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How a racing heart may alter decision-making brain circuits

Anxiety, addiction, and other psychiatric disorders are often characterized by intense states of what scientists call arousal: The heart races, blood pressure readings rise, breaths shorten, and "bad" decisions are made. In an effort to understand how these states influence the brain's decision-making processes, scientists at the Icahn School of Medicine at Mount Sinai analyzed the data from a previous study of non-human primates. They found that two of the brain's decision-making centers contain neurons that may exclusively monitor the body's internal dynamics. Furthermore, a heightened state of arousal appeared to rewire one of the centers by turning some decision-making neurons into internal state monitors.

"Our results suggest that the brain's decision-making circuits may be wired to constantly monitor and integrate what is happening inside the body. Because of that, changes in our level of arousal can alter the way that these circuits work," said Peter Rudebeck, PhD, Associate Professor in the Nash Family Department of Neuroscience and Friedman Brain Institute at Mount Sinai and the senior author of the study published in PNAS (Proceedings of the National Academy of Sciences). "We hope that these results will help researchers gain a better understanding of the brain areas and fundamental cellular processes that underlie several psychiatric disorders."

The study was led by Atsushi Fujimoto, MD, PhD, an Instructor in Dr. Rudebeck's lab who previously studied how the brain controls risk-taking.

For years scientists have described the relationship between arousal and decision-making performance as a "U-shaped curve." Basically, a little of bit of arousal -- such as that experienced after a cup of coffee -- might produce peak performance. But too much or too little arousal increases the chances that the brain will make slow or incorrect decisions.

Initial results from this study supported this idea. The researchers analyzed data from a previous set of experiments that tested the ability of three rhesus monkeys to decide between receiving two rewards: either a lot of tasty juice or a little. Dr. Rudebeck performed these experiments while working as a post-doctoral fellow at the National Institute of Mental Health. As expected, the monkeys consistently chose to have more juice, and on average they made this decision faster when their hearts were beating faster, supporting the idea that an aroused state fosters better performance.

Next, the researchers analyzed the electrical activity recorded from neurons in two of the brain's decision centers called the orbitofrontal cortex and dorsal anterior cingulate cortex.

They found that the activity of about a sixth of the neurons in either area correlated with fluctuations in heart rate. In other words, if an animal's heart rate changed, then the activity of these cells would also change by either speeding up or slowing down. This activity appeared to be unaffected by the decisions made about the different rewards that the monkeys were receiving. Meanwhile, the activity of the remaining cells in each area appeared to be primarily involved in the decision-making process.

"Brain scanning studies have suggested that bodily arousal alters the activity of these decision-making centers. Our results both support this idea on a cellular level and suggest that the sole job of some these neurons is to track the body's internal, or interoceptive, states," Dr. Fujimoto said. "The next question we had was: 'What might happen during the type of heightened arousal states seen in patients who suffer from anxiety, addiction, and other psychiatric disorders?'"

To answer the question, the researchers analyzed the data obtained after the amygdala, the brain's emotional center, was surgically turned off in each animal. This raised heart rates by up to 15 beats per minute. Now, in this higher arousal state, the faster the animals' hearts beat, the slower they were to choose a reward. This suggests that when the animals' arousal state was heightened, it actually hampered the decision-making process.

When the team looked at the neural activity, they found something even more interesting. The heightened arousal state appeared to alter the roles that the neurons played during decision-making. In both brain centers, the researchers saw evidence of a decrease in the number of neurons involved in the decision-making process. Moreover, in the dorsal anterior cingulate cortex, the number of neurons that appeared to track internal states rose slightly. This altered the balance of information represented in this area, as if the neural signals for decision making were "hijacked" by arousal.

"Although not definitive, our results suggest that a heightened arousal state degrades and takes control of the decision-making circuits in the brain," Dr. Rudebeck said. "We plan to continue studying how arousal can influence higher brain functions and how this contributes to psychiatric disorders."

This study was supported by the National Institutes of Health (MH110822), the NIH's BRAIN Initiative (MH117040), the NIH Intramural Research Program at the National Institute of Mental Health (MH002886), the Takeda Science Foundation, and a Brain & Behavior Research Foundation Young Investigator Grant (#28979).

Source: The Mount Sinai Hospital / Mount Sinai School of Medicine. "How a racing heart may alter decision-making brain circuits: Body-state monitoring neurons can hijack the decision-making process." ScienceDaily. ScienceDaily, 30 August 2021. www.sciencedaily.com/releases/2021/08/210830140224.htm

Minimizing the impact of the Delta variant in the Philippines

The Delta variant is the most closely watched coronavirus mutation yet, and with good reason: it’s twice as transmissible as the original virus, with one positive person potentially capable of causing infection in another nine to 13 persons.

Community transmission largely attributed to the Delta variant is causing an increase of reported cases on daily basis including unfortunately hundreds of reported daily deaths. Even countries that previously contained COVID-19 transmission are seeing a rapid rise in cases partly driven by this more transmissible variant. What can the Philippines do to strengthen its response?

To minimize the impact of the Delta variant, the World Health Organization (WHO) encourages the government, local government units (LGUs), employers, and all Filipinos to act proactively and together to break the chains of transmission and prevent its further spread in households, communities, and workplaces. We need to work together to successfully address this evolving challenge.

“The coronavirus has mutated to spread quickly to more people. We also must adapt our own mindsets and behaviours – to adapt quickly to this new reality so we can minimize the impact of the evolving pandemic both as individuals and as a community,” said Dr Rabindra Abeyasinghe, WHO Representative to the Philippines.

Pandemic fatigue behind poor adherence to minimum public health standards

Nearly 20 months into the global health crisis, pandemic fatigue is contributing to and creating risks as the mental distress of losing jobs, keeping families safe, or the sweeping uncertainty of the future takes a toll on many Filipinos.

“People are taking risks to earn a living despite the threats of Delta and other variants or even simply getting together with their loved ones,” said Dr Abeyasinghe. “These are understandable, but in the face of a more transmissible variant, we need to be extra vigilant and adopt ways to be safe in these settings. The minimum public health standards when complied with due diligence are still very effective in preventing transmission and interrupting chains of transmission.”

Aside from wearing masks and physically distancing, WHO emphasizes the need for avoiding closed and crowded settings and ensuring good ventilation. Opening windows at home or in workplaces prevents people from inhaling air carrying very small droplets or aerosol particles that contain infectious coronavirus.

Physical distancing could be more challenging in public spaces like public transport, indoor dining spaces, some workplaces, wet markets and groceries. “We encourage safety or enforcement officers to be on alert and remind people to keep their distance from others,” said Dr Abeyasinghe. “It is not just about telling them what to do, however, but also pointing out why they still need to do it – to keep themselves and others safe.” These behaviours and practices are equally important for the non-vaccinated and the vaccinated. This is because we are seeing breakthrough infections that are usually less severe even among the vaccinated.

Less social mixing, fewer risks

Although it’s not universally clear that the Delta variant itself causes more severe cases, such reports have come from several countries. The higher transmissibility of the Delta variant leads to a larger pool of people getting infected. Unfortunately, this also includes increased numbers among children and unvaccinated elderly persons. The larger number of people infected results in higher numbers of persons developing severe disease and seeking hospital critical care, potentially overwhelming the healthcare systems in many affected countries, especially in countries with low vaccination coverage among elderly and comorbid populations.

“Compared to the SARS-CoV-2 wild type, the highly transmissible Delta variant which causes higher viral loads in the respiratory tract spreads faster and infects more people, potentially affecting every individual in a household if one person gets infected.

In the Philippines, the early lockdown in the country’s capital and areas with increasing COVID-19 cases have decreased the movement of people and somewhat delayed the surge of cases. However the decrease in mobility in the most recent Enhanced Community Quarantine (ECQ) was noticeably higher compared with previous lockdowns.

As the National Capital Region continues in MECQ. we need to all limit our movement to essential errands and turn to online tools for work and social engagements as much as possible.

Vaccination protects the community

Social mixing also poses greater risks to vulnerable people who are unvaccinated. The increase of cases seen by WHO in countries around the world is largely among unvaccinated.

Senior citizens and people with underlying conditions will be gravely affected if the Delta variant spreads far and wide in the country. “Before Delta cause surges everywhere in the Philippines, those at high risk of severe disease and death due to COVID-19, the elderly (A2) and comorbid populations (A3) must be fully vaccinated as soon as possible,” said Dr Abeyasinghe.

“It is not enough to meet population protection in a few areas. Inoculating people in the A2 and A3 priority groups all over the country can create the most impact in decongesting hospitals and saving lives.”

WHO also welcomes the idea of NCR cities “vaccinating as one,” allowing residents of one local government unit (LGU) to get their jabs in another. “We support this localized dose sharing for the elderly and people with comorbidities. It is a resourceful and timely suggestion and addresses the urgency of our situation with the Delta variant.”

Vaccines not only protect elderly and persons with comorbidities, they help reduce severe infections in families preventing the need for out of pocket expenditure, they also protect the hospitals from being overwhelmed contributing to economic recovery of the country. Recent data shows that all vaccines are highly effective in preventing severe disease and death. Vaccines are not 100% effective in preventing infections with the new variants, but fully vaccinated people experience breakthrough infections that are often mild. Additionally, vaccinated people shed the virus for a shorter duration of time potentially reducing the risk of others being infected.

Save beds for severe cases to save lives

WHO has been supporting the expansion of the health care system through the setting up of step-down facilities and expansion of ICU capacities. As the number of cases increases and the health care capacities come under pressure it’s important to better manage the existing capacities through referral and back referrals. Infected persons with no or minimal risk can be managed at home or in isolation facilities, reserving hospital space for high risk and severely ill patients.

Temporary treatment and monitoring facilities (TTMFs) are an important part of the COVID-19 response as they help prevent infection at home and congestion of hospitals. They could be facilities to isolate mild and asymptomatic COVID-19 patients, or step-down facilities for recovering patients.

“The Philippines can learn from countries that stringently implement suggested triage algorithms and save hospital beds for severe cases,” said Dr Abeyasinghe. “We encourage home-based care for those who meet the following criteria: Patients at low risk, those who have a separate isolation room with toilet and good ventilation and can have their daily needs delivered at home.”

If home isolation is not possible, access to TTMFs must be facilitated by LGUs to lessen transmission in the household. Based on PhilHealth’s home isolation guide, health care providers and patients must have daily check-ins for at least 10 days to ensure monitoring of symptoms and immediate action if inpatient care is needed.

Investing in and ensuring telemedicine services are in place facilitates better adherence to infection and prevention control (IPC) measures at all stages of care, and protects care givers from unnecessary exposure.

“The collective health of the nation is based on individual actions,” said Dr Abeyasinghe. “The simple precautionary measures you take for yourself and your family also protect your communities. Now more than ever, we need to see and embrace the bayanihan spirit to overcome this public health crisis together and heal as one.” (Rocel Ann Junio, Communications Officer, WHO Philippines, This email address is being protected from spambots. You need JavaScript enabled to view it. )

Source: https://www.who.int/philippines/news/detail/31-08-2021-minimizing-the-impact-of-the-delta-variant-in-the-philippines

Reducing sugar in packaged foods can prevent disease in millions

Cutting 20% of sugar from packaged foods and 40% from beverages could prevent 2.48 million cardiovascular disease events (such as strokes, heart attacks, cardiac arrests), 490,000 cardiovascular deaths, and 750,000 diabetes cases in the U.S. over the lifetime of the adult population, according to micro-simulation study published in Circulation.

A team of researchers from Massachusetts General Hospital (MGH), the Friedman School of Nutrition Science & Policy at Tufts University, Harvard T.H. Chan School of Public Health and New York City Department of Health and Mental Hygiene (NYC DOH) created a model to simulate and quantify the health, economic, and equity impacts of a pragmatic sugar-reduction policy proposed by the U.S. National Salt and Sugar Reduction Initiative (NSSRI). A partnership of more than 100 local, state and national health organizations convened by the NYC DOH, the NSSRI released draft sugar-reduction targets for packaged foods and beverages in 15 categories in 2018. This February, NSSRI finalized the policy with the goal of industry voluntarily committing to gradually reformulate their sugary products.

Implementing a national policy, however, will require government support to monitor companies as they work toward the targets and to publicly report on their progress. The researchers hope their model will build consensus on the need for a national-sugar reformulation policy in the US. "We hope that this study will help push the reformulation initiative forward in the next few years," says Siyi Shangguan, MD, MPH, lead author and attending physician at MGH. "Reducing the sugar content of commercially prepared foods and beverages will have a larger impact on the health of Americans than other initiatives to cut sugar, such as imposing a sugar tax, labeling added sugar content, or banning sugary drinks in schools."

Ten years after the NSSRI policy goes into effect, the U.S. could expect to save $4.28 billion in total net healthcare costs, and $118.04 billion over the lifetime of the current adult population (ages 35 to 79), according to the model. Adding the societal costs of lost productivity of Americans developing diseases from excessive sugar consumption, the total cost savings of the NSSRI policy rises to $160.88 billion over the adult population's lifetime. These benefits are likely to be an underestimation since the calculations were conservative. The study also demonstrated that even partial industry compliance with the policy could generate significant health and economic gains.

The researchers found that the NSSRI policy became cost-effective at six years and cost-saving at nine years. The policy could also reduce disparities, with the greatest estimated health gains among Black and Hispanic adults, and Americans with lower income and less education -- populations that consume the most sugar as a historical consequence of inequitable systems.

Product reformulation efforts have been shown to be successful in reducing other harmful nutrients, such as trans fats and sodium. The U.S., however, lags other countries in implementing strong sugar-reduction policies, with countries such as the UK, Norway, and Singapore taking the lead on sugar-reformulation efforts. The US may yet become a leader in protecting its people from the dangers of excessive sugar consumption if the NSSRI's proposed sugar-reduction targets are achieved. "The NSSRI policy is by far the most carefully designed and comprehensive, yet achievable, sugar-reformulation initiative in the world," says Shangguan.

Consuming sugary foods and beverages is strongly linked to obesity and diseases such as type 2 diabetes and cardiovascular disease, the leading cause of mortality in the U.S. More than two in five American adults are obese, one in two have diabetes or prediabetes, and nearly one in two have cardiovascular disease, with those from lower-income groups being disproportionately burdened.

"Sugar is one of the most obvious additives in the food supply to reduce to reasonable amounts," says Dariush Mozaffarian, MD, DrPH, co-senior author and dean of the Friedman School of Nutrition Science and Policy at Tufts University. "Our findings suggest it's time to implement a national program with voluntary sugar reduction targets, which can generate major improvements in health, health disparities, and healthcare spending in less than a decade."

Major funding for this study provided by the National Institutes of Health.

Shangguan is an attending at MGH and an instructor of Medicine at Harvard Medical School. Mozaffarian is dean of the Friedman School of Nutrition Science and Policy at Tufts University. Thomas Gaziano, MD, MSc, is associate professor at Brigham and Women's Hospital and assistant professor of Medicine at HMS. Renata Micha, PhD, is research associate professor at the Friedman School of Nutrition Science and Policy at Tufts University and associate professor at the University of Thessaly in Greece.

Source: Massachusetts General Hospital. "Reducing sugar in packaged foods can prevent disease in millions." ScienceDaily. ScienceDaily, 27 August 2021. https://www.sciencedaily.com/releases/2021/08/210827082431.htm

DBM lauds DOST-PCHRD for achieving all performance indicators in 2020

The Department of Budget and Management (DBM) commends the performance of the Department of Science and Technology (DOST) and its attached agencies for attaining its targets and major outputs despite the limitations brought by the COVID-19 pandemic in 2020.

Of the 19 DOST agencies, DBM lauded the Philippine Council for Health Research and Development (PCHRD) for achieving all its performance indicators committed for 2020 with an accomplishment rate of 100% to 377%, and for attaining an almost 100% budget utilization rate.

“The government appreciates the efforts of DOST in delivering its commitments in terms of the performance indicators, particularly for being an active agency in curbing the effects of the virus through its scientific intervention in medicine as well as its promotion of a better-designed, well-prepared programs and projects for the agency,” said DBM Undersecretary Tina Rose Marie L. Canda in a DBM summary report sent to DOST.

In 2020, the Council supported 36 research and development (R&D) projects implemented in response to COVID-19 and maintained its support to 138 ongoing research projects under its nine R&D priority areas, of which 22 have completed implementation in the said year. The Council also welcomed a total of 332 R&D research proposals, where 46 new projects were approved for funding and implementation.

In terms of capacity building, PCHRD has supported 53 MD-PhD in Molecular Medicine scholars in 2020, welcomed 12 new Balik Scientists, and approved 22 projects in addition to the 37 ongoing projects being supported under its Regional Research Fund Program. More so, the Council also provided important inputs to 17 legislations, filed 76 intellectual property applications, and co-organized 40 health-related webinars, among many of its information, communication, and technology transfer services.

“Our ultimate goal as the country’s lead coordinating body for health research has always been the same for the last three decades: to make life better for the Filipinos through health research-based solutions and innovations. We thank the DBM for recognizing our efforts to address the needs of our country’s health system amid major crises, including the COVID-19 pandemic. We share this recognition with our Filipino researchers, partners, and stakeholders who strive to create research-based solutions to our pressing health needs,” said PCHRD Executive Director Jaime C. Montoya.

The DBM report also highlighted that DOST supported a total of 1,267 projects in 2020, out of its target of 954 projects, and all agencies surpassed their targets including PCHRD with 207 projects implemented under the Grants-In-Aid (GIA) program. DBM also reports that all DOST agencies posted “very impressive” obligation rates under their operations.

“I believe that we have accomplished much more than what the financial and physical performance indicators present. We have put in place pioneering and strategic programs that respond to national problems particularly the COVID-19 pandemic. Our interventions have long and enduring positive impacts on the economic development, poverty reduction, and social transformation as affirmed by our various clients and stakeholders,” said DOST Secretary Fortunato T. de la Peña.

The physical performance is measured in terms of the outcome and output performance indicators committed in the Performance Informed Budget for FY 2020, while the financial performance is measured in terms of budget utilization rate both in obligation and disbursement and income performance.

Source: https://www.pchrd.dost.gov.ph/news/6704-dbm-lauds-dost-pchrd-for-achieving-all-performance-indicators-in-2020

DOST-PCHRD, FIF, and UPM sign partnership advancing PH liver research

The Department of Science and Technology- Philippine Council for Health Research and Development (DOST-PCHRD), University of the Philippines Manila (UP Manila), and the Fondazione Italiana Fegato (FIF), signed a memorandum of understanding (MOU) last August 18, 2021, to formalize the parties’ commitment to advance liver research in the Philippines.

According to data from the World Health Organization 2018, liver disease accounts for 7,491 or 1.23% of total deaths in the Philippines. “It is an opportune time to realize and to reiterate the state of the Philippines in terms of liver health and why this collaboration and these actions we are taking are just as crucial in improving the lives of our countrymen,” DOST-PCHRD Executive Director Jaime Montoya said as he highlighted liver diseases as a persistent health concern in the country.

What to expect
An offshoot of the existing cooperation between the DOST-PCHRD and FIF, this tripartite partnership will promote joint research efforts and capacity-building initiatives on liver research both for Filipino and Italian researchers. One of the core outputs to be expected is the organization of the Philippine Liver Network composed of Filipino academic and research institutions. “The network will become the natural hub in which the collaboration between the Foundation, DOST, and UP Manila will be harbored,” said FIF President Decio Ripandelli, emphasizing the importance of the network in enabling sustainable liver research in the country.

Under the MOU, the DOST-PCHRD is tasked to overlook the initiatives to be undertaken by the cooperating parties. As one of the country’s premier institutions on research, UP Manila is mandated to lead the conduct of R&D efforts aligned with the objectives of the program. Lastly, the FIF, a leading institution in the field of translational research in liver diseases, will be sharing its expertise in establishing liver disease research programs with its Philippine counterparts.

The program will explore the application of various fields of research such as OMICS technologies, animal and non-animal models for liver diseases, and artificial intelligence in the context of liver disease. UP Manila through Chancellor Carmencita Padilla expressed the institution’s anticipation for the expected outputs of the program. “We envision to promote multidisciplinary investigations of liver health and disease. We look forward to novel treatment approaches. We look forward to more cutting-edge care for liver diseases and clinical trials,” she said.

What has been done
Various initiatives have been launched to jumpstart the partnership’s activities according to Dr. Janus Ong, lead of the liver research program in the Philippines. As a result of the partnership between the DOST-PCHRD and FIF back in 2019, four Filipino researchers are currently undergoing a fellowship program focused on molecular hepatology at the University of Trieste, Italy. Dr. Ripandelli commended the work of the Filipino fellows who were able to produce at least five publications in international peer-reviewed journals in the past year.

In 2020, the liver research agenda was formulated in collaboration with the Alliance for Improving Health Outcomes (AIHO) which will guide liver research strategies to be undertaken in the future. As of August 2021, research proposals are already in the pipeline which will be submitted to the DOST-PCHRD and UP Manila for funding support.

Source: https://www.pchrd.dost.gov.ph/news/6703-dost-pchrd-fif-and-upm-sign-partnership-advancing-ph-liver-research