Ode to Recall: To remember events in order, we rely on the Brain’s ‘Symphony’

Newswise, October 17, 2016 — To remember events in the order they occur, the brain’s neurons function in a coordinated way that is akin to a symphony, a team of New York University scientists has found. Their findings offer new insights into how we recall information and point to factors that may disrupt certain types of memories.

“The findings enhance our understanding of how the brain keeps track of what happened and when it happened relative to other events,” explains Lila Davachi, associate professor in NYU’s Department of Psychology and Center for Neural Science and the study’s senior author.

“We’ve known for some time that neurons increase their activity when we encode memories. What our study shows is there’s a rhythm to how they fire in relation to one another—much like different instruments in a symphony orchestra.”

The study’s first author was Andrew Heusser, a doctoral candidate in NYU’s Department of Psychology. Its collaborators were David Poeppel, a professor in NYU’s Department of Psychology and Center for Neural Science, and Youssef Ezzyat, also a doctoral candidate in NYU’s Department of Psychology at the time of the research and now a postdoctoral fellow at the University of Pennsylvania.

The research, which appears in the journal Nature Neuroscience, sought to determine the validity of a long-standing hypothesis, proposed in 1995 by neuroscientists John Lisman and Marco Idiart, which outlines how the order of memories is encoded.

The “theta-gamma phase coding” model states that when our brains create a memory for a specific event, our neurons oscillate in a coordinated fashion, with cells firing at high (gamma) frequencies. To encode the order of multiple events, cells representing each event fire in a sequence that is coordinated by a lower (theta) frequency brain rhythm.

To test this, the scientists had the study’s participants view a series of six objects (e.g., a butterfly, headphones, etc.), one at a time, on a computer screen.

During the experiment, researchers examined the subjects’ neural activity using magnetoencephalography (MEG), which captures measurements of the tiny magnetic fields generated by the brain.

Later, they asked subjects to recall the order of the objects they viewed.

In their analysis, the researchers examined the neuronal activity of the subjects when they first viewed the objects, then matched it to the results of the recall test.

Their data showed notable differences in the patterns of neural activity when the order of the objects was correctly encoded compared to when it was not.

Specifically, when the order of the objects was correctly encoded, the gamma activity associated with each object was temporally ordered along a slower theta oscillation so that the gamma activity for object 1 preceded that for object 2 and so on.

By contrast, when subjects incorrectly recalled the order in which the objects were presented, gamma activity was just as high—but there was no discernible pattern.

“When particular oscillations are in step with each other, we remember the order,” Davachi observes. “But when they are not, we don’t.”

The research was supported by a grant from the National Institute of Mental Health (RO1–MH074692).

Can Older Adults with Dementia Continue to Drive? More Study is Needed

Newswise, October 9, 2016--How do you know when it's time for an older adult with mild dementia to stop driving? Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. It can impact a person's ability to drive safely.

Although all people with dementia will have to stop driving eventually, each case can be unique based on the individual. According to a new study published in the Journal of the American Geriatrics Society, we still need to explore mental or physical tests that can best predict when people with dementia should stop driving.

People with dementia are between two and eight times more likely than adults of the same age without dementia to be involved in car accidents. Since dementia makes it difficult for people to evaluate their own ability to drive safely, furthermore, the decision about when to stop driving must be based on objective tests.

To determine which kinds of tests best evaluate driving safety, researchers from Macquarie University in Sydney, Australia, reviewed 28 studies that investigated the relationship between driving and cognitive function in people with dementia.

The study was the first of its kind to examine drivers with dementia and which existing tests might be most helpful in assessing their driver safety.

The researchers reviewed studies that examined various testing methods, including mental status tests, on-road assessments, tests using computerized and simulated driving, and those using motor vehicle crash data.

The researchers determined that current testing procedures are only about 77 percent accurate for predicting how safely people with dementia can drive.

They concluded that better, more accurate testing tools are needed to assess whether or not people with dementia can continue to drive safely. In the interim, older adults and caregivers should continue to work closely with their healthcare professionals when it comes to safe driving. Doctors, nurses, social workers, and other experts can evaluate your abilities and help you transition to driver retirement when the time is right.

When Washington Doesn't ‘Get America

Newswise, October 9, 2016--  Washington doesn’t think very highly of the American people, concludes a yearlong Johns Hopkins University study of 850 non-elected officials working in the nation’s capital….These Beltway insiders, who work in federal agencies, on Capitol Hill and in other Washington policy jobs, tend to think Americans are uninformed, know “very little” about key issues, and have opinions that can be ignored.

The findings by political scientists Jennifer Bachner and Benjamin Ginsberg, will appear in the book, What Washington Gets Wrong: The Unelected Officials Who Actually Run the Government and Their Misconceptions about the American People, which will be published by Penguin Random House on Oct. 4.

“This disdain for the public results from the wide gulf between the life experiences of ordinary Americans and the denizens of official Washington,” the authors say.

 “Official Washington is wealthier, whiter and better educated than ordinary citizens. It lives in its own inside-the-Beltway bubble, where Washingtonians converse with one another and rarely interact on an intellectual plane with Americans at large.”

In their 2013 survey, the authors found people who either work in government or directly with it not only have very little in common with other Americans, but have a disturbingly low opinion of them.

They found 73 percent of government officials think the public knows little or nothing about programs aimed at helping the poor, 71 percent think the public knows little or nothing about science and technology policy, and 61 percent think the public knows almost nothing about childcare.

In fact, when it comes to fundamental policy areas like social security, public schools, crime, defense and the environment, it was hard to find government officials who thought the public knew “a great deal.”

Assuming Americans know so little, government officials tend to use their own judgment rather than the people’s when making policy decisions, the authors conclude.

With issues of science and defense, more than half of officials think they should “always” or “mostly” heed their own opinions. With crime, welfare and the environment, at least 42 percent of officials felt the same way.

Government officials actually tended to believe their own views diverged more from those of ordinary Americans than they actually did.

For example, 76 percent of officials believe they disagree with average Americans on half of the policy areas surveyed, but only 12 percent of them really do. The data on “average Americans” is largely drawn from the 2012 American National Election Study.

“This sense of “false uniqueness” reflects a sense of cultural or intellectual superiority,” the authors say. “The officials tend to view the citizenry with a considerable amount of disdain.”

Previously released findings from the book showed:

--Ninety-one percent of those who work for federal agencies are white, versus 78 percent of the public.

--In 2012, federal workers compensation averaged $81,704, or 48 percent more than the private sector average of $54,995, according to the U.S. Bureau of Economic Analysis. That puts federal workers in the top 10 percent of American earners.

--Sixty percent of those who work on the Hill are Democrats versus 35 percent of Americans at large.

--In the 2012 presidential election, 97 percent of congressional and White House staffers voted versus 80 percent of other Americans. Sixty-two percent of those Hill staffers believe election votes are counted fairly “very often” compared with 33 percent of other Americans.

--Washingtonians are reading the news at least five days a week compared with about three days a week for the rest of the country.

Bachner is director of the Master of Science in Government Analytics program at Johns Hopkins. She teaches courses in statistical analysis, survey research, public opinion, elections and American political behavior. Her research examines coalition building in Congress, government responsiveness and the growth of online education.

Ginsberg is the David Bernstein Professor of Political Science and chairman of the Johns Hopkins Center for Advanced Governmental Studies. His research interests include American politics, Jewish history, higher education policy, and the societal impact of war and violence. He is the author of 24 books, most recently The Worth of War.

CONFUSION ON END-OF-LIFE FORMS CAN CAUSE ELDERLY PATIENTS TO RECEAVE WANTED

The majority of end-of-life forms for elderly patients in the study were incomplete

Newswise, October 3, 2016. – In recent years, Physicians’ Orders for Life Sustaining Treatments (POLST) forms have been seen as an important way to honor the end-of-life wishes of frail elderly or terminally ill patients who cannot speak for themselves.

But while the goal of filling out POLST forms is to let providers know patients’ preferences regarding life-sustaining treatments, the information they contain is often ambiguous, a new University at Buffalo study has found. 

Published online  in the Journal of the American Medical Directors Association, the study is called “Decisions by Default: Incomplete and Contradictory POLST in Emergency Care.”

“We called it ‘Decisions by Default’ to make patients aware that if they don’t make a decision about a specific life-sustaining treatment, then in an emergency, they will most likely get the most aggressive treatment available,” said Brian Clemency, DO, associate professor in the Department of Emergency Medicine in the Jacobs School of Medicine and Biomedical Sciences at UB and first author on the paper. He also is a physician with UBMD Emergency Medicine.

Deborah P. Waldrop, PhD, professor in the UB School of Social Work and a nationally- recognized expert on palliative care, is senior author.
The study was conducted in the busy Emergency Department of Erie County Medical Center (ECMC), a partner hospital of the Jacobs School of Medicine and Biomedical Sciences, where Clemency is an emergency medicine attending physician.

“In emergency medicine, we are trained to do everything we can to prolong life,” Clemency said.

“The goal of this paper is to help us as emergency medicine physicians honor our patients’ wishes as much as possible.”

Strictly speaking, the study’s focus was not on the patients themselves, but on the forms that had been completed before their emergency. In New York State, the forms are called Medical Orders for Life Sustaining Treatment or MOLST forms.

One hundred MOLST forms were collected from patients arriving at the emergency department.

Items included on the form cover whether or not patients requested cardiopulmonary resuscitation (CPR), do not resuscitate (DNR) orders, intubation, hospitalization, intravenous fluids, feeding tubes and antibiotics.

Incomplete forms

Of the 100 forms collected, 69 percent were incomplete with at least one section left blank. That may compel emergency medicine providers to perform interventions the patient would not have wanted.

“We want to do what the patient wants,” explained Clemency, “but if you don’t tell us what you want, we’re forced to assume you want ‘everything’ done.”

Waldrop, who has spent her career working to provide families dealing with end-of-life issues with better options, says that the research demonstrates a need for greater training among primary care providers.

“Primary care providers are having these difficult conversations with their patients,” said Waldrop.

“More education and training are needed to help them be comfortable guiding people with serious illnesses to effectively communicate their wishes about life-sustaining treatment.”

That means going over any inconsistencies in the patients’ responses, Clemency said.

 For example, if a patient says they don’t want any life-saving interventions but they do want a breathing tube inserted, Clemency said that that discrepancy may reflect a lack of understanding on the part of the patient and should be questioned by the physician.

“I think the doctor’s job is to guide the patient through it and ask them about the implications of their decisions,” said Clemency.

Waldrop noted that the forms about life-sustaining treatment and the conversations about them are a major step toward improving end-of-life care for patients, but there is room for improvement.

“This research shows that to be effective in reflecting patients’ wishes, these forms need to be filled out completely and without contradictory orders after an informed conversation between a primary care provider and the patient,” she said.

Improving communication

“Our hope is that this paper will improve communication between patients and providers, better informing the end-users, the emergency medicine doctors who typically meet these patients when they arrive at the emergency department at 3 a.m.,” Clemency added.

And it isn’t only the emergency physicians who need more clarity, he noted. Families need it too.

“You already have many stressors when an elderly parent is ill,” Clemency said, “but if the parents’ wishes aren’t clearly articulated, you might have multiple children, all of whom have the best of intentions, each of whom has a different understanding of what that parent wanted.

“Patients and their families can only benefit when the patients’ wishes are clearly articulated.”

UB co-authors are Jeanne M. Basior, MD, associate professor and Heather A. Lindstrom, PhD, assistant professor, both in the Department of Emergency Medicine. Colleen Clemency Cordes, PhD, of Arizona State University also is a co-author.

SELF-ADHESIVE DRESSING GENERATES ELECTRICAL CURRENT THAT PROMOTES HEALING, REDUCES INFECTION RISK

Newswise, October 3, 2016-- Good news for the millions of people who suffer from skin wounds that won’t heal. A team of researchers at The Ohio State University has brought a potentially transformative solution to the problem by creating a portable adhesive patch that drives a continuous, small electrical current to stimulate healing and reduce the risk of infection.

Nearly 7 million Americans have chronic wounds – typically a result of diabetes, obesity or other conditions that impact circulation – costing the healthcare system nearly $25 billion each year. The non-healing wounds are painful, can permanently damage nerves, prevent mobility and in extreme cases, cause infection that can lead to death.

The patch’s design significantly advances existing FDA-approved wireless electroceutical dressing (WED) that harnesses the body’s innate response to injury to help wounds heal.

“A wound naturally produces its own electrical fields that help reduce bacteria and promote cell regeneration; however, this function is likely impaired in chronic wounds,” said Sashwati Roy, PhD, an Associate Professor in the Department of Surgery at Ohio State’s College of Medicine.

“The prototype dressing mimics this physiological process, and while it has proven to create an optimal environment where chronic wounds can heal, we are always looking for new ways to keep pathogens under better control.”

Roy notes that chronic wounds are particularly susceptible to infection because bacteria, which at times are free floating within a wound – can sometimes mobilize, creating colonies covered by a thick sticky coating called a biofilm.

The immune system cannot penetrate the biofilm, and antibiotics can’t get in either – causing constant inflammation and low-level infection that can further dampen the healing process.

Now, with support from Ohio State’s Center for Clinical and Translational Science (CCTS), researchers from both the College of Engineering and the College of Medicine are taking the technology to the next level.

Working with a mechanical and aerospace engineering team led by Shaurya Prakash, PhD and Vish Subramaniam, PhD, the scientists have optimized the bandage’s design and the amount of electrical current delivered. Like present WEDs, the new prototype is flexible, portable and self-contained.

 Made of silk and silver, the experimental dressing includes a self-contained battery that delivers a continuous, safe, low-level electrical current to the injury. 

“We’re hoping this new design may allow electric fields and currents to penetrate more deeply into wounds, and really get to where these biofilms may be hiding,” said Subramaniam, chair of the Department of Mechanical and Aerospace Engineering at Ohio State.

“The destruction of the biofilm would enable antibiotics to start killing off bacteria, reduce chronic inflammation and allow the body’s natural immune response to work more effectively. Bacteria are known to quickly acquire resistance against antibiotics, but to our knowledge, bacteria do not develop resistance against electroceuticals.” 

To test the experimental design, Roy and a team of scientists developed an animal model to mimic the skin function of a person suffering from metabolic syndrome – obesity, high blood pressure, high blood sugar - which mirrors the type of patient that typically develops chronic wounds.

Animal models had skin injuries infected with Pseudomonas aeruginosa, Staphylococcus aureus or Acinetobacter baumannii, three different types of bacteria that commonly infect wounds and develop biofilms that are treatment resistant.

Early results, which were presented at the Wound Healing Society’s Annual Meeting in April 2016 indicate that infected wounds covered by the experimental bioelectric dressing healed better and more quickly than those covered with a plain dressing that is commonly used in the care of wounds today.

Scientists hypothesize that the electrical currents may disrupt bacteria in two ways: by interrupting the production of chemical messages that instruct bacteria to develop biofilms and by weakening the molecular structure of existing biofilms, potentially making them more susceptible to antibiotics or the body’s natural immune response.

The team’s next move is to focus on the bioelectric bandage as a treatment for chronic wounds in a patient population; however, the technology could also be used to treat acute injuries.

Roy also notes that the U. S. Department of Defense is very interested in the dressing as a temporary measure to help prevent infection in soldiers wounded on the battle front.

“This technology has a long shelf life and is compact enough to be put into any field medical kit. It could be applied immediately to wounds help keep bacteria from mobilizing and start promoting healing until the soldier could be transported to a facility for more intensive medical care.”

The team already has interest from several industry partners, and is hoping to begin testing the new technology in patients before the end of the year to determine optimal treatment duration and more about the healing effects of electrical fields on skin cells on a molecular level.

Roy’s research team includes Shomita S. Steiner, PhD; Shaurya Prakash, PhD; Gayle Gordillo, MD; Vish Subramaniam, PhD and Chandan K. Sen, PhD.
# # #

The Ohio State University Center for Clinical and Translational Science (CCTS) is funded by the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) program (UL1TR001070, KL2TR001068, TL1TR001069) The CTSA program is led by the NIH’s National Center for Advancing Translational Sciences (NCATS). The content of this release is solely the responsibility of the CCTS and does not necessarily represent the official views of the NIH.

SURVEY: MOST OF US WANT MORE REST AND WELL-BEING

Newswise, October 3, 2016 — Over two thirds (68 per cent) of the public would like more rest, according to the world’s largest ever survey on the topic.

The results of the survey, led by Durham University researchers, also revealed that nearly a third (32 per cent) of respondents said they need more rest than the average person, while 10 per cent think they need less.

Rest and well-being

More than 18,000 people from 134 different countries took part in the Rest Test, an online survey to investigate the public’s resting habits and their attitudes towards relaxation and busyness, and the results were unveiled during BBC Radio 4’s programme The Anatomy of Rest.

The survey found that those who felt they needed more rest scored lower in terms of well-being.

Similarly, those who responded saying they think they get more rest than average or don’t feel in need of more rest, had well-being scores twice as high as those who wanted more rest. This suggests that the perception of rest matters, as well as the reality.

Dr Felicity Callard, principal investigator on the project and social scientist in the Department of Geography,said: “The survey shows that people’s ability to take rest, and their levels of well-being, are related. We’re delighted that these findings combat a common, moralizing connection between rest and laziness.”

Five most restful activities

The survey asked people to choose the activities that they find the most restful. The results show that the top five most restful activities are those often done alone:

Reading (58 per cent)
Being in the natural environment (53.1 per cent)
Being on their own (52.1 per cent)
Listening to music (40.6 per cent)
Doing nothing in particular (40 per cent)

Dr Felicity Callard continued: “It’s intriguing that the top activities considered restful are frequently done on one’s own. Perhaps it’s not only the total hours resting or working that we need to consider, but the rhythms of our work, rest and time with and without others.”

Modern life

The results of the survey come at a time when the urge to be busy defines modern life and the topic of rest is at the forefront of many people’s minds. Rest can seem hard to find, whether in relation to an exhausted body, a racing mind or a hectic city.

Rest is a much broader category than sleep, and has physical, mental and spiritual components. But much less is known about the potentially restorative benefits of rest – in part because it means different things to different people.

The survey asked respondents to state how many hours rest they had within the last 24 hours.

The results showed that, on average, being younger and having a higher household income was associated with having fewer hours of rest. Those with caring responsibilities or in shift work which included nights also reported fewer hours of rest. The average time spent resting by UK respondents the previous day was 3 hours and 8 minutes.

Pressing issue

Claudia Hammond, presenter of Radio 4’s All in the Mind and associate director of Hubbub, said:

“We had no idea how many people would choose to complete the Rest Test. More than 18,000 gave up their precious sparetime to tell us what they thought about rest which shows us what a pressing issue it is. These results show just how crucial it is to our well-being to ensure people do have time to rest. We can begin to try to work out what the optimum amount of rest might be and how we should go about resting.”

The Rest Test has been designed by Hubbub, an international collective of social scientists, artists, humanities researchers, scientists, broadcasters, public engagement professionals and mental health experts, in residence at the Hub at Wellcome Collection in London, led by Durham University.

A full analysis of the data will be published in the next year. Hubbub hope the results will increase understanding of people’s perceptions of rest and the way these relate to an individual’s work or daily habits, as well as their experiences of health, illness, disability, satisfaction with life and the tendency to mind wander.

The results coincide with a new exhibition Rest & its discontents open at Mile End Art Pavilion from 30 September-30 October and a new Hubbub publication The Restless Compendium available free to download or to buy as a hard copy from 27 Septemberwww.hubbubresearch.org/publications.

EPIGENETIC CLOCK PREDICTS LIFE EXPECTANCY

UCLA-led study shows 5 percent of population ages faster, faces shorter lifespan

The rate of your biological clock influences how long you'll live.

Why do some people lead a perfectly healthy lifestyle yet still die young? A new international study suggests that the answer lies in our DNA.

Newswise, October 3, 2016 — UCLA geneticist Steve Horvath led a team of 65 scientists in seven countries to record age-related changes to human DNA, calculate biological age and estimate a person’s lifespan. A higher biological age—regardless of chronological age—consistently predicted an earlier death.

The findings are published in today’s edition of the journal Aging.

“Our research reveals valuable clues into what causes human aging, marking a first step toward developing targeted methods to slow the process,” said principal investigator Horvath, a professor of human genetics and biostatistics at UCLA’s David Geffen School of Medicine and Fielding School of Public Health.

Drawing on 13 sets of data, including the landmark Framingham Heart Study and Women’s Health Initiative, a consortium of 25 institutions analyzed the DNA in blood samples collected from more than 13,000 people in the United States and Europe.

Applying a variety of molecular methods, including an epigenetic clock developed by Horvath in 2013, the scientists measured the aging rates of each individual.

The clock calculates the aging of blood and other tissues by tracking methylation, a natural process that chemically alters DNA over time. By comparing chronological age to the blood’s biological age, the scientists used the clock to predict each person’s life expectancy.

“We were stunned to see that the epigenetic clock was able to predict the lifespans of Caucasians, Hispanics and African-Americans,” said first author Brian Chen, a postdoctoral fellow at the National Institute on Aging.

“This rang true even after adjusting for traditional risk factors like age, gender, smoking, body-mass index, disease history and blood cell counts.”

The group’s findings, however, don’t bode well for everyone.

“We discovered that 5 percent of the population ages at a faster biological rate, resulting in a shorter life expectancy,” Horvath said. “Accelerated aging increases these adults’ risk of death by 50 percent at any age.”

For example, two 60-year-old men, Peter and Joe, both smoke to deal with high stress. Peter’s epigenetic aging rate ranks in the top 5 percent, while Joe’s aging rate is average. The likelihood of Peter dying within the next 10 years is 75 percent compared to 60 percent for Joe.

The preliminary finding may explain why some individuals die young – even when they follow a nutritious diet, exercise regularly, drink in moderation and don’t smoke. 

“While a healthful lifestyle may help extend life expectancy, our innate aging process prevents us from cheating death forever,” Horvath emphasized. “Yet risk factors like smoking, diabetes and high blood pressure still predict mortality more strongly than one’s epigenetic aging rate.”

Scientists have long searched to identify biomarkers for biological age, according to coauthor Dr. Douglas Kiel, a professor at Harvard Medical School and a senior scientist for the Institute of Aging Research at Hebrew SeniorLife.

“In geriatric medicine, we are always struck by the difference between our patients’ chronological age and how old they appear physiologically,” said Kiel.

“This study validates the use of DNA methylation as a biomarker for biological age. And if we can prove that DNA methylation accelerates aging, we can devise strategies to slow the rate and maximize a person’s years of good health.”

The precise role of epigenetic changes in aging and death, however, remains unknown, said coauthor Dr. Themistocles Assimes, an assistant professor of cardiovascular medicine at Stanford University School of Medicine.

“Do the epigenetic changes associated with chronological aging directly cause death in older people?” said Assimes.

“Perhaps they merely enhance the development of certain diseases--or cripple one’s ability to resist the progression of disease after it has taken root. Future research is needed to address these questions.”

Larger studies focused only on cases with well-documented causes of death will help scientists tease out the relationship between epigenetic age and specific diseases, he added.

By 2017, according to the World Health Organization, the number of people worldwide over age 65 will outnumber those under age 5 for the first time in recorded history.

By 2050, the proportion of the global population over 60 will double from 11 to 22 percent. Many countries will be ill-prepared to keep pace with the high costs associated with disease and disability as more people live longer, said Horvath.

“We must find interventions that prolong healthy living by five to 20 years. We don’t have time, however, to follow a person for decades to test whether a new drug works.” said Horvath. “The epigenetic clock would allow scientists to quickly evaluate the effect of anti-aging therapies in only three years.”

The University of California has applied for a provisional patent on the epigenetic clock.