Use of antiseizure drugs with known or uncertain risks during pregnancy continues

Higher use seen among people with low level of resources

American Academy of Neurology

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MINNEAPOLIS — Despite evidence of the risk of malformations at birth, or birth defects, use of some antiseizure drugs during pregnancy has persisted, according to a study published on July 23, 2025, in Neurology®, the medical journal of the American Academy of Neurology. Use has also increased for drugs where there is not enough evidence to know if they are safe during pregnancy. People with a low level of resources had a disproportionately higher use of these drugs than people with a higher level of resources.

“These medications can be used for epilepsy, mood disorders, chronic pain and migraine, which often occur at young ages, and sometimes people are taking them before they realize that they are pregnant,” said study author Rosemary Dray-Spira, MD, PhD, of the French National Agency for the Safety of Medicines and Health Products in Saint-Denis. “The good news is that use of the drugs with the greatest risks has decreased, and use of the safest drugs has increased, but we are concerned to still see use during pregnancy of some drugs with known risks and new drugs with uncertain risk.”

The study looked at comprehensive data from a French national pregnancy registry for information on all pregnancies with exposure to at least one antiseizure medication from 2013 to 2021. The drugs were placed in three safety categories. The safest: lamotrigine and levetiracetam; those with uncertain risk, including pregabalin, gabapentin and newer drugs such as lacosamide and zonisamide; and those with known risks, including valproic acid, valpromide, carbamazepine and topiramate.

A total of 55,801 pregnancies were exposed to at least one antiseizure medication.

Those exposed to the safest drugs increased by 30% over the study.

Those exposed to valproic acid and valpromide dramatically decreased due to decreasing numbers of exposed pregnancies (down by more than 80%), increased termination rates of exposed pregnancies and among those that ended in childbirth, decreasing numbers of people having more than one 30-day prescription filled for the drug or sustained exposure to the drug throughout pregnancy.

Exposure to carbamazepine and topiramate barely decreased over the study period.

Pregabalin and gabapentin became widely used during pregnancy during this time, resulting in more newborns exposed (28% increase) and for pregabalin increasingly with multiple prescriptions and sustained exposure throughout pregnancy.

Exposure to newer drugs with uncertain risks also increased over time.

Researchers also divided the participants into three groups based on level of resources, which was defined by salary and use of a program that helps cover health care costs that are not covered by basic health insurance for people with a low income.

While mothers with low resources accounted for nearly one-fifth of pregnancies exposed to drugs with either known risks or uncertain risks (18% and 19%, respectively), this proportion was lower among pregnancies exposed to the safest drugs (14%).

“These disparities could be due to various factors, including more frequent unplanned pregnancies and suboptimal care before conception or during pregnancy for people who are socioeconomically disadvantaged,” Dray-Spira said. “More work is needed to further reduce exposure during pregnancy to these drugs, especially among the most socially disadvantaged populations.”

A limitation of the study was that information about exposure to the drugs was based on claims, not on actual use of the drugs.

Discover more about epilepsy at BrainandLife.org, from the American Academy of Neurology. This resource also offers a magazine, podcast, and books that connect patients, caregivers and anyone interested in brain health with the most trusted information, straight from the world’s leading experts in brain health. Follow Brain & Life® on Facebook, X, and Instagram.

The American Academy of Neurology is the leading voice in brain health. As the world’s largest association of neurologists and neuroscience professionals with more than 40,000 members, the AAN provides access to the latest news, science and research affecting neurology for patients, caregivers, physicians and professionals alike. The AAN’s mission is to enhance member career fulfillment and promote brain health for all. A neurologist is a doctor who specializes in the diagnosis, care and treatment of brain, spinal cord and nervous system diseases such as Alzheimer's disease, stroke, concussion, epilepsy, Parkinson's disease, multiple sclerosis, headache and migraine.

Explore the latest in neurological disease and brain health, from the minds at the AAN at AAN.com or find us on Facebook, X, Instagram, LinkedIn, and YouTube.

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Journal

Neurology

 

Fungicides intended to suppress turfgrass diseases may damage fairways

Some widely used compounds applied to treat and prevent diseases in turfgrass can do harm to golf courses

DON'T OVERWET!

Penn State

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Study first author Maureen Kahiu, who earned her master’s degree from Penn State with this research project, maneuvers a light box on a research fairway, used to take closeup photos of turfgrass damage resulting from fungicides that golf course managers use to suppress diseases such as dollar spot. 

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Credit: Penn State

UNIVERSITY PARK, Pa. — Golf course managers have much more insight into which fungicides to use to suppress turfgrass diseases, such as the common and costly dollar spot disease, without damaging the grass on their fairways, thanks to a new study by researchers at Penn State.

The team evaluated variation in turfgrass injury caused by nine commercially available demethylation inhibitor (DMI) fungicides — a class of fungicide widely used in turfgrass management — commonly used to suppress dollar spot and other major turfgrass diseases when applied to annual bluegrass and creeping bentgrass fairways. In Pennsylvania and much of the Northeast, golf course fairways often are a mix of creeping bentgrass and annual bluegrass.

In findings  published online ahead of inclusion in a printed edition of International Turfgrass Society Research Journal, the researchers reported that two of the fungicides, metconazole and triticonazole, result in injury to annual bluegrass but not creeping bentgrass. And another fungicide, mefentrifluconazole, resulted in the lowest injury on both annual bluegrass and creeping bentgrass.

This research was driven by the need to better understand the turf safety of both older and newer DMI fungicides that are commonly used on golf courses, according to John Kaminski, professor of turfgrass science in the College of Agricultural Sciences and senior author on the study.

“While these products are highly effective for disease control, their potential to cause injury to different turfgrass species — especially under varying environmental and management conditions — hasn’t been systematically studied,” he said. “Golf course superintendents have long relied on anecdotal experience or manufacturer guidance, but there’s been no side-by-side comparison that puts all of these fungicides through the same testing protocols.”

In 2020, two field trials were conducted on research fairways at Penn State’s Valentine Turfgrass Research Centre, located at University Park. Nine fungicides were applied in 14-day intervals over three summer months. The trials were repeated in 2021. The researchers applied nine fungicides to the research fairways and monitored the turfgrass for ill effects: propiconazole, triadimefon, myclobutanil, mefentrifluconazole, pydiflumetofen, flutriafol, tebuconazole, metconazole and triticonazole.

Study first author Maureen Kahiu, who earned her master’s degree from Penn State with this research project, applied all the fungicides to the research fairways with a backpack hand sprayer. To determine any phytotoxicity, or evidence of toxic effects, caused by the fungicide treatments, Kahiu examined the plots on a daily basis, looking for turfgrass injury, based on deviations in color, texture, density and growth.

A former golf course superintendent for three years in her native Kenya, Kahiu came to Penn State to study in the turfgrass science program with Kaminski as her adviser, after meeting him at an international golf industry show. She said the vaunted reputation of Penn State’s turfgrass science program attracted her.

“Anywhere you go in the world, when it comes to turfgrass management, Penn State is where you want to be. It's known as the best internationally,” she said.

Kaminski suggested Penn State’s turfgrass science program is so respected because of its close relationship with so many golf course managers around the world — many who are alumni of the program. Penn State focuses on what the industry needs, he pointed out, and this recent research is a good example.

“Our study is the first to directly compare a broad range of DMI fungicides on both annual bluegrass and creeping bentgrass,” he said. “We focused on real-world application scenarios to make the findings immediately useful to superintendents. The results help clarify which products are more likely to cause phytotoxicity on specific species and under what circumstances, providing actionable guidance for choosing safer options without sacrificing disease control.”

Turfgrass research at Penn State is rooted in solving practical challenges for golf course managers, Kaminski explained.

“Whether it’s improving fungicide strategies, identifying disease outbreaks or evaluating new technologies, our work is always focused on delivering solutions that make turf management more effective and sustainable,” he said.

The Paul R. Latshaw Graduate Fellowship partially supported this research.

Maureen Kahiu organizes fungus isolates collected from various turfgrass species following the repeated application of DMI fungicides. 

Credit

Penn State

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Journal

International Turfgrass Society Research Journal

DOI

10.1002/its2.70062 

Method of Research

Experimental study

Subject of Research

Not applicable

Article Title

Phytotoxicity of commercially available demethylation-inhibiting fungicides when applied to an annual bluegrass (Poa annua) and creeping bentgrass (Agrostis stolonifera) fairways

 

Measuring how – and where – Antarctic ice is cracking with new data tool

A team led by researchers at Penn State developed a novel technique to analyze ice fractures in the ‘Doomsday Glacier’

Penn State

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UNIVERSITY PARK, Pa. — A total collapse of the roughly 80-mile-wide Thwaites Glacier, the widest in the world, would trigger changes that could lead to 11 feet of sea-level rise, according to scientists who study Antarctica. To better predict fractures that could lead to such a collapse — and to better understand the processes driving changes in Antarctic ice shelves — a team led by researchers at Penn State developed a new method to evaluate cracks that destabilize ice shelves and accelerate those losses.

They reported their technique for analyzing fractures in the ice shelves, which are floating tongues of ice connected to land that extend out to float on ocean water, in the Journal of Geophysical Research: Earth Surface.

Drawing from NASA satellite data, the researchers focused on measuring vertical fractures in the Antarctic ice sheet — which shrinks by around 136 billion tons every year but is still the largest on Earth — over time. The group specifically evaluated ice fractures in the Thwaites Glacier, the so-called “Doomsday Glacier” in West Antarctica, to develop their method, which could help reveal the structural integrity of ice shelves and if – and when – they might give way, the researchers said.

“We know little about fractures, and their behavior is much more complex than conventional models suggest,” said lead author Shujie Wang, assistant professor of geography and faculty associate in the Earth and Environmental Systems Institute at Penn State. “Conventional models depend largely on simplified models and scarce, hard-to-obtain field observations.”

Modeling ice-shelf retreat is complex, especially due to limited data on ice fracturing. This challenge is pronounced at the Thwaites Ice Shelf, an extension of the Thwaites Glacier that is known for its rapid changes, fractured surface and fast ice flow, according to the researchers. They said they see the Thwaites shelf as a bulwark against further disintegration of the glacier.

Richard Alley, Evan Pugh University Professor of Geosciences at Penn State and a co-author on the paper, likened ice shelves to flying buttresses, an architectural feature that holds up exterior building walls.

“We’ve seen ice shelves break off, but we’ve never seen one grow back,” Alley said. “This new research indicates we can predict better the point at which these will break off. It’s helping to establish the early-warning signals.”

To establish more detail about fracture depth and activity, the research team analyzed data collected by NASA’s Ice, Cloud, and Land Elevation Satellite-2 (ICESat-2) from 2018 to 2024. The satellite measures glaciers, ocean heights, tree canopies and other natural features.

The researchers developed a workflow for processing and analyzing the satellite data to measure fractures over time. The two-step approach generates high-resolution profiles of surface elevations and visual cross-sections of the fractures. Building on an earlier algorithm that Wang developed to detect individual fractures, the new method reveals a range of fracture types and characteristics amid shifting landscapes.

Among their discoveries, the researchers found more aggressive fracturing in the Thwaites shelf’s eastern part and relative stability to the west. Although they did not determine certain causes for the differences, they said warmer winter air, reduced sea ice and changes in the ocean circulation beneath the ice shelf are potential contributors to fracture growth that require more research.

Worsening fractures promote faster ice flow and a domino effect of fissures and instability within ice formations, according to the researchers. Wang said their study should contribute to overall understanding of fracture origins.

“We believe that if the Thwaites Glacier gets very unstable, it will have catastrophic consequences,” Wang said. “It’s an important area to be studied, to say what’s going to change next.”

The work follows a 2023 research paper, also led by Wang, that explored the 2002 collapse of the Larsen B Ice Shelf on the Antarctic Peninsula. Atmospheric and oceanic factors weakened the shelf over a period of years, leading the 1,250-square-mile body to break up and fall apart over about five weeks, that research found.

While conventional modeling of ice-shelf fractures has depended on theory, the new observations provide a foundation for more refined models that should emerge from longer-term research, Wang said.

Part of her hope, she said, is that better predictions on the behavior of Antarctic ice will lessen uncertainty around sea-level changes, contribute to public confidence in scientific research and help inform policymaking.

“I feel this is a bridge, really,” Wang said.

For future research efforts, Zhengrui Huang, doctoral candidate in geography and co-author on the paper, assembled satellite data for more than 40 Antarctic ice shelves. The dataset involves 3D fracture features, with details featuring locations and depths.

The group intends to offer that material as an open-source resource for use by the wider research community, Huang said.

“We expect this will be a key observational dataset of fractures for researchers who study and model Antarctic ice-shelf dynamics,” he said.

Other contributors to the paper from Penn State include Sridhar Anandakrishnan, professor of geosciences and faculty affiliate at the Earth and Environmental Systems Institute; Byron Parizek, professor of mathematics and geosciences and environmental scholar at the institute; and Amanda Willet, doctoral candidate in geosciences.

Patrick M. Alexander, associate research scientist at Lamont-Doherty Earth Observatory at Columbia University, also contributed.

The research was supported by the NASA Cryospheric Sciences Program, the U.S. National Science Foundation, the Heising-Simons Foundation and the Penn State College of Earth and Mineral Sciences John T. Ryan, Jr., Faculty Fellowship.

At Penn State, researchers are solving real problems that impact the health, safety and quality of life of people across the commonwealth, the nation and around the world.

For decades, federal support for research has fueled innovation that makes our country safer, our industries more competitive and our economy stronger. Recent federal funding cuts threaten this progress.

Learn more about the implications of federal funding cuts to our future at Research or Regress.

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Journal

Journal of Geophysical Research Earth Surface

DOI

10.1029/2024JF008118 

Method of Research

Observational study

Subject of Research

Not applicable

Article Title

Recent Variability in Fracture Characteristics and Ice Flow of Thwaites Ice Shelf, West Antarctica

Simulating the unthinkable: Models show nuclear winter food production plunge

Researchers use Penn State’s Cycles agroecosystem model to predict how nuclear war ramifications would impact crops; recommend preparing ‘agricultural resilience kits’

Peer-Reviewed Publication

Penn State

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This comparison global map illustration shows one potential scenario outcome and how corn crops would be negatively affected by cold temperatures and shorter growing seasons resulting from soot injections into the atmosphere from nuclear explosions. On top: In mid-latitude regions of the Northern Hemisphere, planting is limited by temperature, with dates typically falling between April and May. In tropical and southern mid-latitude regions, planting is more variable due to precipitation-limited regimes, with spatial patterns reflecting the timing of rainy seasons. On the bottom: Corn types that would take longer to mature can grow in the tropics, while those that take less time to mature do better in the Northern Hemisphere.  

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Credit: Penn State

UNIVERSITY PARK, Pa. — A nuclear winter is a theoretical concept, but if the climate scenario expected to follow a large-scale nuclear war, in which smoke and soot from firestorms block sunlight, came to fruition, global temperatures would sharply drop, extinguishing most agriculture. A nuclear winter could last for more than a decade, potentially leading to widespread famine for those who survive the devastation of the bomb blasts. Now, a team led by researchers at Penn State have modeled precisely how various nuclear winter scenarios could impact global production of corn — the most widely planted grain crop in the world. They also recommended preparing “agricultural resilience kits” with seeds for faster-growing varieties better adapted to colder temperatures that could potentially help offset the impact of nuclear winter, as well as natural disasters like volcanic eruptions. 

In findings recently published in Environmental Research Letters, the team reported that the level of corn crop decline would vary, depending on the scale of the conflict. A regional nuclear war, which would send about 5.5 tons of soot into the atmosphere, could reduce world-wide annual corn production by 7%. A large-scale global war, injecting 165 tons of soot into the atmosphere, could lead to an 80% drop in annual corn yields. In all, the study simulated six nuclear war scenarios with varying soot injections. 

Because of the crop’s global significance, the researchers chose to model corn’s collapse in a nuclear winter to represent the expected fate of agriculture overall, according to study first author Yuning Shi, associate research professor in Penn State’s Department of Plant Science. He noted that an 80% drop in global crop production would have catastrophic consequences, leading to a widespread global food crisis. Even a 7% drop in global crop production would have a severe impact on the global food system and economy, likely resulting in increased food insecurity and hunger. 

The simulations were possible thanks to the Cycles agroecosystem model, created a few years ago by scientists in Penn State’s College of Agricultural Sciences, including lead developer Armen Kemanian, professor of production systems and modeling and corresponding author on this study. Using high-performance computing and considering atmospheric conditions, Cycles enables large-scale, high-resolution, multi-year simulations of crop growth by meticulously tracking the carbon and nitrogen cycles within the soil-plant-atmosphere system.  

“We simulated corn production in 38,572 locations under the six nuclear war scenarios of increasing severity — with soot injections ranging from 5 to 165 tons,” Shi said. “This investigation advances our understanding of global agricultural resilience and adaptation in response to catastrophic climatic disruptions.” 

In addition to considering the effects of massive amounts of soot in the atmosphere, the researchers modeled the increase in UV-B radiation — a type of ultraviolet radiation that can lead to DNA damage, oxidative stress and reduced photosynthesis in plants — that would reach Earth’s surface in a nuclear winter that could further limit agriculture.  

Shi said he believes that this was the first study to estimate the extent of UV-B radiation damage to agriculture after nuclear explosions, which the researchers predicted would peak six to eight years after a global war. They estimated this could further cut corn production by an additional 7%, for a total worst-case scenario of an 87% drop in corn production.  

Ozone high in Earth’s atmosphere effectively absorbs the bulk of UV radiation the planet receives from the sun, but nuclear war would dismantle this ability, Shi explained. 

“The blast and fireball of atomic explosions produce nitrogen oxides in the stratosphere,” he said. “The presence of both nitrogen oxides and heating from absorptive soot could rapidly destroy ozone, increasing UV-B radiation levels at the Earth’s surface. This would damage plant tissue and further limit global food production.” 

While the predictions point to potentially catastrophic drops in the production of corn varieties currently grown, Shi said, switching to crop varieties that can grow under cooler conditions in shorter growing seasons could boost global crop production by 10% compared to no adaptation. However, seed availability for these crops could become a serious problem — a "bottleneck to adaptation,” the researchers said. 

Their proposed solution is to prepare “agricultural resilience kits” ahead of any nuclear disaster, containing region- and climate-specific seeds for crop varieties that can grow under cooler conditions with shorter growing seasons to survive lower temperatures. 

“These kits would help sustain food production during the unstable years following a nuclear war, while supply chains and infrastructure recover,” Kemanian said. “The agricultural resilience kits concept can be expanded to other disasters — when catastrophes of these magnitude strike, resilience is of the essence.” 

Shi noted that while proactive, internationally coordinated planning for such kits is unlikely, simply increasing awareness could help lead to better preparedness. “If we want to survive, we must be prepared, even for unthinkable consequences,” he said.  

Kemanian said he sees value in the research beyond human-caused calamity. 

“Recall that catastrophes of this nature can happen not just because of nuclear war, but due to, for example, violent volcanic eruptions,” he said. “One may think that studies of this nature are just navel gazing, but they force us to realize the fragility of the biosphere — the totality of all living things and how they interact with one another and the environment.” 

Contributing to the research at Penn State were Felipe Montes, associate research professor of cropping systems modeling; Francesco Di Gioia, associate professor of vegetable crop science; and Charles Anderson, professor of biology and principal investigator of the project funding this work; as well as Charles Bardeen, with the Atmospheric Chemistry Observations and Modeling Laboratory, National Center for Atmospheric Research, Boulder, Colorado; and Yolanda Gil, Deborah Khider and Varun Ratnakar, all with the Information Sciences Institute, University of Southern California. 

This research was supported by Open Philanthropy, the Defense Advanced Research Projects Agency, the U.S. Department of Agriculture National Institute of Food and Agriculture, the U.S. National Science Foundation and the Future of Life Institute. 

At Penn State, researchers are solving real problems that impact the health, safety and quality of life of people across the commonwealth, the nation and around the world.   

For decades, federal support for research has fueled innovation that makes our country safer, our industries more competitive and our economy stronger. Recent federal funding cuts threaten this progress.   

Learn more about the implications of federal funding cuts to our future at Research or Regress.

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Journal

Environmental Research Letters

DOI

10.1088/1748-9326/adcfb5 

Method of Research

Computational simulation/modeling

Subject of Research

Not applicable

Article Title

Adapting agriculture to climate catastrophes: the nuclear winter case

 

When dreams turn dark: Neuroscientists to study nightmares and mental health

Penn State

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Nanyin Zhang, the Dorothy Foehr Huck and J. Lloyd Chair in Brain Imaging and professor of biomedical engineering, of electrical engineering and of engineering science and mechanics; Patrick Drew, professor of engineering science and mechanics, of biomedical engineering, of neurosurgery and of biology; and Nikki Crowley, associate professor of biology and of biomedical engineering, Huck Early Career Chair in Neurobiology and Neural Engineering and director of the Penn State Neuroscience Institute at University Park, received a three-year, $1.2 million grant from the W.M. Keck Foundation to gain insight into the purpose of dreams. 

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Credit: Keith Hickey/Penn State

UNIVERSITY PARK, Pa. — Dreams, and likely nightmares, are experienced universally across humans and animals, but neuroscientists still do not know why. Now, with a three-year, $1.2 million grant from the W.M. Keck Foundation, an interdisciplinary team of researchers at Penn State will study the underlying mechanisms of nightmares and their relationship with anxiety-related mental health disorders, such as post-traumatic stress disorder (PTSD).  

The team aiming to expand the scientific understanding of nightmares includes principal investigator Patrick Drew, professor of engineering science and mechanics at Penn State; and co-principal investigators Nikki Crowley, associate professor of biology and of biomedical engineering, Huck Early Career Chair in Neurobiology and Neural Engineering and director of the Penn State Neuroscience Institute at University Park; and Nanyin Zhang, the Dorothy Foehr Huck and J. Lloyd Chair in Brain Imaging and professor of biomedical engineering, of electrical engineering and of engineering science and mechanics. 

“To me, the exciting thing about this research is that we now have a way to gain insight into the purpose of dreams,” said Drew, who also has affiliations with the biomedical engineering, neurosurgery and biology departments at Penn State. “The question of why we dream has puzzled mankind for millennia, and by looking at what changes in neural circuits and behaviors nightmares cause, we hope to be able to figure out the biological purpose of dreaming.” 

To investigate the neural mechanics of nightmares, the researchers will rely on the side effects of the drug mefloquine, which was once used by American soldiers as a disease preventative during deployments to Somalia, Afghanistan and Iraq. Though effective in preventing malaria, the drug is no longer prescribed due its serious neurological side effects, including inducing nightmares. The researchers will test mice treated with the drug for two weeks while monitoring them for unusual behaviors.  

“In the past, it has been hard to study dreams, because it is hard to determine what is a regular dream state and what is a nightmare,” Zhang said.  

Led by Drew, researchers will use novel imaging techniques to map the mice’s facial expressions and pupil sizes to know which sleep stage they are in. The team will also use functional magnetic resonance imaging (fMRI), led by Zhang, and calcium signal recording, led by Drew, to record the specific neuron type that might be underlying the dream or nightmare.  

Through the various imaging methods and behavioral observations, researchers will record what is happening within the animals’ brains at each sleep stage, including rapid eye movement and non-rapid eye movement stages. The researchers, led by Crowley, will also monitor the neurotransmitters and neuromodulators in two regions of the brain, the prefrontal cortex and amygdala, to understand how these systems are disrupted during nightmares. Through these observations, the researchers said they hope to determine if there is an indication of nightmares having a relationship with mental health disorders, like PTSD.  

“Most people believe that nightmares are a consequence of having PTSD, but there is also the possibility that nightmares could exacerbate symptoms or even cause the presence of mental disorders,” Zhang explained.  

Using the mice as a model, the researchers said they plan to develop a framework to predict the onset of mental health disorders, such as anxiety, due to the presence or absence of nightmares. If successful, their model could lead to sleep intervention-based treatments for people suffering with these conditions, according to the researchers.  

“Penn State is distinctively suited to carry out this research, both in the capabilities of our team and in possessing the resources and intellectual space for a high-risk question like this one,” Crowley said. “Our post-docs and grad students, in particular, have an opportunity to contribute to a fascinating philosophical and biological research question that very few scientists will ever get to work on in their entire career.”  

The W. M. Keck Foundation was established in 1954 by oil company founder William Myron Keck. As a philanthropic institution, the foundation supports discoveries in science, engineering and medical research that are distinctive or novel in their approach or promise to develop new technologies, instrumentation or methods. This award is the first W. M. Keck Foundation grant directed to Penn State in almost 25 years.