Publisher Health

PABLO, Mont. — In the mountain streams of southern British Columbia and northern Montana, a rugged part of the world, fish with misshapen skulls and twisted spines have been caught over the years.Many scientists attribute the malformed creatures and declines in certain fish populations to five enormous open-pit coal mines that interrupt this wild landscape of dense forest flush with grizzly bears and wolves.For decades, these mines owned by Teck Resources, a multinational mining company based in Canada, have been the subject of environmental concerns because of chemicals like selenium, a mining waste product, that leach into mountain rivers flowing through Indigenous land and across the border into U.S. waterways.Selenium is a naturally occurring chemical important in the environment as a trace element. But selenium pollution has long been recognized as an extremely hazardous byproduct of coal mining. In larger concentrations, the chemical accumulates in the eggs and reproductive organs of fish and birds, and can cause a variety of detrimental effects, including lowered reproduction, deformities and death. The risk to human health from eating contaminated fish is not well understood.Teck has repeatedly disputed various state and federal regulatory standards over what should be considered as safe levels of selenium in waterways. And those limits differ for lakes and rivers and between countries, complicating oversight efforts.The latest case involves Montana and Idaho, where environmentalists’ lawsuits are waging a campaign over levels set by Montana for Lake Koocanusa in 2020. Its state standard is being challenged as a debate rages over cross-border pollution of the waterways, part of the war among regulators, tribal nations and scientists against Teck over whether the levels pose a hazard to aquatic life.In a letter in the journal Science in 2020, a group of scientists warned of the cross-boundary pollution from Canadian mines and criticized what they and others attributed to a lack of regulatory oversight. “Mine assessment and permitting do not require incorporation of transparent, independent and peer-reviewed science,” they wrote. In Canada, they said, “Teck’s Elk Valley permit allows contaminant discharges up to 65 times above scientifically established protective thresholds for fish.”They urged the Canadian and U.S. governments to begin bilateral negotiations, through the International Joint Commission, although previous appeals had gone unheeded.In March, President Biden and Prime Minister Justin Trudeau of Canada pledged to reach an agreement by this summer to reduce and mitigate the water pollution in the Elk-Kootenay watershed. U.S. and Canadian officials say they are engaged in talks to set up a bilateral process in the coming months.On the Montana standard, Teck has challenged the state’s levels, which are more restrictive than U.S. standards. “Significant, ongoing monitoring confirms selenium concentrations in the Koocanusa Reservoir are safe, not increasing and have been stable since 2012 and do not pose a risk to aquatic or human health,” said Chris Stannell, a spokesman for Teck.Fish without gills or with misshapen spines caught on the Elk River in Montana. Experts say the culprit is open-pit mining, which spills pollutants into waterways. Jim Dunnigan/Montana Fish & WildlifeIn its annual report for 2022, the company said it was continuing “to engage with U.S. regulators to work toward the establishment of appropriate science-based standards for the reservoir.” And the company has also pointed out that there are other lakes in Montana with high levels of naturally occurring selenium.Scientists in Montana, however, do not accept Teck’s assessments or assertions of levels in the lake, which spans the international border. Selenium levels in the Kootenai River have not decreased, environmentalists said.At the site where the Kootenai River empties into Lake Koocanusa in Canada, levels have steadily increased well above those metrics, said Erin Sexton, a senior scientist at the Yellow Bay Biological Station, operated by the University of Montana on Flathead Lake.. “It’s a hockey-stick graph, it just goes up and up,” she said.Provincial government officials say there are “robust monitoring and assessment programs in place” that have not detected any effects.The environmentalists’ lawsuit is seeking to preserve the more restrictive Montana standard, which has come under fire from Republican-led lawmakers and some state agency officials. In its company report, Teck questioned whether the lower limit was in force, presumably because of the internecine feud among state authorities.The U.S. level for selenium in rivers is 1.5 micrograms per liter in lakes and 3.1 in flowing rivers. Montana’s standard for Lake Koocanusa, after six years of research, was set at 0.8. The level for protection of aquatic life in British Columbia is 2.Tracing the waterway chemicalsWhen rain falls or snow melts, waste rock from the mines leaches selenium into waterways. The level of selenium in the Fording and Elk Rivers in British Columbia near the mines have at times reached levels many times higher than provincial standards. A population of genetically pure cutthroat trout in the Fording River was decimated, at least in part, by selenium levels. In 2021, Teck was fined $60 million, a record, under Canada’s Fisheries Act for release of selenium into the Fording River.The Elk River flows 140 miles from its source until it enters Lake Koocanusa, created by the damming of the Kootenai River, which straddles the border. The lake becomes the Kootenai River again below the Libby Dam in Montana and Idaho, and it flows back north into Kootenai Lake in British Columbia. Eventually it empties into the Columbia River.Unlike in an oil spill, the effects of high selenium levels do not result in large kills of fish that suddenly appear belly up in the water. Instead, selenium poisoning reduces fish numbers by causing mortality in the larval stage.“It’s a really nasty contaminant because it causes deformities in reproductive organs,” Ms. Sexton said. “They call it an invisible contaminant because they fail to thrive. You don’t find eggs that don’t hatch.”Trout fishing below the Libby Dam on the Kootenai River. “Our native fishery is extremely important to us,” said Tom McDonald, a tribal official.Grant Hindsley for The New York TimesIndigenous land concernsU.S. and tribal officials argue that the mining-related presence of chemical pollution violates the 1909 International Boundary Waters Treaty. Tribal leaders in the United States claim it may breach their treaty rights of 1855, which guarantee “taking fish at all usual and accustomed places.” They want the International Joint Commission, a U.S.-Canadian body that oversees trans-boundary disputes, to study the issue and prepare recommendations for cleanup.But the government of British Columbia has continued to oppose efforts to remedy the situation, Montana officials say.Part of the problem, Ms. Sexton said, is that the province of British Columbia allows industries, including mining companies, to largely monitor themselves and offer evidence produced by their own scientists.Mr. Stannell pointed out that the company had spent $1.2 billion on wastewater treatment near the mines, and planned to spend $750 million more to improve water quality in the coming years.A region rich in coalCoal mining in this Canadian province began more than a century ago, though the methods changed in the 1980s, when underground mining was largely abandoned for open pits.High-grade metallurgical coal is mined using a method called cross-valley fill, similar to the mountaintop-removal technique employed in West Virginia and some other states. Explosive charges blast away the top of the mountains, removing whole sections of a range, to expose rich deposits of coal. Giant shovels and massive 550-ton dump trucks mine the coal, which is transported by rail to Vancouver and then by ship to Asia, where it is essential for steel manufacturing.Other mining-related pollutants, partly from the extensive use of explosives in the blasting, include cadmium, sulfates and nitrates, experts say.Teck’s open-pit mines produce more than 21 million metric tons of coal a year. An analysis issued last year by the British Columbia Chamber of Commerce estimated that the company provided nearly 13,000 jobs in the province and $4.6 billion to its gross national product.The company is seeking to expand one of its five Elk Valley mines, and it has applied to open two new ones.Burbot at the Kootenai Tribe of Idaho’s Twin River Hatchery; young white sturgeon, a native species, at the hatchery; burbot roe.Grant Hindsley for The New York TimesCalvin Sandborn, the legal director of the Environmental Law Center at the University of Victoria and one of the authors of a 2021 report, accused the governments of British Columbia and Canada of deliberately failing to regulate Teck.“If they had acted on the warnings of their scientists years ago, they would have dealt with this problem,” Mr. Sandborn said. “And they didn’t because it’s a corporation that’s too big to fail.”According to the Elk Valley Water Quality Plan, British Columbia allows Teck to continue to operate its mines as long as it stabilizes selenium levels and eventually reduces them after 2030.Scientists worry that the existing mines could pollute the rivers for centuries. And some do not believe the technology exists to remove enough selenium from flowing rivers or groundwater to reach safe levels. Ms. Sexton said Teck could do more to seal the contaminants in the waste rock.Critics of government policies point out that when John Horgan stepped down from his post as premier of British Columbia in 2022, he became a member of the board of Elk Valley Resources, a spinoff of Teck Coal, created to manage the mining resources. According to BIV, a publication that covers business in British Columbia, board members are paid at least $235,000 annually.The Canadian Ministry of the Environment and Climate Change Strategy did not respond directly to questions seeking a response to accusations that the government’s oversight of the mining giant was inadequate or lax.“We are pleased that Canada and the United States have committed to working together to reduce and mitigate the impacts of water quality concerns,” said David Karn, a spokesman for the agency. “Protecting and enhancing water quality is a key priority, and through our regulatory activities, we continue to undertake and oversee projects to improve and protect water quality in the Elk River Valley and Koocanusa Reservoir.”New policies cannot come soon enough for Indigenous people and conservationists in both countries.The mining on the ancestral lands of the Kootenai people, (known as Ktunaxa in British Columbia), has become a longstanding issue. “Over a century of mountaintop-removal mining has laid waste to the traditional territory of the Ktunaxa Nation, contaminating the Kootenay River and fish that depend on it,” the six governments of the tribal nation said.“Our native fishery is extremely important to us,” said Tom McDonald, chairman of the Confederated Salish and Kootenai Tribes at their headquarters in Montana and a fisheries biologist. “Water to us is almost considered holy water. It’s very sacred.”Lake Koocanusa on the Kootenai River, seen from the Libby Dam. White fish populations are down by 55 percent in 2023 in the lake. Grant Hindsley for The New York Times“You catch a fish and its gill plate is missing or its jaw is all malformed, are you going to eat it?” Mr. McDonald said. “No, you are not going to. When you lose that ability to fish, it disconnects you from your culture. It takes a whole thing away from the people — their society, their sense of place, their community and their family. It’s an extreme taking.”The Kootenai/Ktunaxa tribes have worked to protect water quality and fisheries in their territory. The Kootenai band in Bonners Ferry, Idaho, has a long-term program to restore burbot to the Kootenai River. The long, eel-like fish, known for its flaky white flesh, is important for subsistence fishing, and it almost became extinct before the tribe built a hatchery to rear fish for introduction back into the river. Now, selenium has been found in the fish there.Whitefish populations below Libby Dam, which created Lake Koocanusa, have declined considerably in recent years. Monitoring in 2018 found that populations, which are usually 700 fish per 1,000 feet, were down 53 percent in 2018 and 55 percent in 2023. High levels of selenium, above state and U.S. limits, have been found in fish eggs and ovaries.The selenium from the mines “is likely causing the decline,” said Jim Dunnigan, a fisheries biologist for the Montana Department of Fish, Wildlife and Parks who is studying the contamination. “It’s cause for serious concern.”Wyatt Petryshen of Wildsight, the Canadian environmental group that monitors Teck’s operations, said environmentalists were worried about recent moves by Teck that split its operations into Teck Metals Corp. and Elk Valley Resources, which will own the coal-mining operation.“There are very real concerns that Teck is trying to spin off the company to avoid paying for environmental damages while maintaining cash flow to their metal mining business,” Mr. Petryshen said.Sheila Murray, chairwoman of Teck’s board, defended the change, saying it would be more profitable for shareholders and would “support a sustainable future for the benefit of employees, local communities and Indigenous peoples.”U.S. officials and advocates said the International Joint Commission, the bilateral body, would be the best authority to seek ways to contain and reduce the mining pollutants. “We need a scientific advisory panel of both U.S. and Canadian scientists,” Mr. Sandborn said. “We need to get this to the International Joint Commission so that we have a proper watchdog.”Jennifer Savage, a spokeswoman for the U.S. State Department, which oversees the United States’ role in the commission, said it wanted the international body to take the matter up soon.“Indigenous communities along the watershed depend on these waters for cultural survival and for their survival,” said Ms. Savage, director of the department’s office of Canadian affairs. “We’re impatient. We are definitely eager to find a solution.”

A study of adults who were mistreated in childhood found that those who did not recall it showed fewer psychological aftereffects.For generations, our society has vacillated about how best to heal people who experienced terrible things in childhood.Should these memories be unearthed, allowing their destructive power to dissipate? Should they be gently molded into something less painful? Or should they be left untouched?Researchers from King’s College London and the City University of New York examined this conundrum by conducting an unusual experiment.Researchers interviewed a group of 1,196 American adults repeatedly over 15 years about their levels of anxiety and depression. Unbeknown to the subjects, 665 of them had been selected because court records showed they had suffered mistreatment such as physical abuse, sexual abuse or neglect before age 12.Not all of them told researchers that they had been abused, though — and that was linked to a big difference.The 492 adults who reported having been mistreated and were in court records substantiating the abuse had significantly higher levels of depression and anxiety than a control group with no documented history of abuse, according to the study, which was published last week in JAMA Psychiatry. The 252 subjects who reported being abused without court records reflecting it also had higher levels.But the 173 subjects who did not report having been abused, despite court records that show that it occurred, had no more distress than the general population.The findings suggest how people frame and interpret events in their early childhood powerfully shapes their mental health as adults, said Dr. Andrea Danese, a professor of child and adolescent psychiatry at King’s College London and one of the study’s joint authors.“It goes back to almost the stoic message, that it’s what you make of the experience,” he said. “If you can change how you interpret the experience, if you feel more in control at present, then that is something that can improve mental health in the longer term.”In a meta-analysis of 16 studies of childhood maltreatment published in 2019, Dr. Danese and colleagues found that 52 percent of people with records of childhood abuse did not report it in interviews with researchers, and 56 percent of those who reported it had no documented history of abuse.This discrepancy could be partly because of problems in measurement — court records may not have all abuse history — and may also reflect that self-reporting of abuse is influenced by a person’s levels of anxiety and depression, Dr. Danese said.“There are many reasons why people may, in some ways, forget those experiences, and other reasons why others might misinterpret some of the experiences as being neglect or abuse,” he said.But even considering these caveats, he said, it was notable that adults who had a documented history of having been abused but did not report it — because they had no memory of the events, interpreted them differently or chose not to share those memories with interviewers — seemed healthier.“If the meaning you give to these experiences is not central to how you remember your childhood so you don’t feel like you need to report it, then you are more likely to have better mental health over time,” he said.Traumatic childhood experiences have been the subject of some of psychiatry’s most pitched battles. Sigmund Freud postulated early in his career that many of his patients’ behaviors indicated a history of childhood sexual abuse but later backtracked, attributing them to subconscious desires.In the 1980s and 1990s, therapists used techniques like hypnosis and age regression to help clients uncover memories of childhood abuse. Those methods receded under a barrage of criticism from mainstream psychiatry.Recently, many Americans have embraced therapies designed to manage traumatic memories, which have shown to be effective in the treatment of post-traumatic stress disorder. Experts increasingly advocate screening patients for adverse childhood experiences as an important step in providing physical and mental health treatment.The new findings in JAMA Psychiatry suggest therapy that seeks to alleviate depression and anxiety by trying to unearth repressed memories is ineffective, said Dr. Danese, who works at the Institute of Psychiatry, Psychology & Neuroscience at King’s College.But he cautioned that the results of the study should not be interpreted as endorsing the avoidance of distressing memories, which could make them “scarier” in the long term. Instead, they point to the promise of therapies that seek to “reorganize” and moderate memories.“It’s not about deleting the memory, but having the memory and being more in control of that so that the memory feels less scary,” he said.Memory has always posed a challenge in the field of child protection because many abuse cases involve children below the age of 3, when lasting memories begin to form, said David Finkelhor, the director of the Crimes Against Children Research Center at the University of New Hampshire, who was not involved in the study.In treating people with histories of having been abused, he said, clinicians must rely on sketchy, incomplete and changing accounts. “All we have is their memories, so it’s not like we have a choice,” he said.He warned against concluding that forgotten maltreatment has no lingering effect. Early abuse may emerge through what he described as “residues” — difficulty in modulating emotions, feelings of worthlessness or, in the case of sexual abuse victims, the urge to provide sexual gratification to others.Elizabeth Loftus, a psychologist at the University of California, Irvine, and a prominent skeptic of the reliability of memories of abuse, noted that the study stops short of another conclusion that could be supported by the data: Forgetting about abuse might be a healthy response.“They could have said, people who don’t remember in some ways are better off, and maybe you don’t want to tamper with them,” she said. “They don’t say that, and that, to me, is of great interest.”

A new study finds that private equity firms own more than half of all specialists in certain U.S. markets.In recent years, private equity firms have been gobbling up physician practices to form powerful medical groups across the country, according to a new report released Monday.In more than a quarter of local markets — in places like Tucson, Ariz.; Columbus, Ohio; and Providence, R.I. — a single private equity firm owned more than 30 percent of practices in a given specialty in 2021. In 13 percent of the markets, the firms owned groups employing more than half the local specialists.The medical groups were associated with higher prices in their respective markets, particularly when they controlled a dominant share, according to a paper by researchers at the Petris Center at the University of California, Berkeley, and the Washington Center for Equitable Growth, a progressive think tank in Washington, D.C. When a firm controlled more than 30 percent of the market, the cost of care in three specialties — gastroenterology, dermatology, and obstetrics and gynecology — increased by double digits.When Private Equity Takes OverResearchers found that when a firm controlled more than 30 percent of the market, the prices paid by private insurers for gastroenterology and other specialties increased sharply.

.dw-chart-subhed {
line-height: 1;
margin-bottom: 6px;
font-family: nyt-franklin;
color: #121212;
font-size: 15px;
font-weight: 700;
}

Average price of gastroenterology visit
Source: Nicholas C. Petris Center on Health Care Markets and Consumer Welfare, University of
California, Berkeley; Washington Center for Equitable GrowthBy The New York TimesThe paper, published by the American Antitrust Institute, documented substantial private equity purchases across multiple medical specialties over the last decade. Urology, ophthalmology, cardiology, oncology, radiology and orthopedics have also been major targets for such deals.“It’s shocking when you look at it,” said Laura Alexander, director of markets and competition policy for the Washington Center, who said private equity firms dominated only a handful of markets a decade ago. By looking at individual markets, the researchers were able to document the local impact. “National rates mask this much more acute problem in local markets,” she said.The higher prices paid by private insurers contribute to high insurance premiums, and may increase out-of-pocket costs for patients.Private equity firms, which pool funds from institutional investors and individuals to form investment funds, tend to purchase companies using debt, with an eye to reselling them in a few years. The industry has turned to health care fairly recently, but it has begun purchasing doctors’ practices at a steady clip, combining smaller practices to form larger companies.When a private equity arm of a Canadian pension fund, OMERS Private Equity, bought Gastro Health, a large gastroenterology medical group, in 2021, it proceeded to acquire nearly a dozen smaller practices, according to the researchers, who say the group is now dominant in markets including the Miami area. The company now operates in seven states, employing over 390 doctors. The researchers saw similar patterns in other markets, where a firm would buy one large practice, then increase its market share by adding nearby smaller practices in the same medical specialty.Historically, doctors’ practices have been relatively small, and owned by doctors themselves. But that model has been rapidly declining as the business of medicine has become more complex and the insurance companies that negotiate with doctors over prices have become bigger. Nearly 70 percent of all doctors were employed by either a hospital or a corporation in 2021, according to a recent analysis from the Physicians Advocacy Institute.“We’re seeing a fundamental change in how medicine is being practiced in the U.S.,” said Richard Scheffler, a professor of health economics and public policy at Berkeley and director of the Petris Center.Hospitals and insurance companies have also bought out many independent physicians’ practices. Optum, an arm of the publicly traded UnitedHealth Group, which also owns one of the nation’s largest insurers, employs roughly 70,000 physicians. Studies have shown that these types of concentrated ownership of doctors in a given market are also associated with higher prices.Private equity is often viewed by physicians as an attractive alternative to having their practice bought by a hospital. In part, the doctors are “getting more scale and gaining efficiencies,” including help with office administration and technology, said Lisa Walkush, a national managing principal for the professional services firm Grant Thornton. “It can be a really good thing, but the private equity firms have to keep their promises and be held accountable,” she said.Michael Kroin, the founder and chief executive of Physician Growth Partners, a Chicago firm that advises independent practices, said the private equity firms “provide scale to allow independent practice groups to survive and maintain their autonomy.” If they could, given their rising costs and how squeezed they feel by insurers, “every independent group would want to increase its fees,” he said.The private equity industry has begun to attract particular scrutiny from researchers and policymakers. Lawmakers in the House are considering legislation to require more reporting when the firms buy health care companies. Currently, the acquisitions can be difficult to track. The authors of the new paper relied on data on deals from a company called PitchBook, which they then matched with doctors in a health care claims database to measure payments from private health insurers.The researchers couldn’t be sure whether the payment increases they measured happened because doctors were performing more complex procedures or just negotiating higher prices, but they suspected the prices explained most of the effect.Previous studies of private equity-acquired hospitals and physician practices from Zirui Song, an associate professor of health policy and medicine at Harvard Medical School, have also documented increasing revenue associated with the purchases. In an interview, Dr. Song said he expected the industry would continue to buy doctors’ practices in the coming years. “We still have a lot of small physician-owned specialty practices,” he said. “That’s an opportunity for consolidation. It’s an easy opportunity.”Critics of the industry, including Professor Scheffler, have also raised concerns about the medical care delivered by private equity-owned health care companies, arguing that the industry’s emphasis on profits could cause patient harm. Research on private equity ownership of nursing homes has shown evidence of lower staffing levels and higher rates of prescriptions for antipsychotic medicines.But little rigorous research has been published on patient care in the office-based medical specialties that the new paper focuses on.How the change in ownership and independence affects doctors and how they treat patients “has been very severely understudied,” said Barak Richman, a professor of law and business administration at Duke University, who reviewed the paper. But he said there is evidence that these firms are skilled at exploiting loopholes in existing regulations to maximize their profits.“Private equity is like the system on steroids,” said Sherry Glied, the dean of the Wagner School of Public Service at New York University. “Every time there’s an opportunity for making money, P.E. is going to move faster than everyone else. And consolidation is the way to do that.”While federal regulators are contemplating changes to how they oversee these deals, researchers say the report underscores the need to pay attention to what happens when a company makes a series of seemingly modest acquisitions. “This builds the case for strong antitrust tools for these incrementally small but collectively larger consolidation trends,” said Erin Fuse Brown, the director of the Center for Law, Health and Society at Georgia State University.

Although most people don’t associate oral disease with serious health problems, increasing evidence shows that oral bacteria play a significant role in systemic diseases like colon cancer and heart disease. Now, new research from the Forsyth Institute shows a link between periodontal (gum) disease and the formation of amyloid plaque, a hallmark of Alzheimer’s disease.
In their paper, “Microglial cell response to experimental periodontal disease,” published in the Journal of Neuroinflammation, Forsyth scientists and their collaborators at Boston University demonstrate that gum disease can lead to changes in brain cells called microglial cells, which are responsible for defending the brain from amyloid plaque. This plaque is a type of protein that is associated with cell death, and cognitive decline in people with Alzheimer’s. The study provides important insight into how oral bacteria makes its way to the brain, and the role of neuroinflammation in Alzheimer’s disease.
“We knew from one of our previous studies that inflammation associated with gum disease activates an inflammatory response in the brain,” said Dr. Alpdogan Kantarci, senior member of staff at Forsyth and a senior author of the study. “In this study, we were asking the question, can oral bacteria cause a change in the brain cells?”
The microglial cells the researchers studied are a type of white blood cell responsible for digesting amyloid plaque. Forsyth scientists found that when exposed to oral bacteria the microglial cells became overstimulated and ate too much. “They basically became obese” Dr. Kantarci said. “They no longer could digest plaque formations.”
The finding is significant for showing the impact of gum disease on systemic health. Gum disease causes lesions to develop between the gums and teeth. The area of this lesion is the size of your palm. Dr. Kantarci explained, “It’s an open wound that allows the bacteria in your mouth to enter your bloodstream and circulate to other parts of your body.” These bacteria can pass through the blood/brain barrier and stimulate the microglial cells in your brain.
Using mouse oral bacteria to cause gum disease in lab mice, the scientists were able to track periodontal disease progression in mice and confirm that the bacteria had traveled to the brain.
They then isolated the brain microglial cells and exposed them to the oral bacteria. This exposure stimulated the microglial cells, activated neuroinflammation and changed how microglial cells dealt with amyloid plaques.
“Recognizing how oral bacteria causes neuroinflammation will help us to develop much more targeted strategies,” said Dr. Kantarci. “This study suggests that in order to prevent neuroinflammation and neurodegeneration, it will be critical to control the oral inflammation associated with periodontal disease. The mouth is part of the body and if you don’t take care of oral inflammation and infection, you cannot really prevent systemic diseases, like Alzheimer’s, in a reproducible way.”
This study is the first time that scientists caused periodontal disease with mouse-specific bacteria and could study the effects of same-species oral microbiome on the brain. Having same-species bacteria and cells brings the test closer to replicating what the process looks like in humans.
The research team consisted of Rawan Almarhoumi, Carla Alvarez, Theodore Harris, Bruce J. Paster, and Alpdogan Kantarci of Forsyth, and Christina M. Tognoni, Isabel Carreras, and Alpaslan Dedeoglu of Boston University. This study was supported by a grant from the NIH/NIA (R01AG062496) awarded to Drs. Dedeoglu and Kantarci).

A new study measured manganese levels in the residential tap water of a Holliston, Mass. community and found that the manganese concentrations occasionally exceeded the maximum safety level recommended in state and federal guidelines.
Manganese is an unregulated contaminant often found in drinking water, but safe levels of this metal are currently unknown, and prior research has indicated that overexposure to manganese may be harmful to children.
Now, a new study led by researchers at Boston University School of Public Health (BUSPH) has found that concentrations of manganese in a Massachusetts community’s drinking water often surpassed the maximum recommended levels of manganese stated in current guidelines.
Published in the Journal of Exposure Science & Environmental Epidemiology, a Nature publication, the findings also suggest that the observed manganese levels may be high enough to pose a risk to children and other vulnerable communities who are exposed.
Manganese is a naturally occurring component of soil and rock, and it is both an essential nutrient and a toxic substance — so, too little or too much exposure can be harmful to health. Despite the fact that manganese is found in many communities’ drinking water across the US, it is not federally regulated. The US Environmental Protection Agency has developed guidelines that identify a maximum level of daily exposure to manganese for “aesthetic” purposes (i.e. color and taste), as well as for the overall health and safety of the general population. But these guidelines are only recommendations; they cannot be enforced in the way that established primary standards can.
“Some level of manganese is needed for health, but growing evidence suggests that excess levels of manganese can harm children’s brains,” says study lead and corresponding author Alexa Friedman, a doctoral student at BUSPH at the time of the study. “Our findings suggest that the level of manganese that is present in public drinking water exceeded, on average, the aesthetic guidelines 40 percent of the time, and health-based guidelines 9 percent of the time. These data support the need for a legally enforceable primary drinking water standard for manganese in order to better protect children’s health.”
The new study is among the first to examine manganese concentrations in drinking water across time and location in the United States.
For the study, Friedman and colleagues examined residential tap water samples collected between September 2018 to December 2019 in the suburban community of Holliston, Mass., as part of a community-initiated pilot study called ACHIEVE (Assessing Children’s Environmental Exposures). Holliston residents had reported concerns about the quality of their drinking water and the safety of children in the community after noticing that their tap water turned black or brown occasionally. Communities that receive tap water from shallow aquifers are especially vulnerable to being exposed to high levels of manganese, and Holliston residents rely on this source for almost all of their drinking water.
“Although averagewater manganese concentrations in Holliston were relatively low, our work showed that levels nonetheless often exceed the current aesthetic and health-based guidelines,” says study senior author Birgit Claus Henn, associate professor of environmental health at BUSPH. “While the existing guidelines may be helpful benchmarks, without an enforceable standard in place, there is a limit to what will be done to ensure the water is safe to drink and/or meets these guidelines.”
The researchers also compared their community-level manganese samples to public data on state-wide manganese levels. They found comparable ranges, suggesting that overexposure to manganese is not an isolated issue within the Holliston community.
To better understand the health risks of exposure to manganese in drinking water, Claus Henn and Friedman recommend that policymakers and other researchers increase monitoring of manganese in water, conduct health studies on this exposure in communities, and consider an enforceable standard.
“If residents are concerned about the level of manganese in their drinking water, they should refer to these resources online from Massachusetts Department of Environmental Protection,” Friedman says. “It is also important to know that manganese cannot be removed by boiling the water, and many household filters are not effective for removing manganese from water,” she adds. “Residents should only use filters that are capable of removing manganese, and the filtration units should clearly state this capability.”

With just a few clicks of a mouse, you can purchase your very own redtail garra, a type of fish that feeds on algae. Information about the fish’s biology, however, is much less easily obtained. That’s because redtail garra, although popular in the aquarium trade since the early 2000s, has until now been unknown to science.
Researchers were peripherally aware of the fish’s existence, but “discovering” a new species requires scientific description based on specimens collected in their natural environment. Redtail garras appear to be restricted to a small stretch of river straddling the border between Thailand and Myanmar. The locality is isolated and difficult to reach, so wild redtail garras have existed in relative obscurity, despite their global appeal.
Larry Page, curator of ichthyology at the Florida Museum of Natural History, has surveyed fishes in Thailand every year since 2007. He recently encountered a few redtail garras while conducting fieldwork along the Kasat River, a tributary of the Ataran River in neighboring Myanmar.
“When we first collected specimens, we thought it must be widespread in Myanmar because of its popularity in the aquarium trade. But it turns out it’s not. It’s only in the Ataran River basin,” he said.
Page and his colleagues published the new species description in the journal Zootaxa. Redtails take their place among nearly 200 additional species in the genus Garra, one of the most diverse and widely distributed fish groups anywhere on Earth. Garra can be found in streams and rivers from the farthest reaches of western Africa through the Middle East, India and southern and eastern Asia, including parts of China. Yet their ubiquity has not resulted in a corresponding amount of research on the group.
“There’s surprisingly little information on their natural history,” Page said. There are few studies that broadly assess diversity in the genus, and little is known about relationships or how various groups within Garra have diversified.

According to Page, basic information about the fishes’ biology is available, but often in the form of studies on individual species or regions. “Most of them live in fast-moving water, and they have a disclike structure formed from a modification of the lower lip, which they use as an adhesive pad to cling to rocks and maintain their position in the water column as they feed,” he said.
Garra primarily subsist on algae and the occasional arthropod, which they eat by scraping detritus off rocks with specialized mouthparts. Like other species in the genus, redtails lack stomachs and have a snout encrusted with modified and hardened scales called tubercles. Similar structures in other fish groups are temporary; they’re used to defend nests but fall off after the breeding season has ended. Redtail tubercles are permanently attached and seem to be used as weapons, based on aggressive behavior observed in aquaria.
Redtail garra can be distinguished by their unique, elongated snout, covered in even more tubercles, which they can raise or lower, ostensibly as a means of intimidating opponents during combative encounters. And, as their common name suggests, their tails are emblazoned in red like a signal fire.
Their unique color pattern and their industrious ability to clear away algae have made them a coveted component of aquarium tanks, but their late addition to the roster of scientifically described species underscores a pressing need to take stock of biodiversity in understudied regions.
Page, who is working on a book describing the fishes of the Mae Klong River basin in Thailand, said the belated description of redtail garra is part of a larger recurring pattern. “Many of the fishes in Southeast Asia are referred to by names given to species discovered in India or Indonesia because they look similar.” People know particular species exist, Page said, but they are mistaken for those from other geographic areas, and their diversity has consequently been drastically underestimated.

Page and his colleagues named the new species Garra panitvongi after the author of another book on Thailand’s fishes, Nonn Panitvong. Lauded as a biodiversity hero by the Association of Southeast Asian Nations, Panitvong is both a businessman and an avid naturalist. He’s nurtured a passion for nature since his childhood days spent translating books about animals written in English with the help of his mom. He developed a special appreciation for Thailand’s aquatic life from his dad, who took him on fishing trips.
“Over the years, I found that in many of the places we went fishing, the environments were getting worse. There were fewer fish overall, and the fish assemblage changed for the worse, with a decreasing number of native species and more invasives,” he said.
Panitvong obtained a Master of Business Administration at the University of North Carolina Wilmington so he could effectively run his family’s sugarcane farm, but when it came time for a doctorate, he opted to study environmental science. After returning to Thailand, he created the website Siamensis.org, an open platform on which nature enthusiasts could share information about Thailand’s flora and fauna and plan excursions to wilderness areas.
In 2006, Panitvong and a friend discovered one of Thailand’s redtail garra populations and helped introduce the fish to the aquarium trade. Now, more than 15 years later, he said the official naming of redtail garra — and the discovery of species like it — help bring the world into clearer focus.
“I like to imagine humanity in a big room, painted in white. As we turned around, we would have no conception of which direction we were facing,” he said. “With each new discovery, a dot is added, a point made, and we know more and more about where we stand as a species.”

A unique collaborative study on hospital clinician wellbeing by teams at 60 of the nation’s best hospitals, defined by Magnet Hospital Recognition, was published today in JAMA Health Forum. The study found that physicians and nurses, even at hospitals known to be good places to work, experienced adverse outcomes during the pandemic and want hospital management to make significant improvements in their work environments and in patient safety. The solutions to high hospital clinician burnout and turnover, they say, are not resilience training for clinicians to better cope with adverse working conditions but organizational improvements that provide safe workloads and better work-life balance.
Researchers at Penn Nursing’s Center for Health Outcomes and Policy Research (CHOPR) in collaboration with the U.S. Clinician Wellbeing Study Consortium sought information in 2021 from 21,050 physicians and registered nurses practicing in 60 Magnet recognized hospitals in 22 states. Forty-seven percent of nurses and 32% of physicians experienced high burnout. Twenty-three percent of physicians and 40% of nurses said they would leave their jobs if possible. Less than 10% of physicians and nurses reported experiencing joy in their work. Not having enough nurses to care for patients, having little control over workloads, lack of confidence in management to resolve problems in patient care, and concerns about patient safety were all associated with higher burnout, job dissatisfaction, and intent to leave among both nurses and physicians.
Lead author Linda H Aiken, PhD, Professor of Nursing and Sociology, Founding Director of the Center for Health Outcomes and Policy Research, and Senior Fellow of the Leonard Davis Institute for Health Economics at the University of Pennsylvania said, “Physicians and nurses largely agree about what hospital management could do to address their burnout, job dissatisfaction, and plans to leave their current jobs; they want improved staffing, modern working conditions in which they can spend more time in direct patient care, greater control over their workloads and work schedules, and a higher priority on patient safety.”
Eighty-seven percent of nurses and 45% of physicians said improving nurse staffing was very important to their own mental health and wellbeing. Other high priorities for clinicians were health breaks without interruption and reduced time spent on documentation. Aiken added, “Many clinicians are downright hostile to programs — like resilience training — that are designed to adapt them to poor work conditions; clinicians want the working conditions improved.”
Clinicians are concerned about quality and safety of care. Half of physicians and nurses lack confidence that their patients can safely manage their care after discharge highlighting the need for improvement in discharge planning. Patient safety remains a concern with 26% of nurses and 12% of physicians giving their own hospitals an unfavorable patient safety grade. Thirty-nine percent of nurses and 33% of physicians feel mistakes are held against them contrary to recommendations of the National Academy of Medicine to search for and correct system deficiencies that cause most medical errors.
The study was carried out by Penn Nursing’s Center for Health Outcomes and Policy Research in collaboration with the U.S. Clinician Wellbeing Study Consortium composed of 60 Magnet Hospitals. The study took place in 2021 during the COVID-19 pandemic, a time when all US hospitals were severely challenged. Previous research shows that clinicians in hospitals like Magnet hospitals with better work environments prior to the pandemic had better outcomes during the pandemic. The Consortium committed to this study to learn from their experiences during the pandemic how to sustain and further improve their favorable work environments to better withstand external threats and to rebound rapidly.

The summer of 2022 was the hottest summer ever recorded in Europe and was characterised by an intense series of record-breaking heat waves, droughts and forest fires. While Eurostat, the European statistical office, already reported unusually high excess mortality for those dates, until now the fraction of mortality attributable to heat had not been quantified. This is precisely what has been done in a study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the “la Caixa” Foundation, in collaboration with the French National Institute of Health (Inserm). The analysis, published in Nature Medicine, estimates 61,672 heat-attributable deaths between 30 May and 4 September 2022.
The research team obtained temperature and mortality data for the period 2015-2022 for 823 regions in 35 European countries, whose total population represents more than 543 million people. These data were used to estimate epidemiological models and predict temperature-attributable mortality for each region and week of the summer period.
The summer of 2022 was a season of unrelenting heat. Records show that temperatures were warmer-than-average during every week of the summer period. The highest temperature anomalies were recorded during the hottest month, from mid-July to mid-August. This coincidence magnified, according to the researchers, heat-related mortality, causing 38,881 deaths between 11 July and 14 August. Within that period of just over a month there was an intense pan-European heatwave between 18 and 24 July, to which a total of 11,637 deaths are attributed.
Most affected countries
In absolute terms, the country with the highest number of heat-attributable deaths over the entire summer of 2022 was Italy, with a total of 18,010 deaths, followed by Spain (11,324) and Germany (8,173).
If the data is ordered by heat-related mortality rate, the top country is Italy, with 295 deaths per million, followed by Greece (280), Spain (237) and Portugal (211). The European average was estimated at 114 deaths per million.

On the other hand, looking only at temperature anomalies, the country with warmest value was France, with +2.43°C above the average values for the period 1991-2020, followed by Switzerland (+2.30°C), Italy (+2.28°C), Hungary (+2.13°C) and Spain (+2.11°C).
63% higher mortality in women
The study included an analysis by age and sex, showing a very marked increase in mortality in the older age groups, and especially in women. Thus, it is estimated that there were 4,822 deaths among those under 65, 9,226 deaths among those between 65 and 79, and 36,848 deaths among those over 79.
In terms of gender analysis, the data show that heat-attributable mortality was 63% higher in women than in men, with a total of 35,406 premature deaths (145 deaths per million), compared to an estimated 21,667 deaths in men (93 deaths per million). This greater vulnerability of women to heat is observed in the population as a whole and, above all, in those over 80 years of age, where the mortality rate is 27% higher than that of men. In contrast, the male mortality rate is 41% higher in those under 65, and 13% higher in those aged 65-79.
Lessons from the 2003 heatwave
To date, the highest summer mortality in Europe was registered in 2003, when over 70,000 excess deaths were recorded.

“The summer of 2003 was an exceptionally rare phenomenon, even when taking into account the anthropogenic warming observed until then. This exceptional nature highlighted the lack of prevention plans and the fragility of health systems to cope with climate-related emergencies, something that was to some extent addressed in subsequent years,” explains Joan Ballester Claramunt, first author of the study and researcher at ISGlobal, who holds a grant from the European Research Council.
“In contrast, the temperatures recorded in the summer of 2022 cannot be considered exceptional, in the sense that they could have been predicted by following the temperature series of previous years, and that they show that warming has accelerated over the last decade,” adds Ballester.
“The fact that more than 61,600 people in Europe died of heat stress in the summer of 2022, even though, unlike in 2003, many countries already had active prevention plans in place, suggests that the adaptation strategies currently available may still be insufficient,” says Hicham Achebak, researcher at Inserm and ISGlobal and last author of the study. “The acceleration of warming observed over the last ten years underlines the urgent need to reassess and substantially strengthen prevention plans, paying particular attention to the differences between European countries and regions, as well as the age and gender gaps, which currently mark the differences in vulnerability to heat,” he adds.
Europe is the continent experiencing the greatest warming, up to 1°C more than the global average. Estimates by the research team suggest that, in the absence of an effective adaptive response, the continent will face an average of more than 68,000 premature deaths each summer by 2030 and more than 94,000 by 2040.

Adults who voluntarily take part in mindfulness courses are less likely to experience symptoms of anxiety and depression for at least six months after completing the programmes, compared to adults who do not take part, a new analysis pooling data from 13 studies has confirmed.
University of Cambridge researchers looked at participants of group-based and teacher-led mindfulness courses, conducted in person and offered in community settings.
They say the results, published in the journal Nature Mental Health, should encourage uptake of similar teacher-led programmes in workplaces and educational institutions keen to help prevent mental health problems developing in members of their community.
“In our previous work it was still not clear whether these mindfulness courses could promote mental health across different community settings,” said lead researcher, Dr Julieta Galante, who conducted the research while at the University of Cambridge. “This study is the highest quality confirmation so far that the in-person mindfulness courses typically offered in the community do actually work for the average person.”
Mindfulness in these courses is typically defined as “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment.”
These courses, formally known as mindfulness-based programmes (MBPs), often combine elements of meditation, body awareness and modern psychology, and are designed to help reduce stress, improve wellbeing, and enhance mental and emotional “resilience.” They consist of groups of participants led by mindfulness teachers, who promote reflection and sharing over several one-to-two hour sessions.

The body of research into the effectiveness of MBPs to date has been mixed. Cambridge researchers sought to confirm the effect of MBPs on psychological distress — which encompasses disturbing or unpleasant mental or emotional experiences including symptoms of anxiety and depression.
They pooled and analysed data from 2,371 adults who had taken part in trials to assess the effectiveness of MBPs. Roughly half the participants had been randomly allocated places on mindfulness programmes that lasted for eight weeks, with a one- to two-and-a-half hour session per week and compared them to those that were not through self-reported questionnaires.
The study found that MBPs generated a small to moderate reduction in adults’ psychological distress, with 13% more participants seeing a benefit than those who did not attend an MBP.
The researchers found that existing psychological distress, age, gender, educational level and a disposition towards mindfulness did not change the effectiveness of MBPs.
Galante said: “We’ve confirmed that if adults choose to do a mindfulness course in person, with a teacher and offered in a group setting, this will, on average, be beneficial in terms of helping to reduce their psychological distress which will improve their mental health. However, we are not saying that it should be done by every single person; research shows that it just doesn’t work for some people.

“We’re also not saying you should absolutely choose a mindfulness class instead of something else you might benefit from, for example a football club — we have no evidence that mindfulness is better than other feel-good practices but if you’re not doing anything, these types of mindfulness courses are certainly among the options that can be helpful.”
The researchers conducted a systematic review to select previous studies for inclusion in their large-scale analysis. They obtained complete but anonymised data from 13 trials representing eight countries. The median age was 34 years-old, while 71% of participants were women.
While mindfulness apps are on the rise, researchers remain unsure whether it is the practice of mindfulness that reduces psychological distress, or the fact that courses involve in-person group-work with a teacher present.
“Apps may be cheaper, but there is nowhere near the same evidence base for their effectiveness,” said Galante. “Some apps may say they are evidenced based, but they are often referring to trials that are in-person with a teacher and a group.”
The effectiveness of smartphone apps, as well as what happens when people continue to practice mindfulness meditation by themselves, will be investigated by Galante, who has recently taken up a new position as Deputy Director of the Contemplative Studies Centre, at the University of Melbourne.
“If you are offered an in-person four- or eight-week mindfulness course in a group setting with a teacher, and you are curious about it, I’d say based on this study, just go ahead and try it,” said Galante. “And for organisations wondering about offering these types of mindfulness courses to members of their community — this research suggests it may be a good investment if their communities express an interest.”
This research was funded by the National Institute for Health Research.

A new study published in the BMJ’s Archives of Disease in Childhood has found young people of both sexes who were hospitalised due to burns were less likely to finish high school than their peers.
Led by Associate Professor Rebecca Mitchell from the Australian Institute of Health Innovation (AIHI) at Macquarie University, the research compared the academic performance and high school completion rates of about 2000 young people to matched peers who had not been hospitalised for an injury.
The study found that the young people who had been burned were four times as likely to not finish Year 10, and more than twice as likely to not finish Year 11 or Year 12.
This research is the latest in a series of studies looking at the effects of hospitalisation for injuries and illnesses including broken bones, asthma, diabetes, epilepsy and mental health on young people’s educational outcomes.
The research team used linked birth, health and education records in New South Wales from 2005 to 2018 to analyse national literacy and numeracy test results and high school completion.
To create a peer comparison group, each hospitalised young person was matched against a randomly selected peer of the same age and gender who lived in the same postcode but had not been hospitalised for an injury.

In the case of the burns patients, the most common cause of injury was contact with hot drinks, food, fats or cooking oils, followed by other hot fluids including hot or boiling water.
Almost all of the children in the burns cohort had more than 10 per cent of the surface of their bodies affected, with torsos the most commonly injured area, followed by hands or wrists.
Associate Professor Mitchell says in addition to an increased risk of not finishing high school, girls who had burn injuries also had a higher risk of not achieving the national minimum standards in reading.
“Reasons why young females hospitalised with a burn have worse academic performance for reading could include reduced learning opportunities, school absenteeism, or psychosocial anxieties due to lower self-esteem and stigmatisation,” she says.
“This research shows that we need to monitor academic progression in young people after they sustain a burn to identify if they require any learning support.”
Paediatric burns specialist and co-author Professor Andrew Holland says while most burns occur early in childhood, the effects can extend far beyond the initial period of acute care and recovery.
“In some cases, burns patients experience ongoing pain and poor sleep quality, which can disrupt a young person’s ability to engage and learn,” he says.
“In addition to this, scarring can have an influence on their motivation or ability to attend school.”