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Wagner et al. 2022

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In the study, stroke patients had their heart rhythm monitored for 12 months with a tiny implanted device. "More than 90% of stroke patients found to have atrial fibrillation had no symptoms of the heart rhythm disorder," said study author Dr. Barbara Ratajczak-Tretel of Østfold Hospital Trust, Sarpsborg, Norway. "For many patients, atrial fibrillation would have gone undiagnosed and untreated without the continuous monitoring, putting them at risk of another stroke."

Most strokes are ischaemic, meaning a blockage stops blood flow to the brain. In approximately one in four ischaemic strokes the cause is undetermined. "The best therapy to prevent another stroke depends on the underlying cause," said Dr. Ratajczak-Tretel. "Those with atrial fibrillation should receive oral anticoagulants but a definitive diagnosis is needed before these drugs can be prescribed. Atrial fibrillation can be transient and asymptomatic making it difficult to detect."

The Nordic Atrial Fibrillation and Stroke (NOR-FIB) study examined the ability of continuous heart rhythm monitoring for one year with an implanted device to identify atrial fibrillation in patients with an ischaemic stroke or mini-stroke (transient ischaemic attack; TIA) of unknown aetiology.

The prospective, observational study included 259 patients with no documented history of atrial fibrillation from 18 centres in Norway, Denmark and Sweden. All patients received a cardiac monitor, which was implanted a median of nine days after the stroke or TIA. The device is one-third the size of a AAA battery and was inserted subcutaneously over the heart under local anaesthesia.

Data from the device were transmitted automatically through a secure network to a core lab of two neurologists and two cardiologists and evaluated once a week. When atrial fibrillation lasting at least two minutes was detected, the core lab contacted the patient's physician who then prescribed oral anticoagulants. Patients were followed up for 12 months.

During the 12-month monitoring period, 74 patients (29%) were diagnosed with atrial fibrillation, of whom 93% were asymptomatic. Oral anticoagulation was recommended for all patients with atrial fibrillation and at 12 months, 72 of 74 patients (97%) were on this therapy.

In the course of follow-up, two strokes occurred in the atrial fibrillation group (both before the first atrial fibrillation episode was detected and anticoagulation initiated) and nine in patients without atrial fibrillation, however the difference was not statistically significant.

Device complications were experienced by three patients (1.2%). One patient had an infection at the implantation site and the device had to be removed. One patient had a skin tear and the device had to be moved to another position. The third patient developed a subcutaneous haematoma (bruising).

Dr. Ratajczak-Tretel said: "In this study, we found that an implantable cardiac monitor was effective for diagnosing underlying atrial fibrillation, which was identified in 29% of patients with a stroke or TIA of indeterminate cause. As the probable cause of the stroke or TIA was detected, these patients were able to start oral anticoagulation. Atrial fibrillation was asymptomatic in most cases and may not have been detected or treated without continuous monitoring."

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Erik Kroeze, a spokesman for railway operator NS, said the problem was in a planning software system. He said there were no indications it was caused by a cyberattack.

NS said trains would be halted until 5 p.m. while it sought to fix the problem.

"We are working hard on recovery, but unfortunately it is not yet possible to say how long this situation will last," NS said in a statement on its website.

Regional trains run by other operators were still running, NS said.

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Today, NASA suspended the last major test of its Space Launch System (SLS) rocket after pressurization issues prevented technicians from safely loading propellants into the rocket. The test — known as a wet dress rehearsal — has been postponed until Monday, April 4th at the earliest, NASA announced in a post on the Artemis I live blog.

“Teams have decided to scrub tanking operations for the wet dress rehearsal due to loss of ability to pressurize the mobile launcher,” NASA explained. Some fans on the mobile launcher — the platform that provides support for the rocket up until launch — were unable to maintain positive pressure, which is crucial in warding off hazardous gases. As a result, NASA technicians couldn’t “safely proceed” with the fuel-loading process.

This type of dress rehearsal gets its “wet” label since it’s essentially a run-through of all the procedures NASA will have to carry out when the first actual launch of SLS takes place, including filling the 322-foot rocket with 700,000 gallons of propellant. In a press conference on Sunday evening, NASA said its team is currently on the launchpad attempting to troubleshoot the issue. The agency says it’s on track to resume the wet dress rehearsal tomorrow.

The test originally began on April 1st at the Kennedy Space Center in Florida and was supposed to wrap up on Sunday. NASA encountered some rough weather Saturday night, as lightning struck the towers around the SLS’s launchpad. Jeremy Parsons, the deputy program manager at NASA’s Exploration Ground Systems, said one of these strikes was one of the strongest NASA has seen since installing the lightning protection system. “It hit the catenary wire that runs between the 3 towers,” Parsons wrote in a tweet from the EGS Twitter account. “System performed extremely well & kept SLS and Orion safe.”

The SLS is supposed to carry the Orion spacecraft on an uncrewed mission around the Moon as part of the Artemis program, a flight called Artemis I. That mission, tentatively scheduled for this summer, is supposed to get the rocket — and NASA — ready for the mission that will eventually carry humans to the lunar surface.

You can keep checking back for updates on the test on NASA’s live blog, as well as on the agency’s Twitter.

NASA delays dress rehearsal of new megarocket

Scientists have mostly looked for clues on Earth. Yet a new discovery suggests that the answer could be found beyond the sky, inside dark interstellar clouds.

Last month in Nature Astronomy, a group of astrobiologists showed that peptides, the molecular subunits of proteins, can spontaneously form on the solid, frozen particles of cosmic dust drifting through the universe. Those peptides could in theory have traveled inside comets and meteorites to the young Earth—and to other worlds—to become some of the starting materials for life.

The simplicity and favorable thermodynamics of this new space-based mechanism for forming peptides make it a more promising alternative to the known purely chemical processes that could have occurred on a lifeless Earth, according to Serge Krasnokutski, the lead author on the new paper and a researcher at the Max Planck Institute for Astronomy and the Friedrich Schiller University in Germany. And that simplicity “suggests that proteins were among the first molecules involved in the evolutionary process leading to life,” he said.

Whether those peptides could have survived their arduous trek from space and contributed meaningfully to the origin of life is very much an open question. Paul Falkowski, a professor at the School of Environmental and Biological Sciences at Rutgers University, said that the chemistry demonstrated in the new paper is “very cool” but “doesn’t yet bridge the phenomenal gap between proto-prebiotic chemistry and the first evidence of life.” He added, “There’s a spark that’s still missing.”

Still, the finding by Krasnokutski and his colleagues shows that peptides might be a much more readily available resource throughout the universe than scientists believed, a possibility that could also have consequences for the prospects for life elsewhere.

Cells make the production of proteins look easy. They manufacture both peptides and proteins extravagantly, empowered by environments rich in useful molecules like amino acids and their own stockpiles of genetic instructions and catalytic enzymes (which are themselves typically proteins).

But before cells existed, there wasn’t an easy way to do it on Earth, Krasnokutski said. Without any of the enzymes that biochemistry provides, the production of peptides is an inefficient two-step process that involves first making amino acids and then removing water as the amino acids link up into chains in a process called polymerization. Both steps have a high energy barrier, so they occur only if large amounts of energy are available to help kick-start the reaction.

Because of these requirements, most theories about the origin of proteins have either centered on scenarios in extreme environments, such as near hydrothermal vents on the ocean floor, or assumed the presence of molecules like RNA with catalytic properties that could lower the energy barrier enough to push the reactions forward. (The most popular origin-of-life theory proposes that RNA preceded all other molecules, including proteins.) And even under those circumstances, Krasnokutski says that “special conditions” would be needed to concentrate the amino acids enough for polymerization. Though there have been many proposals, it isn’t clear how and where those conditions could have arisen on the primordial Earth.

But now researchers say they’ve found a shortcut to proteins—a simpler chemical pathway that reenergizes the theory that proteins were present very early in the genesis of life.

Last year in Low Temperature Physics, Krasnokutski predicted through a series of calculations that a more direct way to make peptides could exist under the conditions available in space, inside the extremely dense and frigid clouds of dust and gas that linger between the stars. These molecular clouds, the nurseries of new stars and solar systems, are packed with cosmic dust and chemicals, some of the most abundant of which are carbon monoxide, atomic carbon and ammonia.

In their new paper, Krasnokutski and his colleagues showed that these reactions in the gas clouds would likely lead to the condensation of carbon onto cosmic dust particles and the formation of small molecules called aminoketenes. These aminoketenes would spontaneously link up to form a very simple peptide called polyglycine. By skipping the formation of amino acids, reactions could proceed spontaneously, without needing energy from the environment.

To test their claim, the researchers experimentally simulated the conditions found in molecular clouds. Inside an ultrahigh vacuum chamber, they mimicked the icy surface of cosmic dust particles by depositing carbon monoxide and ammonia onto substrate plates chilled to minus 263 degrees Celsius. They then deposited carbon atoms on top of this ice layer to simulate their condensation inside molecular clouds. Chemical analyses confirmed that the vacuum simulation had indeed produced various forms of polyglycines, up to chains 10 or 11 subunits long.

The researchers hypothesized that billions of years ago, as cosmic dust stuck together and formed asteroids and comets, simple peptides on the dust could have hitchhiked to Earth in meteorites and other impactors. They might have done the same on countless other worlds, too.

The delivery of peptides to Earth and other planets “certainly would provide a head start” to forming life, said Daniel Glavin, an astrobiologist at NASA’s Goddard Space Flight Center. But “I think there’s a large jump to go from interstellar ice dust chemistry to life on Earth.”

First the peptides would have to endure the perils of their journey through the universe, from radiation to water exposure inside asteroids, both of which can fragment the molecules. Then they’d have to survive the impact of hitting a planet. And even if they made it through all that, they would still have to go through a lot of chemical evolution to get large enough to fold into proteins that are useful for biological chemistry, Glavin said.

Is there evidence that this has happened? Astrobiologists have discovered many small molecules including amino acids inside meteorites, and one study from 2002 discovered that two meteorites held extremely small, simple peptides made from two amino acids. But researchers have yet to discover other convincing evidence for the presence of such peptides and proteins in meteorites or samples returned from asteroids or comets, Glavin said. It’s unclear if the nearly total absence of even relatively small peptides in space rocks means that they don’t exist or if we just haven’t detected them yet.

But Krasnokutski’s work could encourage more scientists to really start looking for these more complex molecules in extraterrestrial materials, Glavin said. For example, next year NASA’s OSIRIS-REx spacecraft is expected to bring back samples from the asteroid Bennu, and Glavin and his team plan to look for some of these types of molecules.

The researchers are now planning to test whether bigger peptides or different types of peptides can form in molecular clouds. Other chemicals and energetic photons in the interstellar medium might be able to trigger the formation of larger and more complex molecules, Krasnokutski said. Through their unique laboratory window into molecular clouds, they hope to witness peptides getting longer and longer, and one day folding, like natural origami, into beautiful proteins that burst with potential.

Original story reprinted with permission from Quanta Magazine, an editorially independent publication of the Simons Foundation whose mission is to enhance public understanding of science by covering research developments and trends in mathematics and the physical and life sciences.

Peptides on Stardust May Have Provided a Shortcut to Life

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Researchers from the Imperial College of London learned a great deal about the virus during the initial study period in March 2021 and in follow-up assessments, including the fact that a tiny 10-micron droplet from a cough or sneeze can make someone sick, according to the findings, which were published Thursday in the journal Nature Medicine.

Other findings include that it only takes two days after a person is infected to start shedding virus, and that people shed a lot of virus before they show symptoms.

Challenge studies are controversial because they carry some risk, even with safeguards, but they are valuable for being able to follow the course of a virus from start to finish. The success of this study may pave the way for future challenge studies in low-risk individuals, CNN reported.

"Really, there's no other type of study where you can do that, because normally, patients only come to your attention if they have developed symptoms, and so you miss all of those preceding days when the infection is brewing," lead study author Dr. Christopher Chiu, an infectious disease physician and immunologist at Imperial College London, told CNN.

For this study, the 36 volunteers were between the ages 18 and 30 and had no risk factors for severe COVID-19.

The research team infected the group with a tiny drop of fluid of the original virus strain that was delivered through a thin tube inserted in their noses.

The patients were infected in phases as a precaution, with the first 10 individuals given the antiviral drug remdesivir to reduce their chances of severe disease, which was deemed unnecessary. They could also have been given monoclonal antibodies, but no one received them.

Researchers monitored the patients 24 hours a day while they stayed for two weeks in rooms at London's Royal Free Hospital.

Of the 36 patients, 18 became infected. Two of those never developed symptoms. Those who were ill had mild cases with stuffy noses, congestion, sneezing and sore throats. None of the patients developed lung problems, possibly because of their good health or the fact that they were given small amounts of virus.

About 83% did lose their sense of smell, at least partially. Six months after the study ended, one person has not had their sense of smell return, but it is improving.

Researchers also gave the participants thinking tests, to check their short-term memory and reaction time, which they are still assessing.

The study volunteers shed virus for about 6.5 days, on average, or up to 12 days, even if they had no symptoms.

The virus showed up on nose swabs after 58 hours and at the back of the throat after 40 hours. Rapid, at-home tests did well at diagnosing infection when a person was contagious, before 70% or 80% of viable virus was generated.

Chiu's team plans another challenge study, this time with vaccinated people infected with the Delta variant.

The group will also continue studying the 18 people who didn't get sick despite receiving the same amount of virus. Those individuals also never developed any antibodies and were screened for closely related viruses to rule out cross-protection.

"There are lots of other things that help protect us," Chiu said. "There are barriers in the nose. There are different kinds of proteins and things which are very ancient, primordial, protective systems, and they are likely to have been contributing to them not being infected, and we're really interested in trying to understand what those are."

Dr. Kathryn Edwards, a pediatric infectious disease specialist at Vanderbilt University who wrote an editorial published with the study, said the research offers important information about infection with the new coronavirus.

Blood and tissue samples collected for the study will be analyzed for years to come, she said.

"I think those are all in the freezer, so to speak, and are being dissected. So, I think that should be very powerful," Edwards told CNN.

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Researchers examined Australian psychological distress trends from 2001 to 2018 from six national health surveys that showed a 40% increase in mental distress disproportionally affecting women aged 55 to 64, young women and those from low-income backgrounds. More recent data highlights that post-COVID-19, one in five women have high to very high distress.

The results are now published in Frontiers in Psychiatry.

This alarming trend has only been exacerbated by COVID-19 as more women faced job losses, increased caring and domestic responsibilities and loss of income for retirement with women accounting for 80% of superannuation withdrawals during the pandemic.

The first author Dr. Joanne Enticott, Head of Mental Health Epidemiology Research at the Monash School of Public Health and Preventive Medicine, says there is a greater risk of depression in populations with higher income inequality and the pandemic has exacerbated the endemic problems of gender inequity, built on generational societal change.

"Financial economic security for Australian women is at an all-time low, and women and their families continue to be relatively disadvantaged. There is an urgent need for a bold new agenda that delivers broader cooperation to improve financial insecurity and optimize mental and physical health," Dr. Enticott said.

Australia's gender inequity gap is widening with the World Economic Forum showing Australia has dropped to 50th on the global gender gap index. This is due to increasing gender disparity around economic opportunities for women, which causes financial insecurity, linked to elevated mental distress in Australian women.

Professor Helena Teede, Director of the Monash Centre for Research Health and Implementation (MCHRI), says we can no longer fail to recognize and address the fact that inequity by gender is a major challenge in this country with key health and wellbeing impacts, especially for women.

"There have been attempted strategies to improve women's economic security that has not yet delivered for women. With financial insecurity the primary determinant of health, if society does not fix this problem, many Australian women face unprecedented physical and mental health challenges," Professor Teede said.

Monash University is working with the Federal Government to establish a national institute to support women of all ages. It will work across the social determinants of health with a strong focus on financial insecurity and equity to optimize health and wellbeing.

"The institute will better serve women and their families through greater partnership, with women by women, for women. The national institute will be expanded to advance women's careers to improve financial inequity and reduce mental distress," said Professor Teede.

Dr. Enticott added: "It's time to focus on the health and wellbeing of women and the proposed institute will enable the establishment of a national approach to optimizing wellbeing, mental and physical health."

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Kellyn N. Bellsmith, M.D., from the Casey Eye Institute at the Oregon Health & Science University in Portland, and colleagues validated three at-home visual acuity tests (printed chart, mobile phone app, and website) compared with in-office visual acuity among eligible participants with VA of 20/200 or better, recruited from four ophthalmology clinics. Participants were randomly assigned to self-administer two of three at-home tests within three days before their clinic visit.

One hundred twenty-one participants completed the study. The researchers found that the mean in-office VA was 0.11 logMAR (Snellen equivalent, 20/25). The mean difference between the at-home and in-office VA was −0.07, −0.12, and −0.13 for the printed test, mobile phone app, and website, respectively. The Pearson correlation coefficient was 0.72, 0.58, and 0.64 for the printed test, mobile phone app, and website, respectively.

"The COVID-19 pandemic has created an opportunity for expansion of teleophthalmology services due to the necessity of limiting in-person exposures," the authors write. "Validated at-home tests provide an important first step in the expansion of teleophthalmology."

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But that sharp rise may have more to do with better public awareness, more detailed medical records and Medicare billing practices than an actual rise in the condition, the researchers say.

Even so, they note, this offers a chance for more older adults to talk in advance with their families and health care providers about the kind of care they want at the end of life if they do develop Alzheimer's disease or another form of cognitive decline.

The study, published in JAMA Health Forum by a University of Michigan team, uses data from 3.5 million people over the age of 67 who died between 2004 and 2017. It focuses on the bills their providers submitted to the traditional Medicare system in the last two years of the patients' lives.

In 2004, about 35% of these end-of-life billing claims contained at least one mention of dementia, but by 2017 it had risen to more than 47%. Even when the researchers narrowed it down to the patients who had at least two medical claims mentioning dementia, 39% of the patients qualified, up from 25% in 2004.

The biggest jump in the percentage of people dying with a dementia diagnosis happened around the time Medicare allowed hospitals, hospices and doctors' offices to list more diagnoses on their requests for payment.

But around this same time, the National Plan to Address Alzheimer's Disease also went into effect, with a focus on public awareness, quality of care and more support for patients and their caregivers.

The end-of-life care that patients with dementia received changed somewhat overtime, including a drop in the percentage who died in a regular hospital bed or a ICU bed, or who had a feeding tube in their last six months. The percentage who received hospice services rose dramatically, from 36% to nearly 63%, though the authors note this is in line with a national trend toward more hospice care by the late 2010s.

"This shows we have far to go in addressing end-of-life care preferences proactively with those who are recently diagnosed, and their families," said Julie Bynum, M.D., Ph.D., senior author of the study and a professor of geriatric medicine at Michigan Medicine. "Where once the concern may have been underdiagnosis, now we can focus on how we use dementia diagnosis rates in everything from national budget planning to adjusting how Medicare reimburses Medicare Advantage plans."

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Some of these ancient objects are tall and cylindrical, others bulbous, yet others shaped like two cones stacked together. Some are partially or almost fully buried. Who made them, and what purpose they served, is unknown. Whatever their use, however, it seems more widespread than we knew.

The discovery brings the total number of known megalithic jar sites in Assam to 11. Similar sites have also been found in Laos and Indonesia. Together, they date between the second millennium BCE and 13th century CE. Human remains found in and around the Laos jars suggest those ones may have been used for mortuary practices.

Megalithic jar sites in Assam were first formally described in 1929 by British civil servants Philip Mills and John Henry Hutton, who reported six sites. The seventh site wasn't discovered until a 2016-2017 expedition, part of work to relocate and catalog the sites described by Mills and Hutton.

Led by archaeologist Tilok Thakuria of North Eastern Hill University in India, work recommenced in 2020, and that's when the previously unknown sites started to emerge.

Jars at Thaimodholing. (Thakuria et al., Asian Archaeology, 2022)

"At the start the team just went in to survey three large sites that hadn't been formally surveyed. From there grids were set up to explore the surrounding densely forested regions," says archaeologist Nicholae Skopal of the Australian National University in Australia.  

"This is when we first started finding new jar sites."

The four new sites were the village of Herakilo, at which 10 jars were found, six at the outskirts, and the remaining four relocated to the village; a ridgeline at Thaimodholing, where 12 badly damaged jars were found; a spur at Thaimodholing, where eight jars were found, some relocated a short distance from the original spot, possibly due to the construction of a road; and Lower Chaikam, where 35 jars were found in a field surrounded by dense forest.

When added to the seven previously known sites, a total of 797 jars have been identified, in various states of preservation, over an area of 300 square kilometers (115 square miles). These jars seem to have been deliberately positioned on ridges, spurs and hills, with views of lowlands.

Furthermore, archaeologists haven't found any sources of the sandstone from which the jars are carved in the vicinity of any of the sites.

"We still don't know who made the giant jars or where they lived. It's all a bit of a mystery," Skopal says.

Jars at Lower Chaikam. (Thakuria et al., Asian Archaeology, 2022)

However, there are traces of clues to suggest that, like the Laos jars, the Assam jars may have been used for mortuary practices.

Mills and Hutton reported that one of the jars contained cremated bone fragments. British anthropologist Ursula Graham Bower lived with the Zemi Naga people in the 1930s; according to her reports, the Zemi believed that the jars were made by the lost Siemi people, for funerary purposes.

"There are stories from the Naga people, the current ethnic groups in north-east India, of finding the Assam jars filled with cremated remains, beads, and other material artifacts," Skopal notes.

It's likely there are many more jar sites out there in the heavily forested uplands of Assam, since the team only searched a limited area. This, the researchers said, is very important for protecting the heritage of Assam, as human habitation expands. Additional surveys are warranted with urgency across Assam, Meghalaya, and Manipur, the researchers note.

"It seems as though there aren't any living ethnic groups in India associated with the jars, which means there is an importance to maintain the cultural heritage," Skopal says.   

"The longer we take to find them, the greater chance that they will be destroyed, as more crops are planted in these areas and the forests are cut down."

Finding more sites could also help archaeologists piece together not just what the jars were for, but the heritage of the mysterious people who made them.

The research has been published in Asian Archaeology.

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NIH begins trial of COVID boosters to fight future variants

Ivermectin worthless against COVID in largest clinical trial to date

Even though stresslaxation is a new term, it describes relaxation-induced anxiety which has been studied for years. This is shown to happen to between 30% and 50% of people when they try to do relaxing things, causing symptoms of stress (such as rapid heart beat or sweating).

It's paradoxical, given people who experience stresslaxation may need to do something relaxing to de-stress. This can turn into a destructive, vicious cycle where they can't alleviate the stress they're experiencing—which could result in having more negative emotions and panic attacks.

Not everyone will experience stresslaxation. Some research even suggests people who have anxiety may be more prone to it. But here are just a few of the other reasons why it happens—and what you can do to get over it.

1. You're denying you're stressed

Pretending that a problem doesn't exist—also known as denial—is one of the least effective coping strategies for stress. In the case of stresslaxing, this might be denying you're stressed to begin with.

Short periods of denial can actually help us adapt to change. For example, denial can help a person cope with their emotions after experiencing the death of someone close. But when denial is used frequently to deal with daily stressors, it can leave people feeling perpetually stuck in a rut.

When you're in denial, your body continues sending stress signals in order to prompt you to take action and resolve your problems. This is why attempting (and failing) to relax instead of actually addressing the causes of your stress can make you feel more stressed out.

Here's how to fix this:

• Acknowledge that the stress symptoms can be helpful. Your body is trying to alert you that a problem needs fixing, so it's activating all its physiological resources to help you do this. For example, an increased heart rate helps your body carry more oxygenated blood to your brain, so that your brain can come up with a solution quickly to the problems that are causing you stress.

• Write down your deepest thoughts and feelings associated with your stress. This will help you understand the source of your stress so you can tackle it. For example, there's little point in doing meditation daily to de-stress if the cause of your stress is being overworked. In this case, actually speaking with a manager or colleague to adjust your workload would do more to help relieve your stress than relaxing activities might.

• Think outside the box. When we're stressed, we might only think certain activities (such as meditation or exercise) can help us relax. But speaking to friends or family, or using an app or online resource, might be a better way to address your stress and help you feel better.

2. You're worrying about what other people will say

Most of us have something we're passionate about—whether that's our work or even a hobby. But the reason you're motivated to do these things is important.

Some people pursue their passion because they want to—whether that's to improve themselves or learn a new skill. But others may only pursue their passion because they want recognition from other people. People with certain personality types may be more prone to obsessing over their passion. Others may simply follow a certain pursuit to get praise from their colleagues or even to prove their worth to friends or family.

The problem with pursuing a passion for the wrong reason is that it can cause a person to push themselves to the limit—which could mean working despite being sick, or not taking time off to de-stress. This can make it difficult and stressful to relax—like you're wasting time that could be spent pursuing your passion when you try doing relaxing things. You might even be worried that people will think badly of you for taking time off. Ultimately, this can negatively affect wellbeing.

For people who feel like this, taking a short "mental break" from what you're passionate about may be helpful. The break doesn't have to be long, nor does it have to involve doing something you necessarily see as relaxing. But taking even short breaks may help you to eventually feel that it's okay to take time away from your passion every now and again to de-stress and relax.

3. You can't make up your mind

When making a decision, some people can't help but explore all possible options available to them—known as maximizing thoughts. This can even happen when trying to pick something relaxing to do. Even after picking something, you may instead think about the other options, wondering if something else would've helped you feel more relaxed. So instead of relaxing your mind, you're stressing yourself even more.

Unfortunately, maximizing leads to self-blame regret, no matter what option we choose. It's also sometimes associated with lower wellbeing.

For a person who has a habit of maximizing, they may be thinking of all the other things they have to do that day instead of actually relaxing—which may lead to feelings of stress.

Here's how to work through this:

• Limit the number of decisions you need to make on the day you want to do something relaxing. Or even plan when you're going to do something relaxing (such as watching a movie or meditating) and how long you're going to do it for. This may make it easier to relax when the time comes as you'll know you aren't putting other things off.

• Remember why you're trying to relax. Your health is important, so remembering this may help you feel less stressed while trying to do a relaxing activity.

On the bright side, even if relaxation causes anxiety, it can still have a positive effect on mental health—and may even help you grow as a person. The most crucial thing is finding a relaxing activity you enjoy. Whether that's cooking, gardening or even running, it's important that it helps you switch off from your day's stress.

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We are two neuroscientists who study the processes of learning and numerical cognition—how people use and understand numbers. While there is still much to discover about the mathematical abilities of the human brain, one thing is certain: People are terrible at processing large numbers.

During the peak of the omicron wave, over 3,000 U.S. residents died per day—a rate faster than in any other large high-income country. A rate of 3,000 deaths per day is already an incomprehensible number; 1 million is unfathomably larger. Modern neuroscience research can shed light on the limitations of the brain in how it deals with large numbers—limitations that have likely factored in to how the American public perceives and responds to COVID-related deaths.

The brain is built to compare, not to count

Humans process numbers using networks of interconnected neurons throughout the brain. Many of these pathways involve the parietal cortex—a region of the brain located just above the ears. It's responsible for processing all different sorts of quantities or magnitudes, including time, speed and distance, and provides a foundation for other numerical abilities.

While the written symbols and spoken words that humans use to represent numbers are a cultural invention, understanding quantities themselves is not. Humans—as well as many animals including fish, birds and monkeys—show rudimentary numerical abilities shortly after birth. Infants, adults and even rats find it easier to distinguish between relatively small numbers than larger ones. The difference between 2 and 5 is much easier to visualize than the difference between 62 and 65, despite the fact that both number sets differ by only 3.

The brain is optimized to recognize small quantities because smaller numbers are what people tend to interact with most on a daily basis. Research has shown that when presented with different numbers of dots, both children and adults can intuitively and rapidly recognize quantities less than three or four. Beyond that, people have to count, and as the numbers get higher, intuitive understanding is replaced by abstract concepts of large, individual numbers.

This bias toward smaller numbers even plays out day to day in the grocery store. When researchers asked shoppers in a checkout line to estimate the total cost of their purchase, people reliably named a lower price than the actual amount. And this distortion increased with price—the more expensive the groceries were, the larger the gap between the estimated and actual amounts.

Once you get into large numbers like millions and billions, the brain begins to start thinking of these values as categories rather than actual numbers.

Bad at big numbers

Since anything bigger than 5 is too large a quantity to intuitively recognize, it follows that the brain must rely on different methods of thinking when confronted with much bigger numbers.

One prominent theory proposes that the brain relies on an inexact method whereby it represents approximate quantities through a sort of mental number line. This line, imagined in our mind's eye, organizes small to large numbers from left to right (though this orientation depends on cultural convention). People tend to make consistent errors when using this internal number line, often underestimating extremely large quantities and overestimating relatively smaller quantities. For example, research has shown that college students in geology and biology courses commonly underestimate the time between the appearance of the first life on Earth and the dinosaurs—which is billions of years—but overestimate how long dinosaurs actually lived on Earth—millions of years.

Further research looking at how people estimate the value of large numbers shows that many people place the number 1 million halfway between 1,000 and 1 billion on a number line. In reality, a million is 1,000 times closer to 1,000 than 1 billion. This number line gaffe may visually represent how people people use words like "thousand" and "billion" as category markers that represent "big" and "bigger" rather than distinct values.

When grappling with numbers outside of everyday experience, precise values just mean less.

1,000,000 deaths

Numbers are a useful, clear and efficient way to summarize the harms of the pandemic, but the truth is that the brain simply can't understand what it means that a million people have died. By abstracting deaths into impossibly large numbers, people fall prey to the limitations of the mind. In doing so, it's easy to forget that every single numerical increase represents the entire lived experience of another human being.

This pandemic has been full of hard-to-comprehend numbers. The filtration efficiency of various face masks, the accuracy of different COVID-19 tests, statewide case numbers and worldwide death rates are all complicated concepts far beyond the brain's intuitive number processing abilities. Yet these numbers—and how they are presented—matter immensely.

If the brain were built to understand these kinds of numbers, perhaps we would have made different individual decisions or taken different collective action. Instead, we now mourn for the million people behind the number.

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The first vaccine against the most common cause of cervical cancer was approved in 2006, and in the years that followed, parents were eager to get their daughters protected.

More than a decade later, that kind of anticipation for a vaccine would be hard to imagine. Two years into the COVID-19 pandemic, fewer than half of McKean County residents were fully inoculated, according to the Centers for Disease Control and Prevention, and just 38% had received a booster shot by early March—among the lowest rates in Pennsylvania.

This rural Central Pennsylvania county is hardly an outlier: Among adults in the U.S., only about 4 in 10, or 42%, had gotten a booster as of January, according to an ongoing study by the Kaiser Family Foundation.

Two years of a pandemic tearing a path of sickness and death through the U.S.—surging, ebbing, then surging again—eroded trust in medicine along the way, doctors and others say.

Low U.S. rates for booster shots are a reflection of that wariness.

The numbers are not much better in urban Allegheny County. Fewer than half of those eligible—46.7%—had gotten a COVID-19 booster shot by the end of February. That's a month shy of the two-year anniversary of Gov. Tom Wolf's closure of schools statewide because of the pandemic, keeping more than 1.7 million kids out of the classroom.

Doctors are pushing back against the distrust, as they have always done, with candor and science, but also by building trust one patient at a time through new professional relationships with patients. Discouraged by health insurers' growing control of medical care, a group of Pittsburgh-area doctors has created a new model for the patient-doctor relationship, one they say is the future of medicine.

In the mid-20th century, the response to medical advances was different.

The peak of the polio outbreak in the U.S. came in 1952, when about 58,000 cases were reported. Children with parents' permission packed school auditoriums to get polio shots in 1955—and vaccinations against measles, mumps, rubella and HPV in the decades that followed.

But in early 2020, as a new disease quickly spread around the world, so did the rumors and sometimes contradictory information about what to do about it. Individual interpretations of scientific evidence became the norm, and distrust of medicine rose—even as COVID-19 became the third leading cause of death in the U.S. that year with 350,831 recorded fatalities, trailing only heart disease and cancer.

A pre-existing distrust of science was "exacerbated by conflicting messages, questionable treatments reported in research publications, concerns about political interference in public health recommendations and decisions regarding the efficacy of therapeutics, and pseudoscience and conspiracy theories," a 2020 column in the Journal of the American Medical Association noted.

Among the confusing issues:

— Face masks were discouraged to save supplies, then recommended for everyone, then later sometimes mandated.

— Officials said COVID-19 was spread by close contact, then it turned out getting infected didn't have to mean close contact at all.

— Even after vaccines were made available, people who were fully vaccinated sometimes died, feeding an alternative narrative about the shots.

And the situation grew worse as the pandemic wore on. A Pew Research Center study in February found 60% of U.S. adults said they have felt confused by changing public health recommendations on how to curb COVID-19 cases, up 7 percentage points from August.

"Everybody feels really lied to," said the 53-year-old Brown, who lives in Elk County and who recalled a time when people seemed more confident in their doctors. The office of her physician grandfather was attached to his house into the 1970s, a time when trust in doctors was high.

The shift began before COVID.

In a 1966 survey of adults in the U.S., 73% said they had great confidence in the leaders of the medical profession, according to a Journal of American Medical Association column in 2020. A survey done in 2012 found only 34% expressing such confidence.

The fall from embracing science to "pseudoscience and conspiracy theories" was steep.

"We had problems with people using too many antibiotics," Brown said. "Now they turn to essential oils. We have essential oils and this YouTube guy. These are societal failures."

Through February, the COVID-19 pandemic had taken 824,708 lives in the U.S., including 42,247 Pennsylvanians, according to a new survey by Kaiser Health News and PolitiFact.

The start of the pandemic in the U.S. brought with it an "historic level of disregard of scientific advice" about the disease, Naomi Oreskes, professor of the history of science at Harvard University, wrote in Scientific American magazine in 2020. That made the outbreak "worse in the U.S. than in many other countries."

She compared the message that presented use of face masks as an issue of personal freedoms to Big Tobacco's longtime marketing of cigarettes.

Brown, for her part, blames the distrust of medicine on the opioid epidemic, which took the lives of many of her friends and former students. Trust in medicine and corporate America was easier before the overdose deaths began piling up, she said.

The opioid epidemic began in the 1990s with doctors writing more prescriptions for the medicine, having been given assurances of safety from the drug industry. But overdoses began spiking by 1999, leading to the declaration of a public health emergency in 2017.

In 2021, U.S. overdose deaths topped 100,000 for the first time.

Hampton family physician Kirsten Lin says the distrust of medicine was there all along—the pandemic just brought it to light.

In 2016, for the first time, fewer than half of practicing physicians had an ownership stake in their practice as health systems snapped up medical practices, turning doctors into employees. The shift meant pumped-up patient volume requirements for doctors as health systems sought to juice revenue.

The result was shorter office visits and a deterioration in the doctor-patient relationship.

"People are more easily able to access information on the internet than from their physician," Dr. Lin said. "Trust is really the issue."

The shift helped prompt Dr. Lin and family practice partner Natalie Gentile in 2017 to form Direct Primary Care Physicians, which operates outside the traditional health care system by eliminating barriers to patient care they say health insurers can create.

Direct Primary Care offers patients office visits that can last 45 minutes rather than the standard 10- to 15-minute increments. The doctors make house calls. The practice doesn't accept Medicare, Medicaid or commercial insurance, so the service may not be for everyone.

The concept has been around for about 10 years but has been getting traction recently. There are 22 independent direct primary care offices in the state, according to the Pennsylvania Direct Primary Care Association.

Drs. Lin and Gentile say they've counseled people who distrusted the COVID vaccines.

Whatever the reasons, recent studies showing booster shots provide the best protection against infection did not seem to resonate among those who were already wary—some of whom had to be convinced earlier to get the first two rounds of COVID vaccinations.

Only 1% of those eligible in January said they would get a booster "as soon as possible," down sharply from 34% who said they would in December 2020 before the sense of urgency about the virus waned, according to the Kaiser study. About 34% of adults had received two shots, but not a third.

Only 10 of Pennsylvania's 67 counties exceeded 50% for residents getting boosted, including Beaver County with 50.6%—the highest in Western Pennsylvania, according to CDC data from early March.

In four Pennsylvania counties, the booster rate was under 40%.

The issue is bigger than Western Pennsylvania. A New York Times analysis in January found that the U.S. lagged well behind Belgium, Britain, Germany and five other countries for share of the population getting booster shots, pushing up death rates in the U.S. from COVID-19.

The digital era has supercharged the speed at which information—and disinformation—spreads, feeding the belief that science is a matter of personal opinion, said Kenneth Behrend, a Downtown lawyer who has represented students at North Allegheny and other school districts in court who challenged the lifting of mask mandates in schools.

Recently, a man asked Behrend to represent him in a case fighting mask use before realizing that Behrend very much believes in the value of face masks in curbing the spread of COVID-19.

"Well, you have your science," the man told Behrend, who remembers standing in line as a child for sugar cubes containing the polio vaccine. "And I have mine."

Meanwhile, on a recent weekday, Direct Primary Care Physicians of Pittsburgh co-founder Dr. Gentile drove to the O'Hara home of Megan and Greg Hilkert, both 35, to see their son, 2-month-old Owen. It was a well-baby visit, where he would be weighed, measured—and get four vaccines.

Dr. Gentile, 33, reassured Hilkert about a light rash on the infant's scalp and marveled at the child's size, tugging at his foot on a long measuring tape to get a reading.

Later, the doctor said she believes she can build a trusting relationship with patients minus the treatment limitations health insurers can impose. Personal trust fosters trust in science and medicine.

"The dissolution of trust in the health care system—where are you going to go for answers?" Dr. Gentile said. "How are you going to expect them to trust you when you recommend a vaccine?"

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Using a super-sensitive probe that took decades to invent, researchers have shown sand dunes regularly inhale and exhale tiny amounts of water vapor.

The inhales are harder to achieve when the sand is drier. But when the wind flows over the surface of a dune, it carries off the top layer, creating a rapid change in surface moisture and pressure. As a result, "evanescent waves of humidity" from the atmosphere above flow downward.

The probe used to detect this flow is so sensitive to moisture, it can pick up tiny films of water on a single grain of sand.

When plunged into a dune in the Qatar desert, the instrument was able to scan the temperature, radiation, and moisture in its surroundings on a millimeter-scale resolution in just 20 seconds.

These measurements were repeated every 2.7 minutes for two whole days, amassing a huge quantity of data.

The authors know of no other instruments that can keep tabs on a sand dune with such high spatial or temporal resolution.

In combination with data on wind speed and direction as well as ambient temperature and humidity, the authors have revealed an extremely subtle behavior of sand in the desert.

Unlike heat, which is conducted through individual sand grains, water vapor seems to percolate between grains.

The pores of a sand dune, therefore, carry moisture from the surface downward, and these pathways are made and remade as the wind blows.

"The wind flows over the dune and as a result creates imbalances in the local pressure, which literally forces air to go into the sand and out of the sand. So the sand is breathing, like an organism breathes," explains mechanical engineer Michel Louge from Cornell University. 

This 'breathing' could be part of what allows microbes to live deep in sand dunes, even when no liquid water is available.

Interestingly, at the surface of the dune, the probe measured less evaporation than scientists were predicting. For such a hyper-arid region, the leaching of moisture from the sand dune to the atmosphere was a relatively slow chemical process.

"This is the first time that such low levels of humidity could be measured," says Louge.

The sensitivity of the new probe is a feat of technology that could allow scientists to more accurately measure how agricultural lands turn to desert, a process exacerbated by climate change.

"The future of the Earth, if we continue this way, is a desert," warns Louge.

Knowing more about how deserts work could, therefore, be really useful. And not just for a better understanding of our own planet.

Probes that can sensitively measure moisture within sand could help experts find invisible signs of water on, say, Mars.

Just because the desert looks deserted on the surface, doesn't mean there isn't life hiding below.

The study was published in the Journal of Geophysical Research: Earth Surface.

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It’s no surprise that when a person gets a diagnosis of heart disease, cancer or some other life-limiting or life-threatening physical ailment, they become anxious or depressed. But the reverse can also be true: Undue anxiety or depression can foster the development of a serious physical disease, and even impede the ability to withstand or recover from one. The potential consequences are particularly timely, as the ongoing stress and disruptions of the pandemic continue to take a toll on mental health.

The human organism does not recognize the medical profession’s artificial separation of mental and physical ills. Rather, mind and body form a two-way street. What happens inside a person’s head can have damaging effects throughout the body, as well as the other way around. An untreated mental illness can significantly increase the risk of becoming physically ill, and physical disorders may result in behaviors that make mental conditions worse.

In studies that tracked how patients with breast cancer fared, for example, Dr. David Spiegel and his colleagues at Stanford University School of Medicine showed decades ago that women whose depression was easing lived longer than those whose depression was getting worse. His research and other studies have clearly shown that “the brain is intimately connected to the body and the body to the brain,” Dr. Spiegel said in an interview. “The body tends to react to mental stress as if it was a physical stress.”

Despite such evidence, he and other experts say, chronic emotional distress is too often overlooked by doctors. Commonly, a physician will prescribe a therapy for physical ailments like heart disease or diabetes, only to wonder why some patients get worse instead of better.

Many people are reluctant to seek treatment for emotional ills. Some people with anxiety or depression may fear being stigmatized, even if they recognize they have a serious psychological problem. Many attempt to self-treat their emotional distress by adopting behaviors like drinking too much or abusing drugs, which only adds insult to their pre-existing injury.

And sometimes, family and friends inadvertently reinforce a person’s denial of mental distress by labeling it as “that’s just the way he is” and do nothing to encourage them to seek professional help.

How common are anxiety and depression?

Anxiety disorders affect nearly 20 percent of American adults. That means millions are beset by an overabundance of the fight-or-flight response that primes the body for action. When you’re stressed, the brain responds by prompting the release of cortisol, nature’s built-in alarm system. It evolved to help animals facing physical threats by increasing respiration, raising the heart rate and redirecting blood flow from abdominal organs to muscles that assist in confronting or escaping danger.

These protective actions stem from the neurotransmitters epinephrine and norepinephrine, which stimulate the sympathetic nervous system and put the body on high alert. But when they are invoked too often and indiscriminately, the chronic overstimulation can result in all manner of physical ills, including digestive symptoms like indigestion, cramps, diarrhea or constipation, and an increased risk of heart attack or stroke.

Depression, while less common than chronic anxiety, can have even more devastating effects on physical health. While it’s normal to feel depressed from time to time, more than 6 percent of adults have such persistent feelings of depression that it disrupts personal relationships, interferes with work and play, and impairs their ability to cope with the challenges of daily life. Persistent depression can also exacerbate a person’s perception of pain and increase their chances of developing chronic pain.

“Depression diminishes a person’s capacity to analyze and respond rationally to stress,” Dr. Spiegel said. “They end up on a vicious cycle with limited capacity to get out of a negative mental state.”

Potentially making matters worse, undue anxiety and depression often coexist, leaving people vulnerable to a panoply of physical ailments and an inability to adopt and stick with needed therapy.

A study of 1,204 elderly Korean men and women initially evaluated for depression and anxiety found that two years later, these emotional disorders increased their risk of physical disorders and disability. Anxiety alone was linked with heart disease, depression alone was linked with asthma, and the two together were linked with eyesight problems, persistent cough, asthma, hypertension, heart disease and gastrointestinal problems.

Treatment can counter emotional tolls

Although persistent anxiety and depression are highly treatable with medications, cognitive behavioral therapy and talk therapy, without treatment these conditions tend to get worse. According to Dr. John Frownfelter, treatment for any condition works better when doctors understand “the pressures patients face that affect their behavior and result in clinical harm.”

Dr. Frownfelter is an internist and chief medical officer of a start-up called Jvion. The organization uses artificial intelligence to identify not just medical factors but psychological, social and behavioral ones as well that can impact the effectiveness of treatment on patients’ health. Its aim is to foster more holistic approaches to treatment that address the whole patient, body and mind combined.

The analyses used by Jvion, a Hindi word meaning life-giving, could alert a doctor when underlying depression might be hindering the effectiveness of prescribed treatments for another condition. For example, patients being treated for diabetes who are feeling hopeless may fail to improve because they take their prescribed medication only sporadically and don’t follow a proper diet, Dr. Frownfelter said.

“We often talk about depression as a complication of chronic illness,” Dr. Frownfelter wrote in Medpage Today in July. “But what we don’t talk about enough is how depression can lead to chronic disease. Patients with depression may not have the motivation to exercise regularly or cook healthy meals. Many also have trouble getting adequate sleep.”

Some changes to medical care during the pandemic have greatly increased patient access to depression and anxiety treatment. The expansion of telehealth has enabled patients to access treatment by psychotherapists who may be as far as a continent away.

Patients may also be able to treat themselves without the direct help of a therapist. For example, Dr. Spiegel and his co-workers created an app called Reveri that teaches people self-hypnosis techniques designed to help reduce stress and anxiety, improve sleep, reduce pain and suppress or quit smoking.

Improving sleep is especially helpful, Dr. Spiegel said, because “it enhances a person’s ability to regulate the stress response system and not get stuck in a mental rut.” Data demonstrating the effectiveness of the Reveri app has been collected but not yet published, he said.

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