Self-Amplifying RNA Shots Are Coming: The Untold Danger

 by Klaus Steger via The Epoch Times (emphasis ours),

The next generation of RNA-based injections will contain self-amplifying RNA (saRNA). If the term “self-amplifying RNA” sounds frightening, it should. It likely brings to mind images of scientific experiments run amok.

As discussed in a previous article, “mRNA vaccines” are not made with messenger RNA but with modified RNA (modRNA). These so-called vaccines are actually gene therapy products (GTPs), as modRNA hijacks our cells’ software. We have no possibility at all to gain influence on modRNA (or saRNA) after it has been injected.

What Distinguishes saRNA From modRNA?

The term “self-amplifying” is self-explanatory: saRNA replicates itself repeatedly, which is not natural, as natural mRNA is always (without exception) transcribed from DNA (this is called the “central dogma of molecular biology”).

Compared to modRNA, a small amount of saRNA results in an increased amount of produced antigen; one shot of saRNA-based injection may be enough to generate sufficient antibodies against a virus.

Both saRNA and modRNA represent the blueprint for a viral protein, which, after entering our cells, will be produced by our cell machinery (i.e., ribosomes).

Scientists created the genetically modified modRNA sequence by replacing natural uridines with synthetic methyl-pseudouridines to generate a maximum amount of viral antigen. This modification is the basis of Pfizer-BioNTech and Moderna COVID-19 shots.

Unlike modRNA, saRNA does not contain methyl-pseudouridines, but uridines. Why? Since saRNA self-replicates and synthetic methyl-pseudouridines are not available in our cells, saRNA must rely on natural uridines that exist in our cells. Our cells will produce foreign proteins using their own cell machinery and their own natural resources—the main reason these cells finally become exhausted.

However, this causes a significant problem: mRNA is highly unstable and, therefore, has only a short lifespan—too short for our immune system to produce sufficient antibodies. The solution to this problem is the second difference between modRNA and saRNA.

Unlike modRNA, saRNA contains an additional sequence for the replicase, as destroyed (by RNases) saRNA must be replaced by new saRNA.

As natural mRNA will never self-replicate, saRNA definitely represents a genetically modified RNA (modRNA).

Put simply, saRNA is just another type of modRNA.

Why the Change to saRNA?

saRNA is the political solution: the same amount (or even more) of antigen in only one shot! The public will likely be told that due to the regular mutations of the virus, yearly adapted boosters will continue to be necessary.

Numerous preclinical and clinical studies applying saRNA technology have already been undertaken. A 2023 review in the journal Pathogens touts saRNA vaccines as “improved mRNA vaccines.” The journal Vaccines published a summary of five years of saRNA study findings. Once the requisite clinical studies are finished, these new vaccines can be approved for use. It can be expected that this process will be as quick as it was for the COVID-19 vaccines. The approval process will become simpler, as it could be argued that the technique (modRNA in lipid nanoparticles) is already approved and that only the modRNA sequence is different. Hence, these new saRNA vaccines could be injected into an unsuspecting public at any time.

While BioNTech performed experiments with saRNA (BNT162c2) but finally focused on modRNA (BNT162b2), Arcturus Therapeutics was the first to announce (in 2022) that its COVID-19 saRNA vaccine candidate ARCT-154—now the most advanced saRNA vaccine in trials—meets the primary efficacy endpoint in a phase-3 study.

In the Arcturus Therapeutics study, participants received two doses, each containing 5 micrograms of saRNA. This is far less than the modRNA concentrations used by Pfizer-BioNTech (30 micrograms/shot) and Moderna (100 micrograms/shot).

saRNA Injections Will Not Solve the Problems With modRNA Injections

As we discovered with modRNA, the spike protein is poisonous to our bodies. We know that modRNA results in the production of more spike protein than would be available during a natural infection, and we know that repeated boosters cause immune tolerance.

Compared to modRNA, a small amount of saRNA results in an increased amount of produced antigen.

The “dose” of viral antigen that current and future RNA-based vaccines bring about will show large fluctuations from one individual to the next, depending on the cell type producing the desired antigen, genetic predisposition, medical history, and other factors. This fact alone should prohibit the use of RNA-based injections as vaccines for healthy people.

Another Dubious Step Forward: From Linear to Circular saRNA

As RNA-degrading enzymes (RNases) are known to act from both ends of linear RNA, scientists tried to prevent these enzymes from doing their natural duty—degrading mRNAs that are no longer needed—and created circular RNA. This resulted in increased stability and translation efficiency, followed by the production of an increased amount of the desired antigen.

But is this really another step forward? Consider the negative effect of long-lasting antigen presentation. Due to increased antigen levels, one injection of saRNA—whether linear or circular—may cause adverse events comparable with repeated (booster) injections of modRNA.

Long-Term Presentation of an Antigen Is Known to Cause Immune Tolerance

After getting vaccinated, our bodies generate antibodies, mostly immunoglobulin G (IgG), including IgG1 and IgG4.

Vaccinated individuals show an antibody class switch starting with the third COVID-19 injection (the first booster). This is from inflammatory IgG1 antibodies (that fight the spike protein) to non-inflammatory IgG4 antibodies (that tolerate the spike protein). Elevated levels of IgG4 antibodies, in the long run, will exhaust the immune system, causing immune tolerance. This may explain COVID-19 “breakthrough” infections, reduced immune response to other viral and bacterial infections, and reactivation of latent viral infections. It may also cause autoimmune diseases and uncontrolled growth of cancer.

Notably, long-term IgG4 responses have been significantly associated with RNA-based injections, while individuals with a COVID-19 infection prior to vaccination exhibited no increased IgG4 levels, even when they received a shot after the infection.

This observation clearly discredits the World Health Organization’s policy that—assuming people have no immunity against novel viruses (completely ignoring the reality of cross-immunity)—people should be vaccinated before they come into contact with the virus.

RNA-Based Injections Are Recognized as Gene Therapy Products

Incomprehensibly, RNA-based injections for protecting against infectious diseases were named “vaccines,” which allowed exclusion from the strict regulations for gene therapy products (GTPs). Again, this happened without providing the public with any scientific justification.

Details on the regulatory issues of RNA-based vaccines are reported in excellent and comprehensive reviews by Guerriaud & Kohli and Helene Banoun.

In 2014, Uğur Şahin, already CEO of BioNTech, co-wrote an article published in Nature about developing a new class of drugs, “mRNA-based therapeutics.” The authors wrote, “One would expect the classification of an mRNA drug to be a biologic, gene therapy or somatic cell therapy.”

In 2021, the author of correspondence printed in Genes & Immunity described RNA-based vaccines created by Moderna and Pfizer-BioNTech as “a breakthrough in the field of gene therapy” and “a great opportunity for the FDA and EMA to revise the drug development pipeline to make it more flexible and less time-consuming.”

Two disturbing pieces of information have now come to light:

• The contaminating DNA results from Pfizer-BioNTech’s change in the manufacturing process after finishing the BNT162b2 (Comirnaty) Clinical Trial C4591001. Initially (Process 1), Pfizer-BioNTech modRNA was produced by in-vitro transcription from synthetic DNA and amplified by PCR (polymerase chain reaction). However, to scale up manufacturing (see rapid responses to this BMJ study), modRNA encoding DNA was cloned into bacterial plasmids (Process 2). Put simply, the clinical trial was run on process-1 lots, but the world’s populations received process-2 lots.

This means that individuals who gave consent to be vaccinated were injected with a substance different from the one approved by regulatory agencies and to which they had consented.

• Detailed sequence analyses revealed that the plasmid-DNA in the Pfizer-BioNTech and Moderna COVID-19 shots contain a 72-base pair sequence of the Simian Virus-40 (SV40) promoter, which is well-known to enhance transport of the plasmid DNA into the nucleus.

It is now irrefutable that the RNA-based COVID-19 injections contain DNA.

RNA-based technology—especially when applied as vaccines to healthy individuals—is unjustifiable and unethical. Independent from the tragic number of adverse events or excess mortality rates, it is the technique that is the issue, and the same problems will occur in all future RNA-based “vaccines.”

1. RNA-based “vaccine” technology goes against the central idea of evolution over the past millions of years. While injected modRNA and saRNA produce antigens without stopping, in fact, the short lifespan of natural messenger RNA (mRNA) is a prerequisite for healthy and specific cell functions. (The short lifespan of mRNA allows our cells to adapt as quickly as possible to changing circumstances and avoid the production of unnecessary proteins.)
2. A premise of RNA-based “vaccine” technology—that all of our body cells have to produce a foreign viral protein—goes against fundamental biological principles, like distinguishing between our own cells and foreign invaders, and will result in our immune system attacking our own cells.
3. RNA can be reverse-transcribed into DNA even without the presence of (the enzyme) reverse transcriptase (i.e., by LINE1 elements present in our genome/DNA). Contaminating DNA (in RNA-based vaccines) is the rule rather than the exception. As both RNA and DNA can be integrated into the human genome, the so-called “vaccines” based on RNA technology are actually gene therapy products.

It is in no way justifiable to subject RNA-based GTPs for medical use to strict controls but to exclude RNA-based GTPs, called vaccines, from these regulations even though they are intended for most of the human population. Even in an emergency, no one should be forced to be injected with any substance—least of all by politicians.

What Did COVID-19 Teach Us About Science, Politics, and Society?

For many years, scientists dreamed of manipulating human “software”—that is, DNA or RNA. Ethically, manipulating DNA has always been taboo. In retrospect, COVID-19 may represent the dawn of RNA-based “vaccines” and the end of the taboo against manipulating human DNA.

In a 2023 commentary in the Journal of Evaluation in Clinical Practice, the authors wrote that from the earliest days of the pandemic, it was obvious that some influential scientists and their political allies demonized dissenting scientific views and evidence offering a second opinion. Despite contradictory evidence, national politicians “assured the public that they were adopting COVID-19 policies by ‘following the science.’” However, scientific consent was achieved only by suppressing scientific debate.

Remember: When questions are allowed, it is science; when they are not, it is propaganda.

So-called “experts” selected by politicians told us that we must be vaccinated to be able to fight a new respiratory virus. This contradicts the science of the human immune system. Our immune systems are dynamic and can clear a virus they have never encountered; they can also develop cross-immunity to identify variants even if the virus mutates. However, since RNA-based vaccines will produce a single antigen, our immune system is deprived of the possibility of developing cross-immunity against virus variants. This applies, in particular, to respiratory viruses exhibiting a high mutation rate. In the long run, this will lead to an increase in both the frequency and the severity of infectious diseases. Thus, politicians interested in protecting the population against future infections would be well-advised to offer health programs that strengthen the immune system before seasonal infections.

Scientists haven’t the faintest idea of how to direct modRNA or saRNA to a specific cell type or how to stop the translation of administered RNA. However, they continue to study how the stability of injected RNA and the amount of generated antigen can be further increased. The current development of RNA-based vaccine technology reminds one of the poem “The Sorcerer’s Apprentice,” which German poet Johann Wolfgang von Goethe wrote over 200 years ago:

“The spirits, whom I’ve careless raised, are spellbound to my power not.”

https://www.zerohedge.com/medical/self-amplifying-rna-shots-are-coming-untold-danger

Optimistic thinking may be linked with lower cognitive abilities

 Optimistic thinking has long been immortalized in self-help books as the key to happiness, good health and longevity but it can also lead to poor decision-making, with particularly serious implications for people's financial well-being.

Research, published in Personality and Social Psychology Bulletin, from the University of Bath shows that excessive optimism is actually associated with lower cognitive skills such as verbal fluency, fluid reasoning, numerical reasoning, and memory. Whereas those high on cognitive ability tend to be both more realistic and pessimistic in their expectations about the future.

"Forecasting the future with accuracy is difficult and for that reason we might expect those with low cognitive ability to make more errors in judgments, both pessimistic and optimistic. But the results are clear: low cognitive ability leads to more self-flattering biases—people essentially deluding themselves to a degree," said Dr. Chris Dawson of the University's School of Management.

"This points to the idea that while humans may be primed by evolution to expect the best, those high on cognitive ability are more able to override this automatic response when it comes to important decisions. Plans based on overly optimistic beliefs make for poor decisions and are bound to deliver worse outcomes than would realistic beliefs," Dr. Dawson added.

Decisions on major financial issues such as employment, investments or savings, and any choice involving risk and uncertainty, were particularly prone to this effect and posed serious implications for individuals.

"Unrealistically optimistic financial expectations can lead to excessive levels of consumption and debt, as well as insufficient savings. It can also lead to excessive business entries and subsequent failures. The chances of starting a successful business are tiny, but optimists always think they have a shot and will start businesses destined to fail," Dr. Dawson said.

The study, "Looking on the (B)right Side of Life: Cognitive Ability and Miscalibrated Financial Expectations," took data from a UK survey of over 36,000 households and looked at people's expectations of their financial well-being and compared them with their actual financial outcomes. The research found that those highest on cognitive ability experienced a 22% increase in the probability of "realism" and a 35% decrease in the probability of "extreme optimism."

"The problem with our being programmed to think positively is that it can adversely affect our quality of decision-making, particularly when we have to make serious decisions. We need to be able to over-ride that and this research shows that people with high cognitive ability manage this better than those with low cognitive ability," he said.

"Unrealistic optimism is one of the most pervasive human traits and research has shown people consistently underestimate the negative and accentuate the positive. The concept of 'positive thinking' is almost unquestioningly embedded in our culture—and it would be healthy to revisit that belief," Dr. Dawson added

More information: Chris Dawson, Looking on the (B)right Side of Life: Cognitive Ability and Miscalibrated Financial Expectations, Personality and Social Psychology Bulletin (2023). DOI: 10.1177/01461672231209400

https://medicalxpress.com/news/2023-12-optimistic-linked-cognitive-abilities.html

Reading nursery rhymes and singing to babies may help them to learn language

 Parents should speak to their babies using sing-song speech, like nursery rhymes, as soon as possible, say researchers. That's because babies learn languages from rhythmic information, not phonetic information, in their first months.

Phonetic information—the smallest sound elements of speech, typically represented by the alphabet—is considered by many linguists to be the foundation of language. Infants are thought to learn these small sound elements and add them together to make words. But a new study suggests that phonetic information is learned too late and slowly for this to be the case.

Instead, rhythmic speech helps babies learn language by emphasizing the boundaries of individual words and is effective even in the first months of life.

Researchers from the University of Cambridge and Trinity College Dublin investigated babies' ability to process phonetic information during their first year.

Their study, published today in the journal Nature Communications, found that phonetic information wasn't successfully encoded until seven months old and was still sparse at 11 months old when babies began to say their first words.

"Our research shows that the individual sounds of speech are not processed reliably until around seven months, even though most infants can recognize familiar words like 'bottle' by this point," said Cambridge neuroscientist Professor Usha Goswami. "From then individual speech sounds are still added in very slowly—too slowly to form the basis of language."

The researchers recorded patterns of electrical brain activity in 50 infants at four, seven and eleven months old as they watched a video of a primary school teacher singing 18 nursery rhymes to an infant. Low-frequency bands of brainwaves were fed through a special algorithm, which produced a 'read out' of the phonological information that was being encoded.

Individual differences in the brain's response to rhythmic speech at 2 months predicted later language outcomes. Credit: Centre for Neuroscience in Education, University of Cambridge

The researchers found that phonetic encoding in babies emerged gradually over the first year of life, beginning with labial sounds (e.g. d for "daddy") and nasal sounds (e.g. m for "mummy"), with the 'read out' progressively looking more like that of adults.

First author, Professor Giovanni Di Liberto, a cognitive and computer scientist at Trinity College Dublin and a researcher at the ADAPT Centre, said, "This is the first evidence we have of how brain activity relates to phonetic information changes over time in response to continuous speech."

Previously, studies have relied on comparing the responses to nonsense syllables, like "bif" and "bof" instead.

The current study forms part of the BabyRhythm project led by Goswami, which is investigating how language is learned and how this is related to dyslexia and developmental language disorder.

Goswami believes that it is rhythmic information—the stress or emphasis on different syllables of words and the rise and fall of tone—that is the key to language learning. A sister study published in Brain and Language, also part of the BabyRhythm project, has shown that rhythmic speech information was processed by babies at two months old—and individual differences predicted later language outcomes. The experiment was also conducted with adults who showed an identical 'read out' of rhythm and syllables to babies.

"We believe that speech rhythm information is the hidden glue underpinning the development of a well-functioning language system," said Goswami. "Infants can use rhythmic information like a scaffold or skeleton to add phonetic information on to. For example, they might learn that the rhythm pattern of English words is typically strong-weak, as in 'daddy' or 'mummy', with the stress on the first syllable. They can use this rhythm pattern to guess where one word ends and another begins when listening to natural speech."

Infant electrical brain responses were recorded using a special headcap. Credit: Centre for Neuroscience in Education, University of Cambridge

"Parents should talk and sing to their babies as much as possible or use infant-directed speech like nursery rhymes because it will make a difference to language outcome," she added.

Goswami explained that rhythm is a universal aspect of every language all over the world. "In all language that babies are exposed to, there is a strong beat structure with a strong syllable twice a second. We're biologically programmed to emphasize this when speaking to babies."

Goswami says that there is a long history in trying to explain dyslexia and developmental language disorder in terms of phonetic problems but that the evidence doesn't add up. She believes that individual differences in children's language originate with rhythm.

More information: Usha Goswami et al, Emergence of the cortical encoding of phonetic features in the first year of life,, Nature Communications (2023). DOI: 10.1038/s41467-023-43490-x

Áine Ní Choisdealbha et al, Neural phase angle from two months when tracking speech and non-speech rhythm linked to language performance from 12 to 24 months, Brain and Language (2023). DOI: 10.1016/j.bandl.2023.105301

https://medicalxpress.com/news/2023-11-nursery-babies-language.html

One in eight older adults use cannabis products, suggesting need to screen for risks

 More older Americans use cannabis now than before the pandemic, with 12% saying they've consumed a THC-containing substance in the past year and 4% saying they do so multiple times a week, according to a new study of people aged 50 to 80. Those who drink alcohol at risky levels have a much higher rate of cannabis use.

The new findings, published in the journal Cannabis and Cannabinoids Research by a team from the University of Michigan's Institute for Healthcare Policy and Innovation, suggest a need for more education and screening of older adults for cannabis-related risks.

"As the stress of the pandemic and the increased legalization of cannabis by states converged, our findings suggest cannabis use increased among older adults nationally. Older adults represent a vulnerable age group for cannabis use due to interactions with medications, risky driving, cannabis-related mental health impacts and increased possibility of falls and memory issues," said Anne Fernandez, Ph.D., an addiction psychologist in the U-M Addiction Center and Department of Psychiatry who led the study.

The data in the study come from the National Poll on Healthy Aging, which IHPI runs with funding from AARP and Michigan Medicine, U-M's academic medical center. The national poll of 2,023 older adults was taken in January 2021, nine months into the official pandemic declaration and just as the first COVID-19 vaccines were being made available to the groups at the highest risk.

The 12% overall past-year use of cannabis seen in the new study is higher than the 9.5% seen in 2019 by other researchers pre-pandemic, and far higher than the 3% seen in another study in 2006, when only 12 states had passed medical cannabis laws. The NPHA in 2017 found that 6% of older adults had used cannabis for medical purposes.

In the new study, in addition to the 4% who said they use cannabis products four or more times a week, another 5% said they use cannabis once a month or less. The poll question asked about use of any product containing THC, the main psychoactive component of cannabis—including edibles—and used multiple common names for cannabis. It did not differentiate between medical and recreational use of cannabis.

Older adults who said they were unemployed, those who said they were unmarried and had no partner, and those who said they drank alcohol were more likely to say they used cannabis.

Fernandez notes an especially concerning finding: those whose alcohol use was high enough to cause physical and psychological harms were nearly eight times as likely to say they had used cannabis in the past year. But even those with low-risk alcohol drinking patterns were more than twice as likely to say they had used cannabis in the past year.

This group of dual-substance users is one that doctors and public health officials should pay special attention to, she said.

"Other research has shown that using both alcohol and cannabis increases the chance that a person will drive while impaired," she explained. "They are also more likely to have physical and mental health issues, including substance use disorders. Screening for alcohol use, cannabis use, and other drug use could help more people get counseling and reduce their risk and risk to others."

While there were no statistical differences among older adults by age, health or mental health status, income or education, those who said they had Hispanic backgrounds were less likely than non-Hispanic older adults to say they used cannabis. Fernandez says this is consistent with other research showing lower cannabis use in the Latino community.

She advises any older adult who chooses to use cannabis products for any reason to be open with their health care provider about it, especially if they also drink alcohol or take certain medications. Physicians, nurse practitioners and pharmacists can advise if any medications a person is taking might interact with cannabis, including ones for insomnia, depression and anxiety, opioid-containing pain medications, seizure medications, and blood thinners.

In addition to Fernandez, the study's authors are U-M addiction psychologist Lara Coughlin, Ph.D., poll deputy director Erica S. Solway, Ph.D., poll manager Dianne C. Singer, poll director Jeffrey T. Kullgren, M.D., M.S., M.P.H., poll data lead Matthias Kirch, M.S. and Preeti N. Malani, M.D., former poll director and current poll senior advisor.

More information: Anne C. Fernandez et al, Prevalence and Frequency of Cannabis Use Among Adults Ages 50–80 in the United States, Cannabis and Cannabinoid Research (2023). DOI: 10.1089/can.2023.0056

https://medicalxpress.com/news/2023-12-older-adults-cannabis-products-screen.html

Human behavior guided by fast changes in dopamine levels

 What happens in the human brain when we learn from positive and negative experiences? To help answer that question and better understand decision-making and human behavior, scientists are studying dopamine.

Dopamine is a neurotransmitter produced in the brain that serves as a chemical messenger, facilitating communication between nerve cells in the brain and the body. It is involved in functions such as movement, cognition and learning. While dopamine is most known for its association with positive emotions, scientists are also exploring its role in negative experiences.

Now, a new study from researchers at Wake Forest University School of Medicine published Dec. 1 in Science Advances shows that dopamine release in the human brain plays a crucial role in encoding both reward and punishment prediction errors. This means that dopamine is involved in the process of learning from both positive and negative experiences, allowing the brain to adjust and adapt its behavior based on the outcomes of these experiences.

"Previously, research has shown that dopamine plays an important role in how animals learn from 'rewarding' (and possibly 'punishing') experiences. But, little work has been done to directly assess what dopamine does on fast timescales in the human brain," said Kenneth T. Kishida, Ph.D., associate professor of physiology and pharmacology and neurosurgery at Wake Forest University School of Medicine.

"This is the first study in humans to examine how dopamine encodes rewards and punishments and whether dopamine reflects an 'optimal' teaching signal that is used in today's most advanced artificial intelligence research."

For the study, researchers on Kishida's team utilized fast-scan cyclic voltammetry, an electrochemical technique, paired with machine learning, to detect and measure dopamine levels in real-time (i.e., 10 measurements per second). However, this method is challenging and can only be performed during invasive procedures such as deep-brain stimulation (DBS) brain surgery. DBS is commonly employed to treat conditions such as Parkinson's disease, essential tremor, obsessive-compulsive disorder and epilepsy.

Kishida's team collaborated with Atrium Health Wake Forest Baptist neurosurgeons Stephen B. Tatter, M.D., and Adrian W. Laxton, M.D., who are also both faculty members in the Department of Neurosurgery at Wake Forest University School of Medicine, to insert a carbon fiber microelectrode deep into the brain of three participants at Atrium Health Wake Forest Baptist Medical Center who were scheduled to receive DBS to treat essential tremor.

While the participants were awake in the operating room, they played a simple computer game. As they played the game, dopamine measurements were taken in the striatum, a part of the brain that is important for cognition, decision-making, and coordinated movements.

During the game, participants' choices were either rewarded or punished with real monetary gains or losses. The game was divided into three stages in which participants learned from positive or negative feedback to make choices that maximized rewards and minimized penalties. Dopamine levels were measured continuously, once every 100 milliseconds, throughout each of the three stages of the game.

"We found that dopamine not only plays a role in signaling both positive and negative experiences in the brain, but it seems to do so in a way that is optimal when trying to learn from those outcomes. What was also interesting, is that it seems like there may be independent pathways in the brain that separately engage the dopamine system for rewarding versus punishing experiences. Our results reveal a surprising result that these two pathways may encode rewarding and punishing experiences on slightly shifted timescales separated by only 200 to 400 milliseconds in time," Kishida said.

Kishida believes that this level of understanding may lead to a better understanding of how the dopamine system is affected in humans with psychiatric and neurological disorders. Kishida said additional research is needed to understand how dopamine signaling is altered in psychiatric and neurological disorders.

"Traditionally, dopamine is often referred to as 'the pleasure neurotransmitter,"' Kishida said. "However, our work provides evidence that this is not the way to think about dopamine. Instead, dopamine is a crucial part of a sophisticated system that teaches our brain and guides our behavior. That dopamine is also involved in teaching our brain about punishing experiences is an important discovery and may provide new directions in research to help us better understand the mechanisms underlying depression, addiction, and related psychiatric and neurological disorders."

More information: Paul Sands et al, Sub-second fluctuations in extracellular dopamine encode reward and punishment prediction errors in humans, Science Advances (2023). DOI: 10.1126/sciadv.adi4927. www.science.org/doi/10.1126/sciadv.adi4927

https://medicalxpress.com/news/2023-12-human-behavior-fast-dopamine.html

Ukraine conducts new attack on Russian railway deep in Siberia - source

 Ukraine's domestic spy agency has detonated explosives on a Russian railway line deep in Siberia, the second attack this week on military supply routes in the area, a Ukrainian source told Reuters on Friday.

The incidents appear to show Kyiv's readiness and ability to conduct sabotage attacks deep inside Russia and disrupt Russian logistics far from the front lines of Moscow's 21-month-old war in Ukraine.

The source, who declined to be identified, said the explosives were detonated as a freight train crossed the Chertov Bridge in Siberia's Buryatia region, which borders Mongolia and is thousands of kilometres from Ukraine.

The train had been using a backup railway line after an attack on a nearby tunnel a day earlier caused trains to be diverted, the source said.

Baza, a Russian media outlet with security sources, said diesel fuel tanks had ignited on a train using the backup route and that six goods wagons had caught fire. It reported no casualties and said the cause of the explosions was unknown.

The Ukrainian source, who said both operations were conducted by the Security Service of Ukraine (SBU), gave a similar assessment of the damage, citing Russian Telegram channels.

Reuters could not independently verify the accounts or assess whether the route is used for military supplies. Russian Railways declined to comment on the latest incident. The regional branch of Russia's Investigative Committee did not immediately respond to a written request for comment.

The Ukrainian source said on Thursday the SBU had detonated explosives in the earlier attack as a cargo train moved through the Severomuysky tunnel in Buryatia.

Russian investigators have concluded that train was blown up in a "terrorist act" by unidentified individuals, the Moscow-based Kommersant newspaper cited unnamed sources as saying.

Russian Railways, the state company that operates the vast rail network, said traffic had been diverted along a new route after the first attack, slightly increasing journey times but not interrupting transport.

The Ukrainian source said the second attack had anticipated the diversion of rail traffic and targeted the backup route at Chertov Bridge, which is on Russia's Baikal-Amur Mainline traversing Eastern Siberia and the Russian Far East.

Russia's Trans-Siberian Railway is widely seen as more important for Russian freight transport than the Baikal-Amur Mainline.

A Russian industry source who declined to be identified said the backup route was functioning and being used by trains carrying freight on Friday afternoon.

https://news.yahoo.com/ukraine-conducts-attack-russian-railway-153117067.html

Hospital Prices in Medicaid Managed Care

 Jeffrey Marr, BA¹; Yang Wang, PhD¹; Jianhui Xu, PhD¹; et al

 doi:10.1001/jamanetworkopen.2023.44841

Introduction

As of 2020, 70% of Medicaid beneficiaries (57 million) were insured through Medicaid managed care (MMC), in which a private insurer covers a beneficiary’s medical care in exchange for fixed payments from state Medicaid agencies.¹ A key role of MMC insurers is to negotiate prices with hospitals. MMC prices have important implications for government health expenditures and access to care for Medicaid beneficiaries. However, little is known about MMC prices.² We used hospitals’ self-disclosed pricing information to characterize MMC hospital prices.

Methods

This cross-sectional study obtained data on MMC outpatient hospital prices from Turquoise Health (as of July 3, 2023), which compiles prices reported by hospitals complying with the Hospital Price Transparency rule.^3,4 We included 30 shoppable services, as defined by the Centers for Medicare & Medicaid Services, and emergency department (ED) visits that were paid by Medicare through the Outpatient Prospective Payment System. We calculated the traditional Medicare rate for each hospital and each service in 37 states and the District of Columbia with a significant presence of MMC, expressing median MMC prices among insurers at that hospital as a percentage of the Medicare rate. We summarized prices as a percentage of the Medicare rate following prior research on health care prices.⁵ We analyzed median prices as a percentage of the Medicare rate across 3 procedure categories (surgery and medicine, imaging, and ED) both nationally and at the state level. Details on sample selection, including the set of procedures and states, are included in the eMethods and eTable in Supplement 1. This study followed the STROBE reporting guidelines. No institutional review board approval was sought because no human participants were involved in the study. Analysis was conducted using Stata, version 17 (StataCorp) and R, version 4.3.0 (R Project for Statistical Computing).

Results

Our sample included prices reported by 1487 general acute care hospitals. Across outpatient service types, the median MMC prices varied from 69.8% of the Medicare rate (IQR, 40.5%-107.6%) for outpatient surgery and medicine services to 83.6% of the Medicare rate (IQR, 45.5%-143.7%) for ED services to 120.3% of the Medicare rate (IQR, 82.8%-210.9%) for imaging services (Figure 1).

Median MMC prices relative to the Medicare rate varied across states (Figure 2). Median MMC prices for surgery and medicine were highest in North Dakota (133.0% of Medicare) and lowest in West Virginia (18.6%). Median MMC prices for imaging were highest in Utah (371.7% of Medicare) and lowest in Wisconsin (52.0%). Median MMC prices for ED visits were highest in Washington, DC (176.9% of Medicare), and lowest in Wisconsin (26.0%). Prices by service category were correlated across states. State-level correlation coefficients were 0.49 for surgery and medicine and imaging, 0.70 for surgery and medicine and ED, and 0.56 for imaging and ED.

Discussion

Medicaid prices have been believed to be lower than Medicare prices.⁶ Existing research has found this to be the case for Medicaid fee-for-service hospital prices.² However, the results of this study suggest that MMC outpatient hospital prices vary widely and are sometimes above Medicare rates, especially for imaging services. This study was limited by hospitals’ potential reporting errors, incomplete reporting by hospitals, and the lack of data to weight prices by use. Additionally, the pricing information does not include Medicaid supplemental lump-sum payments, a sizable share of Medicaid payments to hospitals.²

This study suggests that MMC hospital prices may affect government health expenditures and access to care for Medicaid beneficiaries. Further research should examine the causes of the variation in MMC hospital prices, including potential market and policy factors.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812254