Daily Archives: June 1, 2020

Could nearly half of those with Covid-19 have no idea they are infected? – The Guardian

Posted: June 1, 2020 at 3:53 am

When Noopur Rajes husband fell critically ill with Covid-19 in mid-March, she did not suspect that she too was infected with the virus.

Raje, an oncologist at Massachusetts General Hospital in Boston, had been caring for her sick husband for a week before driving him to an emergency centre with a persistently high fever. But after she herself had a diagnostic PCR test which looks for traces of the Sars-CoV-2 virus DNA in saliva she was astounded to find that the result was positive.

My husband ended up very sick, she says. He was in intensive care for a day, and in hospital for 10 days. But while I was also infected, I had no symptoms at all. I have no idea why we responded so differently.

It took two months for Rajes husband to recover. Repeated tests, done every five days, showed that Raje remained infected for the same length of time, all while remaining completely asymptomatic. In some ways it is unsurprising that the virus persisted in her body for so long, given that it appears her body did not even mount a detectable immune response against the infection.

When they both took an antibody test earlier this month, Rajes husband showed a high level of antibodies to the virus, while Raje appeared to have no response at all, something she found hard to comprehend.

Its mind-blowing, she says. Some people are able to be colonised with the virus and not be symptomatic, while others end up with pretty severe illness. I think its something to do with differences in immune regulation, but we still havent figured out exactly how this is happening.

Epidemiological studies are now revealing that the number of individuals who carry and can pass on the infection, yet remain completely asymptomatic, is larger than originally thought. Scientists believe these people have contributed to the spread of the virus in care homes, and they are central in the debate regarding face mask policies, as health officials attempt to avoid new waves of infections while societies reopen.

You dont need to be coughing to transmit a respiratory infection: talking, singing, even blowing a vuvuzela

But the realisation that asymptomatic people can spread an infection is not completely surprising. For starters, there is the famous early 20th century case of Typhoid Mary, a cook who infected 53 people in various households in the US with typhoid fever despite displaying no symptoms herself. In fact, all bacterial, viral and parasitic infections ranging from malaria to HIV have a certain proportion of asymptomatic carriers. Research has even shown that at any one time, all of us are infected with between eight and 12 viruses, without showing any symptoms.

From the microbes perspective, this makes perfect evolutionary sense. For any virus or bacteria, making people infectious but not ill is an excellent way to spread and persist in populations, says Rein Houben, an infectious diseases researcher at the London School of Hygiene and Tropical medicine.

However, when Covid-19 was identified at the start of the year, many public health officials both in the UK and around the world failed to account for the threat posed by asymptomatic transmission. This is largely because they were working on models based on influenza, where some estimates suggest that only 5% of people infected are asymptomatic. As a result, the large scale diagnostic testing regimes required to pick up asymptomatic Covid-19 cases were not in place until too late.

I warned on 24 January to consider asymptomatic cases as a transmission vehicle for Covid-19, but this was ignored at the time, says Bill Keevil, professor of environmental healthcare at the University of Southampton. Since then, many countries have reported asymptomatic cases, never showing obvious symptoms, but shedding virus.

The first identified case of asymptomatic transmission of Covid-19 occurred in early January, when a traveller from Wuhan passed on the virus to five family members in different parts of the city of Anyang. After testing positive, she then remained asymptomatic for the entire 21-day follow-up period.

While scientists still dont know whether asymptomatic people are as contagious as those who display symptoms, there are still many ways in which they can pass on Covid-19. We know that you dont need to be coughing to transmit a respiratory infection like Sars-CoV-2, says Houben. Talking, singing, even blowing instruments like a vuvuzela in the past all of those have been shown to transmit respiratory viruses in some way.

Since January, the race has been on to try and identify just how many asymptomatic cases are out there, with varying findings. One study in the Italian town of Vo reported that 43% of the towns cases of Covid-19 were asymptomatic, while initial reports from the US Centers for Disease Control and Prevention investigation into the spread of Covid-19 on the Theodore Roosevelt aircraft carrier in March, suggest that as many as 58% of cases were asymptomatic. Some 48% of the 1,046 cases of Covid-19 on the Charles de Gaulle aircraft carrier proved to be asymptomatic while, of the 712 people who tested positive for Covid-19 on the Diamond Princess cruise ship, 46% had no symptoms.

Almost all evidence seems to point to a proportion of asymptomatic infections of around 40%, with a wide range, says Houben. The proportion is also highly variable with age. Nearly all infected children seem to remain asymptomatic, whereas the reverse seems to hold for the elderly.

Houben points out that, because most asymptomatic people have no idea they are infected, they are unlikely to be self-isolating, and studies have shown this has contributed to the rampant spread of the virus in facilities such as homeless shelters and care homes. He says this means there is a need for regular diagnostic testing of almost all people in such closed environments, including prisons and psychiatric facilities.

When it comes to controlling Covid-19, this really shows that we cannot rely on self-isolation of symptomatic cases only, he says. Going forwards we need trace and test approaches to account for individuals who are not reporting any symptoms.

Since February, the country that has arguably had the greatest success in suppressing asymptomatic spread of Covid-19 is South Korea. Armed with a rigorous contact tracing and diagnostic testing regime, which involved dozens of drive-through testing centres across major cities enabling tests to be carried out at a rate of one every 10 minutes, they put specific policies in place to offset the threat of asymptomatic carriers from the moment the virus began to spread out of control in Daegu.

Once identified, all asymptomatic people are asked to self quarantine in their house until they test negative, with health service officials checking on them twice daily, and monitoring their symptoms, says Eunha Shim, an epidemiologist at Soongsil University in Seoul.

As Korea attempts to prevent a second wave of infections while reopening schools and allowing people to return to offices, preventing asymptomatic spread is one of their main priorities. This is being done by a mass public health campaign advocating the wearing of masks at all times outside the home. In Seoul, it is not possible to access the subway without a mask.

Many scientists are increasingly calling for this policy to be officially introduced in the UK, especially as more and more people resume commuting in the coming months. Keevil says: There is a strong case to be made for the public wearing appropriate face covers in confined areas such as stations, trains, metro carriages and buses, where it is extremely difficult to maintain the two-metre gap, considered essential to allow respiratory droplets from infected people to fall down before making contact with other people.

The argument is that face covers may not protect the wearer, but might significantly reduce transmission of virus particles to adjacent people in the closed environment. If there is any benefit to be gained, then everyone should wear a mask, which is why some countries are fining people who do not wear a mask and preventing them travelling.

Some have argued that masks may pose a risk of harm to the wearer because of their potential to become an infectious surface, but Keevil says this can be avoided through proper cleaning.

There would need to be policies such as, when arriving at work, place the mask immediately in a plastic bag and wash your hands, he says. And then, when returning home, carefully take off the mask and place it immediately in a washing machine for a 60C wash and wash your hands.

It remains to be seen whether the UK government endorses this as an official recommendation, but a recent study across Barts NHS Trust hospitals in London has illustrated how regular testing and social distancing combined with use of facial protection in this case PPE can prevent asymptomatic spread of the virus. Researchers James Moon and Charlotte Manisty said they found that the rate of asymptomatic infection among hospital staff fell from 7% to 1% between the end of March and early May.

For Raje, understanding why asymptomatic patients like her respond the way they do to the virus, will have some critical implications for all of us over the coming months, for example in determining whether vaccines turn out to be effective.

The big question I have after my experience, is whether a vaccine will really work in all people, she says. The vaccination approach is to create an immune response, which then protects you. But if asymptomatic people are not producing a normal antibody response to the virus, what does that mean? Because its these people who are the vectors and the carriers of this virus, I think we cant get away from social distancing until we have some of these answers out there.

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Could nearly half of those with Covid-19 have no idea they are infected? - The Guardian

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How to Recover From Covid-19 at Home – The New York Times

Posted: at 3:53 am

If youre sick and dont have supplies, see if a friend can pick them up for you, or if a grocery store or bodega will deliver. (Tip well!) Either way, avoid contact: Whether its a friend or a delivery person, have the bag left outside your door, and dont open the door until the delivery person is gone.

Over-the-counter drugs may not be enough. In particular, the coughing and nausea caused by Covid-19 can be severe enough to warrant prescription medication.

For my husband and me, benzonatate (for the cough) and promethazine (for the nausea) were lifesavers. Some colleagues were prescribed codeine-based cough medicine or Zofran. If you feel you might need them, ask your doctor about medications sooner rather than later. Dont wait until youre doubled over coughing or cant keep anything down.

If you dont have a primary care doctor, some urgent care clinics offer virtual appointments, and some pharmacies offer prescription delivery.

Dry air can exacerbate some symptoms such as coughing and chest tightness. If you have a humidifier, use it. If not, a hot shower works.

Several readers reported that they felt better when they lay on their stomach. A woman in Britain whose partner was sick for several weeks told me that a particular breathing exercise helped him:

You take a deep breath, hold it for 5 seconds and release. Do that 5 times, then on the 6th time on the release, cough hard. Do that cycle twice, then lie on your front and take slightly deeper breaths for 10 minutes. Try to do it a couple of times a day.

In some cases, your doctor may also prescribe an albuterol inhaler to reduce your cough and ease your breathing.

As soon as you get sick, start a detailed log. Every time you take your temperature do it several times a day, at consistent times log it. Every time you take a pill, log it. Every time you eat or drink, log it. If one symptom resolves or a new one develops, log it.

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Nearing 100000 COVID-19 Deaths, U.S. Is Still ‘Early In This Outbreak’ – NPR

Posted: at 3:53 am

Memorial Day weekend at Robert Moses State Park on Fire Island, N.Y. As the pandemic continues, Harvard's Dr. Ashish Jha says, mask wearing, social distancing and robust strategies of testing and contact tracing will be even more important. Jeenah Moon/Bloomberg via Getty Images hide caption

Memorial Day weekend at Robert Moses State Park on Fire Island, N.Y. As the pandemic continues, Harvard's Dr. Ashish Jha says, mask wearing, social distancing and robust strategies of testing and contact tracing will be even more important.

The bleak milestone the U.S. is about to hit 100,000 deaths from COVID-19 is far above the number of deaths seen from the pandemic in any other country.

So far, the impact of the coronavirus has been felt unevenly, striking certain cities and regions and particular segments of society much harder than others.

To get a sense of how that may change, and where in the course of the epidemic the U.S. is right now, NPR's Morning Edition host David Greene spoke Tuesday with Dr. Ashish Jha, director of the Harvard Global Health Institute and professor of health policy at the Harvard T.H. Chan School of Public Health.

Their conversation has been edited for length and clarity.

As you look at this number looming now, what are you reflecting on?

Well, a couple of things. First of all, it is a solemn moment to reflect on the idea that about 100,000 Americans have died mostly just in the last two months. The speed with which this has happened is really devastating. Of course, we've had very little opportunity to mourn all those losses because most of us have been shut down. And I've been thinking about where we go into the future and fall and reminding myself and others that we're early in this outbreak. We're not anywhere near done.

The U.S. ... has had more deaths than any country in the world. Do you think that the country is absorbing the significance of these numbers?

I think for a majority of Americans, this doesn't quite feel real because the deaths have been concentrated in [a] few places. Obviously, New York has been hit very hard, and some other places like Seattle, Chicago some of the big cities. And so people who don't live in those areas may not be absorbing it.

But the nature of this pandemic is that it starts and kind of accelerates in big cities, but then it moves out into the suburbs and into the rural areas. So, by the time we're done with this, I think every American will have felt it much more up close and personal. That's what I worry about that it shouldn't have to take that for people to really understand how tragic this is and how calamitous in many ways this is.

Q: We're coming out of Memorial Day weekend, and we saw many regulations relaxed in many parts of the country. As you were watching that, what are you predicting in terms of what we could see by the end of summer?

If you look at all of the models out there and most models have been relatively accurate a few of them have been too optimistic. But then, if you sort of look at the models of models the ones that really sort of combine it all and put it together and make projections the projections are that we're probably going to see 70,000 to 100,000 deaths between now and the end of the summer.

While the pace will slow down, because we are doing some amount of social distancing and testing is ramping up we're going to, unfortunately, see a lot more sickness and, unfortunately, a lot more deaths in the upcoming months.

Q: There's been talk of a seasonal aspect to this. Whatever happens over the summer, do we face even more deaths as we head later in the year?

Yes. I'm hoping that the models of the summer of an additional 70,000 to 100,000 deaths are too pessimistic. And they may be, because we may get a seasonal benefit because of the summer: People are outside more.

But the flip side of the seasonal benefit of the summer is what will almost surely be a pretty tough fall and winter with a surge of cases a wave that might be bigger than the wave we just went through. And we've got to prepare for that, because we can't be caught flat-footed the way we were this time around.

Q: What can we do to prepare? We're seeing so many states relax restrictions right now. Is it a matter of potentially putting those restrictions back in place where they need to be? Or are there other things we could be doing?

There are two things that I would say. First of all, people can't be locked down for the rest of this pandemic. I understand that people need to get out, and being outside is a good thing. But we have to maintain a certain amount of social distancing. I think mask wearing is really important.

The only other tool we have in our toolbox is a really robust testing, tracing, isolation program. You know, if you think about how it is that South Korea and Germany have been able to do much, much better? They have had a really aggressive testing, tracing, isolation program. We know that works. It allows us to kind of have more of our lives back without the number of deaths that we've suffered. So I really think that still remains and should remain one of our priority areas.

Q: The federal government's new strategic testing plan calls on states to take a lot of the responsibility for testing. ... Do you see that as the best approach?

I think this is a real missed opportunity and very unfortunate in many ways, because while states have a critical role to play, testing capacity and testing supply chains are national and international.

We don't want 50 states competing. We want a federal strategy that helps states. And I'm worried that we're just not getting that from the federal government.

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Nearing 100000 COVID-19 Deaths, U.S. Is Still 'Early In This Outbreak' - NPR

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New research rewrites history of when Covid-19 took off in the US – STAT

Posted: at 3:53 am

New research has poured cold water on the theory that the Covid-19 outbreak in Washington state the countrys first was triggered by the very first confirmed case of the infection in the country. Instead, it suggests the person who ignited the first chain of sustained transmission in the United States probably returned to the country in mid-February, a month later.

The work adds to evidence that the United States missed opportunities to stop the SARS-CoV-2 virus from taking root in this country and that those opportunities persisted for longer than has been recognized up until now.

Our finding that the virus associated with the first known transmission network in the U.S. did not enter the country until mid-February is sobering, since it demonstrates that the window of opportunity to block sustained transmission of the virus stretched all the way until that point, the authors wrote in the paper. The paper has been posted to a preprint server, meaning it has not yet been peer-reviewed or published in a journal.

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The research was led by Michael Worobey, a professor of evolutionary biology at the University of Arizona.

Using available genetic sequence data, Worobey and his co-authors modeled how SARS-CoV-2 viruses would have evolved if the original case, known in the medical literature as WA1 (short for Washington state patient 1), had been the source of the states outbreak. They ran the model 1,000 times, comparing the genetic sequences of 300 randomly selected simulated cases to those retrieved from 300 actual patients. The results didnt jibe.

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In all likelihood this didnt start with WA1, Worobey told STAT in an interview. It started with some unidentified person who arrived in Washington state at some later point. And we dont know from where.

Worobey said the sequence data suggest the infection may have been brought to the country by someone returning from China, or from a nearby Asian country, or even from Asia via British Columbia, Canada.

Trevor Bedford, a computational biologist at the Fred Hutchinson Cancer Research Center in Seattle, drew the initial line between the first Washington state case a man who returned to the state from Wuhan on Jan. 15 and the states first reported case in someone who had not traveled outside the country. That person, a high school student who had been tested negative for influenza, was recognized as a Covid-19 case at the end of February.

Analysis of the genetic sequences of the viruses that infected these two people looked close enough that Bedford concluded SARS-CoV-2 had been spreading undetected in the Seattle area for about six weeks.

But in a series of tweets he posted on Sunday, Bedford said he now concludes that theory was not correct.

Based on data thats emerged in the intervening months, I no longer believe that a direct WA1 introduction is a likely hypothesis for the origin of the Washington State outbreak, he tweeted.

Others agree.

Im convinced by the Worobey study, Kristian Andersen of Scripps Research, an expert on viral genomes, told STAT.

Samuel Scarpino, an assistant professor at Northeastern Universitys Network Science Institute, said Worobeys paper confirms what a lot of what we were starting to suspect from the epidemiological data, that there were some early introductions in the West Coast that did not spark sustained transmission.

Worobey and his co-authors estimated that the infection that started the Seattle area outbreak arrived in the country around Feb. 13, shortly after President Trumps ban on travel from China went into effect on Feb. 2. Thousands of Americans in the country fled back to the United States in the days after the ban was announced.

Worobey said the work isnt merely an effort to set the historical record straight. If WA1 sparked the Seattle outbreak, there was really little more that could have been done to prevent it. The patient had recognized he was probably ill and alerted his physician to the risk. Public health authorities mapped his travel and contacted his contacts, isolating him and quarantining the people hed been in contact with.

When the first case of local transmission was linked back to WA1, it appeared that the efforts to contain his infection hadnt been adequate. But in fact, they probably were, Worobey said.

Conclusions that the Seattle area was already six weeks into an epidemic by the end of February, rather than two or three, and the notion that stringent efforts to prevent spread had failed in the WA1 case, may have influenced decision-making about how to respond to the outbreak, including whether such measures were worth the effort, he and his co-authors wrote.

Scarpino said the research supports the idea that contact tracing and isolation can work. Everything is sort of lining up in the direction that if were serious about it, we can control this thing, he said. Were just not being serious about it.

Worobeys group also disputed a claim, published earlier this month, that a more transmissible lineage of SARS-CoV-2 viruses has emerged, arguing the increased geographic spread of viruses with that mutation pattern has more to do with timing than with increased infectiousness.

Viruses with these mutations spread from Hubei province to Italy and from there to New York City and began to spread locally undetected for a time. This viral lineage appears to have been amplified because of luck, not high fitness, they wrote.

Correction: The headline on an earlier version of this story misstated a key finding of the new research that the coronavirus took off in the U.S. later than previously thought.

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New research rewrites history of when Covid-19 took off in the US - STAT

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Confused by the science behind Covid-19? You’re not alone – CNN

Posted: at 3:53 am

The answer, though fanciful, illustrates just how hard it can be to understand exponential growth and doubling, two pieces of math that explain the spread of viruses like Covid-19.

Because by the time you made the 42nd fold, your stack of paper would reach the moon. It's not just a handy fact for trivia night: It shows how exponential growth can result in numbers that are nearly incomprehensible.

"Math concepts are really hard," she said. "It's not a surprise that the general public has a hard time grasping these."

And now, with a pandemic dominating global headlines, Covid-19 is putting Americans' knowledge to the test.

Classroom educators and education activists have said they're concerned by some aspects of the public response to the virus, including angry reactions to the guidelines designed by epidemiologists to keep America safe.

"If people understood how an outbreak could take off so quickly, and it does get back to this concept of exponential growth, they might be more careful about how they go about their day," Wasserman said.

Quiz time

Learning to think like a scientist

While the basics of viral spread, infection and other scientific ideas can help decode stories about Covid-19, many science educators say there's a broader perspective required when it comes to understanding what's happening in the world.

"It's impossible to teach students about everything," said Blake Touchet, who teaches biology at North Vermillion High School and Abbeville High School in Louisiana.

There's simply too much to know, he said. And the frontiers of scientific knowledge are always changing as theories get updated and revised. Instead, Touchet teaches his students to think like scientists.

"It's important that they understand how the process of science works, so that they can continue growing and learning even when they're out of school," he said.

One skill that Touchet emphasizes in his high school classes is called source evaluation, which can be applied to news articles, podcasts or even a study from a scientific journal.

"Analyzing and evaluating it to see if it has bias, or whether it's containing accurate information or whether it's reliable," he said.

In teaching students about the process of science, Touchet also emphasizes the significance of scientific consensus, which can bring clarity to contentious topics.

"There was a study that was published showing that 97% of scientists agree with anthropogenic climate change that humans are causing climate change," he said, offering an example of a clear scientific consensus.

In the news, Touchet said the situation is sometimes represented as an unresolved debate, despite the fact that most experts actually agree on the facts.

"That was a really good visualization of what we're thinking about when we're looking at scientific consensus," Touchet said. "We're not talking about people who are agreeing or disagreeing with each other. We're talking about data."

It's an idea that Touchet said is directly applicable to understanding news about Covid-19, especially when a lone scientist goes on television to tout a so-called cure with little support in the broader community.

America's education gap

Those skills of evaluating scientific ideas are more essential than ever, but Americans' grasp of science varies widely.

Where you went to school matters, too.

Students in some areas have few opportunities to engage with science outside of school, Reid said. She called these places "science deserts," and while the NCSE works in many rural areas, Reid explained that some urban students also lack access to learning opportunities.

Where science meet politics, that information gap feeds a dangerous division.

"Teacher education programs should anticipate, and equip future teachers to deal with, the politicization of science," the report found.

And while the challenges of understanding math and science are not limited to the United States, Americans' competencies in these subjects often fall far behind other developed countries.

In the most recent figures from the Programme for International Student Assessment, students from the United States ranked 37th in math among participating education systems. We did a bit better in science, coming in at 18th place.

Learning more about science at any age

Just because Americans lack some basic information about science doesn't mean they're not interested.

"The term 'anti-science' is thrown around a lot, and I don't think it captures the situation very well," Reid said.

"There are certain areas of science where there's a lot of misinformation pumped into the system, and people accept that information because it's coming from people they trust. But I don't think that makes them anti-science."

In fact, some of the same polls that revealed gaps in Americans' understanding of science spoke to their desire to learn more. A 2016 National Science Board study found that 95% of Americans were interested in new medical discoveries, and 84% were interested in scientific discoveries.

If you're one of the Americans who wants to learn more, there are plenty of free resources for brushing up on your understanding of science.

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Neurohacking, Brain Health and the Formula of the Future …

Posted: at 3:50 am

The word itself neurohacking sounds a little futuristic, a little too on-the-nose and ripped straight from the Matrix movies or an old sci-fi book.

And yet here we are, living at a time when the purposeful tweaking of brain functions is fast becoming an everyday practice for those eager to improve their mental and emotional well-being.

Neurohacking is, simply, a collection of practices intended to upgrade the mind and boost ones personal capacities, and it is not as outlandish as it first seems.

Lets take a commonplace example, say, having a cup of coffee. The chemical properties of caffeine affect your central nervous system and therefore your brain, increasing mental energy and focus. When you sip on that morning cup, youre ingesting a substance that enhances performance. So, in a way, youre hacking your consciousness.

RELATED:6 Supplements that Promise to Give you a Mental Edge

When a cluster of these cognitive enhancing bio-hacks are happening simultaneously, one can be said to be in a flow state, a concept that most of us are familiar with, and one that is widely used as an experiential and experimental benchmark in neurohacking.

Flow states, being in the zone, living in the moment. Weve all had those experiences.

An unflappable and quiet invincibility, done effortlessly without second thought or doubt, when time stands still and the outside world fades away, leaving nothing but a perfect state of you, where Being and Doing overlap, and then merge to become indistinguishable from each other. Stars align, vectors cross perfectly, stars align and we find ourselves incapable of doing wrong: knocking down a barrage of three-pointers, absolutely crushing the critical sales presentation, intrinsically grasping all of the subtleties of a subject during an intense study session.

While rare, we all yearn to experience these moments of transcendence again. Neurohacking, however, sees the flow state as the Holy Grail, and strives to create and then recreate those perfect conditions to be our most perfect self. Currently, the most researched and popular way to do so is through nootropics.

Another term pulled straight from the future, nootropics are also known as smart-drugs and cognitive enhancers, and are any drugs, supplements or substances that purport to improve cognitive functions, particularly focus, memory, creativity and motivation.

Do a quick online scan and youll see that a proliferation of nootropics has flooded the market recently. Some are clearly just riding the wave, while others are better-intentioned and better-designed.

One common problem across the spectrum of companies, however, is that they often fail to deliver a complete and well-rounded product; their nootropics are usually developed so narrowly as to only optimize or enhance one small aspect of cognition at the expense of others. For example, a nootropic may deliver on boosting your mental energy but fail to help you focus, so youll lack the calibration necessary to harness that energy and your efforts will scattershot.

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Clearly, it seems that what is missing is a more systemic, unified approach.

Enter the Neurohacker Collective, a group of scientists, intellectuals and researchers who are exploring the frontiers of bio-plasticity from a higher-order perspective, and working to develop and promote an overall and integrated strategy of complete care for the self.

By stressing the complexity and interdependence of all the factors that make up ones cognitive and emotional well-being, their lofty mission is no less than to upgrade our capacity as a species.

Diverging from the many other nootropic supplements that only focus on a single aspect of improving cognitive functioning, the Neurohacker Collective aims to address the entire body/mind interface and provide many of the tools necessary to enhance cognition.

The Neurohacker Collective seems to be one step ahead of the game, imagining not just a way to cultivate and extend flow states, but better yet, envisioning a future where that state is the new normal.

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A Leg Up in the Search for Prosperity: Economic Freedom – Governing

Posted: at 3:50 am

In the interstate economic-development wars, few rivalries can match the long-running one between California and Texas. At a time when so many Americans have such sharply divided attitudes on the proper role of government, these states illustrate the extremes. They're both also thought to be, in their own way, models of success, yet they have very different outcomes.

Texas is best understood as a place where the private sector prevails over the public sector. Among the 50 states, it ranks near the top in economic freedom, a measure of fiscal and regulatory policy, and near the bottom in overall tax burden. It's a state known for building, with Dallas and Houston routinely among the top metros in new home permits and Austin first in the nation for permits per capita since 2004. But state and local government spending per capita is the 11th-lowest of any state, according to data from the Tax Policy Center.

California's the opposite: a state where the government is large and powerful and the private sector is taxed and regulated to support that. It is near the bottom in economic freedom and near the top in overall tax burden. It ranks as one of the most regulated states for land use, highlighted by famously constricted metros like San Jose and San Francisco. It has strict labor laws high minimum wages, barriers to independent contracting, union favoritism that are meant to foster a middle class. State and local government spending per capita is the nation's sixth-highest.

So which model has better enabled prosperity? Well, advocates on both sides can point to strong numbers. California and Texas are in the top 10 in GDP growth, the top three in the number of Fortune 500 companies, and first and second in population. They're viewed by their respective ideological tribes as policy innovators Texas as a place where the working class can buy homes and start businesses, California as a place that cuts carbon, expands entitlements and spurs tech innovation.

But California's model increasingly comes with an asterisk. While its economy looks impressive on paper, fewer and fewer people get to enjoy it. Heavy land-use regulations make housing markets inelastic and expensive, with median home prices more than double the national number. The labor laws, rather than fostering a robust middle class, just make everything more expensive. The faith in and funding of government has not created superior public services, but rather a bunch of state and local bureaucracies that escalated debt by awarding themselves unsustainable pensions. Despite the high taxes which hit every resident California has the 10th-highest per-capita government debt; of the nine local governments that filed for bankruptcy between 2010 and 2019, three were in California.

People have responded with their feet. More leave California than move in, and a 2019 survey found that 53 percent of its residents were considering leaving the state, citing high costs. Much of the exodus goes to Texas. California is now the No. 1 exporter of people to the Lone Star State. It's not that California is losing population: Since 2010, it has gained 2.3 million residents. Meanwhile, however, Texas has added 3.9 million, more than doubling California's population growth rate.

And it's not just people. Businesses are leaving California too, at an estimated annual clip of over 1,000. For 12 straight years Texas has been the biggest recipient of businesses leaving California. Texas has long sought to capitalize on and accelerate that trend, even running ads in California touting Texas' business friendliness.

More than data, though, it's the feeling of what can be accomplished in a state that emphasizes freedom versus one strangled in red tape and high taxes. Houston ended veterans' homelessness in part by cheaply building large supportive housing projects; California cities have spent billions fighting homelessness, but still have tent cities because it costs so much to build affordable housing there. Dallas has, over three decades, built the nation's longest light-rail system, and a private company is planning high-speed rail between there and Houston. California metros have struggled to add capacity to their transit systems, and last year the state's high-speed rail project lost federal funding due to ongoing delay. Perhaps most damning is an annual survey by Chief Executive magazine asking CEOs nationwide to rank state business climates. Texas has been first for 15 straight years, and California in last place for five.

This should be a wake-up call both to Californians, to fix the flaws within their government, and to those who want to make the California model national policy. While it aims to help people, it ultimately inflicts costs that drive them out. The fact that many of these people go to Texas speaks volumes about which model really works.

Governing's opinion columns reflect the views of their authors and not necessarily those of Governing's editors or management.

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Rich Lowry: The return of the tea party – Salt Lake Tribune

Posted: at 3:50 am

Its 2009 again, or feels like it.

That was when spontaneous, grassroots protests against overweening government sprang up and were widely derided in the media as dangerous and wrong-headed.

The protesters then were inveighing against Obamacare; the protestors now are striking out against the coronavirus lockdowns.

The anti-lockdown agitation shows that, despite the revolution in Republican politics wrought by President Donald Trump, opposition to government impositions is deeply embedded in the DNA of the right, and likely will reemerge even more starkly if former Vice President Joe Biden is elected president.

The tea party that was so powerful in the Obama years, roiling Republican Party politics and making stars out of the likes of Marco Rubio and Ted Cruz, sputtered out and was subsumed by the Trump movement in 2016.

The emphasis on constitutionalism, opposition to deficit spending, and American exceptionalism gave way to an emphasis on American strength, opposition to immigration, and nationalism.

The differences shouldnt be exaggerated the tea party was opposed to amnesty for undocumented immigrants and Trump has faithfully nominated constitutionalist judges. The tea party, like Trump, hated the mainstream media with a passion. But the shift from an overwhelming focus on fiscal issues to Trumpian cultural politics was very real.

The change was exemplified by the House Freedom Caucus, founded in 2015 and defined by its hard line on government spending, reliably lining up behind Donald Trump who has pursued a notably expansionary fiscal policy with huge budget deficits even before the coronavirus crisis.

The intellectual fashion among populists and religious traditionalists has been to attempt to establish a post-liberty or "post-liberal" agenda to forge a deeper foundation for the new Republican Party. Instead of obsessing over freedom and rights, conservatives would look to government to protect the common good.

This project, though, has been rocked by its first real-life encounter with governments acting to protect, as they see it, the common good.

One of its architects, the editor of the religious journal First Things, R.R. Reno, has sounded like one of the libertarians he so scorns during the crisis. First, he complained that he might get shamed if he were to host a dinner party during the height of the pandemic, although delaying a party would seem a small price to pay for someone so intensely committed to the common good.

More recently, he went on a tirade against wearing masks. Reno is apparently fine with a much stronger government, as long as it never issues public-health guidance not to his liking.

Reno has published vituperative attacks on the conservative writer (and my friend and former colleague) David French, supposedly for having a blinkered commitment to classical liberalism. But it is the hated French who has actually tried to thoughtfully balance liberty and the common good during the crisis, favoring the lockdowns at first and favoring reopening now that the lockdowns' goals have been achieved.

What's happened during the lockdowns is that the natural distrust that populists have of experts has expressed itself in opposition to government rules. Being told what to do by epidemiologists and government officials wielding all-caps SCIENCE as their authority has been enough to bring tea party-era liberty back in vogue.

We've also seen a return of the glue that has held moral traditionalists and libertarians together in the conservative coalition for so long the belief that big government is a threat to traditional institutions. Hence, the focus on resuming church services.

In retrospect, the tea party wasn't as much a purely liberty movement as it seemed at the time. A populist anti-elitism was an enormously important factor, which is why it faded into the Trump movement so seamlessly. On the other hand, Trumpian populism has a big streak of liberty to it.

All it has taken to bring it to the fore is extraordinary government intrusion into our lives. If Biden is elected president, there's more where that came from.

Rich Lowry is editor of National Review.

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COVID-19 reveals conflict, compassion of Kansans wrestling with threat of pandemic – Leavenworth Times

Posted: at 3:50 am

This content is being provided for free as a public service to our readers during the coronavirus outbreak. Please support local journalism by subscribing to your local newspaper.

TOPEKA Defiance of Gov. Laura Kellys handling of COVID-19 emerged immediately from members of the Legislature and gained momentum as barbers, ministers and gun-rights activists chafed under statewide government restrictions and led pandemic skeptics to increasingly thumb their nose at health risks.

Criticism of the Democratic governors performance since the crisis bloomed in March hasnt been universal.

President Donald Trump said during Kellys trip to the White House in mid-May that she was doing a "fantastic job," earning her a form of presidential praise Kansas GOP politicians eagerly seek from Trump.

Sen. Dinah Sykes, a Johnson County Democrat, said the decision by Kelly in March to be the first governor to call off in-person classes in all public and private K-12 schools "saved lives."

In self-defense, Kelly said health and safety considerations guided her thought process. She said she clung to that principle even while issuing executive orders disliked by a majority of the people she represented.

"This is not about power," the governor said. "It is about leadership. It means standing up for whats right and not being bullied into taking action that would be disastrous for the people of Kansas."

Divergent voices

Kelly launched a series of news conferences on COVID-19 broadcast live on Facebook. Each represented a rare chance for a Kansas governor to repeatedly take messages directly to the people. Most draw audiences of 30,000 or 60,000 viewers.

Still, the effort wasnt likely to mute criticism.

McPherson barber Luke Aichele created a stir by denouncing Kellys closure of nonessential businesses, including hairdressers and barbers struggling to hold on to their small businesses. He said shutting down his barber shop was "discriminatory, biased and not very well thought out."

In Manhattan, City Commissioner Mark Hatesohl said government officials exaggerated dangers of COVID-19 and he concluded it would be best to welcome spread of the infection and begin developing mass immunity so people could "get back to living."

Todd Eck, of Wichita, showed up at a Statehouse rally in opposition to the governors executive orders. He volunteered to be injected with COVID-19 to demonstrate it wasnt something to be feared. Others at the event, including Kennedy Horacek, brought semi-automatic rifles to proclaim their right to protect themselves from the kind of tyranny embodied by Kelly.

Maj. Gen. David Weishaar, adjutant general for the Kansas Army and Air Guard, had to tamp down bizarre claims on social media the National Guard would be mobilized to enforce a national quarantine. He said such claims "only create confusion" and advised people to seek out COVID-19 information from reliable sources.

Rep. Trevor Jacobs, a Fort Scott Republican, accused the governor of not being transparent with information about COVID-19.

"We are Kansans," Jacobs said. "We dont trust in fear, but in God. Dont keep us in the dark."

Virus cuts deep

Kansas health officials have affirmed nearly 10,000 residents of the state tested positive for the virus. Cases have been found in 88 of 105 counties. More than 840 Kansans have been hospitalized. At least 208 died.

This profound health, economic and political struggle has drawn out the best in people look no further than the mask donation by retired Kansas farmer Dennis Ruhnke, who sent a poignant letter to New Yorks governor while donating a mask to a New York health worker.

But the darker side of pandemic politics remains. There is an ongoing contest to assign blame to public officials, who are easy targets for folks not personally accountable for any outcome but eager to second-guess others shouldering that burden. The governor retains primary control of $1.25 billion in emergency federal aid, but county governments are free of most statewide orders issued in the past two months.

Kansas, so far, has experienced testing equipment shortages, closure of K-12 and college campuses, a shocking racial disparity among those killed, major outbreaks at prisons and meatpacking plants, a projected $1.2 billion state government revenue shortfall and wacky rumors of conspiracy theorists.

The governor issued more than 30 executive orders, most of which caused little controversy. Others, however, fostered huge conflict. That list includes the constitutionally questionable edict on in-person church services. It led to legal challenges, hyper-political commentary and a workable settlement.

Kellys controversial stay-at-home directive triggered distress among people unable to go to work. More than 200,000 people filed for unemployment in Kansas, but the tidal wave of applications inundated the state labor departments computer system. Some people are still waiting for checks.

The governor called on the Legislature to return Wednesday to craft a bipartisan bill updating state law guiding the government during pandemics. She vetoed a reform bill adopted during a 24-hour marathon gathering of the Legislature.

"I wish it had been a joke. I wish it had been some sort of metaphor," said Kelly, a former state senator from Topeka. "I also wish that this had not been the most embarrassing, irresponsible display of governing that we have witnessed throughout this ordeal."

The one-day proceeding at the Capitol was viewed skeptically by Rep. Ken Corbet, R-Topeka, who said: "It kind of reminds me of Gunsmoke everybody wants to load as much s*** on the wagon as they can before it gets out of town."

First case

A Johnson County woman who traveled to the East Coast was the first confirmed case of COVID-19 in Kansas. She was hospitalized in a special hospital unit in Kansas City, Kan.

"We will have more cases in the state," said Lee Norman, secretary of the Kansas Department of Health and Environment. "Its going to be hard ... to contain it."

The case was a preview of how deeply Wyandotte and Johnson counties would be touched by the virus. So far, the two counties account for more than 2,000 cases of infection and at least 130 deaths.

Kelly signed an order declaring a state of emergency on March 12.

Sen. Mike Thompson, a Johnson County Republican appointed to the seat in January, said the governors decision to close schools and limit large gatherings fueled public anxiety.

"For us to limit access of everyone to schools, to business, I think is inciting a panic that is unnecessary. This is not the ebola virus," Thompson said.

In an odd twist, the governors gender became an issue in the COVID-19 debate. Senate Minority Leader Anthony Hensley, D-Topeka, accused some Republicans of trying to blunt the governors authority because she was a woman.

"They are too blinded by their own egos and their fragile masculinity to respect the authority of the position," Hensley said.

Sen. Gene Suellentrop, R-Wichita, took exception to a letter Hensley sent to House and Senate members asserting that Suellentrop and Sen. Rob Olson, R-Olathe, engaged in "implicit racist attacks" of Delia Garcia, secretary of the Kansas Department of Labor. Both GOP senators had aggressively questioned Garcia during a Senate committee hearing about unresolved problems with processing unemployment benefit claims.

"I dont know what its like to be called the N-word. I cant even fathom that," Suellentrop said. "I feel its pretty darn close to that. The vile, vulgar accusation of being a racist."

Holy fight

Kelly issued an order April 7 limiting church gatherings to 10 people or fewer. She was responding to evidence 25% of infection clusters in Kansas were traced to church meetings. The governor, lacking enforcement authority to block church attendance, said she was "committed to protecting Kansas religious liberty."

GOP legislators aggressively argued Kelly sought to criminalize church attendance.

The Kansas Supreme Court let Kellys church order stand, prompting a First Amendment lawsuit in federal court. The case was handled by an Arizona organization on behalf of pastor Aaron Harris, of Calvary Baptist Church in Junction City, and pastor Stephen Ormord, of First Baptist Church in Dodge City.

"Singling out churches for special punishment while allowing others to have greater freedom not only makes no logical sense, its clearly unconstitutional," said Ryan Tucker, an attorney with Alliance Defending Freedom in Scottsdale, Ariz.

Kansas Attorney General Derek Schmidt discouraged law enforcement officers and prosecutors from enforcing Kellys order on gatherings at churches. In response, Kelly accused Schmidt of an "overtly political attack."

Schmidt said he recommended against Kelly issuing the order regulating churches and promised to make his feelings known if she went ahead with her plan.

"She did, and so did I," Schmidt said.

Economic bite

Full scope of COVID-19s influence on the Kansas economy is unknown, but fiscal analysts believe the state government will experience a $1.2 billion budget shortfall in the fiscal year starting July 1. The states cash reserves of more than $900 million and infusion of billions of dollars in federal emergency assistance cushioned immediate impact of a derailed economy and unprecedented unemployment.

David Toland, secretary of the Kansas Department of Commerce, said in mid-April the fallout would be lasting.

"The Kansas economy has taken a body blow from COVID and that extended from the ag sector to manufacturing to the service sector," he said. "Everybody has been hit. Its urban, rural, suburban, across the board."

In Linn County, a county requirement that merchants compile lists of their customers for purposes of possibly tracking down people unknowingly infected with COVID-19 led to a court fight.

Jackie Taylor, owner and publisher of Linn County News, and Linda Jo Hisel, who operates Nana Jos restaurant in La Cygne, filed suit to reverse the order issued by the county regarding contact tracing. Violations of the countywide order carried a $500 fine.

"We have a great deal of trust in our county officials, but this just goes too far," Taylor said. "COVID is serious, but we cant let our most basic rights be eroded."

In the end, the county modified the order and the case was dismissed.

Empathy

Dennis Ruhnke, a retired farmer in his 70s living near Troy with his wife, Sharon, decided in March to share one of his five medical-grade N95 respirators, which were coveted by health care workers.

He kept four masks for protection from the coronavirus pandemic, but mailed the respirator and a letter of explanation to New York Gov. Andrew Cuomo.

"If you could," Ruhnke wrote, "would you please give this mask to a nurse or doctor in your state?"

Cuomo read from the letter during an April news conference.

"It's that love, that courage, that generosity of spirit that makes this country so beautiful," Cuomo said.

Kansas State University presented Ruhnke with a degree that he had been two credits short of earning for 50 years.

Damien Stevens, a critical-care physician at the University of Kansas Health System in Kansas City, Kan., volunteered to work for a week in a New York City hospital at height of the pandemic in April.

He said isolation required of dying patients at the Queens hospital was heartbreaking. In-person visits werent allowed, so nurses used iPads to link patients to family members.

"Thats kind of the final sadness," Stevens said. "I saw some patients that were married 30 to 40 years and we would transition them to comfort measures and the only way they had to say goodbye to family members would be through an iPad."

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To Rebuild the Economy, India Needs to Be Atmanirbhar in Ideas – The Wire

Posted: at 3:50 am

The people of India have by now come to expect the announcement of a new programme from the government at periodic intervals. Thus in the past six years, we have had Make in India, Swachch Bharat and Less Cash. Now there is something larger, a goal. In his address to the nation on May 11, Prime Minister Narendra Modi called for an Atmanirbhar Bharat. Actually, self-reliance was the stated goal of economic policy in India in the early years after 1947. The architect of this plan was Jawaharlal Nehru, whose record as prime minister especially economic intellectuals associated with this government have trashed relentlessly. Now, over half a century after his death, the fulcrum of his vision for India has been ceremoniously brought back with nary an acknowledgement.

Both the facts of economic development across the world and advances in the methodology of empirical research would help us make sense of the economic policies of early independent India. History suggests that India did not pursue a strategy entirely out of line with what was adopted elsewhere. More importantly, we have evidence that growth here first accelerated in the early 1960s. This could only have been a consequence of the policies adopted in the earlier decade, notably the Nehru-Mahalanobis Strategy of investing in capital goods production via newly formed public enterprises. This evidence cannot be jettisoned easily. It is based on a statistical procedure that is free from the predilections of the practitioner. It conclusively disposes of the stance that nothing really changed in India after 1947, a view once held at both ends of the political spectrum but now the preserve of the right-wing. The same procedure also reveals that growth did not accelerate after the Modi government has come to power.

Jawaharlal Nehru. Photo: Wikimedia Commons

However, while we know that the 1950s were literally path-breaking, we also know that the performance of Indias economy has for far too long left much to be desired. This is apparent when we look to our east, where all countries have surged ahead of us, raising national income and spreading it widely. We also know exactly how this has been achieved. Even as they had accumulated physical capital, our East Asian counterparts developed their human resources. The question staring at us is why a society with a highly educated elite in power failed to observe this as development played out over decades.

Swaraj in ideas

The answer may be found in the work of an Indian philosopher who showed us exactly where the problem lay.In an address to the students of Hooghly College close to a century ago, Kalidas Chandra Bhattacharya spoke of swaraj in ideas. By this, he had meant the importance for a people to aim for self-determination in thought. Implicit in this was the idea that political freedom, at that time seen as the liberation of India from colonial rule, was insufficient; Indians must free themselves from the yoke of Europes premises. He was not advocating cultural chauvinism but an intellectual autonomy when choosing what is best for India.

Also Read: Will Indias Economic Recovery Be Quick? Modi Says So, But This Cant Happen in a Vacuum

In a striking demonstration of what can go wrong if we do not keep our own counsel, today India finds herself saddled with an economic model of unbounded growth that destroys natural capital and a political model based on the vision of a majoritarian nation-state that promises endless social turmoil. It is not clear that a course correction will emerge from Indias political parties competing for power. Only a collective effort can achieve it. However, India is severely challenged in doing so, and this stems from the absence of self-determination in the realm of ideas. It has meant that we are unable to see the intrinsic strengths that have served us so well for so long.

From a narrow economic point of view, it is easy to see that the failure to spread education has led India to the cul-de-sac where she finds herself. But the answer does not lie in expanding a flawed model unsuited to India. In his book Constructive Programme, Gandhi had already pointed this out when he said:

Foreign rule has unconsciously, though none the less surely, begun with the children in the field of education. Primary education is a farce designed without regard to the wants of the India of the villages and for that matter even of the cities. Basic education links the children, whether of the cities or the villages, to all that is best and lasting in India. It develops both the body and the mind, and keeps the child rooted to the soil with a glorious vision of the future in the realization of which he or she begins to take his or her share from the very commencement of his or her career in school.

Gandhi was able to identify the immediate consequence of adopting imported ideas without assessing their intrinsic worth, leave alone their suitability to India. An area in which India has had to pay a high price for following this practice is the economy.

The Washington Consensus

At the implosion of the Soviet Union and the end of its East European empire, the view that the world has arrived at the end of history triumphed. While Francis Fukuyama, the author of this view, had had in mind the installation of liberal democracy as the sole model of governance, he could not have imagined the sea change that was to come in the sphere of the economic architecture of societies. There occurred at that stage a wholesale shift to a set of economic ideas termed the Washington Consensus, eponymous with the centre of global power.

Public policy now came to be interpreted almost exclusively as macroeconomic policy, and among its tenets were the avoidance of budget deficits, flexible exchange rates and the pursuit of low inflation. The absence of microeconomic goals was not an accident, it merely followed from the view that there should be no interference with market forces represented by the actions of individuals. From the Washington Consensus emerged the idea of inflation targeting underpinned by central bank autonomy, which meant that there would be explicit inflation targets but none for employment. This implies that monetary policy must remain tight out of fear of stoking inflation even if a more accommodative stance can increase employment. It is not easily seen that this in effect privileges the owners of financial wealth, set to lose from inflation, over the aspiration of workers, who would gain from an expansion in output.

For fiscal policy, the Washington Consensus recommended low budget deficits, though the idea of fiscal deficit caps appears to have come from the architecture of the European Union. By the mid-90s, these ideas had reached Indias shores but it is the government of Narendra Modi that has adhered to them most closely by championing fiscal consolidation, the reduction of deficit, and institutionalising inflation targeting through an act of parliament.

Prime Minister Narendra Modi speaks in the Lok Sabha. Photo: PTI/LSTV

While the US has shown itself to be willing to re-look at the tenets of the Washington Consensus when it faced a financial crisis in 2008 and now in the face of the COVID-19 pandemic, India is locked into them. The principal indicator of this is the unwillingness to budge from a previously announced fiscal deficit target. It is, of course, difficult to conclude from this whether the government is motivated by the desire to adhere to the pre-announced fiscal deficit target on economic grounds or if it uses this arrangement as a convenient alibi for adhering to a non-interventionist stance that is its ideological lodestar. In any case, the so-called stimulus announced by the PM and detailed by finance minister Nirmala Sitharaman reflects the ideas contained in the Washington Consensus.

Also Read: For India to Become Atmanirbhar in 10 Years, Do Indians Have to be Atmanirbhar Now?

India has paid highly for having abandoned the self-reliance in ideas that was the hallmark of its economic policy in the 50s. That experiment had drawn the best economists of the world to the country so that they could observe first-hand what was being attempted here. Right now, we are nowhere near regaining that situation as economic policy here is merely derivative of what was considered kosher in the US 25 years ago. It is striking that education did not figure among the five pillars that the PM identified as the foundation of an atmanirbhar Bharat: economy, infrastructure, system, democracy and demand. This could well turn out to be a momentous omission. Without overhauling our educational system, the prospect for self-reliance is limited.

Pulapre Balakrishnan is professor of Ashoka University, Sonipat and senior fellow of IIM Kozhikode.

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