperm development in a way that allows their genes and the symbiotic bacteria to quickly spread through arthropod populations.”
Because the process of sperm development looks similar across the animal kingdom, the researchers said that knowledge of this process could lend insight into sterility challenges in humans as well as inform new control methods of harmful insect populations.
“Now that we have reverse engineered this process, we can fine tune methods of population control with Wolbachia that are already in use,” Kaur said. “We plan to take advantage of this knowledge to augment currently existing disease vector and pest control methods, and perhaps emulate the technique without Wolbachia or virus proteins in the long-term.”
In addition to Bordenstein and Kaur, the research team includes Angelina McGarry, research technologist II at Penn State; J. Dylan Shropshire, assistant professor at Lehigh University; and Brittany Leigh, a postdoctoral researcher at Vanderbilt University at the time of the research.
Funding from the National Institutes of Health, the U.S. National Science Foundation and Penn State supported this research.

Researchers led by Northwestern University and Washington University School of Medicine in St. Louis have developed a new, first-of-its-kind sticker that enables clinicians to monitor the health of patients’ organs and deep tissues with a simple ultrasound device.
When attached to an organ, the soft, tiny sticker changes in shape in response to the body’s changing pH levels, which can serve as an early warning sign for post-surgery complications such as anastomotic leaks. Clinicians then can view these shape changes in real time through ultrasound imaging.
Currently, no existing methods can reliably and non-invasively detect anastomotic leaks — a life-threatening condition that occurs when gastrointestinal fluids escape the digestive system. By revealing the leakage of these fluids with high sensitivity and high specificity, the non-invasive sticker can enable earlier interventions than previously possible. Then, when the patient has fully recovered, the biocompatible, bioresorbable sticker simply dissolves away — bypassing the need for surgical extraction.
The study will be published on Friday (March 8) in the journal Science. The paper outlines evaluations across small and large animal models to validate three different types of stickers made of hydrogel materials tailored for the ability to detect anastomotic leaks from the stomach, the small intestine and the pancreas.
“These leaks can arise from subtle perforations in the tissue, often as imperceptible gaps between two sides of a surgical incision,” said Northwestern’s John A. Rogers, who led device development with postdoctoral fellow Jiaqi Liu. “These types of defects cannot be seen directly with ultrasound imaging tools. They also escape detection by
even the most sophisticated CT and MRI scans. We developed an engineering approach and a set of advanced materials to address this unmet need in patient monitoring. The technology has the potential to eliminate risks, reduce costs and expand accessibility to rapid, non-invasive assessments for improved patient outcomes.”
“Right now, there is no good way whatsoever to detect these kinds of leaks,” said gastrointestinal surgeon Dr. Chet Hammill, who led the clinical evaluation and animal model studies at Washington University with collaborator Dr. Matthew MacEwan, an assistant professor of neurosurgery. “The majority of operations in the abdomen — when you have to remove something and sew it back together — carry a risk of leaking. We can’t fully prevent those complications, but maybe we can catch them earlier to minimize harm. Even if we could detect a leak 24- or 48-hours earlier, we could catch complications before the patient becomes really sick. This new technology has potential to completely change the way we monitor patients after surgery.”
A bioelectronics pioneer, Rogers is the Louis Simpson and Kimberly Querrey Professor of Materials Science and Engineering, Biomedical Engineering and Neurological Surgery, with appointments at the McCormick School of Engineering and Northwestern University Feinberg School of Medicine. He also directs the Querrey Simpson Institute for Bioelectronics. At the time of the research, Hammill was an associate professor of surgery at Washington University. Rogers, Hammill and MacEwan co-led the research with Heling Wang, an associate professor at Tsinghua University in Beijing.

The importance of being early
All gastrointestinal surgeries carry the risk of anastomotic leaks. If the leak is not detected early enough, the patient has a 30% chance of spending up to six months in the hospital and a 20% chance of dying, according to Hammill. For patients recovering from pancreatic surgery, the risks are even higher. Hammill says a staggering 40-60% of patients suffer complications after pancreas-related surgeries.
The biggest problem is there’s no way to predict who will develop such complications. And, by the time the patient is experiencing symptoms, they already are incredibly ill.
“Patients might have some vague symptoms associated with the leak,” Hammill said. “But they have just gone through big surgery, so it’s hard to know if the symptoms are abnormal. If we can catch it early, then we can drain the fluid. If we catch it later, the patient can get sepsis and end up in the ICU. For patients with pancreatic cancer, they might only have six months to live as it is. Now, they are spending half that time in the hospital.”
In search of improved outcomes for his patients, Hammill contacted Rogers, whose laboratory specializes in developing engineering solutions to address health challenges. Rogers’ team had already developed a suite of bioresorbable electronic devices to serve as temporary implants, including dissolving pacemakers, nerve stimulators and implantable painkillers.
The bioresorbable systems piqued Hammill’s interest. The greatest odds of developing an anastomotic leak occur either three days or two weeks after surgery.

“We like to monitor patients for complications for about 30 days,” Hammill said. “Having a device that lasts a month and then disappears sounded ideal.”
Enhancing ultrasound
Instead of developing new imaging systems, Rogers speculated that his team might be able to enhance current imaging methods — allowing them to “see” features that otherwise would be invisible. Ultrasound technology already has many advantages: it’s inexpensive, readily available, does not require cumbersome equipment and does not expose patients to radiation or other risks.
But, of course, there is a major drawback. Ultrasound technology — which uses sound waves to determine the position, shape and structure of organs — cannot reliably differentiate between various bodily fluids. Blood and gastric fluid, for example, appear the same.
“The acoustic properties of the leaking fluids are very similar to those of naturally occurring biofluids and surrounding tissues,” Rogers said. “The clinical need, however, demands chemical specificity, beyond the scope of fundamental mechanisms that create contrast in ultrasound images.”
Ultimately, Rogers’ team devised an approach to overcome this limitation by using tiny sensor devices designed to be readable by ultrasound imaging. Specifically, they created a small, tissue-adhesive sticker out of a flexible, chemically responsive, soft hydrogel material. Then, they embedded tiny, paper-thin metal disks into the thin layers of this hydrogel. When the sticker encounters acidic fluids, such as stomach acid, it swells. When the sticker encounters caustic fluids, such as pancreatic fluids, it contracts.
Making the invisible visible
As the hydrogel swells or shrinks in response to changing pH, the metal disks either move apart or closer together, respectively. Then, the ultrasound can view these subtle changes in placement.
“Because the acoustic properties of the metal disks are much different than those of the surrounding tissue, they provide very strong contrast in ultrasound images,” Rogers said. “In this way, we can essentially ‘tag’ an organ for monitoring.” Because the need for monitoring extends only during a postsurgical recovery, Rogers team designed these stickers with bioresorbable materials. They simply disappear naturally and harmlessly in the body after they are no longer needed.
Computational collaborator Yonggang Huang, the Jan and Marcia Achenbach Professorship in Mechanical Engineering and professor of civil and environmental engineering at McCormick, used acoustic and mechanical simulation techniques to help guide optimized choices in materials and device layouts to ensure high visibility in ultrasound images, even for stickers located at deep positions within the body.
“CT and MRI scans just take a picture,” Hammill added. “The fluid might show up in a CT image, but there’s always fluid collections after surgery. We don’t know if it’s actually a leak or normal abdominal fluid. The information that we get from the new patch is much, much more valuable. If we can see that the pH is altered, then we know that something isn’t right.”
Rogers team constructed stickers of varying sizes. The largest measures 12 millimeters in diameter, while the smallest is just 4 millimeters in diameter. Considering that the metal disks are each 1 millimeter or smaller, Rogers realized that it might be difficult for radiologists to assess the images manually. To overcome this challenge, his team also developed software that can automatically analyze the images to detect with high accuracy any relative movement of the disks.
Improving quality of life
To evaluate the efficacy of the new sticker, Hammill’s team tested it in both small and large animal models. In the studies, ultrasound imaging consistently detected changes in the shape-shifting sticker — even when it was 10 centimeters deep inside of tissues. When exposed to fluids with abnormally high or low pH levels, the sticker altered its shape within minutes.
Rogers and Hammill imagine that the device could be implanted at the end of a surgical procedure. Or, because it’s small and flexible, the device also fits (rolled up) inside a syringe, which clinicians can use to inject the tag into the body.
“These tags are so small and thin and soft that surgeons can easily place collections of them at different locations,” Rogers said. “For example, if an incision extends by a few centimeters in length, an array of these tags can be placed along the length of the site to develop a map of pH for precisely locating the position of the leak.”
“It’s obviously an early prototype, but I can envision the final product where, at the end of surgery, you just place these little patches for monitoring,” Hammill said. “It does its job and then completely disappears. This could have a huge impact on patients, their recovery time and, ultimately, their quality of life.”
Next, Rogers and his team are exploring similar tags that could detect internal bleeding or temperature changes. “Detecting changes in pH is a good starting point,” Rogerssaid. “But this platform can extend to other types of applications by use of hydrogels that respond to other changes in local chemistry, or to temperature or other properties of clinical relevance.”
The study, “Bioresorbable shape-adaptive structures for ultrasonic monitoring of deep-tissue homeostasis,” was supported by the National Science Foundation, the National Cancer Institute and the Querrey-Simpson Institute for Bioelectronics.

The nationwide baby formula shortage two years ago forced many parents to involuntarily switch brands or types. A recent survey from researchers at the University of California, Davis, highlights how these substitutions led to undesirable effects for babies, including vomiting. The study was published in the journal Nutrients.
In an online survey of 178 parents whose infants were under six months of age during the May 2022 shortage, 81% of respondents switched formulas, with 87% of those switching because they could not find the formula they typically used.
“We have so many food choices as adults; you can eat anything,” said Jennifer Smilowitz, assistant professor of Cooperative Extension for the Department of Nutrition who is a corresponding author of the study. “Infants have strict nutrient requirements; they can only eat two things: human milk and formula.”
Abbott Nutrition, one of the largest U.S. infant formula manufacturers, recalled multiple brands of its powdered formula products in 2022 due to bacterial contamination. The move exacerbated existing shortages caused by pandemic-related supply chain issues.
Researchers found that 60% of infants whose parents had to switch formulas had experienced issues such as fussiness, gas, spit-up, constipation and diarrhea. Infants who relied on specialty formulas due to a medical or metabolic condition, experienced these issues more frequently than babies who had not required specialty formulas.
“I was really shocked to see so many babies have adverse effects from changing formulas, that’s something we don’t really talk about,” Smilowitz said.
The survey shows about 30% of parents switched formulas three to five times during the shortage. They also visited more than four stores in a 24-hour period to find baby formula and traveled more than 20 miles in a 24-hour period to purchase formula.

“If you have a young baby, that’s a burden,” Smilowitz said.
Building a better future
This is the second survey Smilowitz and researchers conducted on this topic. Last year, they published a paper that showed that 48.5% of individuals used at least one unsafe feeding practice during the shortage, up from 8% before.
To help them navigate the formula shortage, parents relied on several resources, including social media (51%) and healthcare providers (48%), followed by relatives or friends (43%), and lactation consultant or lactation counselor (30%), according to the latest survey.
Smilowitz hopes the findings from these surveys will spur changes to healthcare policies and programs to improve the resiliency of the infant food system and hopefully prevent infant-feeding crises in the future. She said informing mothers about their options and resources during and immediately after their pregnancies would be a step in the right direction.
“We see there’s a systematic problem in the infant feeding supply and that is a result of a lack of lactation education and support and priority in human milk feeding,” she said. “We need to improve infants’ food supply and it starts with supporting mothers and babies.”
The research was funded in part by the 2020 UC Davis Chancellor’s Innovation Award. Other listed co-authors are Karla Damian-Medina, Karina Cernioglo and Maha Waheed with the Department of Nutrition, as well as researchers from New York Langone Medical Center and Yale University School of Medicine.

Many suffered setbacks after the State Supreme Court ruled that frozen embryos were children. “Someone else’s opinion changed my future,” one woman said.Leelee Ray and her husband, Austin, have been trying to have a baby for six years, through insemination procedures, two egg retrievals, four embryo transfers, an ectopic pregnancy that could have been deadly and eight miscarriages.With four frozen embryos remaining in storage at a fertility clinic, the Rays, who live in Huntsville, Ala., decided to change course. In February, they turned to an agency in Colorado, where laws about gestational carriers are more forgiving than in Alabama, to find a woman to carry their baby.It all came to a halt just days later, when the Alabama Supreme Court ruled that frozen embryos should be considered “extrauterine children” under state law and several fertility clinics in the state suspended I.V.F. treatments.“When I called my clinic to ask how quickly I could get my embryos out of the state, they told me everything was paused, including shipping embryos,” Ms. Ray, 35, said.Hoping to quell a national furor over the court’s decision, Gov. Kay Ivey, a Republican, signed legislation on Wednesday night shielding I.V.F. clinics against civil actions and criminal prosecutions related to the handling of embryos.But for would-be parents like the Rays, considerable damage had already been done. The ruling disrupted fertility treatments that are expensive, physically and emotionally taxing, and extremely time-sensitive, guzzling precious resources that many couples did not have. Their experiences may soon be repeated in other states as anti-abortion forces push to redefine the beginning of life.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The NewsIncreasingly, doctor visits by adolescents and young adults involve mental health diagnoses, along with the prescription of psychiatric medications.That was the conclusion of a new study that found that in 2019, 17 percent of outpatient doctor visits for patients ages 13 to 24 in the United States involved a behavioral or mental health condition, including anxiety, depression, suicidal ideation, self-harm or other issues. That figure rose sharply from 2006, when just 9 percent of doctor’s visits involved psychiatric illnesses.The study, published Thursday in JAMA Network Open, also found a sharp increase in the proportion of visits involving psychiatric medications. In 2019, 22.4 percent of outpatient visits by the 13-24 age group involved the prescription of at least one psychiatric drug, up from 13 percent in 2006.The Big PictureThe study is the latest evidence in a shift in the kinds of ailments affecting children, adolescents and young adults. For many decades, their health care visits involved more bodily ailments, such as broken bones, viruses and drunken-driving injuries. Increasingly, however, doctors are seeing a wide variety of behavioral and mental health issues.Marshall Motsenbocker, standing right, a researcher at the University of Texas Southwestern Medical Center, leading a mental health session at a school in Dallas in 2018.Benny Snyder/Associated PressThe reasons are not entirely clear. Some experts have said that modern life presents a new kind of mental pressure, even as society has limited the risks of physical ailments.The latest study does not posit a reason for the shift. But the pandemic alone was not to blame, it noted. “These findings suggest the increase in mental health conditions seen among youth during the pandemic occurred in the setting of already increasing rates of psychiatric illness,” wrote the authors, a pediatrician and psychiatrist at Harvard Medical School. “Treatment and prevention strategies will need to account for factors beyond the direct and indirect effects of the pandemic.”The NumbersThe analysis was drawn from the National Ambulatory Care Survey, which asks a sample of clinicians from across the country about the reasons for patient visits. Between 2006 and 2019, patients aged 13 to 24 made 1.1 billion health care visits, of which 145 million involved mental health issues. But the share of mental-health-related visits rose each year, the study found, as did the prescription of psychiatric medications, including stimulants, antipsychotics, mood stabilizers and anti-anxiety drugs.The study found that antidepressants had the greatest increase, but it did not specify the exact level, said Dr. Florence T. Bourgeois, a pediatrician at Boston Children’s Hospital, an associate professor of pediatrics at Harvard Medical School and a co-author of the paper.The prescription patterns leave an open question, she said.“We can’t differentiate whether this speaks to the severity of conditions or changes in prescribing attitudes and trends,” she said. Either way, she added, “We are treating these conditions aggressively.”

In the four years after the border wall height was increased from 17 feet to 30 feet along the US-Mexican border, drowning deaths of migrants in the Pacific Ocean off the coast of San Diego increased by 3200%, according to a new study published in JAMA. Co-authors Anna Lussier, M.D, Ph.D. student in the University of California San Diego School of Medicine, and Peter Lindholm, M.D., Ph.D., Gurnee Endowed Chair of Hyperbaric and Diving Medicine Research and professor in residence in the Department of Emergency Medicine at UC San Diego School of Medicine, hypothesized that the change in wall-height may have resulted in an increase in marine and maritime migration attempts, resulting in more frequent drownings.
The study relied largely on publicly available data from the Missing Migrants Project (MMP), an initiative of the International Organization for Migration (IOM), which coordinates the UN network on migration and compiles data on migrants, refugees, and asylum seekers who die during migration journeys.
The researchers analyzed MMP data across two 4-year periods: 2016-2019, before the 30-foot wall was completed, and 2020-2023, after construction was finished. They categorized deaths according to the body of water in which they occurred — the San Diego region of the Pacific Ocean; canals; and other bodies of water, such as lakes, streams, or drainage ditches. These were compared against drowning rates in the Rio Grande, where the wall is largely absent.
Contrasting before-and-after rates, drowning in the San Diego region of the Pacific Ocean rose from 1 in the four years prior to the wall height change to 33 in the four years after, a net increase of 3200%. In canals, that figure rose from 49 to 64 drownings, an increase of 30.6%, and in other bodies of water, from 15 to 35, an increase of 133.3%. Along the Rio Grande, those numbers remained relatively stable across both periods, with 97 drownings prior to 2020, and 96 drownings after, for a net decrease of 1.03%.
Explains Lindholm, “Looking at the numbers, you can see that it’s about the same in the Rio Grande, and it’s a little more but not extraordinarily more in the ditches and canals. We don’t have absolute data on how many people migrated, but if the number of drownings was related to the rate of migration, you would probably have a similar increase at all places.”
The impetus for the paper came when Lussier discovered an information gap on migrant drowning deaths. She and Lindholm had been looking into the occupational health of people who work in the maritime environment in San Diego, such as lifeguards exposed to pollution and marine contamination. “The lifeguards showed us a presentation on migrant rescues they were performing because of potential human smuggling,” said Lussier, who is also a doctoral student at UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science, whose PhD studies focus on global public health. “Their stories weren’t showing up in the news, and the numbers struck me as odd.”
To fill the information gap, Lussier searched government datasets for data on marine migration and migrant drowning death. The data she was looking for was not readily available and often lacked critical factors, such as the baseline number of people who tried migrating — what Lussier refers to as “the missing denominator.” Lussier eventually chose the MMP, which records the date and coordinates of each drowning and the number of people who drowned. That enabled her and Lindholm to compile a snapshot of migrant drowning deaths before and after the wall was augmented.

Maritime migration is a growing public health issue, and both Lussier and Lindholm feel that their unusual collaboration, which marries global public health with marine and undersea medicine, gives them a unique perspective that will enable them to make innovative contributions to the field.
They’re currently working on a more granular view of their before-and-after picture, teasing apart the numbers to discern their meaning in greater detail. For instance, “drowning” is a bit of a gray zone, said Lindholm. “Drowning is the endpoint of death in the water, but we’re trying to determine the actual cause of death: hypothermia? Hypoxia? Swimming induced pulmonary edema?”
Lussier says they want to expand their dataset to multiple regions and other factors that may be involved, such as weather and water temperature. “Are more people drowning at a certain time of year, for instance? Can other sources give us information about the missing denominator of how many people tried migrating? Basically, we have this one data point, and now we want to understand what’s happening beyond this simple change in numbers.”
One of their end goals is to better understand medical outcomes among migrants who survive drowning, such as infections from contaminated water, lung injuries — even impacts on mental health. The scientists are also hoping to provide data that can inform decision making for policymakers and EMS systems, as well as those who provide medical care to migrants who survive marine migrations.

With technology developed at UC Riverside, scientists can, for the first time, make high resolution images of the human spinal cord during surgery. The advancement could help bring real relief to millions suffering chronic back pain.
The technology, known as fUSI or functional ultrasound imaging, not only enables clinicians to see the spinal cord, but also enables them to map the cord’s response to various treatments in real time. A paper published today in the journal Neuron details how fUSI worked for six people undergoing electrical stimulation for chronic back pain treatment.
“The fUSI scanner is freely mobile across various settings and eliminates the requirement for the extensive infrastructure associated with classical neuroimaging techniques, such as functional magnetic resonance imaging (fMRI),” said Vasileios Christopoulos, assistant professor of bioengineering at UCR who helped develop the technology. “Additionally, it offers ten times the sensitivity for detecting neuroactivation compared to fMRI.”
Until now, it has been difficult to evaluate whether a back pain treatment is working since patients are under anesthesia and asleep. Thus, the patients cannot provide verbal feedback on their pain levels during treatment. “With ultrasound, we can monitor blood flow changes in the spinal cord induced by the electrical stimulation. This can be an indication that the treatment is working,” Christopoulos said.
The spinal cord is an “unfriendly area” for traditional imaging techniques due to significant motion artifacts, such as heart pulsation and breathing. “These movements introduce unwanted noise into the signal, making the spinal cord an unfavorable target for traditional neuroimaging techniques,” Christopoulos said.
By contrast, fUSI is less sensitive to motion artifacts. It emits sound waves into the area of interest, and red blood cells in that area echo the sound, producing a clear image. “It’s like submarine sonar, which uses sound to navigate and detect objects underwater,” Christopoulos said. “Based on the strength and speed of the echo, they can learn a lot about the objects nearby.”
Christopoulos partnered with the USC Neurorestoration Center at Keck Hospital to test the technology on six patients with chronic low back pain. These patients were already scheduled for the last-ditch pain surgery, as no other treatments, including drugs, had helped to ease their suffering. For this surgery, clinicians stimulated the spinal cord with electrodes, in the hopes that the voltage would alleviate the patient’s discomfort and improve their quality of life.

“If you bump your hand, instinctively, you rub it. Rubbing increases blood flow, stimulates sensory nerves, and sends a signal to your brain that masks the pain,” Christopoulos said. “We believe spinal cord stimulation may work the same way, but we needed a way to view the activation of the spinal cord induced by the stimulation.”
The Neuron paper details how fUSI can detect blood flow changes at unprecedented levels of less than 1 millimeter per second. For comparison, fMRI is only able to detect changes of 2 centimeters per second.
“We have big arteries and smaller branches, the capillaries. They are extremely thin, penetrating your brain and spinal cord, and bringing oxygen places so they can survive,” Christopoulos said. “With fUSI, we can measure these tiny but critical changes in blood flow.”
Generally, this type of surgery has a 50% success rate. With improved monitoring of the blood flow changes, Christopoulos hopes this rate will increase dramatically. “We needed to know how fast the blood is flowing, how strong, and how long it takes for blood flow to get back to baseline after spinal stimulation. Now, we will have these answers,” Christopoulos said.
Moving forward, the researchers are also hoping to show that fUSI can help optimize treatments for patients who have lost bladder control due to spinal cord injury or age. “We may be able to modulate the spinal cord neurons to improve bladder control,” Christopoulos said.
“With less risk of damage than older methods, fUSI will enable more effective pain treatments that are optimized for individual patients,” Christopoulos said. “It is a very exciting development.”