Small rewards lead to big wins for saving veterans’ lives

41% drop in risk of death seen in veterans who got incentives to stick with recovery from using stimulants like methamphetamine and cocaine, compared with those who didn’t

Michigan Medicine - University of Michigan

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The chance to win a few dollars every time they pass a drug test, and the possibility of bigger prizes the longer they stay off drugs like methamphetamine and cocaine, may be enough to keep veterans from dying as they navigate early recovery, a new study suggests.

In all, veterans had a 41% lower risk of dying when they received a type of care called contingency management (CM) through the Veterans Administration as part of their recovery from stimulant use disorder, compared with a closely matched group of veterans who didn’t get CM care.

Contingency management uses cash or gift certificate prizes as incentives for keeping up with substance use disorder care and days without substance use.

Past research has shown it to work across substance use disorders to promote recovery -- including for substances where there’s no medication that’s FDA-approved to aid in recovery, including stimulants.

The new study suggests CM saves lives – and not just stimulant-related or drug-related deaths, but all causes of death.

It’s published in the American Journal of Psychiatry by a team from the University of Michigan and the VA Ann Arbor Healthcare System.

“This is the strongest real-world evidence to date that contingency management care for people with stimulant use disorder is linked to a significant drop in deaths. It shows the importance of the VA’s leadership in making CM available to veterans,” says Lara Coughlin, Ph.D., the addiction psychologist and health care researcher who led the study.

“We have made great progress in improving care for people with opioid use disorder, but it’s critical to also treat stimulant use disorder, with half of all overdose deaths in America now involving stimulants,” she added. “We hope these findings will help increase use of CM in the VA as well as in other settings.”

Right now, she notes, only five states have received permission to use CM through their Medicaid programs. Michigan has a demonstration program under way that could pave the way to increase access to CM for people with substance use disorders. Private insurance coverage for CM nationwide is inconsistent.

“The VA was a decade ahead of the rest of the nation in making CM available, and that has given us the ability to study the impacts,” said Coughlin, who co-directs the Michigan Innovations in Addiction Care through Research & Education, or MI-ACRE, program with addiction psychiatrist Allison Lewei Lin, M.D., M.S., senior author of the new paper. Both Coughlin and Lin are faculty in the U-M Department of Psychiatry and members of the U-M Addiction Center, and Lin is an addiction care provider at VAAAHS.

More about the study and its findings

The researchers used data drawn from the VA’s digital health records and started with a pool of 138,280 patients diagnosed with stimulant use disorder between July 2018 and December 2020. They zeroed in on 1,481 who had received CM as part of their care, then identified 1,481 who matched those patients in multiple ways, to make a comparison group.

Their average age was 52, and 95% were male, and just over half of both groups were unhoused. Most (73%) of the veterans in both groups had gone to a VA clinic to receive care for stimulant use disorder in the last year.

Just over half also had an alcohol use disorder, 26% also had opioid use disorder, and nearly 75% had one or more major physical or mental health conditions beyond their substance use conditions.

In the year after the study period began, 27 veterans in the CM group died, compared with 46 in the comparison group.

After statistical analysis, the researchers found the 41% reduction in risk of death in the first year for those enrolled in CM. In addition, they observed a 33% reduction in risk of death by overdose, and 42% reduction in deaths that involved stimulants.

“The magnitude of these reductions are similar to what we see when people with opioid use disorder receive buprenorphine, a first line medication-based treatment for opioid use disorder, to aid their recovery,” said Coughlin. 

But the study also highlights the complexity of this patient population, she said.

As a group, veterans with stimulant use disorder were twice as likely as veterans in general to die within a one-year period.

Among those with stimulant use disorder, those receiving CM were more likely to be hospitalized in the study period and were more likely to have a psychiatric hospitalization than those who didn’t receive CM. But nearly 40% of those in the non-CM group were also hospitalized.

The increase in psychiatric hospitalization in the CM group may have had a protective effect, Coughlin notes, because it may have helped veterans get intensive care for mental health conditions that might affect their ability to engage with recovery, and ultimately to stay alive.

Coughlin and colleagues note that outside the VA setting, CM has faced barriers to getting implemented, including limits on total value of incentives that a person can earn in a year, and general concern about ‘rewarding’ people with substance use conditions.

But, she said, as more CM programs begin and evidence about its real-world impact mounts, the understanding of CM as an aid to recovery is growing.

She and colleagues have also begun leading a digital form of CM, using smartphones and virtual gift card vouchers as prizes, for Michiganders with substance use disorders and for Medicaid participants in Michigan who are pregnant and use tobacco.

 

Additional authors:

 

Additional authors: In addition to Coughlin and Lin, the study’s authors are Devin C. Tomlinson, Ph.D., Lan Zhang, Ph.D., H. Myra Kim, Sc.D., Madeline C. Frost, Ph.D., M.P.H., Gabriela Khazanov, Ph.D., James R. McKay, Ph.D., and Dominick DePhilippis, Ph.D.

Coughlin, Lin and Kim are members of the U-M Institute for Healthcare Policy and Innovation. Coughlin is Mental Health Equity Lead for the Eisenberg Family Depression Center, and Lin and Kim are also members of the VA Center for Clinical Management Research.

The study was funded in part by the VA Office of Mental Health and Suicide Prevention.

Contingency Management for Stimulant Use Disorder and Association With Mortality: A Cohort Study; American Journal of Psychiatry, https://psychiatryonline.org/doi/10.1176/appi.ajp.20250053

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Journal

American Journal of Psychiatry

DOI

10.1176/appi.ajp.20250053 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Contingency Management for Stimulant Use Disorder and Association With Mortality: A Cohort Study

Article Publication Date

10-Sep-2025

 

Switch on, switch off: the dynamic defense of a deadly plant disease

How P. infestans rapidly adapts to fungicide threats

Peer-Reviewed Publication

Boyce Thompson Institute

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The notorious pathogen that caused the Irish Potato Famine in the 1840s is still a major threat to potato and tomato crops worldwide. This oomycete water mold, Phytophthora infestans, can devastate entire fields, posing a constant threat to global food security. For decades, farmers have relied on fungicides like mefenoxam to manage the disease. But P. infestans is a cunning adversary.

Scientists have discovered that even strains considered sensitive to mefenoxam can rapidly develop resistance after a single exposure to a low dose of the chemical. Now, researchers at the Boyce Thompson Institute (BTI) and Universidad de los Andes have uncovered the dynamics of this defense mechanism, revealing a foe that is far more adaptable than previously thought.

“We usually think of resistance as a genetic change that happens over generations,” says Silvia Restrepo, co-lead author of the study and president of BTI. “What we’re seeing here is different. It’s a temporary survival strategy, a kind of biological toggle switch that the pathogen can activate in the face of a threat and deactivate when the danger passes.”

To understand how this switch works, the researchers conducted a series of elegant experiments, as reported in Plant Disease. They took sensitive strains of P. infestans and exposed them to a low dose of mefenoxam. As suspected, this single encounter was enough to "flip the switch," allowing the pathogen to survive and grow even when later moved to a dish with a very high, normally lethal, concentration of the fungicide.

Once the resistance was activated, it was robust. Repeatedly exposing the newly resistant pathogen to high levels of the fungicide didn't make it any stronger or weaker; the switch was simply "on". However, the researchers noted a crucial detail: while the pathogen could now grow in the presence of the fungicide, it didn't gain a reproductive advantage. It wasn't making significantly more spores (the tiny structures it uses to spread). It was surviving, not thriving.

The most remarkable discovery came when the researchers moved the resistant pathogen to a clean, fungicide-free environment. After just one transfer away from the chemical threat, it lost its resistance and became sensitive again. The switch had flipped "off." A subsequent low-dose exposure was all it took to re-activate the resistance, confirming that P. infestans possesses an incredibly flexible defense mechanism.

Such rapid, reversible behavior points away from slow genetic mutation and towards a more dynamic process known as an epigenetic change. Co-first author and BTI scientist Juliana González-Tobón explains, “Think of genetics as the permanent text in a cookbook, while epigenetics are like sticky notes you add or remove from the recipes. Rather than rewriting its DNA, the pathogen uses temporary ‘notes’ to quickly change its behavior in response to its environment.”

The pathogen employs a defense mechanism known as pleiotropic drug resistance (PDR), which activates cellular pumps to eject the fungicide. However, this process requires significant energy, which likely explains why the pathogen readily abandons the resistance once it's no longer necessary.

This research sheds new light on the survival tactics of one of history's most devastating plant pathogens. The finding that resistance doesn't boost reproduction is good news for farmers, but the pathogen's ability to temporarily "hide" from fungicides complicates disease management.

By unraveling the secrets of the pathogen’s survival mechanisms, BTI scientists are paving the way for innovative disease management strategies, helping to protect our vital food crops and advance a more sustainable agricultural future.

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Journal

Plant Disease

DOI

10.1094/PDIS-05-25-1110-RE 

Method of Research

Experimental study

Subject of Research

Cells

Article Title

Mefenoxam sensitive isolates of Phytophthora infestans can quickly acquire and lose resistance to this fungicide

Article Publication Date

5-Sep-2025

 

US State school finance reforms increased racial and ethnic funding inequities, new study finds

American Educational Research Association

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Washington, September 10, 2025—State school finance reforms designed to close funding gaps between high- and low-income districts did not reduce racial and ethnic funding inequities and in some cases increased them, according to new research. As school desegregation efforts slowed in the decades following the 1980s, these findings highlight the limitations of income-based approaches in addressing racial funding disparities in education.

The study, by Emily Rauscher of Brown University and Jeremy E. Fiel of Rice University, appears in Educational Evaluation and Policy Analysis, a peer-reviewed journal of the American Educational Research Association.

Video: Study co-author Emily Rauscher discusses findings and implications of the study

Over time, many states—through legislation or court orders—have restructured school finance systems to reduce reliance on local property taxes and direct more resources to economically disadvantaged districts. Rauscher and Fiel found that while these reforms have narrowed funding gaps by income, they did not lessen—and sometimes widened—disparities by race and ethnicity.

Using data from the U.S. Census Bureau and the National Center for Education Statistics, the researchers examined the effects of school finance reforms across the United States from 1990 to 2022. They found that state finance reforms reduced school spending gaps between the highest- and lowest-income districts by over $1,300 per pupil on average. However, the reforms also increased the spending advantage of districts with low percentages of Black and Hispanic students—by $900 and $1,000 per pupil, respectively.

“The growth in racial and ethnic funding inequity, in light of decades of school finance reforms, is surprising and needs to be addressed,” said co-author Emily Rauscher, professor of sociology at Brown University. “Persistent gaps in educational opportunity and outcomes for students of color, combined with the failure of state reforms, point to the need for new investments at the federal level.”

Reforms were more effective at reducing racial disparities in states where those disparities were already relatively modest. In contrast, reforms were less effective, or even regressive, in states with high levels of racial and economic segregation between school districts. In these more segregated states, reforms not only exacerbated racial and ethnic disparities but also failed to narrow economic gaps.

Where district-level segregation was lower, reforms tended to be more economically progressive, directing more funding to historically marginalized districts. However, the study notes that much of the racial inequality in school funding exists between, not within, states. While most states distribute funding relatively evenly by the racial and ethnic composition of districts, wealthier states still spend significantly more per pupil than poorer ones. These states tend to have higher shares of white students and lower shares of Black and Hispanic students—contributing to persistent national disparities.

Rauscher notes that this raises a critical question: If school funding remains unequal even as states distribute funds more equally, how can we ensure equal educational funding and opportunity for all children? One key solution could be the federal government, which could incentivize states to spend adequately on education and invest in states that struggle to achieve adequate funding levels.

“Slow progress from reforms targeting district economic inequality suggests state-level, class-based approaches are insufficient to address racial disparities in school resources,” said Rauscher. “Federal reforms that explicitly target racial and ethnic inequity are needed to reduce these gaps.”

Study citation: Rauscher, E., & Fiel, J. E. (2025). Slow progress: School finance reforms and racial disparities in funding. Educational Evaluation and Policy Analysis. Prepublished September 10, 2025. https://doi.org/10.3102/01623737251362855

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About AERA
The American Educational Research Association (AERA) is the largest national interdisciplinary research association devoted to the scientific study of education and learning. Founded in 1916, AERA advances knowledge about education, encourages scholarly inquiry related to education, and promotes the use of research to improve education and serve the public good. Find AERA on  Bluesky, LinkedIn,  Facebook, Instagram,  X,  and Threads.

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Journal

Educational Evaluation and Policy Analysis

DOI

10.3102/01623737251362855 

Article Title

Slow Progress: School Finance Reforms and Racial Disparities in Funding

Article Publication Date

10-Sep-2025

 

From Miami to Berlin: a stowaway rat reveals hidden global health risks

DZIF researchers pioneer standardized pathogen screening workflow after extraordinary airplane incident

German Center for Infection Research

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Rats of the species Rattus rattus (pictured) can transmit dangerous zoonotic pathogens such as Leptospira interrogans (leptospirosis), Streptobacillus moniliformis (rat-bite fever), Seoul orthohantavirus, and the rat hepatitis E virus.

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Credit: By Kilessan, CC BY-SA 3.0, Wikimedia Commons

In 2017, a Miami–Berlin flight took an unexpected turn when passengers spotted a rat on board. After landing, the rat was captured and handed over to scientists at the Friedrich-Loeffler-Institut (FLI). There, it was not only seen as a nuisance, but also as an opportunity to examine it as a potential carrier of pathogens. Investigations by scientists from the German Center for Infection Research (DZIF), in collaboration with many other scientists from the “Rodent-borne pathogens network (NaÜPa-net)”, revealed only a few zoonotic and non-zoonotic pathogens. However, the incident underscored how easily pathogens can spread across continents—and why standardized testing of animal stowaways is so important. The findings were recently published in the journal Scientific Reports.

Rats, particularly the species Rattus rattus (black, ship or roof rat) and Rattus norvegicus (brown rat), are among the most successful fellow travelers in human history. For centuries, they have been traveling on ships, trains, and trucks, spreading themselves across the globe. With millions of flights each year, their chances of crossing continents as uninvited “stowaways” are also increasing. Rats can transmit dangerous zoonotic pathogens such as Leptospira interrogans (leptospirosis), Streptobacillus moniliformis (rat-bite fever), Seoul orthohantavirus, and the rat hepatitis E virus. These infections can cause severe illness in humans.

In this case, the rat was observed by passengers on the flight from Miami to Berlin, but may have been on the plane since the passenger aircraft departed from Dubai. “Rats are true globetrotters. Wherever people travel or transport goods, rats can follow—and bring their microbes with them,” explains Prof. Rainer Ulrich, DZIF scientist at FLI and senior author of the study. 

Findings of a comprehensive pathogen screening

The rat was dissected in the FLI's high-containment laboratories, and samples of various tissues and blood samples were examined at the FLI and by numerous network partners. A multi-layered screening strategy was used, comprising bacterial cultures and characterization, high-throughput sequencing, and specific methods such as PCR, RT-PCR, and multiplex serology. This “all tools on deck” approach resulted in a comprehensive workflow that can serve as a model for similar cases in air and sea transport in the future.

The results were both reassuring and illuminating. None of the most feared rat-borne pathogens, such as hantaviruses, Leptospira bacteria, or rat hepatitis E virus, were found. This implies that the risk of infection for passengers and crew during the flight was very low. However, the detection of a methicillin-susceptible Staphylococcus aureus (MSSA) strain in the rat’s nose and intestines was somewhat concerning. Whole-genome sequencing revealed that the strain was nearly identical to those found in humans in Europe and North America. This strain carried human-specific immune evasion genes, suggesting that it had adapted to humans before ending up in the rat. Its presence implies recent transmission from people to rats and potentially the reverse.

“The surprising part was not what we didn’t find, but what we did find: a Staphylococcus aureus strain that is nearly identical to human variants. This shows that rats can pick up pathogens from us and potentially pass them back,” says Prof. Ulrich, a former member of the DZIF research area "Emerging Infections".

In addition, numerous other bacterial and fungal genera were discovered, including mostly harmless commensals such as intestinal bacteria of the genera Lactobacillus or Ligilactobacillus, as well as opportunistic pathogens such as Enterobacter cloacae and Klebsiella aerogenes. The team also identified four new viral genome segments of the little-studied Picobirnaviridae family.

Global spread, invisible risks

The study makes it clear that the risk lies not only in the pathogens that have been found, but also in what could be found in future cases. Whereas rats used to travel from continent to continent mainly by ship, today, thanks to global air travel, they can travel from Dubai to Berlin via Miami in less than 24 hours, potentially carrying viruses across three continents in a single trip.

“Our findings demonstrate that rats are not just urban pests. They should be regarded as active players in the global network of pathogen spread,” emphasizes Prof. Ulrich.

From incident to preparedness

The study provides the first blueprint for dealing with animals discovered on board an aircraft. The authors’ key recommendations include the immediate capture and containment of stowaway animals, in line with WHO and IATA regulations, as well as a standardized laboratory workflow for comprehensive pathogen screening. In the event of an emergency—such as a hantavirus finding—contact tracing, disinfection, and other measures could then be initiated immediately.

Looking ahead: rats as One Health indicators

The researchers see rats as important indicators of ecosystem health in the future. The plan is to trace the origin of such animals through genetic analysis. In this case, mitochondrial DNA analysis showed that the rat belonged to a global line of black rats. However, it remained unclear whether it had boarded in Miami or Dubai.

“This was a wake-up call,” says Prof. Ulrich. “It showed how vulnerable our interconnected world is to the spread of hidden pathogens. But it also showed that science can provide practical solutions.”

The study was conducted by a consortium involving the FLI, the Robert Koch Institute, University Medicine Greifswald, the University of Leipzig, the Universitätsmedizin Göttingen, and other partners, and was supported by the DZIF.

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Journal

Scientific Reports

DOI

10.1038/s41598-025-13199-6 

Method of Research

Experimental study

Subject of Research

Animals

Article Title

Application of a comprehensive approach to pathogen screening in a stowaway rat on an airplane

 

New climate models to reveal secret life of water

Scientists at Rice, NSF National Center for Atmospheric Research will track water’s unique fingerprints to better understand climate systems

Rice University

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image: 

Sylvia Dee, associate professor of Earth, environmental and planetary sciences at Rice University (Photo credit: Jeff Fitlow/Rice University).

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Credit: Jeff Fitlow/Rice University.

When it comes to Earth’s climate system, water is often at the center of the story — whether it’s too much, too little or arriving at the wrong time. And while today’s climate models can tell us how much rain might fall or how humid the air might be, they often can’t answer the simpler, and perhaps more important, question: Where did this water come from?

A new project led by Rice University and the U.S. National Science Foundation National Center for Atmospheric Research (NSF NCAR) is changing that. Backed by a grant from the National Science Foundation, the initiative — called SCI-SWIM, short for sustainable community infrastructure for stable water isotope modeling — will build a new and improved version of the Community Earth System Model (CESM), which can trace water across the entire planet from the clouds in the sky to the thick ice sheets deep underground.

“This work is about expanding our scientific community’s ability to study the water cycle across space and time,” said Sylvia Dee, associate professor of Earth, environmental and planetary sciences at Rice and one of the project’s lead principal investigators. “Our project will help us understand water’s unique fingerprints as it moves through the climate system: We can understand not only how much rain is falling but also where that moisture came from and how it travels through Earth’s oceans, atmosphere or the land surface.”

Those fingerprints come in the form of stable water isotopes — tiny variations in water molecules that shift in predictable ways when water evaporates, condenses, freezes or melts. By following these subtle signals, climate scientists can tell whether a storm drew its moisture from the nearby ocean or from halfway across the globe. They can separate evaporation from plants versus soil, and they can compare their simulations directly to a growing network of real-world isotope measurements collected by satellites, research flights, weather towers and even ancient ice cores.

The approach isn’t entirely new. Earlier versions of CESM with isotope tracking helped researchers unlock mysteries of past climate events. But that older system was built on outdated software and couldn’t keep up with the rapid evolution of CESM. SCI-SWIM is a ground-up redesign that will permanently weave isotope tracking into the model, making it easier to maintain, easier to share and adaptable to advances in technology. The redesign uses a new atmosphere model code base, CAM-SIMA, which implements atmospheric physics schemes through the flexible and interoperable Common Community Physics Package.

The science it enables has the potential to touch some of climate research’s biggest questions. In the atmosphere, isotopes provide clues about how clouds form, processes that play a big role in how quickly Earth warms. Over land, isotopes can help diagnose why models often overestimate humidity in dry regions and can reveal how plants interact with their environment. In polar regions, isotope-enabled ice sheet simulations will offer new insights into how ice cores record climate history and how melting ice sheets may shape sea-level rise.

“Stable water isotopes are nature’s tracers,” said Jiang Zhu, project scientist at NSF NCAR and principal investigator of the project. “They give us a direct line of comparison between models and observations, from the rain falling outside your window today to the ice layers recording climate thousands of years ago.”

The project is designed with the broader community in mind. The team plans to roll out training modules for students, provide tutorials for young researchers and even partner with local schools in Houston to collect rainwater samples for isotope analysis.

“We want the next generation of scientists, including current K-12 students, to see how the water cycle is changing in their own backyards,” Dee said.

The project co-PIs include Peter Lauritzen and William Wieder at the NSF NCAR. By the end of the five-year effort, the team expects to have a production-ready, isotope-enabled CESM that anyone in the climate science community can use. The benefits could range from sharper forecasts of extreme weather to better reconstructions of Earth’s past climate and more reliable predictions of future risks.

“Climate risk is water risk,” Zhu said. “By following every drop of water — where it comes from, where it goes and how it changes along the way — we can give communities, policymakers and scientists the information they need to prepare for what’s ahead.”