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MIT’s top research stories of 2021

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Despite the pandemic’s disruptions, MIT’s research community still found a way to generate a number of impressive research breakthroughs in 2021. In the spirit of reflection that comes with every new orbit around the sun, below we count down 10 of the most-viewed research stories on MIT News from the past year.

We’ve also rounded up the year’s top MIT community-related stories .

10. Giving cancer treatment a recharge . In October, researchers discovered a way to jump-start the immune system to attack tumors. The method combines chemotherapy and immunotherapy to spur immune cells into action. The researchers hope it could allow immunotherapy to be used against more types of cancer.

9. Generating 3D holograms in real-time . Computer scientists developed a deep-learning-based system that allows computers to create holograms almost instantly. The system could be used to create holograms for virtual reality, 3D printing, medical imaging, and more — and it’s efficient enough to run on a smartphone.

8. Creating inhalable vaccines . Scientists at the Koch Institute developed a method for delivering vaccines directly to the lungs through inhalation. The new strategy induced a strong immune response in the lungs of mice and could offer a quicker response to viruses that infect hosts through mucosal surfaces.

7. Assessing Covid-19 transmission risk . Two MIT professors proposed a new approach to estimating the risks of exposure to Covid-19 in different indoor settings. The guidelines suggest a limit for exposure based on factors such as the size of the space, the number of people, the kinds of activity, whether masks are worn, and ventilation and filtration rates.

6. Teaching machine learning models to adapt . Researchers in CSAIL developed a new type of neural network that can change its underlying equations to continuously adapt to new data. The advance could improve models’ decision-making based on data that changes over time, such as in medical diagnosis and autonomous driving.

5. Programming fibers . In June, a team created the first fabric fiber with digital capabilities. The fibers can sense, store, analyze, and infer data and activity after being sewn into a shirt. The researchers say the fibers could be used to monitor physical performance, to detect diseases, and for a variety of medical purposes.

4. Examining the limitations of data visualizations . A collaboration between anthropologists and computer scientists found that coronavirus skeptics have used sophisticated data visualizations to argue against public health orthodoxy like wearing a mask. The researchers concluded that data visualizations aren’t sufficient to convey the urgency of the Covid-19 pandemic because even the clearest graphs can be interpreted through a variety of belief systems.

3. Developing a Covid-detecting face mask . Engineers at MIT and Harvard University designed a prototype face mask that can diagnose the person wearing the mask with Covid-19 in about 90 minutes. The masks are embedded with tiny, disposable sensors that can be fitted into other face masks and could also be adapted to detect other viruses.

2. Confirming Hawking’s black hole theorem . Using observations of gravitational waves, physicists from MIT and elsewhere confirmed a major theorem created by Stephen Hawking in 1971. The theorem states that the area of a black hole’s event horizon — the boundary beyond which nothing can ever escape — will never shrink.

1. Advancing toward fusion energy . In September, researchers at MIT and the MIT spinout Commonwealth Fusion Systems ramped up a high-temperature superconducting electromagnet to a field strength of 20 tesla, the most powerful magnetic field of its kind ever created on Earth. The demonstration was three years in the making and is believed to resolve one of greatest remaining points of uncertainty in the quest to build the world’s first fusion power plant that produces more energy than it consumes.

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The 10 Most Significant Education Studies of 2021

From reframing our notion of “good” schools to mining the magic of expert teachers, here’s a curated list of must-read research from 2021.

It was a year of unprecedented hardship for teachers and school leaders. We pored through hundreds of studies to see if we could follow the trail of exactly what happened: The research revealed a complex portrait of a grueling year during which persistent issues of burnout and mental and physical health impacted millions of educators. Meanwhile, many of the old debates continued: Does paper beat digital? Is project-based learning as effective as direct instruction? How do you define what a “good” school is?

Other studies grabbed our attention, and in a few cases, made headlines. Researchers from the University of Chicago and Columbia University turned artificial intelligence loose on some 1,130 award-winning children’s books in search of invisible patterns of bias. (Spoiler alert: They found some.) Another study revealed why many parents are reluctant to support social and emotional learning in schools—and provided hints about how educators can flip the script.

1. What Parents Fear About SEL (and How to Change Their Minds)

When researchers at the Fordham Institute asked parents to rank phrases associated with social and emotional learning , nothing seemed to add up. The term “social-emotional learning” was very unpopular; parents wanted to steer their kids clear of it. But when the researchers added a simple clause, forming a new phrase—”social-emotional & academic learning”—the program shot all the way up to No. 2 in the rankings.

What gives?

Parents were picking up subtle cues in the list of SEL-related terms that irked or worried them, the researchers suggest. Phrases like “soft skills” and “growth mindset” felt “nebulous” and devoid of academic content. For some, the language felt suspiciously like “code for liberal indoctrination.”

But the study suggests that parents might need the simplest of reassurances to break through the political noise. Removing the jargon, focusing on productive phrases like “life skills,” and relentlessly connecting SEL to academic progress puts parents at ease—and seems to save social and emotional learning in the process.

2. The Secret Management Techniques of Expert Teachers

In the hands of experienced teachers, classroom management can seem almost invisible: Subtle techniques are quietly at work behind the scenes, with students falling into orderly routines and engaging in rigorous academic tasks almost as if by magic. 

That’s no accident, according to new research . While outbursts are inevitable in school settings, expert teachers seed their classrooms with proactive, relationship-building strategies that often prevent misbehavior before it erupts. They also approach discipline more holistically than their less-experienced counterparts, consistently reframing misbehavior in the broader context of how lessons can be more engaging, or how clearly they communicate expectations.

Focusing on the underlying dynamics of classroom behavior—and not on surface-level disruptions—means that expert teachers often look the other way at all the right times, too. Rather than rise to the bait of a minor breach in etiquette, a common mistake of new teachers, they tend to play the long game, asking questions about the origins of misbehavior, deftly navigating the terrain between discipline and student autonomy, and opting to confront misconduct privately when possible.

3. The Surprising Power of Pretesting

Asking students to take a practice test before they’ve even encountered the material may seem like a waste of time—after all, they’d just be guessing.

But new research concludes that the approach, called pretesting, is actually more effective than other typical study strategies. Surprisingly, pretesting even beat out taking practice tests after learning the material, a proven strategy endorsed by cognitive scientists and educators alike. In the study, students who took a practice test before learning the material outperformed their peers who studied more traditionally by 49 percent on a follow-up test, while outperforming students who took practice tests after studying the material by 27 percent.

The researchers hypothesize that the “generation of errors” was a key to the strategy’s success, spurring student curiosity and priming them to “search for the correct answers” when they finally explored the new material—and adding grist to a 2018 study that found that making educated guesses helped students connect background knowledge to new material.

Learning is more durable when students do the hard work of correcting misconceptions, the research suggests, reminding us yet again that being wrong is an important milestone on the road to being right.

4. Confronting an Old Myth About Immigrant Students

Immigrant students are sometimes portrayed as a costly expense to the education system, but new research is systematically dismantling that myth.

In a 2021 study , researchers analyzed over 1.3 million academic and birth records for students in Florida communities, and concluded that the presence of immigrant students actually has “a positive effect on the academic achievement of U.S.-born students,” raising test scores as the size of the immigrant school population increases. The benefits were especially powerful for low-income students.

While immigrants initially “face challenges in assimilation that may require additional school resources,” the researchers concluded, hard work and resilience may allow them to excel and thus “positively affect exposed U.S.-born students’ attitudes and behavior.” But according to teacher Larry Ferlazzo, the improvements might stem from the fact that having English language learners in classes improves pedagogy , pushing teachers to consider “issues like prior knowledge, scaffolding, and maximizing accessibility.”

5. A Fuller Picture of What a ‘Good’ School Is

It’s time to rethink our definition of what a “good school” is, researchers assert in a study published in late 2020.⁣ That’s because typical measures of school quality like test scores often provide an incomplete and misleading picture, the researchers found.

The study looked at over 150,000 ninth-grade students who attended Chicago public schools and concluded that emphasizing the social and emotional dimensions of learning—relationship-building, a sense of belonging, and resilience, for example—improves high school graduation and college matriculation rates for both high- and low-income students, beating out schools that focus primarily on improving test scores.⁣

“Schools that promote socio-emotional development actually have a really big positive impact on kids,” said lead researcher C. Kirabo Jackson in an interview with Edutopia . “And these impacts are particularly large for vulnerable student populations who don’t tend to do very well in the education system.”

The findings reinforce the importance of a holistic approach to measuring student progress, and are a reminder that schools—and teachers—can influence students in ways that are difficult to measure, and may only materialize well into the future.⁣

6. Teaching Is Learning

One of the best ways to learn a concept is to teach it to someone else. But do you actually have to step into the shoes of a teacher, or does the mere expectation of teaching do the trick?

In a 2021 study , researchers split students into two groups and gave them each a science passage about the Doppler effect—a phenomenon associated with sound and light waves that explains the gradual change in tone and pitch as a car races off into the distance, for example. One group studied the text as preparation for a test; the other was told that they’d be teaching the material to another student.

The researchers never carried out the second half of the activity—students read the passages but never taught the lesson. All of the participants were then tested on their factual recall of the Doppler effect, and their ability to draw deeper conclusions from the reading.

The upshot? Students who prepared to teach outperformed their counterparts in both duration and depth of learning, scoring 9 percent higher on factual recall a week after the lessons concluded, and 24 percent higher on their ability to make inferences. The research suggests that asking students to prepare to teach something—or encouraging them to think “could I teach this to someone else?”—can significantly alter their learning trajectories.

7. A Disturbing Strain of Bias in Kids’ Books

Some of the most popular and well-regarded children’s books—Caldecott and Newbery honorees among them—persistently depict Black, Asian, and Hispanic characters with lighter skin, according to new research .

Using artificial intelligence, researchers combed through 1,130 children’s books written in the last century, comparing two sets of diverse children’s books—one a collection of popular books that garnered major literary awards, the other favored by identity-based awards. The software analyzed data on skin tone, race, age, and gender.

Among the findings: While more characters with darker skin color begin to appear over time, the most popular books—those most frequently checked out of libraries and lining classroom bookshelves—continue to depict people of color in lighter skin tones. More insidiously, when adult characters are “moral or upstanding,” their skin color tends to appear lighter, the study’s lead author, Anjali Aduki,  told The 74 , with some books converting “Martin Luther King Jr.’s chocolate complexion to a light brown or beige.” Female characters, meanwhile, are often seen but not heard.

Cultural representations are a reflection of our values, the researchers conclude: “Inequality in representation, therefore, constitutes an explicit statement of inequality of value.”

8. The Never-Ending ‘Paper Versus Digital’ War

The argument goes like this: Digital screens turn reading into a cold and impersonal task; they’re good for information foraging, and not much more. “Real” books, meanwhile, have a heft and “tactility”  that make them intimate, enchanting—and irreplaceable.

But researchers have often found weak or equivocal evidence for the superiority of reading on paper. While a recent study concluded that paper books yielded better comprehension than e-books when many of the digital tools had been removed, the effect sizes were small. A 2021 meta-analysis further muddies the water: When digital and paper books are “mostly similar,” kids comprehend the print version more readily—but when enhancements like motion and sound “target the story content,” e-books generally have the edge.

Nostalgia is a force that every new technology must eventually confront. There’s plenty of evidence that writing with pen and paper encodes learning more deeply than typing. But new digital book formats come preloaded with powerful tools that allow readers to annotate, look up words, answer embedded questions, and share their thinking with other readers.

We may not be ready to admit it, but these are precisely the kinds of activities that drive deeper engagement, enhance comprehension, and leave us with a lasting memory of what we’ve read. The future of e-reading, despite the naysayers, remains promising.

9. New Research Makes a Powerful Case for PBL

Many classrooms today still look like they did 100 years ago, when students were preparing for factory jobs. But the world’s moved on: Modern careers demand a more sophisticated set of skills—collaboration, advanced problem-solving, and creativity, for example—and those can be difficult to teach in classrooms that rarely give students the time and space to develop those competencies.

Project-based learning (PBL) would seem like an ideal solution. But critics say PBL places too much responsibility on novice learners, ignoring the evidence about the effectiveness of direct instruction and ultimately undermining subject fluency. Advocates counter that student-centered learning and direct instruction can and should coexist in classrooms.

Now two new large-scale studies —encompassing over 6,000 students in 114 diverse schools across the nation—provide evidence that a well-structured, project-based approach boosts learning for a wide range of students.

In the studies, which were funded by Lucas Education Research, a sister division of Edutopia , elementary and high school students engaged in challenging projects that had them designing water systems for local farms, or creating toys using simple household objects to learn about gravity, friction, and force. Subsequent testing revealed notable learning gains—well above those experienced by students in traditional classrooms—and those gains seemed to raise all boats, persisting across socioeconomic class, race, and reading levels.

10. Tracking a Tumultuous Year for Teachers

The Covid-19 pandemic cast a long shadow over the lives of educators in 2021, according to a year’s worth of research.

The average teacher’s workload suddenly “spiked last spring,” wrote the Center for Reinventing Public Education in its January 2021 report, and then—in defiance of the laws of motion—simply never let up. By the fall, a RAND study recorded an astonishing shift in work habits: 24 percent of teachers reported that they were working 56 hours or more per week, compared to 5 percent pre-pandemic.

The vaccine was the promised land, but when it arrived nothing seemed to change. In an April 2021 survey  conducted four months after the first vaccine was administered in New York City, 92 percent of teachers said their jobs were more stressful than prior to the pandemic, up from 81 percent in an earlier survey.

It wasn’t just the length of the work days; a close look at the research reveals that the school system’s failure to adjust expectations was ruinous. It seemed to start with the obligations of hybrid teaching, which surfaced in Edutopia ’s coverage of overseas school reopenings. In June 2020, well before many U.S. schools reopened, we reported that hybrid teaching was an emerging problem internationally, and warned that if the “model is to work well for any period of time,” schools must “recognize and seek to reduce the workload for teachers.” Almost eight months later, a 2021 RAND study identified hybrid teaching as a primary source of teacher stress in the U.S., easily outpacing factors like the health of a high-risk loved one.

New and ever-increasing demands for tech solutions put teachers on a knife’s edge. In several important 2021 studies, researchers concluded that teachers were being pushed to adopt new technology without the “resources and equipment necessary for its correct didactic use.” Consequently, they were spending more than 20 hours a week adapting lessons for online use, and experiencing an unprecedented erosion of the boundaries between their work and home lives, leading to an unsustainable “always on” mentality. When it seemed like nothing more could be piled on—when all of the lights were blinking red—the federal government restarted standardized testing .

Change will be hard; many of the pathologies that exist in the system now predate the pandemic. But creating strict school policies that separate work from rest, eliminating the adoption of new tech tools without proper supports, distributing surveys regularly to gauge teacher well-being, and above all listening to educators to identify and confront emerging problems might be a good place to start, if the research can be believed.

The 10 best research stories of 2021

Is the year over already?

2021 brought its fair share of big news and research breakthroughs, COVID and non-COVID alike. Given UC is the  global leader in cited scholarship , it’s no surprise that each campus produced numerous new ways of understanding our world.

We’ve rounded up some of the best stories from each campus: Some were extensively covered by the media, like UC San Francisco’s novel treatment for severe depression; others were underrated but deserving of more attention, like UC Santa Cruz’s study on the social factors that affect teen gender identity. Together, these stories show how the University of California propels research that changes the world.

1. Curing sickle cell disease (UC Berkeley, UCLA, UC San Francisco)

Using the CRISPR/Cas9 gene-editing technology discovered by UC Berkeley biochemist Jennifer Doudna, physicians are launching clinical trials aimed at correcting the defect that causes sickle cell disease. The inherited blood disorder, which is painful and often fatal, affects about 1 in every 365 Black or African American births. The trials will be led by doctors at UCSF and UCLA and are expected to begin by mid-2022. Tapping into UCLA’s expertise in genetic analysis and cell manufacturing and the decades-long expertise at  UCSF Benioff Children’s Hospital Oakland  in cord blood and marrow transplantation and sickle cell gene therapy, they have the potential to create a cure for sickle cell disease that is both affordable and accessible. Doudna won a Nobel Prize in chemistry in 2020 for the CRISPR technology that makes these trials possible. This research is being funded by the California Institute for Regenerative Medicine, the National Heart, Lung, and Blood Institute-led Cure Sickle Cell Initiative, and the Doris Duke Charitable Foundation.

Learn more:   https://www.universityofcalifornia.edu/news/fda-approves-first-test-crispr-correct-genetic-defect-causing-sickle-cell-disease  and  https://www.ucsf.edu/news/2021/03/420137/uc-consortium-launches-first-clinical-trial-using-crispr-correct-gene-defect

2. A new type of supernova (UC Santa Barbara)

Scientists found the first convincing evidence for a new type of stellar explosion — an electron-capture supernova. The concept of an electron-capture supernova had been theorized for 40 years without any real-world proof. The discovery, led by UC Santa Barbara scientists at Las Cumbres Observatory, has been called the Rosetta Stone of astrophysics because it is helping scientists decode thousand-year-old records from cultures around the world, including a supernova from A.D. 1045 so bright it was seen for 23 days, even at daytime.

Learn more:   https://www.news.ucsb.edu/2021/020338/goldilocks-supernova

3. Social factors affect teen gender expression (UC Santa Cruz)

A UC Santa Cruz study showed that a growing number of Gen Z teens are identifying as nonbinary — but this is influenced by regional differences in levels of resources, rights, and visibility for sexual and gender diversity. While almost 25 percent of the LGBTQ+ youth surveyed expressed some form of nonbinary gender, it was more prevalent in those who lived in the Bay Area compared to the Central Valley. Additionally, teens who were assigned female at birth seemed more comfortable with these forms of gender expression, whereas those who were assigned male at birth faced strong pressures to conform to standards of masculinity. The research sheds light on factors that can support or hinder sexual and gender expression among teens.

Learn more:   https://news.ucsc.edu/2021/03/adolescent-gender-sexual-identity.html

4. Novel treatment for severe depression (UC San Francisco)

One of the most hopeful UC San Francisco stories this year was the successful treatment of severe, previously untreatable depression using customizable deep brain stimulation. Physicians were able to tap into a patient's unique brain circuit involved in her depression and interrupt it using the equivalent of a pacemaker for the brain. The breakthrough was hailed as a landmark in the years-long effort to apply advances in neuroscience to the treatment of psychiatric disorders. This precision medicine approach provided the patient with immediate, long-term symptom relief and could be transformative for other patients with chronic, treatment-resistant depression.

Learn more:   https://www.universityofcalifornia.edu/news/hope-treatment-resistant-depression-brain-stimulation-demand

5. Tracking global wastewater testing for COVID-19 (UC Merced)

After the COVID-19 pandemic struck, scientists across the globe realized they could track the virus by testing sewage water. UC Merced professor Colleen Naughton pioneered a dashboard to host global findings, an innovation that earned her the 2021 Grand Prize in University Research by the American Academy of Environmental Engineers and Scientists. Wastewater monitoring allows scientists to test an entire group of people for COVID-19, not just one person at a time. It has also been shown to be effective at predicting outbreaks of COVID-19. Many cities, universities and countries have now adopted this testing approach and have reinforced the value of Naughton’s dashboard by sharing their results.

Learn more:   https://news.ucmerced.edu/news/2021/naughton-lab-creates-dashboard-track-global-wastewater-testing-covid-19

6. Increased wildfire linked to human-induced climate change (UCLA)

Wildfires have been increasing over the last two decades. But how much of that trend has been caused by human-induced climate change and how much could be explained by other factors? This year, scientists from UCLA and Lawrence Livermore National Laboratory set out to find answers. They analyzed a key variable tied to wildfire risk known as “vapor pressure deficit” — a term that reflects warm, dry air — and determined that 68 percent of the increase in vapor pressure deficit across the western U.S. between 1979 and 2020 was likely due to human-caused global warming. This suggests that human-induced climate change is the culprit for increasing fire weather in the western United States and that the trend is likely to worsen in the years ahead.

Learn more:   https://newsroom.ucla.edu/releases/frequent-wildfires-human-caused-climate-change

7. Feeding cattle seaweed reduces their greenhouse gas emissions (UC Davis)

Of greenhouse gas emissions in the U.S., 10 percent comes from agriculture — and half of that from cows and other ruminant animals belching methane throughout the day as they digest. In 2018, researchers from UC Davis were able to reduce methane emissions from dairy cows by over 50 percent by supplementing their diet with seaweed for two weeks. The seaweed inhibits an enzyme in the cow’s digestive system that contributes to methane production. This year, they tested whether those reductions were sustainable over time by feeding cows a touch of seaweed every day for five months. The results were clear: Cattle that consumed seaweed emitted much less methane, and there was no drop-off in efficacy over time.

Learn more: https://www.ucdavis.edu/climate/news/feeding-cattle-seaweed-reduces-their-greenhouse-gas-emissions-82-percent

8. Flame retardants linked to autistic-like behavior (UC Riverside)

Polybrominated diphenyl ethers, or PBDEs, are a class of ubiquitous fire-retardant chemicals, found in upholstery, carpets, curtains, electronics and even infant products. Thanks to the inadvertent digestion of contaminated household dust, they can also be detected in breast milk around the world. A research team led by UC Riverside scientists found that when female mice exposed to PBDEs pass on these chemicals to their developing offspring, the female offspring show traits similar to autism spectrum disorders. In addition to shedding light on a potential cause of autism, the study signals the importance of toxicology studies so that chemicals like PBDEs can be investigated before they are commercially released.

Learn more: https://www.universityofcalifornia.edu/news/flame-retardants-linked-autistic-behavior

9. Plant extract to prevent morphine addiction (UC Irvine)

Over the past two decades, dramatic increases in opioid overdose mortality have occurred in the United States and other nations, with the COVID-19 pandemic only worsening the problem. A UC Irvine-led study has pointed to a possible new therapy in an unlikely place — YHS, an extract of the plant Corydalis yanhusuo, which prevents morphine tolerance and dependence while also reversing opiate addiction. Even better, YHS has been used as an analgesic in traditional Chinese medicine for centuries. It is considered safe and readily available for purchase, either online or as a “botanical” in certain grocery stores. The extract could have an immediate, positive impact in curbing the opioid epidemic.

Learn more: https://www.universityofcalifornia.edu/news/uc-irvine-led-study-finds-medicinal-plant-extract-prevent-morphine-addiction

10. No serious COVID-19 vaccine side effects in breastfeeding moms (UC San Diego)

Mothers who are breastfeeding can get vaccinated and still continue to breastfeed their babies, researchers at the UC San Diego School of Medicine reported. Researchers found that breastfeeding mothers who received either the Pfizer-BioNTech or Moderna vaccination reported the same localized symptoms as non-breastfeeding women, with no serious side effects in their breastfed infants. The results not only demonstrated that the Pfizer and Moderna vaccines were not red flags for breastfeeding mothers but encouraged lactating women to get the COVID-19 vaccine and to continue to breastfeed their infants: Thankfully, they did not have to choose one over the other.

Learn more: https://health.ucsd.edu/news/releases/Pages/2021-09-08-study-no-serious-covid-19-vaccine-side-effects-in-breastfeeding-moms-infants.aspx

Keep reading

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UC researchers are ferreting out discrimination in the algorithms that are shaping our society, and helping build a future where computers do us less harm and more good.

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Widely used in clothing, household products and food, they resist breaking down in the environment.

HBR’s Most-Read Research Articles of 2021

• Dagny Dukach

A look back at the insights that resonated most with our readers.

What will it take to make work better? Over the past year, HBR has published a wide array of research-backed articles that explore topics ranging from retaining employees to overcoming meeting overload to fostering gender equity in the workplace. In this end-of-year roundup, we share key insights and trends from our most-read research articles of 2021.

As the workplace rapidly transforms in the wake of the pandemic, social movements, and more, a fundamental question remains: How can we ensure we’re making work better — for employees, organizations, and society at large?

• Dagny Dukach is a former associate editor at Harvard Business Review.

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Collection  10 March 2022

Top 100 in Neuroscience

This collection highlights our most downloaded* neuroscience papers published in 2021. Featuring authors from around the world, these papers showcase valuable research from an international community.

*Data obtained from SN Inights, which is based on Digital Science's Dimensions.

Musical components important for the Mozart K448 effect in epilepsy

• Robert J. Quon
• Michael A. Casey
• Barbara C. Jobst

Brain structure changes associated with sexual orientation

• Mikhail Votinov
• Katharina S. Goerlich

Selective time-dependent changes in activity and cell-specific gene expression in human postmortem brain

• Fabien Dachet
• James B. Brown
• Jeffrey A. Loeb

Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition

• Lisa Mosconi
• Valentina Berti
• Roberta Diaz Brinton

Multimodal deep learning models for early detection of Alzheimer’s disease stage

• Janani Venugopalan
• May D. Wang

Brain tumor segmentation based on deep learning and an attention mechanism using MRI multi-modalities brain images

• Ramin Ranjbarzadeh
• Abbas Bagherian Kasgari
• Malika Bendechache

Splitting sleep between the night and a daytime nap reduces homeostatic sleep pressure and enhances long-term memory

• James N. Cousins
• Ruth L. F. Leong
• Michael W. L. Chee

Listening to speech with a guinea pig-to-human brain-to-brain interface

• Claus-Peter Richter
• Petrina La Faire
• Alan G. Micco

Benefit of human moderate running boosting mood and executive function coinciding with bilateral prefrontal activation

• Chorphaka Damrongthai
• Ryuta Kuwamizu
• Hideaki Soya

Enhanced activations in syntax-related regions for multilinguals while acquiring a new language

• Keita Umejima
• Suzanne Flynn
• Kuniyoshi L. Sakai

Brain-inspired spiking neural networks for decoding and understanding muscle activity and kinematics from electroencephalography signals during hand movements

• Kaushalya Kumarasinghe
• Nikola Kasabov
• Denise Taylor

Longitudinal effects of meditation on brain resting-state functional connectivity

• Zongpai Zhang
• Wen-Ming Luh
• Weiying Dai

Evidence of a new hidden neural network into deep fasciae

• Caterina Fede
• Lucia Petrelli
• Carla Stecco

Cross-sex hormone treatment and own-body perception: behavioral and brain connectivity profiles

• Behzad S. Khorashad
• Amirhossein Manzouri
• Ivanka Savic

A directional 3D neurite outgrowth model for studying motor axon biology and disease

• Xandor M. Spijkers
• Svetlana Pasteuning-Vuhman
• R. Jeroen Pasterkamp

The role of dorsolateral and ventromedial prefrontal cortex in the processing of emotional dimensions

• Vahid Nejati
• Reyhaneh Majdi
• Michael A. Nitsche

How neurons exploit fractal geometry to optimize their network connectivity

• Julian H. Smith
• Conor Rowland
• R. P. Taylor

Defining early changes in Alzheimer’s disease from RNA sequencing of brain regions differentially affected by pathology

• Boris Guennewig
• Greg T. Sutherland

Narcissistic personality traits and prefrontal brain structure

• Igor Nenadić
• Carsten Lorenz
• Christian Gaser

EEG-based diagnostics of the auditory system using cochlear implant electrodes as sensors

• Christopher J. Long
• Tom Francart

Investigating real-life emotions in romantic couples: a mobile EEG study

• Julian Packheiser
• Gesa Berretz
• Sebastian Ocklenburg

Sex-dependent alterations in behavior, drug responses and dopamine transporter expression in heterozygous DAT-Cre mice

• Kauê Machado Costa
• Daniela Schenkel
• Jochen Roeper

Functional network connectivity during Jazz improvisation

• Victor M. Vergara
• Martin Norgaard
• Vince D. Calhoun

Buspirone alleviates anxiety, depression, and colitis; and modulates gut microbiota in mice

• Jeon-Kyung Kim
• Sang-Kap Han
• Dong-Hyun Kim

Human cerebral organoids as a therapeutic drug screening model for Creutzfeldt–Jakob disease

• Bradley R. Groveman
• Natalia C. Ferreira
• Cathryn L. Haigh

Thioflavin-positive tau aggregates complicating quantification of amyloid plaques in the brain of 5XFAD transgenic mouse model

• YoungSoo Kim

Ambulatory seizure forecasting with a wrist-worn device using long-short term memory deep learning

• Mona Nasseri
• Tal Pal Attia
• Benjamin H. Brinkmann

Post-traumatic seizures and antiepileptic therapy as predictors of the functional outcome in patients with traumatic brain injury

• Valeria Pingue
• Chiara Mele
• Antonio Nardone

Human α-synuclein overexpression in a mouse model of Parkinson’s disease leads to vascular pathology, blood brain barrier leakage and pericyte activation

• Osama Elabi
• Abderahim Gaceb
• Gesine Paul

Neuropsychiatric profiles and conversion to dementia in mild cognitive impairment, a latent class analysis

• Natalia Roberto
• Maria J. Portella
• Sergi Valero

Comparative neuroanatomy of the lumbosacral spinal cord of the rat, cat, pig, monkey, and human

• Amirali Toossi
• Bradley Bergin
• Vivian K. Mushahwar

A personalized and evolutionary algorithm for interpretable EEG epilepsy seizure prediction

• Mauro. F. Pinto
• Adriana Leal
• César A. Teixeira

The effects of positive or negative self-talk on the alteration of brain functional connectivity by performing cognitive tasks

• Junhyung Kim
• Joon Hee Kwon
• Jae-Jin Kim

Deep learning-Based 3D inpainting of brain MR images

• Seung Kwan Kang
• Seong A. Shin
• Jae Sung Lee

Both high fat and high carbohydrate diets impair vagus nerve signaling of satiety

• Hailley Loper
• Monique Leinen
• Matthew A. Schiefer

PINK1 deficiency impairs adult neurogenesis of dopaminergic neurons

• Sarah J. Brown
• Ibrahim Boussaad
• Oliver Bandmann

Altered spontaneous activity in the frontal gyrus in dry eye: a resting-state functional MRI study

Online and offline effects of transcranial alternating current stimulation of the primary motor cortex

• Ivan Pozdniakov
• Alicia Nunez Vorobiova
• Matteo Feurra

Cell type-specific changes in transcriptomic profiles of endothelial cells, iPSC-derived neurons and astrocytes cultured on microfluidic chips

• H. H. T. Middelkamp
• A. H. A. Verboven
• A. D. van der Meer

Brain MRI in SARS-CoV-2 pneumonia patients with newly developed neurological manifestations suggestive of brain involvement

• Batil Alonazi
• Ahmed M. Farghaly
• Mustafa Z. Mahmoud

Diazepam causes sedative rather than anxiolytic effects in C57BL/6J mice

• Marina Pádua-Reis
• Diana Aline Nôga
• Martina Blunder

Photons detected in the active nerve by photographic technique

• Andrea Zangari
• Davide Micheli
• Maria Emiliana Caristo

Cannabidiol induces autophagy via ERK1/2 activation in neural cells

• Talita A. M. Vrechi
• Anderson H. F. F. Leão
• Gustavo J. S. Pereira

Deep learning-based pupil model predicts time and spectral dependent light responses

• Babak Zandi
• Tran Quoc Khanh

ATP signaling in the integrative neural center of Aplysia californica

• János Györi
• Andrea B. Kohn
• Leonid L. Moroz

EEG signals respond differently to idea generation, idea evolution and evaluation in a loosely controlled creativity experiment

Cognitive and MRI trajectories for prediction of Alzheimer’s disease

• Samaneh A. Mofrad
• Astri J. Lundervold
• Alexander S. Lundervold

Characterization of mitochondrial health from human peripheral blood mononuclear cells to cerebral organoids derived from induced pluripotent stem cells

• Angela Duong
• Alesya Evstratova
• Ana C. Andreazza

Astrocytic expression of the Alzheimer’s disease risk allele, ApoEε4, potentiates neuronal tau pathology in multiple preclinical models

• Angela Marie Jablonski
• Bhavya Voleti

Effects of the sigma-1 receptor agonist blarcamesine in a murine model of fragile X syndrome: neurobehavioral phenotypes and receptor occupancy

• Samantha T. Reyes
• Robert M. J. Deacon
• Frederick T. Chin

Magnetic domains oscillation in the brain with neurodegenerative disease

• Gunther Kletetschka
• Robert Bazala
• Eva Svecova

Right frontal anxiolytic-sensitive EEG ‘theta’ rhythm in the stop-signal task is a theory-based anxiety disorder biomarker

• Shabah M. Shadli
• Lynne C. Ando
• Neil McNaughton

Role of miRNAs shuttled by mesenchymal stem cell-derived small extracellular vesicles in modulating neuroinflammation

• Debora Giunti
• Chiara Marini
• Antonio Uccelli

Position sensitive measurement of trace lithium in the brain with NIK (neutron-induced coincidence method) in suicide

• J. Schoepfer
• R. Gernhäuser

Major oscillations in spontaneous home-cage activity in C57BL/6 mice housed under constant conditions

• Karin Pernold
• Eric Rullman
• Brun Ulfhake

Involvement of the dopaminergic system in the reward-related behavior of pregabalin

• Yusuf S. Althobaiti
• Farooq M. Almutairi
• Zahoor A. Shah

A high-density electroencephalography study reveals abnormal sleep homeostasis in patients with rapid eye movement sleep behavior disorder

• Amandine Valomon
• Brady A. Riedner
• Melanie Boly

MEG signatures of long-term effects of agreement and disagreement with the majority

• V. Klucharev
• A. Shestakova

Stroke prediction in patients presenting with isolated dizziness in the emergency department

• June-sung Kim
• Hong Jun Bae
• Won Young Kim

Age-dependent and region-specific alteration of parvalbumin neurons, perineuronal nets and microglia in the mouse prefrontal cortex and hippocampus following obesogenic diet consumption

• Amy C. Reichelt
• Claire A. Lemieux
• Lisa M. Saksida

Recording site placement on planar silicon-based probes affects signal quality in acute neuronal recordings

• Richárd Fiáth
• Domokos Meszéna
• István Ulbert

Amplification of potential thermogenetic mechanisms in cetacean brains compared to artiodactyl brains

• Paul R. Manger
• Nina Patzke

Maternal stress during pregnancy alters fetal cortico-cerebellar connectivity in utero and increases child sleep problems after birth

• Marion I. van den Heuvel
• Jasmine L. Hect
• Moriah E. Thomason

An anomaly detection approach to identify chronic brain infarcts on MRI

• Kees M. van Hespen
• Jaco J. M. Zwanenburg
• Hugo J. Kuijf

The neurodynamic treatment induces biological changes in sensory and motor neurons in vitro

• Giacomo Carta
• Giovanna Gambarotta
• Federica Fregnan

Optimal flickering light stimulation for entraining gamma waves in the human brain

• Kanghee Lee
• Yeseung Park
• Ki Woong Kim

Two-photon GCaMP6f imaging of infrared neural stimulation evoked calcium signals in mouse cortical neurons in vivo

• Attila Kaszas
• Gergely Szalay
• David Moreau

The Aβ(1–38) peptide is a negative regulator of the Aβ(1–42) peptide implicated in Alzheimer disease progression

• Maa O. Quartey
• Jennifer N. K. Nyarko
• Darrell D. Mousseau

Drinking coffee enhances neurocognitive function by reorganizing brain functional connectivity

• Sung Hoon Kang
• Jung Bin Kim

The impact of multisensory integration and perceptual load in virtual reality settings on performance, workload and presence

• Matteo Marucci
• Gianluca Di Flumeri
• Pietro Aricò

CuATSM improves motor function and extends survival but is not tolerated at a high dose in SOD1 G93A mice with a C57BL/6 background

• Jeremy S. Lum
• Mikayla L. Brown
• Justin J. Yerbury

Underlying neurological mechanisms associated with symptomatic convergence insufficiency

• Tara L. Alvarez
• Mitchell Scheiman
• Bharat B. Biswal

Paternal exposure to a common pharmaceutical (Ritalin) has transgenerational effects on the behaviour of Trinidadian guppies

• Alex R. De Serrano
• Kimberly A. Hughes
• F. Helen Rodd

Behavioral arrest and a characteristic slow waveform are hallmark responses to selective 5-HT 2A receptor activation

• April Contreras
• Matthew Khumnark
• Dustin J. Hines

Focused ultrasound mediated blood–brain barrier opening is safe and feasible in a murine pontine glioma model

• Zachary K. Englander
• Hong-Jian Wei
• Cheng-Chia Wu

Basmisanil, a highly selective GABA A -α5 negative allosteric modulator: preclinical pharmacology and demonstration of functional target engagement in man

• Joerg F. Hipp
• Frederic Knoflach
• Maria-Clemencia Hernandez

Spatial memory deficiency early in 6xTg Alzheimer’s disease mouse model

• Shinwoo Kang
• Keun-A Chang

The gut microbiome is associated with brain structure and function in schizophrenia

Static and dynamic functional connectivity supports the configuration of brain networks associated with creative cognition

• Abhishek Uday Patil
• Sejal Ghate
• Chih-Mao Huang

Digital signatures for early traumatic brain injury outcome prediction in the intensive care unit

• Anil K. Palepu
• Aditya Murali
• Robert D. Stevens

LSD-stimulated behaviors in mice require β-arrestin 2 but not β-arrestin 1

• Ramona M. Rodriguiz
• Vineet Nadkarni
• William C. Wetsel

Modified wavelet analysis of ECoG-pattern as promising tool for detection of the blood–brain barrier leakage

• Anastasiya Runnova
• Maksim Zhuravlev
• Jurgen Kurths

Adrenergic inhibition facilitates normalization of extracellular potassium after cortical spreading depolarization

• Hiromu Monai
• Shinnosuke Koketsu
• Hajime Hirase

An atlas for human brain myelin content throughout the adult life span

• Adam V. Dvorak
• Taylor Swift-LaPointe
• Shannon H. Kolind

Immediate and after effects of transcranial direct-current stimulation in the mouse primary somatosensory cortex

• Carlos A. Sánchez-León
• Isabel Cordones
• Javier Márquez-Ruiz

Human brain dynamics in active spatial navigation

• Tien-Thong Nguyen Do
• Chin-Teng Lin
• Klaus Gramann

Reading without phonology: ERP evidence from skilled deaf readers of Spanish

• Brendan Costello
• Sendy Caffarra
• Manuel Carreiras

Alterations in reward network functional connectivity are associated with increased food addiction in obese individuals

• Soumya Ravichandran
• Ravi R. Bhatt
• Arpana Gupta

Disease progression modelling from preclinical Alzheimer’s disease (AD) to AD dementia

• Soo Hyun Cho
• Sookyoung Woo
• Sang Won Seo

The structure dilemma in biological and artificial neural networks

• Thomas Pircher
• Bianca Pircher
• Andreas Feigenspan

Voluntary intake of psychoactive substances is regulated by the dopamine receptor Dop1R1 in Drosophila

• Shun Hiramatsu
• Toshiharu Ichinose

The contribution of platelets to peripheral BDNF elevation in children with autism spectrum disorder

• Cristan A. Farmer
• Audrey E. Thurm
• Joan C. Han

Dopamine-loaded nanoparticle systems circumvent the blood–brain barrier restoring motor function in mouse model for Parkinson’s Disease

• Victoria Monge-Fuentes
• Andréia Biolchi Mayer
• Márcia Renata Mortari

NK1 antagonists attenuate tau phosphorylation after blast and repeated concussive injury

• Frances Corrigan
• Ibolja Cernak
• Robert Vink

Nicotine suppresses Parkinson’s disease like phenotypes induced by Synphilin-1 overexpression in Drosophila melanogaster by increasing tyrosine hydroxylase and dopamine levels

• Angel Carvajal-Oliveros
• Carmen Domínguez-Baleón
• Enrique Reynaud

Free-water diffusion tensor imaging improves the accuracy and sensitivity of white matter analysis in Alzheimer’s disease

• Maurizio Bergamino
• Ryan R. Walsh
• Ashley M. Stokes

A functional spiking neuronal network for tactile sensing pathway to process edge orientation

• Adel Parvizi-Fard
• Mahmood Amiri
• Nitish V. Thakor

The difficulty to model Huntington’s disease in vitro using striatal medium spiny neurons differentiated from human induced pluripotent stem cells

• Kim Le Cann
• Alec Foerster
• Angelika Lampert

Hippocampus-retrosplenial cortex interaction is increased during phasic REM and contributes to memory consolidation

• Daniel Gomes de Almeida-Filho
• Bruna Del Vechio Koike
• Claudio Marcos Queiroz

Machine learning-based classification of mitochondrial morphology in primary neurons and brain

• Garrett M. Fogo
• Anthony R. Anzell
• Thomas H. Sanderson

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In USC labs, another year of groundbreaking discoveries

Year in review: Whether they’re working with patients, test tubes or massive databases, USC scientists continue to push the envelope with discoveries that are literally changing people’s lives.

Pandemic or not, USC researchers continue to make discoveries that are changing people’s lives. From studies on why we’re so polarized to work on treating and someday curing Alzheimer’s, Trojans remain at the forefront of science — whether that’s in a lab, in a big-data repository or in their own living room. There’s a reason USC is considered one of the nation’s top research universities. Take a look at some of this year’s most memorable research stories.

? A promising drug

“The results suggest the drug’s potential for treating white matter strokes in humans, possibly including multiple white matter strokes that result in vascular dementia.”

— Berislav Zlokovic , director of the Zilkha Neurogenetic Institute and professor and chair of the Department of Physiology and Neuroscience at the Keck School of Medicine of USC

https://news.usc.edu/195037/drug-treatment-alzheimers-disease/

? Behind the divide

“We believe that polarization is a communications problem.”

— Fred Cook , director of the USC Center for Public Relations at the USC Annenberg School for Communication and Journalism

https://news.usc.edu/194874/why-is-america-divided/

? How not to address vaccine hesitancy

“Too much of what we do—both in terms of public policy and in our own lives—involves arguing over anecdotes without relying on evidence or sometimes even facts. And as we show in this case, some of these gut-based policies are not just ineffective, but can even backfire.”

— Tom Chang , associate professor, USC Marshall School of Business

https://news.usc.edu/194758/vaccine-incentives-dont-work-and-may-actually-backfire-usc-marshall-research-finds/

? When tech hits home 

“Imagine someone in a care facility across the country. Instead of a phone call where you’re trying to figure out what to say when somebody isn’t engaging, it’s ‘Do you want to go to Rome?’ ‘Do you want to go to London today?’”

— Skip Rizzo , director for medical virtual reality at the USC Institute for Creative Technologies

https://news.usc.edu/194092/usc-researcher-envisions-siri-like-assistants-and-vr-travel-for-older-people-and-their-caregivers/

? Of mice — and men?

“The study indicates that it’s possible for mice to eat a relatively bad diet that is counterbalanced by five days of a fasting-mimicking diet.”

— Valter?Longo , the director of the Longevity Institute at the USC Leonard Davis School of Gerontology and professor of biological sciences at the USC Dornsife College of Letters, Arts and Sciences

https://news.usc.edu/193126/fasting-mimicking-diet-in-mice-longer-life-usc-study/

? One of the nation’s leading Alzheimer’s research centers

“More than one-third of our 2020 NIH Alzheimer’s funding supports USC’s work as a global research hub. USC maintains and interrogates data gathered from patients throughout the world.”

— Ishwar Puri , USC vice president of research

https://news.usc.edu/192025/usc-alzheimers-disease-research-nih-funding-2020/

? Discovering a deadly trend

“These findings indicate that many people are at risk of an opioid overdose and underscore the importance of strengthening the implementation of overdose prevention — particularly naloxone access laws — and harm reduction strategies ”

— Dima M. Qato , USC School of Pharmacy

https://news.usc.edu/191550/opioid-overdose-risk-older-americans-usc-study/

? An ancient fight over water spills into modern times

“Averaging losses from all of the announced filling scenarios, these water shortages could nearly double Egypt’s present water supply deficit and will have dire consequences for Egypt’s economy, employment, migration and food supply.”

— Essam Heggy , USC Viterbi School of Engineering research scientist

https://news.usc.edu/188414/nile-river-water-dispute-filling-dam-egypt-ethiopia-usc-study/

? When your local pharmacy closes

“We observed stark disparities in Los Angeles, where one-third of all Black and Latino neighborhoods were pharmacy deserts, particularly neighborhoods in South Central L.A., including Florence, Broadway-Manchester and Watts.”

— Jenny S. Guadamuz , postdoctoral fellow at the USC Schaeffer Center and the Program on Medicines and Public Health at the USC School of Pharmacy

https://news.usc.edu/185748/pharmacy-deserts-american-cities-health-disparities-usc-research/

? Another cost of COVID-19

“It’s a social crisis that merits far greater attention, as well as a collective response to slow the tide of loss that’s washing over children.”

— Emily Smith-Greenaway , associate professor of sociology and spatial sciences at the USC Dornsife College of Letters, Arts and Sciences

https://news.usc.edu/184646/thousands-of-children-lost-a-parent-to-covid-19-usc-research/

? The natural gas field next door

“We found that a significant number of Black, Indigenous and Latinx people live near flaring. High rates of poverty and other barriers to health in rural areas — such as a lack of access to health care — could worsen the health effects of flaring-related exposures.”

— Jill Johnston , an environmental health scientist and assistant professor of preventive medicine at the Keck School of Medicine of USC

https://news.usc.edu/183286/americans-oil-gas-flaring-health-risks-usc-research/

? Commuting at a crossroads

“We wanted to examine the question of how the sudden transition to work from home will affect the city overall,” said Parkhomenko. “So we looked at Los Angeles specifically. And what we found was that the changes will positively impact the city on several levels if work from home remains common after the pandemic.”

— Andrii Parkhomenk , USC Marshall assistant professor of finance and business economics

https://news.usc.edu/183230/telecommuting-los-angeles-work-from-home-usc-research/

USC 2021 | A LOOK BACK — See more of our year-end package :

• The passionate Trojans who inspired us .
• A game-changing commitment to sustainability .
• Groundbreaking advances from our research labs .
• Athletic highlights that made the Trojan Family stand up and cheer.
• The stories you couldn’t help but share .

Related Articles

L.a. times festival of books draws big crowds to usc university park campus, 4 usc faculty members named as fellows of prestigious science organization aaas, trojans to look for at this weekend’s los angeles times festival of books at usc.

MARK H. EBELL, MD, MS, AND ROLAND GRAD, MD, MSc

Am Fam Physician. 2022;106(1):61-69

Published online June 1, 2022.

Author disclosure: Dr. Ebell is cofounder and editor-in-chief of Essential Evidence Plus; see Editor’s Note. Dr. Grad has no relevant financial relationships.

This article summarizes the top 20 research studies of 2021 identified as POEMs (patient-oriented evidence that matters) that did not address the COVID-19 pandemic. Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists prevent adverse cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and also reduce all-cause and cardiovascular mortality. Most older adults (mean age, 75 years) with prediabetes do not progress to diabetes. Among patients in this age group with type 2 diabetes treated with medication, an A1C level of less than 7% is associated with increased risk of hospitalization for hypoglycemia, especially when using a sulfonylurea or insulin. For patients with chronic low back pain, exercise, nonsteroidal anti-inflammatory drugs, duloxetine, and opioids were shown to be more effective than control in achieving a 30% reduction in pain, but self-discontinuation of duloxetine and opioids was common. There is no clinically important difference between muscle relaxants and placebo in the treatment of nonspecific low back pain. In patients with chronic pain, low- to moderate-quality evidence supports exercise, yoga, massage, and mindfulness-based stress reduction. For acute musculoskeletal pain, acetaminophen, 1,000 mg, plus ibuprofen, 400 mg, without an opioid is a good option. Regarding screening for colorectal cancer, trial evidence supports performing fecal immunochemical testing every other year. For chronic constipation, evidence supports polyethylene glycol, senna, fiber supplements, magnesium-based products, and fruit-based products. The following abdominal symptoms carry a greater than 3% risk of cancer or inflammatory bowel disease: dysphagia or change in bowel habits in men; rectal bleeding in women; and abdominal pain, change in bowel habits, or dyspepsia in men and women older than 60 years. For secondary prevention in those with established arteriosclerotic cardiovascular disease, 81 mg of aspirin daily appears to be effective. The Framingham Risk Score and the Pooled Cohort Equations both overestimate the risk of cardiovascular events. Over 12 years, no association between egg consumption and cardiovascular events was demonstrated. Gabapentin, pregabalin, duloxetine, and venlafaxine provide clinically meaningful improvements in chronic neuropathic pain. In patients with moderate to severe depression, initial titration above the minimum starting dose of antidepressants in the first eight weeks of treatment is not more likely to increase response. In adults with iron deficiency anemia, adding vitamin C to oral iron has no effect. In children with pharyngitis, rhinosinusitis, acute bronchitis, or acute otitis media, providing education combined with a take-and-hold antibiotic prescription results in 1 in 4 of those children eventually taking an antibiotic.

Annually for 23 years, a team of clinicians has systematically reviewed English-language medical journals to identify the research most likely to change and improve primary care. The team includes experts in family medicine, pharmacology, hospital medicine, and women’s health. 1 , 2

The goal of this process is to identify POEMs (patient-oriented evidence that matters). A POEM must report at least one patient-oriented outcome, such as improvement in symptoms, morbidity, or mortality. It should also be free of important methodologic bias, making the results valid and trustworthy. Finally, if the results were applied in practice, some physicians would change what they do by adopting a new practice or discontinuing an old one shown to be ineffective or harmful. Adopting POEMs in clinical practice should improve patient outcomes. Of more than 20,000 research studies published in 2021 in the journals reviewed by the POEMs team, only 260 met criteria for validity, relevance, and practice change. These POEMs are emailed daily to subscribers of Essential Evidence Plus (Wiley-Blackwell, Inc.).

The Canadian Medical Association purchases a POEMs subscription for its members, many of whom receive the daily POEM. As these physicians read each POEM, they can rate it using a validated questionnaire. This process is called the Information Assessment Method ( https://www.mcgill.ca/iam ). POEM ratings address the domains of clinical relevance, cognitive impact, use in practice, and expected health benefits if that POEM is applied to a specific patient. 2 , 3 In 2021, each of the 260 daily POEMs were rated by an average of 1,189 physicians.

In this article, the 11th installment of our annual series ( https://www.aafp.org/pubs/afp/content/top-poems.html ), we present the 20 most clinically relevant POEMs of 2021 as determined by Canadian Medical Association members. Looking beyond COVID-19, our patients continue to face the usual (and unusual) health problems of everyday life. Thus, we summarize the clinical questions and bottom-line answers for research studies about a variety of topics that were identified as top 20 POEMs, followed by a brief discussion. This set of 20 POEMs includes the most relevant practice guidelines of the year. The full POEMs are available online at https://www.aafp.org/pubs/afp/content/top-poems/2021.html .

The five most highly rated POEMs in 2021, and eight of the top 15, were about the COVID-19 vaccines and their effectiveness in different populations. Because of the emergence of variants and widespread endorsement of the vaccine by family physicians, these POEMs are not as likely to lead to practice changes as they were when originally published. One additional COVID-19 POEM reported the incidence of myocarditis following vaccination with the Pfizer BioNTech and Moderna mRNA vaccines in U.S. military personnel. The incidence of approximately 4 more cases than expected per 100,000 patients is significantly lower than the more than 300 per 100,000 patients seen among those with SARS-CoV-2 infection. 4 The rest of this article includes POEMs not related to the COVID-19 pandemic.

Type 2 Diabetes Mellitus

The first three POEMs in this category are about the management of type 2 diabetes ( Table 1 ) . 5 – 8 The first study identified 2,482 adults with a mean age of 75 years who had prediabetes (defined as an A1C level between 5.7% and 6.4%, a fasting glucose level between 100 and 125 mg per dL [5.55 and 6.94 mmol per L], or both). 5 Over an average of 6.5 years, only 8% to 9% of patients progressed to diabetes, many regressed to normoglycemia, and the remainder stayed at prediabetic levels. These results will help reassure physicians and avoid overtreatment of older patients with prediabetes. Of note, the U.S. Preventive Services Task Force does not recommend screening for prediabetes or type 2 diabetes beyond 70 years of age. 9

A study in the United Kingdom identified 6,288 people 70 years and older with type 2 diabetes and three consecutive A1C measurements of less than 7%. 6 Approximately 90% were taking a sulfonylurea. Compared with a similar group of people with type 2 diabetes who did not have A1C levels of less than 7% and were not taking a sulfonylurea, those with tight control were 2.5 times more likely to be hospitalized for severe hypoglycemia, with a 1 in 7 risk of hospitalization over 10 years. Use of a sulfonylurea or insulin was associated with severe hypoglycemia and death. A more relaxed A1C target of 7.0% to 8.0% is more appropriate, especially for older patients, and sulfonylureas should be used with caution.

A systematic review assessed the effectiveness of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes. 7 The authors did not receive pharmaceutical funding. Both classes of drugs reduced all-cause mortality, cardiovascular mortality, nonfatal myocardial infarction, and kidney failure. SGLT-2 inhibitors were more effective at reducing hospital admission, whereas GLP-1 receptor agonists were more likely to reduce nonfatal stroke. The absolute benefit of treatment increased with a patient’s cardiac risk. For example, over five years, there were 2 to 5 fewer deaths per 1,000 patients at low cardiac risk compared with 24 to 48 fewer deaths per 1,000 patients at the highest risk. A useful calculator that allows estimates of benefit at various risk levels is available at https://magicevidence.org/match-it/200820dist .

The final study is a meta-analysis that examined the effect of SGLT-2 inhibitors in patients with and without type 2 diabetes or heart failure. 8 These drugs similarly reduced all-cause and cardiovascular mortality in patients with or without type 2 diabetes and with or without heart failure (overall hazard ratio for all-cause mortality = 0.84 [95% CI, 0.78 to 0.91]). SGLT-2 inhibitors reduced the progression of renal disease in all patients.

Musculoskeletal Conditions

The next, and largest, category of POEMs addresses musculoskeletal conditions ( Table 2 ) . 10 – 14 The first three present research on low back pain, one of the most challenging conditions in primary care. The first POEM is a systematic review of a broad range of therapies for chronic low back pain. 10 The review included 63 randomized controlled trials (RCTs) reporting a clinical response, generally a reduction in pain of at least 30%, to any one of 15 interventions. Exercise was effective at reducing pain (number needed to treat [NNT] = 7) and had a sustained benefit. Although other medical therapies such as oral nonsteroidal anti-inflammatory drugs (NNT = 6), duloxetine (Cymbalta; NNT = 10), and opioids (NNT = 16) also reduced pain, they did not have sustained benefits and were associated with adverse effects. Lower-quality data suggest that manipulation and topical capsaicin are also effective.

Another systematic review, this time looking at muscle relaxants for nonspecific low back pain, found small reductions in pain intensity that were not clinically important and not seen when only the highest-quality studies were included. 11 We have said it before—it is inappropriate to routinely prescribe muscle relaxants for low back pain.

The next study showed the power of language on health outcomes. 12 Patients with low back pain and no red flags on magnetic resonance imaging (MRI) or indications for surgery were randomized to receive their MRI results in one of two ways: by stating that all findings were normal and incidental or age-related or by stating that all findings were normal and incidental or age-related but also including words such as degeneration, tears, ruptures, and neural compression. Patients receiving the easily misinterpreted version of the report that used alarming words had more pain, lower self-efficacy, and less function over six weeks of follow-up compared with patients who were essentially told their findings were normal. Physicians should develop their own script for sharing results that avoids catastrophizing language.

The next POEM studied several types of musculoskeletal pain other than back pain. 13 Patients presenting in the emergency department with acute musculoskeletal pain were randomized to one of five single-dose pain regimens: (1) acetaminophen, 1,000 mg, with ibuprofen, 400 mg; (2) acetaminophen, 1,000 mg, with ibuprofen, 800 mg; (3) acetaminophen, 300 mg, with codeine, 30 mg; (4) acetaminophen, 300 mg, with hydrocodone, 5 mg; or (5) acetaminophen, 325 mg, with oxycodone, 5 mg. Pain scores decreased by about 3 points on a 10-point scale in all five groups at one hour and by about 4.5 points at two hours, with no significant difference between groups. About 1 out of 4 patients in each group required rescue pain medication, again with no difference. Nausea and vomiting were more common in patients receiving an opioid. Thus, a good choice is acetaminophen, 1,000 mg, plus ibuprofen, 400 mg, or even acetaminophen alone, without an opioid. 15

A large systematic review asked the question: Which nondrug therapies are effective for chronic musculoskeletal pain? 14 For chronic low back pain, exercise, massage, yoga, cognitive behavior therapy, mindfulness-based stress reduction, acupuncture, spinal manipulation, low-level laser therapy, and rehabilitation all reduced pain and/or improved function. There was evidence for the use of exercise, massage, low-level laser therapy, acupuncture, and Pilates in the treatment of chronic neck pain. Only exercise and cognitive behavior therapy were helpful for knee osteoarthritis. There is evidence only for the use of exercise and manual therapies for the treatment of hip osteoarthritis. Patients with fibromyalgia benefited from cognitive behavior therapy, myofascial release massage, tai chi, qi gong, acupuncture, rehabilitation, and exercise.

Gastrointestinal

The next set of POEMs addresses colorectal cancer screening, constipation treatment, and vague abdominal symptoms ( Table 3 ) . 16 – 18 Most countries screen for colorectal cancer using fecal immunochemical testing (FIT) as the initial method. Canada includes flexible sigmoidoscopy as an option, and the United States most commonly uses colonoscopy. The first POEM on gastrointestinal conditions is a Norwegian RCT that invited previously unscreened adults 50 to 74 years of age to undergo flexible sigmoidoscopy (52% had the procedure) or FIT every two years (68% had at least one test). 16 Although flexible sigmoidoscopy initially identified more cancers and advanced adenomas, FIT surpassed it over time, with a cancer detection rate of 0.49% after three rounds of FIT testing vs. 0.27% with flexible sigmoidoscopy. This is a very important point—screening programs must be compared over time, not just after a single round, using different tests. RCTs comparing FIT with colonoscopy over time are underway.

In a systematic review of over-the-counter treatments for chronic constipation, polyethylene glycol (Miralax) and senna were the most effective initial options. 17 Fiber supplements, other stimulant laxatives, magnesium-based products, and fruit-based products were also effective.

The final POEM evaluated the predictive value of common abdominal symptoms for cancer or inflammatory bowel disease. 18 Combinations of symptoms, such as change in bowel habits with rectal bleeding, were more predictive but varied by age and sex. Dysphagia or changes in bowel habits in men and rectal bleeding in women should prompt referral for further workup to exclude cancer or inflammatory bowel disease. Dyspepsia was largely unhelpful, except in patients older than 60 years. The severity and duration of gastrointestinal symptoms and whether they appear to be progressive were not part of this study but are important additional factors.

Cardiovascular Disease

Four POEMs about cardiovascular disease made the top 20 list ( Table 4 ) . 19 – 22 The first two addressed prevention. One was a large pragmatic trial that randomized 15,076 patients with established arteriosclerotic cardiovascular disease to 81 mg or 325 mg of aspirin daily and evaluated the likelihood of death, nonfatal myocardial infarction, or nonfatal stroke after a median of two years. 19 There was no difference between groups for these outcomes (7.3% for 81 mg and 7.5% for 325 mg) and no difference in hospitalization for major bleeding. The trial was a bit messy, with 7% in the 81-mg group switching to 325 mg and 42% in the 325-mg group switching to the lower dose. It is not clear why so many switched to the lower dose, but, for whatever reason, there is no advantage with the higher dose.

U.S. guidelines for cardiovascular prevention all begin with an assessment of cardiovascular risk using the Pooled Cohort Equations. The second cardiovascular POEM warns us that this score significantly overestimates risk. The Canadian researchers identified more than 80,000 people 40 to 79 years of age and estimated their risk using the Framingham Risk Score and the Pooled Cohort Equations. 20 Cardiovascular risk estimates from both tools were about twice as high as the real-world risk. The overestimates occurred in all groups regardless of age and sex but tended to be larger in younger patients. This is important for shared decision-making. For example, an estimated risk of 10% based on the Pooled Cohort Equations might lead to prescribing a statin, but the true cardiovascular risk may be significantly lower.

The U.S. Preventive Services Task Force draft guidelines recommend prescribing a statin for adults 40 to 75 years of age with at least one cardiovascular risk factor (dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year cardiovascular risk of 10% or greater. Statins should be selectively offered to those with a risk factor and a risk between 7.5% and 10% because the benefits are smaller than those at higher risk. 23

Another calibration issue was addressed by the third POEM. The researchers compared the blood pressure measurements used by researchers in SPRINT (Systolic Blood Pressure Intervention Trial) with those recorded by the patients’ regular primary care physicians. 21 The physician-recorded systolic blood pressure measurements were about 5 to 7 mm Hg higher; therefore, the SPRINT recommendations to lower systolic blood pressure to less than 120 mm Hg need to be interpreted accordingly—in the real world, achieving a level of 130 mm Hg is probably similar to 120 mm Hg in the trial setting.

The next POEM made our day, as egg lovers. This systematic review included 23 observational studies with nearly 1.4 million patients. 22 Eating more eggs was not shown to increase the risk of cardiovascular events. In fact, compared with eating one or no eggs per day, those eating more than one egg per day had a decreased risk of coronary disease (hazard ratio = 0.89; 95% CI, 0.86 to 0.93).

Miscellaneous

Four top POEMs do not fall easily into a single category ( Table 5 ) . 24 – 27 A systematic review addressed treatment of chronic pain caused by diabetic neuropathy or postherpetic neuralgia. 24 It included only studies reporting an outcome of clinically meaningful response, defined as a 30% improvement on a pain or function score. Moderate-quality evidence supported the use of the anticonvulsants gabapentin (Neurontin) and pregabalin (Lyrica) and the serotonin-norepinephrine reuptake inhibitors duloxetine and venlafaxine, and low-quality evidence supported the use of rubefacients (usually salicylates). The NNT was 7 or 8 for all the identified therapies. Opioid studies were of low quality and also showed more harms (number needed to harm = 12). Only a few trials with low-certainty evidence studied acupuncture and tricyclic antidepressants.

A systematic review identified RCTs that compared treatment of moderate to severe depression using the minimum licensed dose of a selective serotonin reuptake inhibitor, venlafaxine, or mirtazapine (Remeron) with a dosing regimen that allowed titration to higher doses. 25 There was no improvement in the balance of effectiveness and harms between taking the minimum dose and titrating to higher doses, although patients taking venlafaxine may respond to a higher dose if they show no response to the minimum dose.

The next POEM identified 436 children with pharyngitis, rhinosinusitis, acute bronchitis, or acute otitis media whose treating physician had reasonable doubts about the need for an antibiotic. 26 Patients were randomized to no antibiotics; an immediate antibiotic; or an antibiotic prescription to be filled only if the child had fever, felt much worse after 24 hours, or was not improving after a longer period (varied by type of infection). Only 25% of children in the delayed antibiotic group and 12% in the no antibiotic group ultimately filled a prescription, and there was no difference between these groups and the immediate antibiotic group in the duration of symptoms (eight days) or complications. Gastrointestinal symptoms and cost were higher in those receiving an antibiotic.

Finally, clinicians have long recommended that people taking iron supplements also take vitamin C because it theoretically improves absorption. A study tested the theory by randomizing 440 adults with iron deficiency anemia to ferrous succinate, 100 mg, plus vitamin C, 200 mg, or to ferrous succinate alone, each given every eight hours. There was no difference in hemoglobin or serum ferritin levels at three months. 27

Practice Guidelines

POEMs sometimes summarize high-impact clinical practice guidelines. Key messages from the three highest-rated guidelines, which address antibiotics for common infections, non–low back musculoskeletal injuries, and tobacco screening and cessation, are summarized in Table 6 . 28 – 30

Editor's Note: This article was cowritten by Dr. Mark Ebell, deputy editor for evidence-based medicine for AFP and cofounder and editor-in-chief of Essential Evidence Plus, published by Wiley-Blackwell, Inc. Because of Dr. Ebell’s dual roles and ties to Essential Evidence Plus, the concept for this article was independently reviewed and approved by a group of AFP ’s medical editors. In addition, the article underwent peer review and editing by four of AFP ’s medical editors. Dr. Ebell was not involved in the editorial decision-making process.—Sumi Sexton, MD, Editor-in-Chief

The authors thank Wiley-Blackwell, Inc., for giving permission to excerpt the POEMs; Drs. Allen Shaughnessy, Henry Barry, David Slawson, Nita Kulkarni, and Linda Speer for selecting and writing the original POEMs; the academic family medicine fellows and faculty of the University of Missouri–Columbia for their work as peer reviewers; Canadian Medical Association Joule for supporting the POEMs CME program in Canada; Pierre Pluye, PhD, for codeveloping the Information Assessment Method; and Maria Vlasak for her assistance with copyediting the POEMs.

Shaughnessy AF, Slawson DC, Bennett JH. Becoming an information master: a guidebook to the medical information jungle. J Fam Pract. 1994;39(5):489-499.

Ebell MH, Barry HC, Slawson DC, et al. Finding POEMs in the medical literature. J Fam Pract. 1999;48(5):350-355.

Grad RM, Pluye P, Mercer J, et al. Impact of research-based synopses delivered as daily e-mail: a prospective observational study. J Am Med Inform Assoc. 2008;15(2):240-245.

Montgomery J, Ryan M, Engler R, et al. Myocarditis following immunization with mRNA COVID-19 vaccines in members of the US military. JAMA Cardiol. 2021;6(10):1202-1206.

• Rooney MR, Rawlings AM, Pankow JS, et al. Risk of progression to diabetes among older adults with prediabetes [published correction appears in JAMA Intern Med . 2021;181(4):570]. JAMA Intern Med. 2021;181(4):511-519.

Ling S, Zaccardi F, Lawson C, et al. Glucose control, sulfonylureas, and insulin treatment in elderly people with type 2 diabetes and risk of severe hypoglycemia and death: an observational study. Diabetes Care. 2021;44(4):915-924.

• Palmer SC, Tendal B, Mustafa RA, et al. Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials [published correction appears in BMJ . 2022;376:o109]. BMJ. 2021;372:m4573.
• Salah HM, Al'Aref SJ, Khan MS, et al. Effect of sodium-glucose cotransporter 2 inhibitors on cardiovascular and kidney outcomes. Systematic review and meta-analysis of randomized placebo-controlled trials. Am Heart J. 2021;232:10-22.

U.S. Preventive Services Task Force. Final recommendation statement. Prediabetes and type 2 diabetes: screening. August 24, 2021. Accessed March 15, 2022. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes

Kolber MR, Ton J, Thomas B, et al. PEER systematic review of randomized controlled trials: management of chronic low back pain in primary care. Can Fam Physician. 2021;67(1):e20-e30.

Cashin AG, Folly T, Bagg MK, et al. Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis. BMJ. 2021;374:n1446.

Rajasekaran S, Dilip Chand Raja S, Pushpa BT, et al. The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting’: results from an RCT and blinded trials. Eur Spine J. 2021;30(7):2069-2081.

Bijur PE, Friedman BW, Irizarry E, et al. A randomized trial comparing the efficacy of five oral analgesics for treatment of acute musculoskeletal extremity pain in the emergency department. Ann Emerg Med. 2021;77(3):345-356.

Skelly AC, Chou R, Dettori JR, et al. Noninvasive nonpharmacological treatment for chronic pain: a systematic review update. Comparative Effectiveness Review no. 227. Agency for Healthcare Research and Quality; 2020. Accessed May 13, 2022. https://www.ncbi.nlm.nih.gov/books/NBK556229/

Gong J, Colligan M, Kirkpatrick C, et al. Oral paracetamol versus combination oral analgesics for acute musculoskeletal injuries. Ann Emerg Med. 2019;74(4):521-529.

Randel KR, Schult AL, Botteri E, et al. Colorectal cancer screening with repeated fecal immunochemical test versus sigmoidoscopy: baseline results from a randomized trial. Gastroenterology. 2021;160(4):1085-1096.e5.

Rao SSC, Brenner DM. Efficacy and safety of over-the-counter therapies for chronic constipation: an updated systematic review. Am J Gastroenterol. 2021;116(6):1156-1181.

Herbert A, Rafiq M, Pham TM, et al. Predictive values for different cancers and inflammatory bowel disease of 6 common abdominal symptoms among more than 1.9 million primary care patients in the UK: a cohort study. PLoS Med. 2021;18(8):e1003708.

Jones WS, Mulder H, Wruck LM, et al.; ADAPTABLE Team. Comparative effectiveness of aspirin dosing in cardiovascular disease. N Engl J Med. 2021;384(21):1981-1990.

Ko DT, Sivaswamy A, Sud M, et al. Calibration and discrimination of the Framingham Risk Score and the Pooled Cohort Equations. CMAJ. 2020;192(17):E442-E449.

Drawz PE, Agarwal A, Dwyer JP, et al. Concordance between blood pressure in the systolic blood pressure intervention trial and in routine clinical practice. JAMA Intern Med. 2020;180(12):1655-1663.

Krittanawong C, Narasimhan B, Wang Z, et al. Association between egg consumption and risk of cardiovascular outcomes: a systematic review and meta-analysis. Am J Med. 2021;134(1):76-83.e2.

U.S. Preventive Services Task Force. Draft recommendation statement. Statin use for the primary prevention of cardiovascular disease in adults: preventive medication. February 22, 2022. Accessed March 10, 2022. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/statin-use-primary-prevention-cardiovascular-disease-adults

Falk J, Thomas B, Kirkwood J, et al. PEER systematic review of randomized controlled trials: management of chronic neuropathic pain in primary care. Can Fam Physician. 2021;67(5):e130-e140.

Furukawa TA, Salanti G, Cowen PJ, et al. No benefit from flexible titration above minimum licensed dose in prescribing antidepressants for major depression: systematic review. Acta Psychiatr Scand. 2020;141(5):401-409.

Mas-Dalmau G, Villanueva López C, Gorrotxategi PG, et al.; DAP Pediatrics Group. Delayed antibiotic prescription for children with respiratory infections: a randomized trial. Pediatrics. 2021;147(3):e20201323.

Li N, Zhao G, Wu W, et al. The efficacy and safety of vitamin C for iron supplementation in adult patients with iron deficiency anemia: A randomized clinical trial. JAMA Netw Open. 2020;3(11):e2023644.

Lee RA, Centor RM, Humphrey LL, et al. Appropriate use of short-course antibiotics in common infections: best practice advice from the American College of Physicians. Ann Intern Med. 2021;174(6):822-827.

Qaseem A, McLean RM, O'Gurek D, et al. Nonpharmacologic and pharmacologic management of acute pain from non–low back, musculoskeletal injuries in adults: a clinical guideline from the American College of Physicians and American Academy of Family Physicians. Ann Intern Med. 2020;173(9):739-748.

Krist AH, Davidson KW, Mangione CM, et al. Interventions for tobacco smoking cessation in adults, including pregnant persons. US Preventive Services Task Force recommendation statement. JAMA. 2021;325(3):265-279.

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Top 20 Research Studies of 2021 for Primary Care Physicians

• PMID: 35839363

This article summarizes the top 20 research studies of 2021 identified as POEMs (patient-oriented evidence that matters) that did not address the COVID-19 pandemic. Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists prevent adverse cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and also reduce all-cause and cardiovascular mortality. Most older adults (mean age, 75 years) with prediabetes do not progress to diabetes. Among patients in this age group with type 2 diabetes treated with medication, an A1C level of less than 7% is associated with increased risk of hospitalization for hypoglycemia, especially when using a sulfonylurea or insulin. For patients with chronic low back pain, exercise, nonsteroidal anti-inflammatory drugs, duloxetine, and opioids were shown to be more effective than control in achieving a 30% reduction in pain, but self-discontinuation of duloxetine and opioids was common. There is no clinically important difference between muscle relaxants and placebo in the treatment of nonspecific low back pain. In patients with chronic pain, low- to moderate-quality evidence supports exercise, yoga, massage, and mindfulness-based stress reduction. For acute musculoskeletal pain, acetaminophen, 1,000 mg, plus ibuprofen, 400 mg, without an opioid is a good option. Regarding screening for colorectal cancer, trial evidence supports performing fecal immunochemical testing every other year. For chronic constipation, evidence supports polyethylene glycol, senna, fiber supplements, magnesium-based products, and fruit-based products. The following abdominal symptoms carry a greater than 3% risk of cancer or inflammatory bowel disease: dysphagia or change in bowel habits in men; rectal bleeding in women; and abdominal pain, change in bowel habits, or dyspepsia in men and women older than 60 years. For secondary prevention in those with established arteriosclerotic cardiovascular disease, 81 mg of aspirin daily appears to be effective. The Framingham Risk Score and the Pooled Cohort Equations both overestimate the risk of cardiovascular events. Over 12 years, no association between egg consumption and cardiovascular events was demonstrated. Gabapentin, pregabalin, duloxetine, and venlafaxine provide clinically meaningful improvements in chronic neuropathic pain. In patients with moderate to severe depression, initial titration above the minimum starting dose of antidepressants in the first eight weeks of treatment is not more likely to increase response. In adults with iron deficiency anemia, adding vitamin C to oral iron has no effect. In children with pharyngitis, rhinosinusitis, acute bronchitis, or acute otitis media, providing education combined with a take-and-hold antibiotic prescription results in 1 in 4 of those children eventually taking an antibiotic.

• Analgesics, Opioid
• Anti-Bacterial Agents
• COVID-19* / complications
• Cardiovascular Diseases*
• Diabetes Mellitus, Type 2* / complications
• Diabetes Mellitus, Type 2* / drug therapy
• Duloxetine Hydrochloride
• Low Back Pain*
• Physicians, Primary Care* / education
• Sodium-Glucose Transporter 2 Inhibitors*
• Sodium-Glucose Transporter 2 Inhibitors

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Growing share of childless adults in U.S. don’t expect to ever have children

Birth rates in the United States dropped during the COVID-19 pandemic amid the twin public health and economic crises, lending evidence to predictions from early on in the outbreak that economic uncertainty might trigger a baby bust. This continued the downward trend in U.S. fertility rates, which were already at a record low before the pandemic began.

A new Pew Research Center survey finds that a rising share of U.S. adults who are not already parents say they are unlikely to ever have children, and their reasons range from just not wanting to have kids to concerns about climate change and the environment.

Pew Research Center conducted this study to learn more about Americans who don’t expect to have children in the future and the reasons they give.

This analysis is based on 3,866 U.S. adults ages 18 to 49, collected as a part of a larger survey conducted Oct. 18-24, 2021. Everyone who took part is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way, nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the ATP’s methodology .

Here are the questions used for this post, along with responses, and its methodology .

Some 44% of non-parents ages 18 to 49 say it is not too or not at all likely that they will have children someday, an increase of 7 percentage points from the 37% who said the same in a 2018 survey. Meanwhile, 74% of adults younger than 50 who are already parents say they are unlikely to have more kids, virtually unchanged since 2018.

Among parents and non-parents alike, men and women are equally likely to say they will probably not have kids (or more kids) in the future. Perhaps not surprisingly, adults in their 40s are far more likely than younger ones to say they are unlikely to have children or to have more children in the future. Some 85% of non-parents 40 to 49 say this, compared with 37% of those younger than 40. And while 91% of older parents say they probably won’t have more kids, 60% of younger parents say the same.

A majority (56%) of non-parents younger than 50 who say it’s unlikely they will have children someday say they just don’t want to have kids. Childless adults younger than 40 are more likely to say this than those ages 40 to 49 (60% vs. 46%, respectively). There are no differences by gender.

Among childless adults who say they have some other reason for thinking they won’t have kids in the future, no single reason stands out. About two-in-ten (19%) say it’s due to medical reasons, 17% say it’s for financial reasons and 15% say it’s because they do not have a partner. Roughly one-in-ten say their age or their partner’s age (10%) or the state of the world (9%) is a reason they don’t plan to have kids. An additional 5% cite environmental reasons, including climate change, and 2% say their partner doesn’t want children.

When it comes to 18- to 49-year-old parents who say they are unlikely to have more children in the future, again a majority (63%) say it’s because they just don’t want to. Fathers (69%) are more likely to say this than mothers (59%), as are parents younger than 40 (71%) when compared with those 40 to 49 (57%).

Among those younger than 50 who say there was some other reason why they probably will not have more children, age (theirs or their partner’s) and medical reasons were among the top reasons why (29% and 23% of this group said so, respectively), followed by financial reasons (14%) and the fact that they already have kids (11%). Smaller shares cite the state of the world (4%), not having a partner (2%) or having a partner who doesn’t want kids (2%).

Mothers and fathers generally give similar reasons for saying it’s unlikely they will have more children, but mothers are more likely than fathers to mention medical reasons (27% vs. 16%), while fathers are more likely than mothers to cite already having kids (18% vs. 6%).

About a quarter of parents younger than 40 who don’t expect to have more children in the future cite financial reasons (26%), compared with 8% of those 40 to 49. The younger group is also more likely to mention not having a partner (6% vs. 1%), while older parents are more likely to say age is a reason why they don’t expect to have more kids (41% of those 40 to 49 vs. 5% of those younger than 40).

Note: Here are the questions used for this post, along with responses, and its methodology .

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Few East Asian adults believe women have an obligation to society to have children

A growing share of americans say they’ve had fertility treatments or know someone who has, key facts as india surpasses china as the world’s most populous country, key facts about china’s declining population, global population skews male, but un projects parity between sexes by 2050, most popular.

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News Release

Wednesday, September 15, 2021

NIH builds large nationwide study population of tens of thousands to support research on long-term effects of COVID-19

The National Institutes of Health awarded nearly $470 million to build a national study population of diverse research volunteers and support large-scale studies on the long-term effects of COVID-19. The NIH REsearching COVID to Enhance Recovery (RECOVER) Initiative made the parent award to New York University (NYU) Langone Health, New York City, which will make multiple sub-awards to more than 100 researchers at more than 30 institutions and serves as the RECOVER Clinical Science Core. This major new award to NYU Langone supports new studies of COVID-19 survivors and leverages existing long-running large cohort studies with an expansion of their research focus. This combined population of research participants from new and existing cohorts, called a meta-cohort, will comprise the RECOVER Cohort. This funding was supported by the American Rescue Plan.

NIH launched the RECOVER Initiative to learn why some people have prolonged symptoms (referred to as long COVID) or develop new or returning symptoms after the acute phase of infection from SARS-CoV-2, the virus that causes COVID-19. The most common symptoms include pain, headaches, fatigue, “brain fog,” shortness of breath, anxiety, depression, fever, chronic cough, and sleep problems.

“We know some people have had their lives completely upended by the major long-term effects of COVID-19,” said NIH Director Francis S. Collins, M.D., Ph.D. “These studies will aim to determine the cause and find much needed answers to prevent this often-debilitating condition and help those who suffer move toward recovery.”

Data from the RECOVER Cohort will include clinical information, laboratory tests, and analyses of participants in various stages of recovery following SARS-CoV-2 infection. With immediate access to data from existing, diverse study populations, it is anticipated researchers will be able to accelerate the timeline for this important research.

“This scientifically rigorous approach puts into place a collaborative and multidisciplinary research community inclusive of diverse research participants that are critical to informing the treatment and prevention of the long-term effects of COVID-19,” said Gary H. Gibbons, M.D., director of NIH’s National Heart, Lung, and Blood Institute and one of the co-chairs of the RECOVER Initiative.

Researchers, people affected by long COVID, and representatives from advocacy organizations worked together to develop the RECOVER master protocols that use standardized trial designs and research methods to enable uniform evaluation of study populations across studies and the ability to quickly pivot the research focus depending on what findings show. This approach allows for data harmonization across research studies and study populations.  Data harmonization allows data to be compared and analyzed, which will facilitate the research process and provide more robust findings. 

Studies will include adult, pregnant, and pediatric populations; enroll patients during the acute as well as post-acute phases of the SARS-CoV-2 infection; evaluate tissue pathology; analyze data from millions of electronic health records; and use mobile health technologies, such as smartphone apps and wearable devices, which will gather real-world data in real time. Together, these studies are expected to provide insights over the coming months into many important questions including the incidence and prevalence of long-term effects from SARS-CoV-2 infection, the range of symptoms, underlying causes, risk factors, outcomes, and potential strategies for treatment and prevention.

“Given the range of symptoms that have been reported, intensive research using all available tools is necessary to understand what happens to stall recovery from this terrible virus. Importantly, the tissue pathology studies in RECOVER will enable in depth studies of the virus’s effects on all body systems” said Walter J. Koroshetz, M.D., director of NIH’s National Institute of Neurological Disorders and Stroke and one of the RECOVER co-chairs.

Research opportunity announcements were issued in February 2021 and awards to launch the RECOVER Clinical Science Core and Data Resource Core were announced in June . An award in support of a RECOVER Biorepository Core has also been made to the Mayo Clinic for approximately $40 million to collect, curate, and distribute comprehensive source of clinical samples for additional research studies. The Cores provide coordination and infrastructure for the RECOVER Initiative, including supporting the activities of the investigator consortium and ensuring that all data are harmonized and shared among researchers. In May and June, short-term awards were provided to more than 30 institutions to develop the master protocols.

These awards pave the path to gaining greater understanding of the long-term effects of SARS-CoV-2 infection and enabling researchers to identify potential interventions and preventive strategies.

About the National Institute of Neurological Disorders and Stroke (NINDS): NINDS is the nation’s leading funder of research on the brain and nervous system. The mission of NINDS is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. For more information, visit www.ninds.nih.gov .

About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information, visit www.nhlbi.nih.gov .

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov .

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An Open Comparative Study of the Effectiveness and Incomparable Study of the Immunogenicity and Safety of the Vaccine (CoviVac) for Adults Aged 60 Years and Older

• Study Details
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Inclusion Criteria:

Volunteers must meet the following inclusion criteria:

Type of participants

• Healthy volunteers or volunteers with a history of stable diseases that do not meet any of the criteria for non-inclusion in the study.

Other inclusion criteria

• Written informed consent of volunteers to participate in a clinical trial
• Volunteers who are able to fulfill the Protocol requirements (i.e., fill out a self-observation Diary, come to control visits).

Exclusion Criteria:

SARS-CoV-2 infection • A case of established COVID-19 disease confirmed by PCR and/or ELISA in the last 6 months.

Diseases or medical conditions

• Serious post-vaccination reaction (temperature above 40 C, hyperemia or edema more than 8 cm in diameter) or complication (collapse or shock-like condition that developed within 48 hours after vaccination; convulsions, accompanied or not accompanied by a feverish state) to any previous vaccination.
• Burdened allergic history (anaphylactic shock, Quincke's edema, polymorphic exudative eczema, serum sickness in the anamnesis, hypersensitivity or allergic reactions to the introduction of any vaccines in the anamnesis, known allergic reactions to vaccine components, etc.).
• Guillain-Barre syndrome (acute polyradiculitis) in the anamnesis.
• The axillary temperature at the time of vaccination is more than 37.0 ° C.
• Acute infectious diseases (recovery earlier than 4 weeks before vaccination) according to anamnesis.
• Donation of blood or plasma (in the amount of 450 ml or more) less than 2 months before inclusion in the study.
• Severe and/or uncontrolled diseases of the cardiovascular, bronchopulmonary, neuroendocrine systems, gastrointestinal tract, liver, kidneys, hematopoietic, immune systems.
• Is registered at the dispensary for tuberculosis, leukemia, oncological diseases, autoimmune diseases.
• Any confirmed or suspected immunosuppressive or immunodeficiency condition in the anamnesis.
• Splenectomy in the anamnesis.
• Neutropenia (decrease in the absolute number of neutrophils less than 1000/mm3), agranulocytosis, significant blood loss, severe anemia (hemoglobin less than 80 g/l) according to anamnesis.
• Anorexia according to anamnesis.

Prior or concomitant therapy

• Vaccination with any vaccine carried out within 30 days before vaccination / the first dose of the studied vaccine or planned administration within 30 days after vaccination / the last dose of the studied vaccine.
• Prior vaccination with an experimental or registered vaccine that may affect the interpretation of the study data (any coronavirus or SARS vaccines).
• Long-term use (more than 14 days) of immunosuppressants or other immunomodulatory drugs (immunoregulatory peptides, cytokines, interferons, immune system effector proteins (immunoglobulins), interferon inducers (cycloferon) during the six months preceding the study, according to anamnesis.
• Treatment with systemic glucocorticosteroids (≥ 20 mg of prednisone, or an analog, for more than 15 days during the last month).
• Volunteers who received immunoglobulin preparations or blood transfusion during the last 3 months prior to the start of the study according to anamnesis.

Other non-inclusion criteria

• Participation in any other clinical trial within the last 3 months.

Exclusion criteria:

• Withdrawal of Informed consent by a volunteer;
• The volunteer was included in violation of the inclusion/non-inclusion criteria of the Protocol;
• Any condition of a volunteer that requires, in the reasoned opinion of a medical researcher, the withdrawal of a volunteer from the study;
• Taking unauthorized medications (see section 6.2);
• The volunteer refuses to cooperate or is undisciplined (for example, failure to attend a scheduled visit without warning the researcher and/or loss of communication with the volunteer), or dropped out of observation;
• For administrative reasons (termination of the study by the Sponsor or regulatory authorities), as well as in case of gross violations of the Protocol that may affect the results of the study.
• For Patients and Families
• For Researchers
• For Study Record Managers
• Customer Support
• Accessibility
• Viewers and Players
• Freedom of Information Act
• HHS Vulnerability Disclosure
• U.S. National Library of Medicine
• U.S. National Institutes of Health
• U.S. Department of Health and Human Services

The rise of the inclusive consumer

The American consumer is undeniably becoming more inclusive. Responding to our survey 1 McKinsey Inclusive Consumer Survey, October 2021. in October 2021, two out of three Americans told us their social values now shape their shopping choices. And 45 percent—likely representing well over a hundred million shoppers 2 Extrapolated data: 45 percent of 270 million US residents over 18 years old would be about 120 million. —believe retailers should actively support Black-owned businesses and brands. This 45 percent represents the inclusive consumer.

About the authors

This article is a collaborative effort by Pamela Brown, Tiffany Burns , Tyler Harris, Charlotte Lucas, and Israe Zizaoui, representing views from McKinsey’s Retail Practice.

Large consumer and retail players from Nordstrom to Yelp are moving quickly to serve this group of influential customers. Indeed, while inclusive consumers tend to be younger, female, and more racially diverse, they include men and women across ethnic backgrounds, income levels, and age groups. Given this diverse and ubiquitous representation, the inclusive consumer holds the unique power to influence all demographic groups (Exhibit 1).

The inclusive consumer is more likely than other shoppers to buy Black-owned brands out of a desire to support diverse entrepreneurs on their growth journeys and small businesses in general (Exhibit 2). Like many other consumers today, they base their shopping choices less on traditional advertising and more on social media, friends’ recommendations, and the stories of those who founded the brands they admire. They are also more likely than other shoppers to care about sustainability and quality. 3 McKinsey Inclusive Consumer Survey, October 2021.

Where the inclusive consumer may be headed

Inclusive consumers are a large and influential population, and they want to spend more on Black-owned brands, which they know are underrepresented on store shelves. However, finding the brands and the products remains a barrier. Indeed, one in five inclusive consumers cited not finding the products they wanted as a reason for not buying from Black-owned brands. This plays out in the bigger picture of US retail spending as well. While about 14 percent of the US population identifies as Black, 4 “Quick facts,” United States Census Bureau, July 1, 2019. Black-owned brands rang up only about $83 billion in sales in 2020 5 Estimated with consumer-reported proportion of holiday shopping with Black-owned brands and National Retail Federation data on 2020 holiday spending of $790 billion. —less than 1.5 percent of $5.4 trillion 6 “Sales for U.S. retail trade sector over $5,411.0 billion,” United States Census Bureau, January 28, 2021. of retail spending. In our survey, about 21 percent of inclusive consumers said they had pledged to devote at least 15 percent of their retail spending to Black-owned brands in an effort to turn the tides. 7 McKinsey Inclusive Consumer Survey, October 2021.

Most retailers will need to make changes to meet the needs of inclusive consumers. Fewer than half of these shoppers say they know which products on retail shelves are from Black-owned brands, and a third don’t know where to go to purchase Black-owned brands. 8 McKinsey Inclusive Consumer Survey, October 2021. About 45 percent of the inclusive consumers we surveyed said they would value relevant labeling on store shelves and the ability to filter website results to find Black-owned brands. About a third would value additional sources of information, such as curated lists of products, a database of Black-owned brands, and recommendations from influencers.

Major retailers are now joining social influencers and other stakeholders to spread the word. Growing support for Black-owned brands is evident in social media and traditional media: a wide range of publications, from New York magazine and GQ to Harper’s Bazaar 9 “The 42 best gifts to shop from Black-owned businesses now and forever,” Harper’s Bazaar , November 17, 2021. and whowhatwear.com, published a curated holiday list of products from Black-owned brands in November 2021. In the same month, Oprah’s “favorite things” list 10 “Oprah’s favorite things 2021 list is here!,” Oprah Daily, November 23, 2021. focused on products from small businesses, many of which are owned by women and people of color.

How retailers could attract the inclusive consumer

In a marketplace being transformed by digitization, social change, and a global pandemic, leading retailers and brand managers know that they must keep meeting evolving consumer preferences to stay relevant. Major retailers are now reviewing how they work—from operations and merchandising to hiring and HR practices—and starting to move the needle. Retailers should consider actions in five main areas to bring the inclusive consumer through their doors and onto their websites.

Action 1: Reshape shelves. Retailers can first and foremost demonstrate a commitment to the inclusive consumer by evaluating and reimagining the brands on their shelves. Many are already taking strong action, reimagining their merchandising mix to make shelves and the brands that sit on them more representative. For example, more than 28 national retailers, including Gap, Macy’s, and Sephora, have signed the Fifteen Percent Pledge’s call for 15 percent of retail shelf space to be dedicated to Black-owned brands. Some of these retailers have doubled their assortments of Black-owned brands in just a year, opening their doors to almost 400 brands. 11 Elizabeth Segran, “In one year, the 15% Pledge got 385 Black-owned brands on the shelves of Macy’s, Gap, Sephora, and more,” Fast Company , July 7, 2021. In addition to introducing Black-owned brands, retailers could also review their planograms and product placement: for example, Ulta Beauty is intentional about placing Black-owned brands in prime locations in stores and creates dedicated efforts to increase Black-owned brands’ features in circular advertising and email marketing. 12 Liz Flora, “Camille Rose expands to Ulta Beauty as retailer makes Black-owned brand push,” Glossy, April 12, 2021.

Retailers can first and foremost demonstrate a commitment to the inclusive consumer by evaluating and reimagining the brands on their shelves.

Action 2: Switch up sourcing. Retailers, especially those who are vertically integrated, could also demonstrate commitment to the inclusive consumer by doubling down on diversity in their supply chain. For example, Best Buy has committed to spending at least $1.2 billion with businesses owned by members of the Black, Indigenous, and people of color (BIPOC) community and other diverse businesses by 2025. 13 “Best Buy commits to spending $1.2 billion with BIPOC and diverse businesses by 2025,” Business Wire, June 24, 2021. The commitment includes plans to increase all forms of spending with businesses from nearly every corner of the company—from how it brings goods and services to stores to where and how it advertises. Supplier diversity is not limited to retailers and can also be considered broadly by most brands and companies. For example, in 2020, the Coca-Cola Company committed to spending an additional $500 million over five years with Black-owned suppliers, more than doubling the company’s previous commitment. 14 “Coca-Cola Company commits $500 million in additional spending with Black-owned suppliers,” Coca-Cola Company, October 10, 2020. These actions show an increasing commitment to diversity across the supply chain, and these types of commitments will likely grow in future years as consumers begin calling for similar levels of diversity in the supply chain as they are calling for on shelves.

Action 3: Map it out. Inclusive consumers consistently say that not knowing which brands are Black-owned or where to shop for them are barriers to spending as much as they would like on brands from diverse founders. And wayfinding is their resounding answer. Retailers could help consumers identify Black-owned brands with clear labeling on shelves and websites, the ability to filter website search results, and curated lists of products, for example.

Sephora responded to these needs by creating a dedicated tab on its website to share Black-owned brands’ stories and products and by enhancing its online site, which features Black-owned brands on its browsing pane, provides a filter for shoppers looking for Black- and BIPOC-owned brands, and provides curated lists of recommended products, including a “Sephora Favorites” bundle in Black-owned beauty. 15 Kori Hale, “Sephora’s planning to double down on Black-owned brands,” Forbes , January 25, 2021. Google is also actively working on multiple initiatives to support Black-owned brands, including a tool that allows Black-owned businesses to identify themselves in maps, listings, and Google business-profile searches. 16 Keyword , “Standing with the Black community,” blog entry by Sundar Pichai, Google, June 3, 2020; “Supporting Black-owned businesses,” Google for Small Business, 2021. Additionally, Google has launched the ByBlack platform, which consists of both a national Black business directory (powered by the US Black Chambers) and a national certification as a Black-owned business (in partnership with American Express). This tool provides Black entrepreneurs access to a community with valuable business resources (including Google trainings) and a way to help reach new customers.

Action 4: Share the stories. Inclusive consumers care about what is on shelves, but they want more. They want to learn about founders’ stories, for example, and support the missions of small businesses. Further, our research shows that inclusive consumers are more likely than other shoppers to buy Black-owned brands based on recommendations from friends, and retailers that incorporate founder stories into marketing and digital placements are more likely than those that don’t to attract the inclusive consumer’s eye. Nordstrom, for example, introduced “Concept 012: Black_Space,” which includes a dedicated shop developed, designed, and curated by Black voices to amplify Black representation through in-store buildouts and merchandising. The concept is further supported with an online site experience that includes video content created by Black curators to represent their perspectives. 17 “New Concepts @Nordstrom launches Concept 012: Black_Space,” Nordstrom, February 22, 2021.

Action 5: Ditch the big-brand playbook. Introducing and cultivating smaller brands takes different capabilities and mindsets  than retailers may be accustomed to when working with larger, more established brands. Unlike big brands, small brands come with more variability in experience and know-how, as well as growing pains as they enter the bigger retail stage. Retailers that are committed to fostering smaller brands will need to work differently, creating teams that understand how these brands operate. For example, those with experience working with small brands know that everyday requirements from retailers, such as buy sizes and inventory systems, can have large-scale repercussions on small brands with limited working capital or team capacity to meet these terms. A retailer that seeks to help smaller brands can boost the odds of success by adapting its playbook and its teams to suit their needs.

The time is now

In the years ahead, millions more consumers will likely join the ranks of inclusive consumers, rewarding businesses that pursue inclusion and avoiding those that don’t.

Businesses that meet the needs of inclusive consumers will likely do more than raise revenues and loyalty—they may also earn dividends in other areas of the business, including attracting and retaining talent. About 70 percent of the US-based employees we surveyed in August 2020 said their sense of purpose is largely defined by work, and nearly two-thirds said COVID-19 had caused them to reflect on their purpose in life, and nearly half were reconsidering the kind of work they do. (For more on this topic, please see Naina Dhingra, Andrew Samo, Bill Schaninger, and Matt Schrimper “ Help your employees find purpose—or watch them leave .”)

Whether employees or customers, the inclusive consumer is changing the imperative for retail. The evidence is overwhelming: the inclusive consumer is leading the pack, influencing consumers across demographics, and voting with their pocketbooks for retailers that support diverse entrepreneurs and their products. (For more on this topic, please see “ The Black unicorn: Changing the game for inclusivity in retail .”)

Pamela Brown is a partner in McKinsey’s New Jersey office, where Charlotte Lucas and Israe Zizaoui are consultants; Tiffany Burns is a partner in the Atlanta office; and Tyler Harris is an associate partner in the Washington, DC, office.

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More than 1 in 4 deaths among young people in Canada were opioid-related in 2021, study finds

Nationally, annual number of opioid overdose deaths surged from 3,007 to 6,222 over three years.

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Opioid-related deaths doubled in Canada between 2019 and the end of 2021, with Manitoba, Saskatchewan and Alberta experiencing a dramatic jump, mostly among men in their 20s and 30s, says a new study that calls for targeted harm-reduction policies.

Researchers from the University of Toronto analyzed accidental opioid-related deaths between Jan. 1, 2019 and Dec. 31, 2021 in those provinces as well as British Columbia, Ontario, Quebec, New Brunswick and Nova Scotia, and the Northwest Territories.

Manitoba saw the sharpest rise in overdose deaths for those aged 30 to 39 — reaching 500 deaths per million population, more than five times the 89 deaths per million population recorded at the beginning of the study period.

In Saskatchewan, the death toll for that age group nearly tripled to 424 per million, up from 146 per million, while Alberta's rate spiked more than 2.5 times to 729 fatalities per million, up from 272 per million. Ontario's death rate reached 384, up from 210 per million.

B.C., which has been the epicentre of the overdose crisis, recorded 229 deaths per million for that age group in 2019, climbing to 394 in 2020. All data for 2021 from that province's coroners service was not yet available when researchers completed their work based on information collected by the Public Health Agency of Canada.

Push to better understand the long-term harms of opioid use

Nationally, the annual number of opioid overdose deaths surged from 3,007 to 6,222 over the three-year study period, which researchers note coincided with pandemic public health measures that reduced access to harm reduction programs and imposed border restrictions that may have increased the toxicity of the drug supply.

"In addition, for many, the pandemic exacerbated feelings of anxiety, uncertainty and loneliness, contributing to increased substance use globally," they said.

The study was published Monday in the Canadian Medical Association Journal .

Senior author Tara Gomes said one in four deaths involved people in their 20s and 30s. More than 70 per cent of the overall deaths were among men.

A spokesperson with the coroners service in B.C. said 78 per cent of people that fatally overdosed in that province between 2019 and the end of 2021 were men.

Devastating impacts

The sharp surge in fatal overdoses — especially among young adults on the Prairies — suggests provinces must act quickly, said Gomes, an epidemiologist who called for more harm-reduction services including supervised consumption sites.

"Being slow and not being as nimble as we would like to be in our responses can have really devastating impacts," said Gomes, also lead principal investigator of the Ontario Drug Policy Research Network.

Response to opioid crisis must be multipronged, says drug policy expert

Bernadette Smith, Manitoba's minister of housing, addiction, homelessness and mental health, said the province plans to open its first supervised consumption site in Winnipeg next year and will also offer drug-testing machines so people can check if their illicit substances are toxic.

"We came out of a previous government that didn't take a harm-reduction approach, unfortunately," said the New Democrat, whose party defeated the Progressive Conservatives last fall.

'They wouldn't have enough beds'

"We're working with front-line organizations because they have not been listened to or worked with for the last seven years in our province, which has been a real problem," Smith said.

Manitoba plans to train family doctors to treat addiction with medications including Suboxone and methadone, said Smith, noting the physicians typically refer patients to detox for care.

"We're creating a model so that folks aren't having to go to a bunch of different places to get different services," said Smith.

She declined to say whether Manitobans will have access to a prescribed safer supply of drugs.

Tanya Hornbuckle of Edmonton said her son Joel Wolstenholme was 30 when he died in 2022. He became addicted to illicit substances at about age 14, starting with cannabis before shifting to methamphetamine, cocaine and other drugs that were increasingly laced with fentanyl.

He also battled a mental illness, but getting help for both that issue and addiction in a single service was challenging, Hornbuckle said.

Wolstenholme tried multiple times to detox, but there were never enough beds at a clinic where people had to line up at 8 a.m., she said.

"It would happen over and over and then he would call me. I went and stood in line or I drove him there and waited with him in the lineup. They wouldn't have enough beds."

Her son's anxieties and addiction worsened when pandemic restrictions prevented her from entering an emergency room with him because he did not trust staff, Hornbuckle said.

On Feb. 6, 2022, Hornbuckle went to her son's home so they could cook together. She found him dead.

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The Alberta government's strategy of focusing more on recovery and abstinence-based treatment than harm reduction, mental health and housing is the wrong approach, said Hornbuckle, noting that for a time her son slept in parks and abandoned houses after losing his vehicle and apartment to addiction.

Rebecca Haines-Saah, an associate professor of community health services at the University of Calgary, called the deaths of young people from overdose a tragedy, and said many more suffer from brain injury due to toxic substances.

Halifax doctor calls for safer opioid access

"Obviously, we have the incorrect response. We do not have the approach and services available to keep people alive," said Haines-Saah, who also called for more harm-reduction services.

"We don't have a full-scale public health response that is required. We don't have any plans to fund anything that relates to what we would call harm reduction."

Much of the current approach to addiction excludes a large number of recreational drug users, said Gomes. She said between a third and half of the deaths in Ontario involved people without an opioid use disorder diagnosis.

"So, focusing on [residential treatment] alone is something that really concerns me because we really need to make sure that we have different options for different people."

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.  

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