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Marci Lobel. Photo from SBU

By Daniel Dunaief

Pregnant women with access to the outdoors are less stressed during the pandemic.

In fact, according to an unpublished finding that isn’t yet peer reviewed, pregnant women who had outdoor access were 67 percent less likely to worry about contracting the virus and 63 percent less likely to feel stress about being unprepared for the birth.

Lobel with a recent doctoral student, Jennifer Nicolo-SantaBarbara.

Stony Brook University recently awarded a project led by Dr. Heidi Preis in the Department of Psychology, with co-Principal Investigators Dr. Marci Lobel in the Department of Psychology and Dr. Brittain Mahaffey in the Department of Psychiatry and Behavioral Health that explored the link between stress and pregnancy. The researchers are hoping to identify what helps pregnant women and what may make them more vulnerable to the impacts of stress.

Stony Brook provided a total of $398,200 in seed funding to 17 research projects in response to the pandemic. Researchers at Stony Brook had put together 63 submissions, using a peer review process to choose the projects to fund, including the COVID-19 Pregnancy Experiences (or COPE) Study. The funding, which is for one year, is designed to provide the kind of seed funding that will lead to further research and that other funding agencies will support.

The COPE study tapped into a global network of collaborators that Lobel, who is the Director of the Stress and Reproduction Lab at SBU, established over the past 30 years to compare the different factors that mitigate or exacerbate stress for pregnant women in Spain, Israel, Italy, Germany Poland and Switzerland.

“The biological impact of COVID-19 is getting the lion’s share of attention, as it should,” said Lobel. “We don’t yet know enough about how the psychological impact will affect vulnerable groups, like pregnant women.”

Indeed, Lobel has spent three decades studying the effect of stress and related psychological factors on pregnancy. In other studies, major stressors, such as earthquakes, ice storms, and periods of warfare, confirm the toxic impact of prenatal stress, particularly for preterm births and low birth weight, she said.

Lobel and her colleagues created a self-report instrument called the Pandemic-Related Pregnancy Stress Scale, or PREPS, in which women report their specific concerns or anxieties caused by COVID-19.

Throughout the United States, the team sought responses from about 4,500 women recruited through social media at the end of April and the beginning of May.

Marci Lobel with her family at Yosemite in 2016. The photo credit is: Photo courtesy of Marci Lobel.

Among the women in the study, just over half of them were pregnant with their first child. In many studies that predated the current work, including some from her own research group, Lobel said women pregnant with their first child had higher levels of stress.

In some preliminary findings, 21.7 percent of pregnant women in the study reported severe levels of anxiety. “I think that is higher than what we typically would find in a population study of pregnant women,” Lobel said.

Women with a history of interpersonal violence also reported higher levels of stress and those whose prenatal appointments were canceled or altered were 1.78 times more likely to experience high stress related to a lack of preparedness and 1.49 times more likely to experience high stress related to worries about perinatal infection.

Some women in the study have found ways to reduce the accumulating stress about the health care crisis. The techniques that work for some women, Lobel said, may not work for others, suggesting that stress relief is specific to the individual and is usually determined by the situation itself.

“I don’t recommend any particular way of coping,” Lobel said. “What works for one may not work for another. It’s good to have a tool kit with lots of ways of coping.”

Indeed, some of the techniques pregnant women have found helpful include meditation, prayer, and faith-based practices. Pregnant women have also benefited from social support, which is particularly important during the pandemic when some women may feel “literally and figuratively isolated from others,” Lobel said.

Of all the research Lobel has done, the one that has received the most attention and landed her in the bible for pregnant women, “What to Expect When You’re Expecting,” was a study on optimism. She found that women who were more optimistic had better birth outcomes due in part to the better are they took of their health during pregnancy.

Coping with stress by avoidance predicts increases in emotional distress, Lobel explained. This corroborates much research which shows that avoidance is usually an ineffective way to cope with stress, except in limited cases such as when a stressful situation is brief and uncontrollable.

When people avoid the things that bother them, they can do it cognitively or through alcohol, which is especially dangerous for pregnant women and their developing fetuses. Avoidance can also involve excessive sleeping, as pregnant women may decide they don’t want to deal with life and stay in bed all day.

The scientists plan to collect a second set of data from these women, who were recruited through social media and who represent a diverse socioeconomic background, race and ethnicity, sexual orientation, and other factors, on July 15th.

Lobel said she already has some preliminary, unpublished findings from Poland, which are showing the same kinds of stressors and distress among pregnant women. Polish women have expressed stress related to worries about lack of preparation for birth during the pandemic and stress related to worries about infection.

Lobel said the researchers hope to explore a host of questions as they collect more information. They hope to look at obsessions and compulsions and would like to measure anger. They also will measure levels of depression and anxiety and will compare that to the norms for non-pregnant women.

On the other side of the stress meter, the group will study how being pregnant during the pandemic may help some women appreciate their pregnancy more. For some women, the pregnancy may give them strength to deal with the pandemic, as they focus on having a baby.

The researchers will also explore the level of control women feel over the outcome of their pregnancy and the health of their baby. Feeling in control can create a positive response associated with lower distress.

While Lobel and her colleagues won’t answer all these questions in a year, they hope their initial studies will lead to more funding and research. “Hopefully, we’ll get a [National Institutes of Health] grant to follow up these women for a couple of years to study them and their children to see if there are any developmental or mental or physical health effects” of the pandemic.

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Kevin Reed. Photo from SBU

By Daniel Dunaief

At the beginning of this month, the North Atlantic started its annual hurricane season that will extend through the end of November.

Each year, the National Oceanic and Atmospheric Administration offers a forecast in May for the coming season. This year, NOAA’s Climate Prediction Center anticipates a 60 percent chance of an above-normal season. The Center anticipates 13 to 19 storms, although that number doesn’t indicate how many storms will make landfall.

These predictions have become the crystal ball through which forecasters and city planners prepare for a season that involves tracking disturbances that typically begin off the West coast of Africa and pick up energy and size as they travel west across the Atlantic towards Central America. While some storms travel back out to sea, others threaten landfall by moving up the Gulf Coast or along Atlantic Seaboard of the United States.

Kevin Reed, an Associate Professor at Stony Brook University’s School of Marine and Atmospheric Sciences, and Alyssa Stansfield, a graduate student in his lab, recently predicted the likely amount of rainfall from tropical cyclones.

Alyssa Stansfield at the 33rd Conference on Hurricanes and Tropical Meteorology in 2018. Photo by Arianna Varuolo-Clarke

 

Using climate change projection simulations, Reed and Stansfield came up with a good-news, bad-news scenario for the years 2070 through 2100. The good news in research they published in Geophysical Research Letters is they anticipate fewer hurricanes.

The bad news? The storms will likely have higher amounts of rain, with increased rain per hour.

“If you focus on storms that make landfall over the Eastern United States, they are more impactful from a rainfall standpoint,” Reed said. “The amount of rainfall per hour and the rainfall impact per year is expected to increase significantly in the future.”

In total, the amount of rainfall will be less because of the lower number of storms, although the intensity and overall precipitation will be sufficient to cause damaging rains and flooding.

Warmer oceans and the air above them will drive the increased rainfall, as these storms pass over higher sea surface temperatures where they can gain energy. Warmer, moist air gives the hurricanes more moisture to work with and therefore more potential rainfall.

“As the air gets warmer, it can hold more water in it,” Stansfield said. “There’s more potential rain in the air for the hurricanes before they make landfall.”

Stansfield said the predictions are consistent with what climatologists would expect, reflecting how the models line up with the theory behind them. She explored how climate change affects the size of storms in this paper, but she wants to do more research looking at hurricane size in the future.

“If hurricanes are larger, they will drop rainfall over a larger area,” which could increase the range of area over which policy makers might need to prepare for potential damage from flooding and high winds, Stansfield said.

While her models suggest that storms will be larger, she cautioned that the field hasn’t reached a consensus about the size of future storms. As for areas where there is greater consensus, such as the increased rainfall their models predict for storms at the end of the century, Stansfield suggested that the confidence in the community about their forecasts, which use different climate models, is becoming “more apparent as more modeling groups reach the same conclusion.”

Alyssa Stansfield at Sequoia National Park in 2018. Photo by Jess Stansfield

In explaining the expectations for higher rainfall in future storms, Reed said that even storms that had the same intensity as current hurricanes would have an increase in precipitation because of the availability of more moisture at the surface.

While storms in recent years, such as Hurricanes Harvey, Florence and Dorian dumped considerable rain in their path because they moved more slowly, effectively dumping rain over a longer period of time in any one area, it’s “unclear” whether future storms would move more slowly or stall over land.

Several factors might contribute to a decrease in the number of storms. For starters, an increase in wind sheer could disrupt the formation of some storms. Vertical wind sheer is caused when wind speed and direction changes with increasing altitude. Pre-hurricane conditions may also change due to internal variability and the randomness of the atmosphere, according to Reed.

Reed said the team chose to use climate models to make predictions for the end of the century because it is common in climate science for comparison to the recent historical record. They also used a 30 year period to limit some of the uncertainty due to internal variability of weather systems.

Stansfield, who is in her third year of graduate school and anticipates spending another two years at Stony Brook University before defending her graduate thesis, said she became interested in studying hurricanes in part because of the effects of Superstorm Sandy in 2012.

Alyssa Stansfield at Yosemite in 2019. Photo by Kathy Stansfield

When she was younger, she and her father Greg used to go to the beach when a hurricane passed hundreds of miles off the coast, where she would see the impact of the storm in larger waves. At some point, she would like to fly in a hurricane hunter plane, traveling directly into a storm to track its speed and direction.

Stansfield said one of the more common misconceptions about hurricanes is that the category somehow determines their destructive power. Indeed, Superstorm Sandy was a Category 1 hurricane when it hit New York and yet it caused $65 billion in damage, making it the 4th costliest hurricane in the United States, according to the NOAA.

After Stansfield earns her PhD, she said she wants to continue studying hurricanes. One question that she’d like to address at some point is why there are between 80 to 90 hurricanes around the world each year. This has been the case for about 50 years, since satellite records began.

“That’s consistent every year,” she said. “We don’t know why that’s the number. There’s no theory behind it.” She suggested that was a “central question” that is unanswered in her field. 

Understanding what controls the number of hurricanes will inform predictions about how that number will change in response to climate change.

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Saket Navlakha. Photo from CSHL

By Daniel Dunaief

When people walk into their own home, they immediately ignore sensory cues around them. They may not notice the picture of their children on the wall, the lush leaves of the ficus plant, or the constant smell of soup that greets them when they return from work.

Similarly, animals and even flies become accustomed to cues in their environment, habituating to them so they can focus on more important signals, like the smell of nearby food or the appearance of a fly swatter.

Cold Spring Harbor Laboratory Associate Professor Saket Navlakha and his post doctoral researcher Yang Shen recently studied the way flies subtract smells from the environment, giving them the opportunity to focus instead on odors that might be more important to their lives.

In a paper last month in the Proceedings of the National Academy of Sciences, Navlakha and Shen converted the way flies use a signal filtering process to create a computer algorithm.

Navlakha explained that the tandem were using computer science to understand better a basic biological phenomenon of habituation and how it happens. “We’ve been studying background subtraction,” he said in a recent interview.

One of the applications for their work is in electronic noses. Hotels and even military departments may in the not too distant future use these systems to process odors to determine what’s in the environment.

These electronic noses detect faint signals within noisy backgrounds. Habituation enables them to remove from consideration those scents that would otherwise distract from the goal of scanning the environment for new information.

Navlakha suggested that humans, who are often a visually dominant species, are not always the best species at using a sense of smell to perceive the environment.

Saket Navlaka with his wife Sejal Morjaria, during a run in Port Washington in mid-May. Photo by Lawrence Lau

“Many other species rely on their noses as much as we rely on vision,” he said. “We don’t always have an intuitive sense of what is possible in the olfactory space. Sometimes, that limits our imagination.”

While Navlakha is not crafting sensors that can detect compounds, he is working on the computer science analogs to odor recognition and discrimination. He is exploring the kind of data analysis that would have applications in a range of fields. 

In one example, he said a sensor in an airport might be surrounded by a symphony of smells, including new pungent or even subtle toppings on pizza or even a new cologne from someone working in a watch repair store. 

The sensor might need to sift through all that data to find someone who is transferring a toxic chemical through an airport, the scent of which might be faint and almost insignificant compared with the other odors spreading through the terminal.

In a more everyday example, a sensor in the refrigerator might detect the subtle changes in odors emitted by foods that are starting to become inedible, such as an onion or cream cheese.

“You want to detect” when food is starting to turn so you can “eat it and use it” before it becomes inedible, Navlakha said. “These are the kind of problems we are exploring on the data analysis side.”

Navlakha specifically looked at the activity of Kenyon cells, which are special odor neurons. When a fly receives a new scent, about five percent of these cells turn on, developing a unique activity tag.

Once the fly becomes habituated to a smell that isn’t relevant for its survival — either to indicate the presence of food or to announce the arrival of a predator — Navlakha believes the number of Kenyon cells that make up the tag for the odor declines. While this is his theory, he said more work needs to be done to confirm these predictions.

A new odor repeats the process, bringing the fly’s attention to a new smell. The fly brain in principal can reverse the subtraction process for habituated odors if the odor becomes more rare or important for the fly’s survival. Researchers need to conduct more work to confirm this as well.

Navlakha hopes to frame the fluid process of recognizing, habituating and bolstering the signal for odors to understand how the brain is functioning.

He said the fly brain responds to smells based on two mechanisms. In the first, the fly has an innate, evolutionary behavior. In the second, the fly learns through experience. Navlakha studied the learned behaviors.

The next steps involve pushing more on the experimental front, determining the limits of odor discrimination and looking at the role of habituation.

He hopes to extend an experiment that others have done with people. Experimenters took three odors that were all relatively similar that come from three flowers. Most people could not discriminate between two out of the three odors. In an experimental group, they allowed people to habituate to one of three smells and then they had to discriminate between the other two. By subtracting out the common part of all three smells, they were more successful at decoding the difference between the others.

“We want to see if we can do this in fruit flies” while recording from a region of the fly brain called the mushroom body.

Navlakha also bought an electronic nose. Using this artificial system, he wants to test odor discrimination algorithms.

“One thing this would allow us to do is to test and validate these algorithms to see how well they perform,” he explained. “There are all kinds of tests to see what kind of power these sensors have.”

In the PNAS paper, Navlakha mostly used the literature for their biological inspiration. They discussed numerous parts of the paper with biological collaborators and including biological experiments. They did not introduce any new biological data.

He came across this literature about 18 months ago.

“We thought it was interesting because we could understand the whole series of transformations when a fly smells,” he said. He worked on how to understand the process from input to output.

During the COVID-19 lockdown, he has been spending considerably more time doing theoretical work and modeling. He and his wife Sejal Morjaria have also gotten out of the house to do some running.

As for his work, Navlakha is hoping to build on what he’s done so far and expects he will, if you’ll pardon the pun, follow his nose as the research progresses.

 

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Bruce Stillman. Photo from CSHL

By Daniel Dunaief

Bruce Stillman, the CEO of Cold Spring Harbor Laboratory, last week won the Dr. H.P. Heineken Prize for Biochemistry and Biophysics, which is considered the most distinguished scientific prize from the Netherlands.

The prize, which has been awarded to 13 researchers who have gone on to win Nobel Prizes, includes a $200,000 award and a crystal trophy.

Stillman earned the award, which began in 1964 and is given every two years in categories including Medicine, Environmental Sciences and History, for his decades of work on mechanisms involved in the replication, or copying, of eukaryotic DNA.

The understated Stillman, who was born and raised in Australia, expects he’ll put the prize money into a foundation, although he hasn’t thought much about it given the other concerns that dominate his time, including not only running his own lab amid the COVID-19 pandemic but also overseeing a facility where he has been the Director since 1994 and its CEO since 2003.

Stillman said the lab has had “extensive discussions” among the faculty about whether to pursue additional research fields on an ongoing basis to combat the current virus as well as any future public health threats.

While CSHL is not an infectious disease center, the facility does have a historical precedent for contributing to public health efforts during a crisis. Indeed, during World War II, the laboratory helped create a mutated strain of fungus that increased its yield of the drug penicillin.

At this point, CSHL does not have a high containment facility like Stony Brook University where it can handle highly infectious agents.

“We may have to have one here,” Stillman said. “The reality is there are tons of infectious diseases” and the lab might need to repurpose its scientific skills towards coming up with answers to difficult questions.

Even without such a Biosafety Level 3 designation, CSHL researchers have tackled ways to understand and conquer COVID-19. Associate Professor Mikala Egeblad has been exploring whether neutrophil extracellular traps, which are ways bodies fight off bacterial infections, are playing a role in blood clotting and severe respiratory distress.

These NETS may be “promoting severe symptoms in COVID,” Stillman said. Egeblad is working on a case study with several other collaborators who have focused on these traps. Egeblad is also studying the effectiveness of NETS as a biomarker for the most severe patients, Stillman said.

CSHL is also investigating a small molecule compound to see if it inhibits viral infection. Researchers including Assistant Professor Tobias Janowitz are about to participate in a combined Northwell Health-CSHL double blind study to determine the effectiveness of famotidine, which is the active ingredient in the ulcer-treating medication Pepcid.

The coronavirus treatment, which will include patients who don’t require hospitalization, would require a higher dose than for heartburn.

As a part of this study, the scientists will use a patient tracking system that has been used for cancer to determine the effectiveness of the treatment through patient reporting, without requiring laboratory tests.

Stillman is pleased with how CSHL has “repurposed ourselves quickly, as have many institutions around the world.” He highlighted the constructive interactions among scientists.

The public health crisis has “generated a different kind of behavior in science, where there’s a lot of interaction and cooperation,” Stillman said. The preprint journal BioRxiv, which CSHL operates, has had nearly 5,000 papers about COVID-19 since January. The preprints have “not only helped disseminate information rapidly [to the scientific community], but they are also “being used to determine policy by government leaders.”

Stillman urged scientists to apply the same analytical technique in reading preprinted research that they do with peer-reviewed studies, some of which have required corrections.

As for the government’s response, Stillman believes a retrospective analysis will provide opportunities to learn from mistakes. “I don’t think the [Centers for Disease Control and Prevention] has done a very good job,” he said. He suggested that the well-documented problems with the roll out of testing as community transmission was increasing, was a “disaster.”

The CSHL CEO also said the balkanized medical system, in which every state has a different system and even some local communities have their own processes, creates inefficiencies in responding to a fluid and dangerous public health crisis.

Coordinating those efforts “could have been done very, very rapidly to develop a modern, clear [polymerase chain reaction] test of this virus and yet states and federal agencies had regulations about how these tests can be approved and controlled and regulated that are far too bureaucratic and did not set a national standard quickly,” he said.

He hopes agencies like the CDC, FDA and the Biomedical Advanced Research and Development Authority have better coordination. The country needs a national response, like it had after the Homeland Security effort following 9/11.

Optimistically, Stillman expects a therapeutic antibody will be available by the end of the summer to treat COVID-19. The treatment, which will use monoclonal antibodies, will likely be injectable and will be able to prevent infection for a month or two. These treatments could also help limit the severity of symptoms for people who have been infected.

Regeneron has taken the same approach with Ebola effectively. Stillman doesn’t think such treatments can be used with everybody in the world, which increases the need to develop a vaccine. Creating a safe vaccine, which could be available as early as next year, is a “massive, under-recognized undertaking.”

Between now and next year, a second wave of the virus is certainly possible and may be likely, given that other coronaviruses have been seasonal. 

“This happened with the influenza pandemic a century ago, so we have to be careful about this,” Stillman said. He believes that the medical community has learned how to treat severe patients, which should help mitigate the effects of a second wave in the United States. 

That may not be the case in developing countries, which is a “concern,” he said.

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Nancy Reich. Photo from SBU

By Daniel Dunaief

Even as pharmaceutical companies are working furiously to produce a vaccine for COVID-19, scientists are taking other approaches that might lead to treatment for this disease or for other viruses that might threaten public health.

Nancy Reich, a Professor in the Department of Microbiology and Immunology at the Renaissance School of Medicine at Stony Brook University, and several colleagues at SBU recently received a $450,000 grant from the G. Harold and Leila Y. Mathers Foundation to pursue the laboratory study of two possible interventions.

Reich and her colleagues plan to investigate the use of interferon-lambda, which is in clinical trials for Hepatitis D virus, and an inhibitor for bradykinin called icatibant, which is approved for angioedema.

“Although we are very hopeful for a vaccine in the near future, vaccines can take months or years” to develop and use, Reich said. “The likelihood is that there will be more emerging diseases” which increases the need for broad spectrum first line defense therapeutics that might provide relief and save lives.

A few months ago, several faculty in microbiology and immunology got together on a Zoom call to discuss what they could do to combat COVID-19. The group was “very enthusiastic” about interferon, which is a natural hormone and is the only cytokine that’s antiviral. It has the ability to prevent the spread of the virus by reducing replication.

Reich will work with Patrick Hearing and Erich Mackow, who are both professors in the Department of Microbiology and Immunology, on the molecular aspects of COVID-19. Associate Professor Janet Hearing and Assistant Professor Hwan Kim are certified to work in high containment biosafety laboratories.

COVID-19 seems to have figured out how to block the action or production of interferon, Reich said, although the lower levels of the hormone haven’t been confirmed yet.

Other researchers are testing how the virus that has caused the pandemic has blocked the production of this defense mechanism. The Reich-led group is also planning to test this process.

To get protection from interferon, people would likely need an increased amount of the antiviral molecule early in the infection process, Reich said. She and her team are focusing on interferon lambda, which is a specific type that primarily affect epithelial cells, which are the type of cells that line the respiratory and digestive systems.

Interferon alpha and beta cause systemic problems, which can trigger an overactive immune system to cause a cytokine storm. This can lead to severe symptoms, if the body’s reaction is strong enough.

“Because interferon lambda is more specialized in the targets it hits, it doesn’t cause this crazy, global effect in your body,” Reich said.

At this point, Reich is looking to use a pre-clinical animal model of COVID-19 to understand the processes involved with the virus and its reaction to different concentrations of this hormone at different times after infection.

Reich has reached out to a company called EIGR Pharmaceuticals, which is the only company that produces a pegylated version of interferon lambda. By adding polyethlylene glycol, or PEG, EIGR can extend the time that the drug remains in the body, reducing the need for new doses.

The interferon lambda receptors are prevalent in hepatocytes, or liver cells. The liver is particularly important in capturing bacteria, viruses and macromolecules that might otherwise cause harm in the human body. The interest in the liver and interferon is mainly because of hepatitis viruses.

Interferon lambda’s higher specificity reduces potential side effects that other interferons trigger in the blood or in the central nervous system. EIGR has created this interferon to treat Hepatitis D.

“I have contacted [EIGR] to do some COVID work and now they are,” Reich said. “They have some clinical trials going on in the United States, Israel and Australia.” In addition to their research work with interferon lambda, the group will also study the effects of bradykinin, which is a small peptide hormone that the angiotensin-converting enzyme 2 (or ACE2) receptor inactivates.

The group is exploring the use of inhibitors for bradykinin, hoping to reduce a molecular trigger that exacerbates symptoms of the disease.

“We are taking two approaches; one is more about the symptoms, through bradykinin inhibition, and the other is trying to block virus replication,” said Reich.

In their research with interferon and inhibitors to bradykinin, Reich is hoping to generate data that will be ready within several months.

If both of the approaches proves effective independently, Reich said the next steps could involve combining them.

If the combination works better than either of the treatments alone, the researchers, and, down the road, the doctors, who might use this approach could use a lower dose of both drugs, which could reduce any potential side effects.

Reich said this research is possible at Stony Brook because it has a Biosafety Level 3.“We are able to do these experiments that others may not be able to do,” she said.

The animal facility that will house the mice for her studies is still not accepting new animals. Reich hopes they start to accept them in June.

Reich appreciated the speed at which the Mathers Charitable Foundation reacted to their request for funds.

The Foundation, which was created by a Santa Barbara, California couple who donated their wealth to research in 1983, made a decision within weeks, reflecting the urgency that the public health crisis triggered by COVID-19 has created.

Many foundations typically take six to eight months to decide on funding.

Reich appreciates that she and her colleagues will have a chance to contribute to a growing body of research about a virus that has caused close to 100,000 deaths in the United States and has disrupted billions of lives around the world.

“Everybody realizes the urgency,” Reich said.

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Jennifer Keluskar. Photo from SBU

By Daniel Dunaief

In the second of a two-part series, Times Beacon Record News Media describes the clinical and research work of Jennifer Keluskar, a Clinical Professor in the Department of Psychiatry at Stony Brook University.

Keluskar and Matthew Lerner, an Associate Professor of Psychology, Psychiatry & Pediatrics (see last week’s paper), recently received a grant from the Office of the Vice President for Research & the Institute for Engineering-Driven Medicine to study the effects of COVID-19-induced social isolation on people with Autism Spectrum Disorder. 

Keluskar spends half her time working at the Outpatient Department of Psychiatry, Child and Adolescent Services, where she provides cognitive behavioral intervention and ASD diagnostic evaluations for youth with autism, and the other half working on the SB Autism Initiative.

The pandemic has challenged young people with autism, as they manage through social isolation and worry about an uncertain future. Many of Jennifer Keluskar’s patients are struggling, with some dreading the return to school in the fall and others grappling with the removal or change in a routine or structure.

Some of her clients have felt increased pressure to organize their time and be productive amid a lack of peer support and without the opportunities to model their performance based on interacting with other students at school.

Through modeling, some students take notes when they notice their classmates writing down concepts or ideas a teacher is sharing or gaining some measure of reassurance when they see that everyone is struggling with the work load.

“This latter point is particularly relevant given the novelty of this situation for teachers as well as the consequent likelihood that they will have trouble knowing how much work to give, especially given the wide variety” of circumstances at home, Keluskar explained in an email.

For some students with autism who have a measure of social-anxiety disorder, the remote learning environment has provided some measure of relief, reducing the difficulty in reading nonverbal cues from their classmates and teachers.

Now that these students are learning remotely, these “social stressors have been lifted,” Keluskar said.

Nonetheless, even the patients who have felt relieved about fewer anxiety-inducing social interactions are starting to develop concerns about a potential resumption of classes in the fall.

Keluskar has already seen some patients who are perseverating on that future upcoming transition. “We are going to see more of it in my clientele as we get closer to reopening schools,” she said, adding that she has some patients who are afraid of not being able to advance in life, to college or to jobs, but who, at the same time, are afraid of taking the next step after getting used to quarantine.

Jennifer Keluskar with her husband Raja, 5-year-old daughter Skylar and three-year-old son Colby.

Working with Alan Gerber, a graduate student in Matthew Lerner’s lab at SBU, Keluskar will assess responses to COVID-19. They have sent out two questionnaires. One, which was released by other researchers, examines how the pandemic has affected circumstances and behaviors, from employment changes to junk food consumption. The other is an evidence-based measure of parental stress that is not specific to the virus. She is going to measure anxiety and depression to see how they change during quarantine. 

Keluskar appreciates how the Initiative offers programs such as a homework club, which students can attend virtually for an hour each day. “I have connected some of my clients in the clinic to undergraduate mentors and so far this has been quite successful” although the scale of these connections has been small so far.

The Initiative currently has a mentoring program geared towards older adolescents. She is planning to offer this program to younger individuals.

Deborah Gross, the Initiative’s coordinator, runs a program called the Sidekicks Squad, which is for older adolescents and young adults with special needs.

“Some of my patients would benefit from pairing with a mentor,” Keluskar said. “Through these mentoring sessions, people with autism hang out with their mentors.”

Child-directed interpersonal time is “so important for people’s well being and development,” Keluskar explained, referring to both the mentor and the mentee.

She appreciates that this mentoring program is laid back and fun and believes that mentors benefit just as much from it as mentees.

Through the Initiative, the group has also done eight weekly, Facebook livestream events. The organizers discuss a topic and add three tips at the end. The tips have provided suggestions, including: using creativity to engage children by adding special interests into activities; taking a collaborative problem solving approach when running into difficulties getting a child to cooperate; and understanding emotional underpinnings to children’s behavioral difficulties.

Keluskar recognizes the challenge that come from having self-directed resources available to children and their parents. Even when people have access to many resources, they do not always know where to begin or what to prioritize, she said.

She advises a parents to try to get enough rest for themselves. “You need to take care of yourself so you can model [appropriate behavior] to your children,” she said.

Through the pandemic challenges, Keluskar also urges parents to be creative in their responses to the stressors that are affecting them and their children. She suggests people to take chances in how they approach their interactions with anxious children.

“You can’t be creative if you’re afraid of being wrong,” she said. “Being able to move past little mistakes shows flexible control. Set limits and be structured, but also be flexible at the same time.”

A resident of Commack, Keluskar lives with her husband Raja Keluskar, who is an engineer, their five-year old daughter Skylar and their three-year old son Colby.

Keluskar said she has been anxious about public speaking since she was young and can empathize with others who struggle with this. Through Facebook groups and other efforts, she said she can “personally attest to the value of multiple exposures and say that it can even become enjoyable with time and practice.”

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On Zoom screen, clockwise from top left, Committee member Hoi-Chung Leung; Committee Member Matthew Lerner; Eve Rosen; Committee Member Nicholas Eaton; Tamara Rosen; graduate student Cara Keifer; and Shira Yudkoff.

By Daniel Dunaief

On April 17, Tamara Rosen did something she had been anticipating for six years: she defended her graduate thesis.

Working in the lab of Matthew Lerner, who is an Associate Professor of Psychology, Psychiatry & Pediatrics in the Department of Psychology at Stony Brook University, Rosen had focused her efforts on the symptoms people with autism exhibit when they are anxious or depressed.

While the questions in her graduate thesis defense followed a pattern she anticipated, with professors asking her about the way she compiled her data and the conclusions she drew, the format wasn’t what she had expected.

Like so many other gatherings that had formerly been public events, Rosen’s thesis defense was broadcast by Zoom. The downside was that she wasn’t in the room with everyone, where she could have a discussion one on one. The upside was that her friends and family could tune in as easily as they do to work calls or other family gatherings. Indeed, Rosen’s mother, Marna; her step-mother Eve; and her father Dennis, all of whom share an appreciation for the work Tammy did for her thesis, watched the defense from start to finish, exulting in a landmark achievement.

“This was a really important day in our family’s history,” Dennis Rosen told his daughter, sharing the pride he felt for her.

“I always knew you were smart, but now I know you are brilliant,” her mother beamed.

After the call, Rosen saw her mother and stepmother overwhelmed with emotions, shedding tears for an achievement she sometimes needs to reassure herself really happened.

Rosen’s work focused on how anxiety and depression, two conditions that mental health professionals are concerned are becoming more prevalent amid the viral pandemic, have different symptoms in the population of people with autism spectrum disorder than they do for those who are not on the spectrum.

Based on prior research, Rosen wanted to account for the different symptoms in her follow-up analysis.

Prior studies have found that the traditional models of anxiety and depression do not adequately fit youth with autism. Others had suggested, but not tested, the notion that the Diagnostic and Statistical Manual model of these symptoms provides an ineffective model of anxiety and/or depression symptoms because of the influence of autism symptoms.

That is why Rosen specifically examined the influence of autism on these conditions in one of her analyses.

Among other findings, Rosen said that autism influences anxiety and depression. The prevalence of anxiety and depression is higher compared to the general population.

There are a range of clinical implications for her work, Rosen said.

Her work validates what clinicians are doing, which is to take the profile of autism into account when they treat anxiety.

Rosen moved to Colorado last July to start her internship year at JFK Partners at the University of Colorado School of Medicine, where she is also starting her post-doctoral clinical fellowship. She is treating clients with autism and anxiety and depression, which she said is in her “wheel house” of expertise.

Rosen is grateful for the support she received from Lerner and the program at Stony Brook. “It was great training,” she said.

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Matthew Lerner. Photo from SBU

By Daniel Dunaief

Though hampered by the pandemic in their direct contact with people who have autism, the founder of The Autism Initiative and research director Matthew Lerner along with the Head of Autism Clinical Education Jennifer Keluskar at Stony Brook University are managing to continue to reach out to members of the community through remote efforts. In a two-part series, Times Beacon Record News Media will feature Lerner’s efforts this week and Keluskar’s work next week.

Through several approaches, including improvisational theater, Matthew Lerner works with people who are on and off the autism spectrum on ways to improve social competence, including by being flexible in their approach to life.

In the midst of the ongoing pandemic, he has had to apply the same approach to his own work.

Lerner, who is an Associate Professor of Psychology, Psychiatry & Pediatrics in the Department of Psychology at Stony Brook University, recognizes that it’s difficult to continue a project called SENSE ® Theatre (for Social Emotional NeuroScience Endocrinology), where the whole function of the process is to provide in-person social intervention.

The SENSE Theater study is a multisite National Institute of Mental Health-funded project focused on assessing and improving interventions to improve social competence among adolescents with autism. The core involves in person intervention through group social interaction.

Matthew Lerner with his sons Everett,6, and Sawyer,2. Photo by Chelsea Finn

That, however, is not where the effort ends.“There are arms of that study that are more educational and didactic,” Lerner said. “We’re starting to think about how we could capitalize on that.”

In the ongoing SENSE effort, Lerner is coordinating with Vanderbilt University, which is the lead site for the study, and the University of Alabama.

Stony Brook is in active contact with the families who are participating in that effort, making sure they know “we are doing our best to get things up and running as quickly as possible,” Lerner said.

The staff is reaching out to local school districts as well, including the Three Village School District, with whom Lerner is collaborating on the project, to ensure that people know the effort will restart as soon as it’s “safe to be together again.”

Lerner is also the founder and Research Director of The Autism Initiative at SBU, which launched last year before the pandemic altered the possibilities for in-person contact and forced many people to remain at or close to home for much of the time. The initiative provides programs and services for the community to support research, social and recreational activities and other therapeutic efforts.

The Stony Brook effort initially involved video game nights, adult socials and book clubs. The organizers and participants in the initiative, however, have “stepped up in a huge way and have created, in a couple of weeks, an entirely new set of programming,” Lerner said.

This includes a homework support club, guidance, webinars and support from clinicians for parents, which address fundamental questions about how to support and adapt programs for people with autism. The group is keeping the book club active. The initiative at least doubled if not tripled the number of offerings, Lerner suggested.

Additionally, SBU has two grants to study a single session intervention adapted for teens with autism. The project has been running for about nine months. Lerner said they are looking to adapt it for online applications. For many families, such remote therapy would be a “real boon to have access to free treatment remotely,” he said.

Lerner had been preparing to conduct a study of social connections versus loneliness in teens or young adults with autism. Since COVID-19 hit, “we have reformulated that and are just about to launch” a longitudinal a study that explores the effects of the lockdown on well-being and stress for people who have autism and their families.

Lerner is looking at how the pandemic has enhanced the importance of resilience. He said these kinds of studies can perhaps “give us some insight when we return to something like normalcy about how to best help and support” people in the autism community. “We can learn” from the stresses for the community of people with autism during the pandemic.

To be sure, the pandemic and the lockdown through New York Pause that followed hasn’t affected the entire community of people with autism the same way. Indeed, for some people, the new norms are more consistent with their behavioral patterns.  “Some autistic teens and young adults have said things to me like, ‘I was social distancing before it was cool,’” Lerner said.

Another teenager Lerner interacted with regularly went to the bathroom several times to wash his hands. When Lerner checked in on him to see how he was doing amid the pandemic, he said, “I was made for this.”

Lerner also said people who aren’t on the spectrum may also gain greater empathy through the changes and challenges of their new routines. People find the zoom calls that involve looking at boxes of people on a full screen exhausting. After hours of shifting our attention from one box to another, some people develop “zoom fatigue.”

Lerner said someone with autism noted that this experience “may be giving the rest of us a taste of what it’s like for folks on the spectrum,” which could provide insights “we might not otherwise have.”

Even though some people with autism may feel like the rest of the world is mirroring their behavioral patterns, many people in and outside the autism community have struggled with the stresses of the public health crisis and with the interruption in the familiar structure of life.

The loss of that structure for many with autism is “really profound,” which is the much more frequent response, Lerner said. “More kids are telling us they are stressed out, while parents are saying the same thing.” In some sense, the crisis has revealed the urgency of work in the mental health field for people who are on and off the spectrum, Lerner said.

The studies in autism and other mental health fields that come out of an analysis of the challenges people face and the possible mental health solutions will likely include the equivalent of an asterisk, to capture a modern reality that differs so markedly from conditions prior to the pandemic. There may be a new reporting requirement in which researchers break down their studies by gender, age, race, ethnicity, income and “another variable we put in there: recruited during social isolation.”

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Life-like reconstruction of Adalatherium hui from the Late Cretaceous of Madagascar. ©Denver Museum of Nature & Science/Andrey Atuchin
Mounted cast skeleton of Adalatherium hui from the Late Cretaceous of Madagascar (left lateral view). Courtesy of Triebold Paleontology
Mounted cast skeleton of Adalatherium hui from the Late Cretaceous of Madagascar (front view). Courtesy of Triebold Paleontology
View of fossil site at which the skeleton of Adalatherium hui was discovered. Co-author Lydia Rahantarisoa is seated at the excavation spot. ©Denver Museum of Nature & Science/David Krause.
View of plaster jacket containing skeleton of Adalatherium hui being carried from excavation site to road. Author David Krause at left front. Photo courtesy of National Geographic Society/Maria Stenzel
Madagascar field study area where skeleton of Adalatherium hui was discovered. Photo courtesy Macalester College/Raymond Rogers
Skeleton of Adalatherium hui from the Late Cretaceous of Madagascar (left lateral view). ©Denver Museum of Nature & Science/Scott Hartman
Author David Krause with skeleton of Adalatherium hui. Photo courtesy of Story Brook University/John Griffin
James Rossie studies CT scan of the Adalatherium cranium. Photo by Helen Cullyer

By Daniel Dunaief

It’s not exactly a Rembrandt hidden in the basement until someone discovers it in a garage sale, but it’s pretty close.

More than two decades ago, a Malagasy graduate student named Augustin Rabarison spotted crocodile bones in northwestern Madagascar, so he and a colleague encased them in a plaster jacket for further study.

David Krause, who was then a Professor at Stony Brook University and is now the Senior Curator of Vertebrate Paleontology at the Denver Museum of Nature & Science, didn’t think the crocodile was particularly significant, so he didn’t open the jacket until three years later, in 2002.

When he unwrapped it, however, he immediately recognized a mammalian elbow joint further down in the encased block of rock. That elbow bone, as it turned out, was connected to a new species that is a singular evolutionary masterpiece that has taken close to 18 years to explore. 

Recently, Krause, James Rossie (an Associate Professor in the Department of Anthropology at Stony Brook University) and 11 other scientists published the results of their extensive analysis in the journal Nature.

The creature, which they have named Adalatherium hui, has numerous distinctive features, including an inexplicable and unique hole on the top of its snout, and an unusually large body for a mammal of its era. The fossil is the most complete for any Mesozoic mammal discovered in the southern hemisphere.

“The fossil record from the northern continents, called Laurasia, is about an order of magnitude better than that from Gondwana,” which is an ancient supercontinent in the south that included Africa, South America, Australia and Antarctica, Krause explained in an email. “We know precious little about the evolution of early mammals in the southern hemisphere.”

This finding provides a missing piece to the puzzle of mammalian evolution in southern continents during the Mesozoic Era, Krause wrote.

The Adalatherium, whose name means “crazy beast” from a combination of words in Malagasy and Greek, helps to broaden the understanding of early mammals called gondwanatherians, which had been known from isolated teeth and lower jaws and from the cranium of a new genus and species, Vintana sertichi, that Krause also described in 2014.

The closest living relatives of gondwanatherians were a group that is well known from the northern hemisphere, called multituberculates, Krause explained.

The body of Adalatherium resembled a badger, although its trunk was likely longer, suggested Krause, who is a Distinguished Service Professor Emeritus at Stony Brook. 

Krause called its teeth “bizarre,” as the molars are constructed differently from any other known mammal, living or extinct. The front teeth were likely used for gnawing, while the back teeth likely sliced up vegetation, which made probably made this unique species a herbivore.

The fossil, which probably died before it became an adult, had powerful hind limbs and a short, stubby tail, which meant it was probably a digger and might have made burrows.

Rossie, who is an expert in studying the inside of the face of fossils with the help of CT scans, explored this unusually large hole in the snout. “We didn’t know what to make of it,” he said. “We can’t find any living mammal that has one.”

Indeed, the interpretation of fossils involves the search for structural and functional analogs that might suggest more about how it functions in a living system. The challenge with this hole, however, is that no living mammal has it.

Gathering together with other cranial fossil experts, Rossie said they agreed that the presence of the hole doesn’t necessarily indicate that there was an opening between the inside of the nose and the outside world. It was likely plugged up by cartilage or other soft tissue or skin.

“If we had to guess conservatively, it would probably be an enlarged hole that allowed the passage of a cluster of nerves and blood vessels,” Rossie said. 

That begs the question: why would the animal need that?

Rossie suggests that there might have been a soft tissue structure on the outside of the nose but, at this point, it’s impossible to say the nature of that structure.

The Associate Professor, who has been a part of the research team exploring this particular fossil since 2012, described the excitement as being akin to opening up a Christmas present.

“You’re excited to see what’s in there,” he said. “Sometimes, you open up the box and see what you were hoping for. Other times, you open the box and say, ‘Oh, I don’t know what to say about this [or] I don’t know what I’m looking at.’”

For Rossie, one of the biggest surprises from exploring this fossil was seeing the position of the maxillary sinus, which is in a space that is similar across all mammals except this one. When he first saw the maxillary sinus, he believed he was looking at a certain part of the nasal cavity, where it usually resides. When he studied it more carefully, he realized it was in a different place.

“All cars have some things in common,” said Rossie, who is interested in old cars and likes to fix them. The common structural elements of cars include front and back seats, a steering wheel, and dashboard. With the maxillary sinus “what we found is that the steering wheel was in the back seat instead of the front.” 

A native of upstate Canton, which is on the border with Canada, Rossie enjoyed camping growing up, which was one of the initial appeals of paleontology. Another was that he saw an overlap between the structures nature had included in anatomy with the ones people put together in cars.

A resident of Centerport, Rossie lives with his wife Helen Cullyer, who is the Executive Director of the Society for Classical Studies, and their seven-year-old son.

As for the Adalatherium, it would have had to avoid a wide range of predators, Krause explained, which would have included two meat-eating theropod dinosaurs, two or three large crocodiles and a 20-foot-long constrictor snake.

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Centre ValBio staff members distribute face masks to the Malagasy people.

By Daniel Dunaief

Long Islanders are pitching in to protect the people of Madagascar, called the Malagasy, from COVID-19. They are also trying to ensure the survival of the endangered lemurs that have become an important local attraction and a central driver of the economy around Ranomofana National Park.

Patricia Wright, a Distinguished Service Professor at Stony Brook University and founder and executive director of the research station Centre ValBio (CVB), is working with BeLocal to coordinate the creation and distribution of masks. They have also donated soap, created hand washing stations at the local market, and encouraged social distancing.

BeLocal, an organization founded by Laurel Hollow residents Mickie and Jeff Nagel, along with Jeff’s Carnegie Mellon roommate Eric Bergerson, is working with CVB to fund and support the creation of 200 to 250 masks per day. BeLocal also purchased over 1,800 bars of soap that they are distributing at hand washing stations.

Wildlife artist Jessie Jordan is volunteering her time to help the Malagasy people.

All administrators for regional government in the national park area near CVB, which is in the southeastern part of the island nation, have received masks. The groups have also given them to restaurant owners and anybody that handles food, including vendors in the market.

At the same time, CVB has received permission to become a testing site for people who might have contracted COVID-19. At this point, Wright is still hoping to raise enough money to buy a polymerase chain reaction machine, which would enable CVB to perform as many as 96 tests each day.

The non-governmental organization PIVOT, which was founded by Jim and Robin Hernstein, has also helped create screening stations to test residents for fever and other symptoms of the virus. As for the masks, BeLocal and CVB are supporting the efforts of seamstresses, who are working 7 days a week.

Jessie Jordan, a wildlife artist based in Madagascar who has been living at CVB for several weeks amid limited opportunities to return to the United States, has been “busy collaborating with local authorities and contributing masks, soap and hand washing stations to the community.”

At this point, Jordan said people were concerned about the economy, but not as afraid of the virus. “The local health centers are less busy right now because of confinement measures and people are scared of testing positive,” she explained in an email.

The Malagasy who benefit from the national park economically through tours and the sale of local artwork have suffered financially. Social distancing in the cities is “nearly impossible,” while Jordan said she has heard that some people in the countryside don’t have access to TV or radio and are not aware of the situation.

As of last week, Madagascar had 132 confirmed positive cases of the virus. Through contact tracing, the government determined that three people brought COVID-19 to the nation when they arrived on different planes. The country had 10 ventilators earlier this month for a population that is well over 23 million.

BeLocal researched the best material to create masks that would protect people who worked in the villages around Ranomafana. “We researched templates and materials and worked together with CVB to choose the best material that would be available,” Leila Esmailzada, the Executive Director of BeLocal, explained in an email.

BeLocal organized a team that reached out to Chris Coulter, who had started making soap several years ago. Coulter has worked with local officials to make soap.

“We knew Coulter from a few years ago” from an effort called the Madagascar Soap Initiative to get soap into every home and make it accessible, explained Mickie Nagel, the Executive Director of BeLocal. “We hope the people making it right now will consider turning this into a business.” Before Madagascar instituted restrictions on travel, BeLocal and CVB had purchased several sewing machines.

Representatives from BeLocal and CVB have been conducting hand washing and social distance education efforts to encourage practices that will limit the spread of COVID-19.  Government officials have also shared instructions on the radio and TV, Wright said. When the mayor of Ranomofana Victor Ramiandrisoa has meetings, everybody stands at least six feet apart.

CVB has produced picture drawings in Malagasy that are plastered on the sides of cars that describe hand washing procedures and social distancing. “We also have educational signs in the post offices, restaurants and in the mayor’s offices that we paid for,” Wright explained. She said the government, CVB and BeLocal are all educating people about practices that can limit the spread of the deadly virus.

“Organizations in Ranofamana are collaborating with the local government on efforts to prevent the spread of COVID-19,” Esmailzada wrote. “The local government recently began conducting PSA’s along the road and in main markets about hand washing, mask wearing and social distancing and CVB staff are leading by example.”

As for the lemurs Wright, whose work was the subject of the Imax film “Island of Lemurs: Madagascar,” said the country has taken critical steps to protect these primates.

“The government of Madagascar is assuming the worst and is not allowing anybody into the park,” Wright said. The president of Madagascar, Andry Rajoelina, has closed national parks to protect the lemurs, Wright said.

The lemurs have the support of conservation leader Jonah Ratsimbazafy, who earned his PhD while working with Wright at Stony Brook University. Ratsimbazafy is one of the founding members of the Groupe d’Etude et de Research sur les Primates, which is a community based conservation organization that protects lemurs. 

Wright and others are concerned the virus may spread to lemurs. Several lemurs species have the angiotensin converting enzyme, or ACE2, that forms the primary point of attachment for the virus in humans.

Indeed, scientists around the world are working to find those species which might be vulnerable to the virus. According to recent research preprinted in bioRxiv from a multi-national effort led by scientists at the University of California in Davis, several species of lemur have high overlap in their ACE2 inhibitors. This includes the endangered aye-aye lemur, which is the world’s largest nocturnal primate, and the critically endangered indri and sifaka.

“We are worried that lemurs might get the virus,” Wright said.

Photos courtesy of Jessie Jordan

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