Category: Health News

  • Ada Health closes Series B funding round at 0M

    Ada Health closes Series B funding round at $120M

    A $30 million (€26 million) extension has helped Ada Health to close its newest series B spherical at $120 million (€105 million).

    Amid the new buyers from Europe and the US are Farallon Funds, Pink River West, Bertelsman Investments and Schroders Funds, the latter with an acquisition of vehicles. With the funding furnished, Ada Wellbeing plans to broaden into the US health care market place.

    “Today’s financial commitment will help us to double down on our advancement in the US and in other vital geographies, when continuing to acquire our suite of AI-powered options, strike new partnerships, and make a genuinely personalized running technique for health”, said Daniel Nathrath, CEO and Co-founder of Ada Health and fitness in the official push release (10 February).

    “We’re amazed with the industrial traction that Ada has realized in the US, especially as they’ve carried out it with a minimal existence in this article so much. As portion of the help we give, they’ll benefit from our unique community of business people who have developed additional than $100B in cumulated price,” he continued.

    THE Larger Pattern

    After continuously growing worldwide partnerships with businesses such as Bayer and Novartis and an expanding desire from North American overall health units and treatment vendors, Ada now seeks to widen its portfolio and services throughout continents.

    Ada Wellness is recognised for its AI-based mostly well being assessment and care navigation system that will help healthcare suppliers, sufferers and individuals evaluate signs and symptoms and digitally navigate treatment processes. As of these days, Ada has registered 11 million people worldwide.

    The intention is to broaden the AI giving to offer buyers with a 360-diploma, information-driven view of their overall health. One more focus is on enterprise methods for health programs, insurance policy and lifetime sciences.

    WHY IT Matters

    Telemedical care provision professional rapid growth for the duration of the pandemic and widens the access to sufficient care for all.

    In the US, 15 for each cent of Americans made use of telehealth in the course of the peak of the pandemic, in accordance to an qualified interview on Healthcare IT News.

    The Ada system is portion of this trend serving to buyers – medical industry experts and patients – all over the world to actively control health and fitness remotely with clever technology. Due to the fact its initial launch in 2016, 26 million assessments have been recorded.

    ON THE File

    Nathrat said: “As a enterprise, our intention is to improve health care results for more than 1 billion people about the planet. COVID-19 has highlighted the need for greater, faster transform within just health care and we are looking at a growing demand from customers from health units, insurers and lifestyle sciences corporations for ground breaking methods to aid renovate health and fitness journeys and push much better outcomes for sufferers, clinicians and suppliers.”

    Vahit Alili, Expense Director, Non-public Fairness at Schroders Funds, extra: “We are happy to commit in Ada Wellbeing, a organization with exceptional world-wide development likely and true influence on how healthcare is sent. We are at the watershed of a key change in health care, as modern digital options guidance superior wellbeing results and scientific excellence with intelligent technological know-how.”

  • What is the future of COVID and incarceration?

    What is the future of COVID and incarceration?


    By Elizabeth Thompson

    From the Alpha variant to Delta to Omicron, the COVID-19 virus is changing, but it doesn’t seem to be going anywhere. Incarcerated people and their families wonder what the future of COVID means for them.

    Incarcerated people have been acutely impacted by the highs and lows of the pandemic. Not only must they cope with the fear of getting ill and dying, or suffering from long-term COVID symptoms, but the pandemic has meant periodically losing much of the few freedoms they still have, such as outdoor recreation time and family calls and visits.  

    For incarcerated people, frequent lockdowns have meant more time in a cell, sometimes with other people, some of whom are sick, sometimes all alone, often for 23 hours a day. 

    Researchers argue that these experiences are adding to the trauma that already exists from spending time behind bars. 

    To prevent widespread illness and additional trauma, advocates for incarcerated people have called for decarceration. This means reforms that would limit the number of people sent to jails and prisons in the first place and reforms that would allow certain people to exit prisons early. 

    As it becomes clearer that quick fixes will continue to be Band-Aids on the larger problem, advocates press for long-term solutions.

    COVID and incarceration

    The United States prison system is not built for a pandemic.

    Communal living conditions in the prison system make it impossible for individual incarcerated people to have autonomy over their own safety — especially against an airborne virus, said Ben Finholt, director the Just Sentencing Project at Duke Law’s Wilson Center for Science and Justice

    “In addition to everyone being on top of each other, there are too many of them in the space allotted,” Finholt said. “The prisons generally have one sort of air circulation system that is common to the whole prison. And so if you get a lot of virus in the air, it’s just going to be in the air everywhere in the prison.”

    Additionally, staff move in and out of the prison, making the prison far from a closed bubble.

    “Prisons are ongoing, constant mass gatherings,” Finholt said.

    One study using mortality records from the Florida State Department of Corrections found that COVID-19 led to a four-year decline in life expectancy in Florida’s prison population.

    The North Carolina Department of Public Safety (DPS) has reported that 57 incarcerated people have died of COVID in North Carolina’s prisons. It is possible that more people have died of COVID, but their deaths have not been properly reported, a North Carolina Health News/ VICE News investigation showed.

    DPS spokesperson Brad Deen said that as the Omicron variant surges across North Carolina’s prisons, most cases “are asymptomatic or manifest mild symptoms in the vaccinated, and that unvaccinated offenders with underlying medical issues are the most at risk of this variant.”

    Incarcerated people who died of COVID are not the only casualty. Three incarcerated people have died by suicide just this calendar year, according to DPS press releases.

    COVID has been and continues to be a problem for incarcerated people, even as the world tries to move on, said Wanda Bertram, communications strategist at the Prison Policy Initiative, which researches the harms of mass incarcerations. 

    Public officials who have declared COVID endemic are “basically admitting that prisons are going to be more dangerous in terms of health risks than they’ve been before,” Bertram said.

    The way prisons have handled COVID thus far is likely to have a lasting effect on incarcerated people. Some people who contracted COVID while they were incarcerated will experience long COVID, but even if they didn’t get sick, the pandemic “absolutely makes it worse in terms of just the trauma of prison,” Finholt said.

    Addressing the dangers of COVID through decarceration

    As COVID-19 continues to evolve, so will DPS, Deen said.

    “DPS will continue to be adaptable and resilient and will continue to follow the science and do what is possible to prevent COVID-19 from getting into the facilities, to help prevent it from spreading to other facilities and to confine it within a facility if it does get in,” Deen said.

    To combat deaths in state prisons, some advocates have called for large-scale decarceration, which would reduce the prison population and create more space.

    It has been almost a year since 3,500 incarcerated people were released early from state prisons following a legal settlement between a number of advocacy groups and the state (NAACP v. Cooper) that aimed to decrease the harms of COVID against vulnerable incarcerated people.

    C. Daniel Bowes, director of policy and advocacy for the ACLU of North Carolina, says it wasn’t enough.

    “Obviously the problem has not been solved,” Bowes said.

    The ACLU of North Carolina is part of a coalition of North Carolinians who have called on the state to address the COVID-19 crisis behind bars through the Vigil for Freedom and Racial Justice, a month-long demonstration outside the North Carolina Executive Mansion.

    Bertram said now is the time for governments to pursue criminal justice reforms that make sentencing reforms retroactive. She also believes states need “any kind of plan” to release older incarcerated people and incarcerated people who are immune-compromised, especially if they are getting close to the end of their sentence.

    Despite the Omicron variant’s toll on the prison system, Deen said DPS is not considering sending prisoners home through Extending the Limits of Confinement, an initiative started in 2020 to send some incarcerated people home who were at increased risk of dying from COVID.

    “The Department wound down the ELC initiative in late 2021, and there are no plans to reactivate it at this time,” Deen said.

    Finholt said if the pandemic continues to pose a public safety threat to the prisons, officials will have two options to make them safer: mass decarceration or vastly increasing funds to prisons to properly staff them.

    The state budget that Gov. Roy Cooper signed into law in November includes a provision that sets aside $3 million to make the adult corrections of DPS a standalone department by 2023.

    One proponent for prison reform, Sen. Bob Steinburg, R-Chowan, told the Daily Advance this move will give the state’s prisons a “seat at the table.”

    Advocates for incarcerated fear it might be too little too late.

    Impact upon reentry

    Almost all incarcerated people in North Carolina will return to society. About 98 percent of people who are incarcerated in North Carolina will be released in the future

    However, many Americans tend to ignore the health of incarcerated people.

    “They just stop at ‘they’re criminals and whatever they get, they deserve,’” Bowes said.

    As the pandemic caused lockdowns and shut down visitation to prisons periodically, that means communication from inside prison to the outside world has also suffered. 

    “I think the problem with the way we use incarceration is that it disappears people,” Finholt said. 

    “In turn, disappearing people makes it so that the problems those people face are not visible.”

    But those people will return and when they do, they are likely to have more health problems than they entered prison with, said Eric Reinhart, resident physician in the Physician Scientist Training Program at Northwestern University’s Department of Psychiatry and Behavioral Sciences. 

    More people will be reentering society with long COVID, Reinhart said, and many people will be reentering traumatized from the conditions they’ve lived with.

    “I think there is a multi-generational burden of care that we are producing now by subjecting people to horrific conditions in U.S. jails and prisons during the pandemic,” Reinhart said, “before as well, and especially now during the pandemic.” 

    There are things that states can do to make reentry more successful, Bertram said.

    Researchers at the Prison Policy Initiative found that simply facilitating contact between incarcerated people and their family and friends on the outside world could improve the mental health of incarcerated people and reduce recidivism.

    “It’s one of the cheapest ‘programs’ that you can have,” Bertram said.

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  • American Indians look for ways to stop overdose deaths

    American Indians look for ways to stop overdose deaths


    By Melba Newsome

    In September 2018, the Eastern Band of Cherokee Indians (EBCI) made it onto a list they probably would have preferred to avoid. The Office of National Drug Control Policy identified the Qualla Boundary, the Eastern Band’s 56,000-acre homeland just south of Smoky Mountains National Park, as one of 10 “high intensity drug trafficking areas” in the country. 

    Following a two-year undercover investigation targeting drug traffickers, federal, state and local law enforcement authorities raided the Boundary, arrested 132 people and seized an array of illegal drugs valued at $1.8 million, including heroin, fentanyl, methamphetamine, oxycodone and marijuana. The operation was touted as a huge success and a possible turning point in the scourge that had plagued the community. 

    “The arrest of these drug dealers is a critical step towards ensuring that the Eastern Band of Cherokee Indians is able to provide the healthy environment our people deserve,” Principal Chief Richard Sneed said in a DOJ press release in 2018. 

    Instead of improving, the community’s drug problems only got worse. Drug-related crimes and addiction rates continued apace and, like everywhere else in the state, grew worse during the pandemic. Statewide, deaths from drug overdoses increased more than 25 percent in the first six months of the pandemic, according to CDC data. Almost immediately, the lockdown on the Boundary led to a dramatic increase in fatal and non-fatal drug overdoses.

    In a May 3, 2020 Facebook video, Sneed issued a warning to the drug dealers: “We’re coming for you,” he said. “It’s a never-ending battle. Every time we take a dealer down, every time there’s interdiction, every time there’s a seizure, that supply chain seems to just continue to keep rolling. [Y]ou’re killing our people, and I’m done. I’ve had it.” 

    Meanwhile, state officials and experts have continued to say that a criminal justice approach to the opioid crisis won’t solve it. Gov. Roy Cooper has repeatedly said that “we cannot arrest our way out of this problem.” 

    There is a growing acknowledgement among treatment and drug policy experts that real solutions must center around prevention and treatment which include mental health counseling, medication-assisted treatment (MAT), as well as the time and support needed to recover. 

    Almost in recognition of that reality, Sneed later added a comment to the video. “I ask for prayers for our tribal citizens who are struggling with addiction as well as their families. Please encourage [those suffering] to seek treatment, remind them that there is help, and there are people that care about them.”

    Racial disparities persist

    More than a decade ago, an analysis from Seattle’s Urban Indian Health Institute revealed that substance use rates are higher among American Indians compared to other racial and ethnic groups. A recent analysis in the North Carolina Medical Journal found a similar disparity in overdose rates in the state, as well. 

    This graph depicts the drug overdose death rate per 100,000 by population in North Carolina. Graph courtesy of NCDHHS’ Opioid and Substance Use Action Plan Data Dashboard

    North Carolina has the largest American Indian population east of the Mississippi River; they represent just 1.2 percent of the overall population, according to the latest available data. However, in 2020, the drug overdose death rate was 2.3 times higher for American Indians than white people in North Carolina (75.4 and 32.7 per 100,000, respectively), according to the state’s Opioid and Substance Use Action Plan Data Dashboard

    “We really don’t understand why that is very well,” said Ronny Bell, a health equity researcher at Wake Forest School of Medicine. “In general, populations in rural communities are more likely to be impacted by this issue because you have more people in jobs that can result in injuries that can lead to pain. The eight tribal homelands are all in rural communities where there is an increased likelihood of being injured in the occupational settings and a lack of access to quality pain treatment.”

    A history of trauma, violence, poverty, high unemployment, lack of health insurance and racism also contribute to an increased risk of addiction. 

    The disproportionate impact of the opioid crisis

    Ronny Bell, Director of the Office of Cancer Health Equity at Wake Forest Baptist Comprehensive Cancer Center. Credit: Ronny Bell.

    Western North Carolina has been hit particularly hard by opioids. Data from the state’s Opioid Addiction Dashboard found the five western North Carolina counties that include the Qualla Boundary had an average of 43.6 unintentional overdose deaths per 100,000 in 2020, compared to 29.7 statewide. 

    On the other side of the state, the overdose death rate was even higher in 2020 for Robeson County, at 64.3 per 100,000. About 45 percent of the Lumbee Tribe’s 55,000 members reside here. Significant numbers also live in Hoke, Cumberland and Scotland counties. 

    Erika Locklear oversees the Lumbee Tribe’s Medication-Assisted Treatment (MAT) support program and has witnessed a disturbing trend in the Lumbee community. 

    “The problem is getting much worse,” Locklear said. “COVID has been the biggest factor. When COVID first started, I don’t know if it was a fear factor or what, but things were getting a bit better. Then, after the first couple of months, the overdose rates just skyrocketed.” 

    Providing solutions

    A huge billboard stands at the Boundary’s main entrance in Cherokee in Jackson County –  

    “Opiate Dependent Addiction Treatment. Confidential. Life Changing. Help.” 

    Two decades ago, tribal leaders recognized the need for robust substance use and mental health treatment services for its tribal members. As the only federally recognized tribe in the state, the Eastern Band of Cherokee Indians receives significant financial support from the federal government, including free healthcare for its members through the Indian Health Service (IHS)

    However, per capita spending on the health of Native Americans is significantly less than for the general population. According to data from the Indian Health Service, the national average for fiscal year 2019 was $4,078 for AIs, compared to $9,726 overall for calendar year 2017.

    That imbalance carries over to treatment for opioid use disorder, as well. As more people of color struggle with and die from opioid use disorder, the funding is still targeted at white people almost exclusively. A $54 million federal grant allowed North Carolina to provide treatment to 12,000 people. Despite being the population with the highest overdose rate, fewer than 1 percent of those who received care were American Indian. 

    Meanwhile, the Eastern Band of Cherokee Indians oversees and operates its own public health care system and provides some of the most extensive substance use and mental health care of any tribe in the nation without copays or deductibles. 

    Significant investments in its health and treatment services include an $80 million hospital and a $16 million, 20-bed adult residential treatment facility. The old hospital building is now a crisis stabilization unit for patients with mental health issues or who require detox services. In addition, there are certified addiction counselors, psychiatric social workers, clinical psychologists and a variety of related community-based support groups.

    Doing more with less

    The Eastern Band’s initiative is viewed as a model for the treatment of substance use disorder but it is not easy to duplicate, particularly for lower-wealth tribes like the Lumbee. The Lumbee is the largest tribe in North Carolina and east of the Mississippi River, but they still lack federal recognition and the health care funding that goes with that. And, unlike the Eastern Band, they don’t operate a casino that might provide them with revenue.

    “The Lumbee tribe does have quite a few tribal members who are practicing physicians, physician assistants, and nurse practitioners,” Bell noted. “That is a benefit to many of the people from the community.” 

    Lumbee’s MAT program is funded by a three-year $1.5 million grant from the state Department of Health and Human Services. It provides services for 65 Lumbee tribe members each year. Locklear doesn’t have an exact number but estimates that they have served hundreds and referred many more to their partnering agency, Lumberton Treatment Center. 

    Eighty percent of the MAT patient population is male although there is no gender divide in substance use in the American Indian population. 

    “Based on data from the Injury and Violence Prevention Branch (of NC DHHS), the proportion of females who die from overdoses seems to be higher in the American Indian population,” said Bell. 

    In addition to providing buprenorphine on-site, methadone is available at the Lumberton Treatment Center. The free services include support group sessions and individual and group counseling sessions. 

    In their North Carolina Medical Journal article, Community-driven Approaches to Preventing Overdoses Among American Indians, Bell and the co-authors recommend providing culturally appropriate, community-driven treatment and social support services. The tribal-run MAT program uses a talking circle approach in their counseling sessions and holds smudging ceremonies, a traditional spiritual cleansing ritual process Locklear describes as like going to church on Sunday. There is also a lot of education about the cultural traditions and history of the Lumbee people. 

    “A lot of people have kind of moved away from that so I think it helps and it’s great that they developed this program,” Bell said. 

    As addiction rates and overdose deaths increase, the MAT program becomes more vital but the funding runs out at the end of the month. 

    Locklear says the tribal administration is looking for resources to keep it going as long as needed, which seems to be for the foreseeable future.

    This story is part of a reporting fellowship on health care performance sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.

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    1

  • Months in, Medicaid transition still confusing patients

    Months in, Medicaid transition still confusing patients


    By Clarissa Donnelly-DeRoven

    About 1.7 million people in the state have experienced a change to their insurance in the seven months since North Carolina began its switch from a Medicaid system administered by the state to one managed by five for-profit organizations (and one by the Eastern Band of Cherokee Indians for tribal members). 

    Despite a marketing push and outreach efforts, a quarter of people with Medicaid didn’t know about the transition back in July according to a study from an advocacy group. And now, more than half a year in, data from the Medicaid Ombudsman’s office — which fields and investigates questions from people with Medicaid — show that thousands are still confused about the technically public insurance, which now looks and acts a lot like private insurance.

    Issues with education, access to care

    From June 27 through Nov. 27, the Medicaid Ombudsman’s office received more than 10,000 calls. This specific office is designed to support patients. A different agency helps providers, but it is also called the Medicaid Ombudsman — meaning, the 10,000 calls likely represent a mix of both patients and providers calling for help. 

    The Ombudsman opened cases for about 6,200 callers. Around 2,800 of those people reached out for general educational information, or to make a complaint. A good chunk called to change their plan, while nearly 10 percent called to discuss “access to care” issues and 184 people called about problems with non-emergency medical transport. 

    Bumps were expected during the start of the transition. Those at the state level have argued the change will be worth it for the budget predictability and improved health outcomes they believe will come under managed care. With the new system, the private plans receive a flat per-person rate, which state health officials argue will encourage the organizations to invest in whole-person health and lead to better health outcomes for patients.

    Still, some providers worry cuts to reimbursement rates will come in the future, which will lead fewer providers to accept Medicaid. Stacy Kozlowski, a pediatric occupational therapist in Johnston County, said she’s had increasing issues with service denials. 

    “Things were supposed to be unchanged for the first year. Already we’re seeing that’s not the case,” she wrote in a text.

    More than anything, people are worried that the neediest Medicaid recipients will be lost in the shuffle. 

    “From a business perspective we can survive,” Kozlowski said. “The increased overhead is burdensome, but the kids will suffer.”

    Geographic distribution

    Judging from the numbers to the Ombudsman, people across the state are struggling with the transition at similar rates, some rural residents more than others. Of Hyde county’s 696 managed care beneficiaries, 9 called the Ombudsman’s office — meaning, 1.3 percent of enrollees, the highest call rate. Similar rates are seen in Martin (1.15 percent) and Mecklenburg (1 percent) counties. 

    While some calls involved multiple managed care organizations, when broken down to include only calls involving individual plans, the greatest percentages came from those enrolled with UnitedHealthcare (.18 percent) and WellCare (.18 percent). The complaints represent a very small portion of overall members, though they are higher than complaint rates from the other managed care organizations across the state.

    The N.C. Department of Health and Human Services has documented other issues with UnitedHealthcare’s MCO plan. In September 2021, the department reported that 15 percent of people enrolled in United’s plan who live in eastern North Carolina do not have an in-network hospital within 30 minutes, putting it out of step with the standard plan network adequacy standards. 

    The state’s Medicaid dashboard lists each MCO and the top three reasons the organizations denied claims in November 2021. The data is broken down into claims submitted by smaller medical offices or solo practitioners (listed as professional claims), institutions, and pharmacies. Some of the most common reasons include failure to obtain prior authorization, service billed for not included within the contract, billing provider not enrolled in Medicaid and many more.

    There are two Medicaid Ombudsman: one helps patients navigate the transition to managed care, while the other helps providers. People with Medicaid can call 877-201-3750 on weekdays from 8 a.m. to 5 p.m. 

    Health care providers should contact [email protected] or 919-527-6666 with any questions.

    Of the denials listed, UnitedHealthcare, which covers the entire state, has the highest number at about 130,100 — nearly 30,000 more than the denials listed from the next highest MCO, Amerihealth Caritas, which also insures people statewide. 

    ‘Raise Your Hand’

    Before the transition, health advocates honed in on one predictable issue with the transition.  They were concerned that the 1 million people who are supposed to stay on the state-run Medicaid Direct — those with significant mental health needs, developmental disabilities, children in foster care, and people on certain Medicaid waivers — might be incorrectly switched to a managed care plan.

    “When we were working with the department on the implementation of all this, one of the things I raised with them was, how are you going to identify all these people?” said Doug Sea, the director of the Family Support and Health Care department at the Charlotte Center for Legal Advocacy. He’s worked in public benefit law since the 1980s. 

    One answer is the “Raise Your Hand” process: if a person was incorrectly switched to a managed care plan, they or their health care provider needs to fill out a form and request to be switched back. The Medicaid Enrollment Broker — another child of the managed care transition — is supposed to help beneficiaries with this process, along with any other person on Medicaid who has questions about how to choose a plan. 

    “Their job is to help people decide which plan to choose, or to help people change between plans, or to help people navigate this process of moving back and forth,” Sea explained. “Your circumstances could change — one day you’re in foster care, the next day you’re back with your parents. One day you need enhanced mental health services, the next day you don’t.”

    Do you have Medicaid? Send an email to [email protected] and tell me how it’s going: What questions do you have? What services are you struggling to get covered? Are there enough doctors in your area who accept your plan? I want to hear it all.

    Maximus, a for-profit company that earned $4.2 billion in revenue last year, was awarded a base $17 million contract with DHHS to be the Enrollment Broker in 2018. According to the company’s 2021 filings with the Securities and Exchange Commission, 39 percent of its revenue comes from state agencies.

    During the five months for which NC Health News reviewed data, 169 callers to the Ombudsman’s office requested to stay on Medicaid Direct, and 94 were referred to the “Raise Your Hand” process. 

    It’s not a huge number, but those who were supposed to be exempt from the managed care transition are those with significant needs, meaning that figuring out how to switch one’s self back to Medicaid Direct is yet another thing to do on a long list of needs. Luckily, once the process is initiated, a spokesperson from DHHS said the switch happens within 24 hours. 

    But, there’s still one more barrier: if a person’s Medicaid eligibility will soon be under review — as happens once a year — the automated system does not allow their transfer to be processed. 

    The Medicaid Enrollment Broker can be reached at 1-833-870-5500. This brochure lists the different agencies people with Medicaid can contact about various issues.

    “Beneficiaries who have not been redetermined [as] eligible are unable to make that change until after their redetermination is complete,” wrote DHHS spokesperson Summer Tonizzo. 

    “The way North Carolina [has] set up this system is very complicated,” Sea said. “We’ve seen a lot of cases where people are not in the right place, or their request to move back doesn’t get processed, or they don’t get written notice that their request has been denied, or their request got lost, or their request can’t be processed in time for them to get the services they need.

    “There’s just a whole host of ways this can go wrong,” he said.

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    1

  • Wake Forest University students on fertilizer plant fire

    Wake Forest University students on fertilizer plant fire


    By Mariama Jallow  

    On the evening of Jan. 31, a fertilizer plant with 600 tons of ammonium nitrate inside caught on fire on Cherry Street in Winston-Salem, displacing 6,500 residents while emergency officials waited to see if the combustible materials would cause explosions.

    The Winston Weaver Company Fertilizer site is not too far from Wake Forest University, a campus with nearly 7,600 students who will return to class this week with many questions after a chaotic several days. Many are wondering about the long-term effects of being in close proximity to such a huge fire.

    Environment North Carolina advocate Krista Early issued a statement commending the Winston-Salem fire department for its abundance of caution while also encouraging a longer-term discussion about how to better protect communities near such facilities.

    “This hazardous chemical poses an immediate threat to life in addition to unnecessary long-term environmental health risks,” Early said. “Hopefully, none of our fellow North Carolinians gets hurt here. And when this crisis is over, we need to have a serious conversation about stockpiling dangerous chemicals.”

    Wake is 1.7 miles from the fertilizer plant, only slightly outside the evacuation zone established by the fire department. Deacon Place, off-campus apartments owned by the university, are closer and the students living there and in other housing within a mile from the plant were encouraged to find alternate housing this past week.

    In an email sent on Jan. 31, Wake Forest administrators told students that the ZSR Library, the Wellbeing Center, and Benson — home to the food court, mailing services, and meeting rooms — were open for those forced to leave their homes. 

    “You may wish to bring a sleeping bag, pillow, and/or blanket to be comfortable if the evacuation lasts more than a short time,” the email said. 

    At 10:03 p.m., the burning building collapsed and firefighters abandoned the blaze because they did not have enough water to contain the fire amid the persistent risk of an explosion.

    It’s unclear what caused the fire. The Winston-Salem Journal reported on Saturday that firefighters had responded to a complaint the day after Christmas from neighbors who reported seeing smog around the plant and smelling a pungent odor. Firefighters found fertilizer material smoldering then, according to the Journal, and flooded it with water, concluding at the time there was no risk of explosion.

    Then five weeks later, thousands of lives were disrupted by a blaze so large and so dangerous that firefighters had to back away for their own safety.

    A threat to marginalized neighbors

    Kristen Minor, health manager at CleanAireNC, a nonprofit based in North Carolina that advocates for the health of all the state’s residents by focusing on air pollution and climate change, says policies need to be created to better protect neighborhoods surrounding plants with hazardous materials.

    Often these facilities, such as the Winston-Salem plant, are in low-income and marginalized communities, underscoring the environmental hazards and long-standing disparities caused by redlining. The Winston-Salem plant is in a predominantly Black, low-income neighborhood surrounded by small businesses.

    “Redlining, it’s a systemic process in which communities of color were prevented from accessing housing, particularly loans, which led to black communities and other communities of color over time being concentrated in areas where they had more exposure to environmentally polluting industries,” Minor said. “So it isn’t a story that happened overnight. This is a systemic issue that has been taking place over decades.”

    The potentially combustible chemical inside the fertilizer plant, ammonium nitrate, was the source of the Beirut explosion in 2020 which killed 135 people and injured more than 5,000. Although there were 2,750 tons of ammonium nitrate in that plant compared to 600 in the Winston-Salem facility, fire officials have said that an explosion would destroy surrounding homes and small businesses owned by marginalized communities.   

    A state of panic

    By late evening on Jan. 31, many Wake students were panicking. Those living on and off-campus started to flee the area. Some stayed with friends further from the site, others booked hotels around Winston-Salem or in neighboring towns. A few returned to their homes out of state.

    Wake Forest announced the cancellation of class the next day just one minute after midnight.

    Sukaina Maadir, a senior at Wake Forest, fled to Clemmons the night of the fire and booked a hotel there with friends. She recalled being on University Parkway, a major thoroughfare near Wake Forest, heading back to her apartment at Deacon Place, when she saw the billowing smoke and fire trucks lined up. That was about 8:20 p.m.

    “An hour had passed and I didn’t hear anything and suddenly all the alerts from Wake started coming in,” Maadir said.

    Initially, Maadir downplayed what she had seen, going about her night as usual. The biggest thing on her mind was what to make for dinner.

    “I didn’t know what to do because the evacuation was voluntary, so my roommates and I started doing some research on past plant explosions and ammonium nitrate,” she said. “We realized that if that does explode, like the gasses and stuff that would come out of it could potentially be harmful so we decided to evacuate and go to campus.”

    Wake Forest Campus covered in smoke from the fire. Photo credit: Kenzey Tracy

    “I took my contacts out because my eyes were irritated, I double-masked and at this point, I was in a stage of panic,” Maadir recalled. “I started grabbing things in my room and shoving it in my backpack.”

    Her eyes became itchy and watery. She worried about her health.

    In her fevered trepidation, though, she hadn’t packed as systematically as she might have.

    Smoke had reached parts of the Wake campus already, Maadir said, leaving her with such an unsettling feeling that she decided it wouldn’t be safe to spend the night there.

    Others decided to stay, at least for a while. Edna Ulysse, a senior at Wake Forest and resident advisor living on campus, was one of those students.

    Late that Monday night, after the fire had been burning for a couple of hours, Ulysse’s entire room was saturated with the smell of the smoke. She described the odor as a mix between toxic chemicals and burning grass.

    “I had to put my mask on when I went to sleep because my nose started getting a little irritated,” Ulysse said.

    Ulysse lives on the fourth floor in a North Campus building where she typically has a view of Wait Chapel, a large parking lot and some surrounding buildings. When she opened her blinds in the morning, she was taken aback. The smoke was so thick, she couldn’t even make out the usual landmarks.

    “That was when I realized I should have evacuated,” she said. “My friends were offering for me to stay with them. At first, I wanted to wait and see how bad it would get, but that morning I was too scared to drive in the fog,” said Ulysse.

    “It wasn’t until I got to the hotel that I realized I packed my computer and a bag of Doritos,” Maadir said, lamenting essentials she had forgotten to grab.

    The invisible threat

    Minor of CleanAire said that while many were focused on the immediate possibility of explosion after the fire, she wanted to remind people of the threat that particulate matter poses. 

    “Particulate matter is very fine particles, not visible to the naked eye, it’s smaller than a hair particle,” Minor said. “There is no safe level of exposure to particulate matter. For short-term exposure, individuals at more risk include pregnant women, children and seniors, as well as individuals with underlying conditions such as any respiratory condition that need to remain indoors.”

    In such situations, people should close all windows and doors if they are indoors, Minor said. Outdoor activities should be minimized, she suggested.

    “Even for individuals who are otherwise healthy and may not have an underlying condition, exposure to particulate matter is a health hazard for everyone,” Minor said. “Short-term exposure could be a cough, sore throat, shortness of breath. But long-term exposure can impact one’s overall health. That could be an increased risk for reproductive health, increased risk for low birth weight preterm delivery, for seniors, increased risk of heart attack or stroke, or any cardiovascular events.”

    Wake Forest Campus covered in orange colored smoke from the fire. Photo credit: Kenzey Tracy

    Minor said that children are a very vulnerable population because their bodies are still developing and since they breathe in air twice as fast as adults, they are exposed to more pollutants in the air. 

    The smoke and particulate matter can be spread farther than initial perimeters, Minor added, by winds and other climate forces. Air Now displays air quality in local areas while also showing what is happening across the state, country and around the world.  

    How much particulate matter enters people’s homes, Minor said, depends on the condition of one’s home and the quality of the air filtration systems that can provide a barricade.

    “One thing you want to regularly do is make sure your air filter is clean,” Minor said. “Some apartment complexes may actually have a maintenance team who regularly checks your air filter. If you do live in an apartment or home where the air filtration system is not in place, we do recommend individuals consider purchasing a healthy air filter and HEPA air filter.”

    Students, parents question the university’s response

    At a press conference on Feb. 2, Winston-Salem fire chief William Mayo said that if the plant exploded, it could be one of the worst explosions caused by a fire in U.S. history.

    Knowing that, some Wake Forest students wonder now whether the university should have been more concerned about the short- and long-term health impacts.

    Eman Maadir, a cousin of Sukaina Maadir’s and a junior at Wake Forest, recalled the initial confusion, the subsequent panic and the current questioning of whether administrators gave the best guidance.

    Immediately after the fire broke out, Maadir was going about her night as she typically would. Then the smell of acid made her go to the window. 

    “When I looked outside the sky was a bleak shade of orange,” she recalled. “At first, I thought, ‘Oh the firefighters will control the fire.’”

    She hopped in the shower. By the time she got out, though, the smell in her room was even worse. She found her roommate having a breathing attack in the living room.

    Resident advisors, who are in dorms to give students guidance when they need it, usually sit in the “RA box” on the first floor of residence halls to be accessible to students. Maadir went downstairs to seek advice, but the RA on duty had already evacuated, she said. 

    Later, she recalled that even then she had a scratchy throat and a slight tingling in her nose.

    “All I saw were swarms of people with overnight bags leaving the building,” Maadir said. “Some people were carrying loose pieces of clothing and running out of the building. I heard some girls screaming and talking about booking a hotel and that is when I realized that I may have to evacuate.”

    It was then Maadir decided to get a hotel room, too. She and five of her other friends crammed into a room with two beds. She didn’t immediately tell her parents because she didn’t want to scare them. 

    “When I woke up I saw the fire being reported by most major news organizations and knew my friends and I would be staying another night,” she said. “Throughout this whole time, Wake Forest was telling us it was safe to stay on campus, but it was not. I also do not think they were very helpful in finding students places to stay, especially students who had to evacuate Deacon Place apartments.” 

    On the Wednesday after the fire broke out, Wake Forest informed students that classes would resume on Thursday. There was an immediate outcry from students and parents. Many turned to their social media accounts to call for the cancellation of classes. A petition gained more than 5,000 signatures on a campus where the undergraduate and graduate student population is about 7,500.

    Wake Forest quickly reversed course and agreed to cancel classes Thursday and Friday, too.

    In an email sent to all students, the university said “we received additional information from students and families regarding the scope and degree of challenges faced by those displaced. This understanding has informed a decision by academic leadership to cancel classes on the Reynolda Campus, Wake Downtown and Brookstown for the remainder of the week Thursday, Feb. 3, and Friday, Feb. 4.”

    University officials tried to soothe concerns about any environmental threats.“In addition, EPA air-quality readings on and near campus continue to indicate that the air currently poses no threat to individual health and is safe to breathe,” the email stated.

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  • Depression responds to transcranial magnetic stimulation treatment in studies : Shots

    Depression responds to transcranial magnetic stimulation treatment in studies : Shots

    Eleanor Cole, Ph.D., demonstrates the treatment on trial participant Deirdre Lehman in May 2019 at the Stanford Brain Stimulation Lab.

    Steve Fisch for Stanford Medicine


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    Steve Fisch for Stanford Medicine


    Eleanor Cole, Ph.D., demonstrates the treatment on trial participant Deirdre Lehman in May 2019 at the Stanford Brain Stimulation Lab.

    Steve Fisch for Stanford Medicine

    After 40 years of fighting debilitating depression, Emma was on the brink.

    “I was suicidal,” said Emma, a 59-year-old Bay Area resident. NPR is not using her full name at her request because of the stigma of mental illness. “I was going to die.”

    Over the years, Emma sat through hours of talk therapy and tried numerous anti-depression medications “to have a semblance of normalcy.” And yet she was consumed by relentless fatigue, insomnia and chronic nausea.

    Depression is the world’s leading cause of disability, partly because treatment options often result in numerous side effects or patients do not respond at all. And there are many people who never seek treatment because mental illness can carry heavy stigma and discrimination. Studies show untreated depression can lead to suicide.

    Three years ago, Emma’s psychiatrist urged her to enroll in a study at Stanford University School of Medicine designed for people who had run out of options. On her first day, scientists took an MRI scan to determine the best possible location to deliver electrical pulses to her brain. Then for a 10 minute block every hour for 10 hours a day for five consecutive days, Emma sat in a chair while a magnetic field stimulated her brain.

    At the end of the first day, an unfamiliar calm settled over Emma. Even when her partner picked her up to drive home, she stayed relaxed. “I’m usually hysterical,” she said. “All the time I’m grabbing things. I’m yelling, you know, ‘Did you see those lights?’ And while I rode home that first night I just looked out the window and I enjoyed the ride.”

    The remedy was a new type of repetitive transcranial magnetic stimulation (rTMS) called “Stanford neuromodulation therapy.” By adding imaging technology to the treatment and upping the dose of rTMS, scientists have developed an approach that’s more effective and works more than eight times faster than the current approved treatment.

    A coil placed on top of Emma’s head created a magnetic field that sent electric pulses through her skull to tickle the surface of her brain. She says it felt like a woodpecker tapping on her skull every 15 seconds. The electrical current is directed at the prefrontal cortex, which is the part of the brain that plans, dreams and controls our emotions.

    “It’s an area thought to be underactive in depression,” said Nolan Williams, a psychiatrist and rTMS researcher at Stanford. “We send a signal for the system to not only turn on, but to stay on and remember to stay on.”

    Williams says pumping up the prefrontal cortex helps turn down other areas of the brain that stimulate fear and anxiety. That’s the basic premise of rTMS: Electrical impulses are used to balance out erratic brain activity. As a result, people feel less depressed and more in control. All of this holds true in the new treatment — it just works faster.

    A recent randomized control trial, published in The American Journal of Psychiatry, shows impressive results are possible in five days of treatment or less. Almost 80{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of patients crossed into remission — meaning they were symptom-free within a month. This is compared to about 13{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of people who received the placebo treatment.

    For the control group, the researchers disguised the treatment with a magnetic coil that mimicked the actual treatment. Neither the scientist administering the procedure nor the patients knew if they were receiving the real or sham treatment. Patients did not report any serious side effects. The most common complaint was a light headache.

    Stanford’s new delivery system may even outperform electroconvulsive therapy, which is the most popular form of brain stimulation for depression, but while quicker, it requires general anesthesia.

    “This study not only showed some of the best remission rates we’ve ever seen in depression,” said Shan Siddiqi, a Harvard psychiatrist not connected to the study, “but also managed to do that in people who had already failed multiple other treatments.”

    Siddiqi also said the study’s small sample size, which is only 29 patients, is not cause for concern.

    “Often, a clinical trial will be terminated early [according to pre-specified criteria] because the treatment is so effective that it would be unethical to continue giving people placebo,” said Siddiqi. “That’s what happened here. They’d originally planned to recruit a much larger sample, but the interim analysis was definitive.”

    Nolan Williams demonstrates the magnetic brain stimulation therapy he and his colleagues developed, on Deirdre Lehman, a participant in a previous study of the treatment.

    Steve Fisch for Stanford Medicine


    hide caption

    toggle caption

    Steve Fisch for Stanford Medicine


    Nolan Williams demonstrates the magnetic brain stimulation therapy he and his colleagues developed, on Deirdre Lehman, a participant in a previous study of the treatment.

    Steve Fisch for Stanford Medicine

    Mark George, a psychiatrist and neurologist at the Medical University of South Carolina, agrees. He points to other similarly sized trials for depression treatments like ketamine, a version of which is now FDA-approved.

    He says the new rTMS approach could be a game changer because it’s both more precise and kicks in faster than older versions. George pioneered an rTMS treatment that was approved by the federal Food and Drug Administration for depression in 2008. Studies show that it produces a near total loss of symptoms in about a third of patients; another third feel somewhat better and another third do not respond at all. But the main problem with the original treatment is that it takes six weeks, which is a long time for a patient in the midst of a crisis.

    “This study shows that you can speed it all up and that you can add treatments in a given day and it works,” said George.

    The shorter treatment will increase access for a lot of people who cannot get six weeks off work or cover child care for that long.

    “The more exciting applications, however, are due to the rapidity,” said George. “These people [the patients] got unsuicidal and undepressed within a week. Those patients are just clogging up our emergency rooms, our psych hospitals. And we really don’t have good treatments for acute suicidality.”

    After 45 years of depression and numerous failed attempts to medicate his illness, Tommy Van Brocklin, a civil engineer, says he didn’t see a way out.

    “The past couple of years I just started crying a lot,” he said. “I was just a real emotional wreck.”

    So last September, Van Brocklin flew across the country from his home in Tennessee to Stanford, where he underwent the new rTMS treatment for a single five-day treatment. Almost immediately he started feeling more optimistic and sleeping longer and deeper.

    “I wake up now and I want to come to work, whereas before I’d rather stick a sharp stick in my eye,” said Van Brocklin. “I have not had any depressed days since my treatment.”

    He is hopeful the changes stick. More larger studies are needed to verify how long the new rTMS treatment will last.

    At least for Emma, the woman who received Stanford’s treatment three years ago in a similar study, the results are holding. She says she still has ups and downs but “it’s an entirely different me dealing with it.”

    She says the regimen rewired her from the inside out. “It saved my life, and I’ll be forever grateful,” said Emma over the phone, her voice cracking with emotion. “It saved my life.”

    Stanford’s neuromodulation therapy could be widely available by the end of this year — that’s when scientists are hoping FDA clearance comes through. The technology is licensed to Magnus Medical, a startup with plans to commercialize it

    Williams, the lead researcher at Stanford, says he’s optimistic insurance companies will eventually cover the new delivery model because it works in a matter of days, so it’s likely more cost-effective than a conventional 6 week rTMS regimen. Major insurance companies and Medicare currently cover rTMS, though some plans require patients to demonstrate that they’ve exhausted other treatment options.

    The next step is studying how rTMS may improve other mental health disorders like addiction and traumatic brain injury.

    “This study is hopefully just the tip of the iceberg,” said Siddiqi. “I think we’re finally on the verge of a paradigm shift in how we think about psychiatric treatment, where we’ll supplement the conventional chemical imbalance and psychological conflict models with a new brain circuit model.”

    In other words, electricity in the form of rTMS could become one of the vital tools used to help people with mental illness.