Monday, August 29, 2022

Music helps patients with dementia connect with loved ones

Novel music intervention sparks emotional connection between patients and caregivers

Peer-Reviewed Publication

NORTHWESTERN UNIVERSITY

  • Patients sing and dance with their caregivers to songs from patients’ youth
  • Music memories remain in brain after patients lose language and other memories
  • Patients had less agitation, anxiety and depression

CHICAGO --- People with dementia often lose their ability to communicate verbally with loved ones in later stages of the disease. But a Northwestern Medicine study, in collaboration with Institute for Therapy through the Arts (ITA), shows how that gap can be bridged with a new music intervention. 

In the intervention — developed at ITA and called “Musical Bridges to Memory” — a live ensemble plays music from a patient’s youth such as songs from the musicals “Oklahoma” or “The Sound of Music.” This creates an emotional connection between a patient and their caregiver by allowing them to interact with the music together via singing, dancing and playing simple instruments, the study authors said. 

The program also enhanced patients’ social engagement and reduced neuropsychiatric symptoms such as agitation, anxiety and depression in both patients and caregivers.

More than 6 million people in the U.S. have Alzheimer’s disease. 

The study is unusual because it targeted patients with dementia and their caregivers, said lead study author Dr. Borna Bonakdarpour. Most prior studies using music for dementia patients have focused only on the patients. 

“Patients were able to connect with partners through music, a connection that was not available to them verbally,” said Bonakdarpour, an associate professor of neurology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine neurologist. “The family and friends of people with dementia also are affected by it. It’s painful for them when they can’t connect with a loved one. When language is no longer possible, music gives them a bridge to each other.”

The study was published Aug. 25 in Alzheimer Disease and Associated Disorders.

Musical memory, processing not as affected by Alzheimer’s

Music memories often remain in the brain even as language and other memories disappear in dementia, Bonakdarpour said. This is because regions of the brain that are involved in musical memory and processing (e.g., the cerebellum) are not as affected by Alzheimer’s or dementia until much later in the disease course. Thus, patients can retain the ability to dance and sing long after their ability to talk has diminished. 

How the study worked

In the study, individuals with dementia — residents of Silverado Memory Care (in a suburb of Chicago) — and their care partners were recorded on video conversing and interacting for 10 minutes before and 10 minutes after the intervention. Before playing the music, each patient/caregiver pair had training on how to interact more effectively during the music. 

During the 45-minute musical intervention, an ensemble of chamber musicians and a singer performed songs that appealed to the patients from their younger days. The patients and their caregivers received simple instruments such as tambourines and shakers to accompany the music. Specially trained music therapists interacted with patients during performances, getting them to beat on drums, sing and dance. 

A group conversation followed the music. Patients were more socially engaged as evidenced by more eye contact, less distraction, less agitation and an elevated mood. In comparison, the control group, which did not receive the intervention and were exposed to usual daily care and programs, did not show such changes within the same time frame.

The program included 12 sessions over three months.  

‘All could relate to their loved one’

Before the intervention, some individuals would not communicate much with their partners. However, during the intervention, they started to play, sing and dance together, which was a significant change for the family. These changes generalized to their behavior outside the sessions as well.

“As the program progressed, caregivers invited multiple family members,” said Jeffrey Wolfe, a neurologic music therapist-fellow at ITA and leader of the Musical Bridges to Memory program. “It became a normalizing experience for the whole family. All could relate to their loved one despite their degree of dementia.”  

The next step in the research is to conduct the study on a larger group of patients. ITA and Northwestern have been funded by a three-year grant through the National Endowment for the Arts to expand this study. 

The study is called “Musical Bridges to Memory: A Pilot Dyadic Music Intervention to Improve Social Engagement in Dementia.”

Other Northwestern authors on the study include co-first author Rhiana Schafer. Co-first author Aimee Karstens, formerly at Northwestern, is now at Mayo Clinic, Rochester. 

PRISON NATION U$A

Research Brief: Study examines support programs for pregnant, postpartum people at state prisons

Peer-Reviewed Publication

UNIVERSITY OF MINNESOTA MEDICAL SCHOOL

MINNEAPOLIS/ST. PAUL (08/29/2022) — Published in the Journal of Criminal Justice, researchers from the University of Minnesota Medical School examined the variation of support programs for pregnant and postpartum people at six state prisons in the U.S. The study found the success of programs was largely dependent on collaboration between program facilitators and partnering prison sites.

"Put simply, prisons were built by men, for men, and there's been very little attention paid to the needs of women, especially those who are pregnant or postpartum in prison. This study is important because it examines unique support programs for pregnant and postpartum people,” said Rebecca Shlafer, PhD, MPH, an associate professor at the U of M Medical School. “When we have a better understanding of what these prisons are doing, these can serve as models for other states to improve the care and treatment of this population."

Researchers conducted interviews to collect information on historical context, conception and key aspects of the implementation of services offered at each site. The authors found each program has created or adapted its components to serve their specific populations and expressed needs. Services fell into five broad categories: group-based education and support, one-on-one support, labor and birth support, lactation facilitation and support, and other support services. Group-based education and support was the only program component offered by all six programs. Four of the six programs also offered one-on-one support, labor and birth support, and lactation support and facilitation.

Based on the first set of interviews with program facilitators, researchers outlined these specific recommendations for corrections and prison administrators:

  • Assess the needs and fit of program components by directly consulting with pregnant and postpartum people who are incarcerated in a specific facility.
  • Identify community-based partners, like nonprofit organizations, universities, or hospital systems, that bring diverse professional expertise and have an interest in building collaborative partnerships to provide these types of programs to people in prison.
  • Identify leaders and champions within the prison and at the Department of Corrections level who will support this type of programming

Researchers say it’s important for sites to share information and resources to help future programs get off the ground. They suggest future research may benefit from assessing the perspectives of other individuals involved with these programs, such as program staff, leadership, and especially program participants, and understanding how these services change over time, particularly as the COVID-19 pandemic recedes.

Funding provided by the National Institute of Child Health and Human Development of the National Institutes of Health (R01HD103634).

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About the University of Minnesota Medical School
The University of Minnesota Medical School is at the forefront of learning and discovery, transforming medical care and educating the next generation of physicians. Our graduates and faculty produce high-impact biomedical research and advance the practice of medicine. We acknowledge that the U of M Medical School, both the Twin Cities campus and Duluth campus, is located on traditional, ancestral and contemporary lands of the Dakota and the Ojibwe, and scores of other Indigenous people, and we affirm our commitment to tribal communities and their sovereignty as we seek to improve and strengthen our relations with tribal nations. For more information about the U of M Medical School, please visit med.umn.edu

Costlier Medicare Advantage plans do not always offer better quality

Better metrics needed to help consumers make quality-focused choices

Peer-Reviewed Publication

RAND CORPORATION

Enrolling in a highercost Medicare Advantage plan may not always get seniors better quality health care, according to a new RAND Corporation study.

Examining 15 different measures of quality among large representative samples of people enrolled in Medicare Advantage plans during 2016 and 2017, researchers found that plans that charged a higher monthly premium provided on average only slightly better care as compared to plans with no monthly premium.

Quality varied substantially within each premium cost tier studied, with high-quality care being observed among a number of plans in each of the cost tiers. More than 700 Medicare Advantage plans were part of the analysis.

The findings are published in the latest edition of JAMA Health Forum.

“Paying higher premiums is not necessary to receive high quality care from a Medicare Advantage plan,” said study lead author Amelia M. Haviland, a professor of statistics and public policy at Carnegie Mellon University and an adjunct statistician at RAND, a nonprofit research organization. “Seniors should look at metrics other than premium costs alone when looking for a Medicare Advantage plan that offers a high-quality of care, including direct measures of quality, such as Star Ratings.”

Health care costs are a concern for both consumers and policymakers. People enrolled in Medicare Advantage plans report that price measures such as premium costs and co-pays are their primary consideration when selecting a plan.

To examine the link between premium cost and quality, RAND researchers analyzed information about the care delivered to people enrolled in Medicare Advantage plans. About 40% of the enrollees were in plans with no monthly premium, while 6% were in plans with a monthly premium of more than $120.

Medicare Advantage plans provide coverage for hospital and physician services like traditional Medicare fee-for-service, but typically also offer additional services such as coverage for dental care and eyeglasses. In exchange for additional services and lower co-pays, members are restricted to in-network providers. More than one-third of Medicare enrollees choose Medicare Advantage plans.

The information used to measure the quality of care from Medicare Advantage plans included clinical quality measures based on administrative information such as medical charts involving more than 2 million enrollees. Those quality measures included items such as whether patients received recommended cancer screenings, whether high blood pressure was controlled and whether diabetes was treated adequately.

The analysis also examined surveys of more than 168,000 randomly sampled plan participants who were asked about their experiences with health care, prescription drug coverage and their plan. Those measures included the ability to get care, the ability to get care quickly and getting needed drugs.

Across most measures, people enrolled in the two higher-premium plan tiers reported similar or slightly better experiences on average than enrollees in the lower-premium categories. For example, people enrolled in the highest premium tiers were more likely to receive annual flu shots.  

However, on one measure, lower-cost plans offered better care. People enrolled in lower-tiered plans received better care on average for osteoporosis than their peers enrolled in higher-premium plans.

Given that many high- and low-quality plans were found in each of the premium tiers we studied, the premium cost is a poor proxy for assessing the quality of a Medicare Advantage plan,” Haviland said. “Making plan quality information more accessible and salient to consumers is a key to reducing consumers’ costs while improving quality.”

Support for the study was provided by the federal Centers for Medicare & Medicaid Services.  Other authors of the study are Sai Ma of Humana, and David J. Klein, Nathan Orr and Marc N. Elliott, all of RAND.

RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries. 

 

Prosthetics design integrating 3D printing takes third place in international challenge

RIT student’s flexible limb socket design is recognized for improved performance and cost effectiveness

Grant and Award Announcement

ROCHESTER INSTITUTE OF TECHNOLOGY

Jade Myers Holding Prosthetic Limb 

IMAGE: JADE MYERS, AN ENGINEERING DOCTORAL CANDIDATE AND MEMBER OF RIT’S LIVEABILITY LAB, RECENTLY PLACED THIRD IN THE INTERNATIONAL NTOPOLOGY-EOS RESPONSIBLE PART CHALLENGE. SHE WAS RECOGNIZED FOR HER IMPROVED PROSTHETIC DEVICE DESIGNED WITH LATTICE STRUCTURES. view more 

CREDIT: A. SUE WEISLER/RIT

Jade Myers’ experience in Haiti several years ago helping refugees after a devastating earthquake left an impression that is inspiring her work today as a researcher in prosthetics and accessibility.

Myers, who uses 3D print technology to develop upper and lower limb prostheses for amputees, was a top three winner of the nTopology-EOS 2022 Responsible Part Challenge, an international design competition. Her project, improving prosthetic sockets with density-graded lattice, was recognized for its innovation and potential impact the new design could have.

Myers was one of the students from 28 colleges and universities across 16 countries who participated in the annual event featuring designs in light-weighting, thermal management, sustainable energy, architected materials, and industrial design categories.

The technology gets Myers one step closer to a distinctive type of prosthesis that is more functional than traditional designs. She created a variable-density lattice structure to improve the connection where the body meets the prosthetic device.

“Light-weighting is super important for people with limited muscle and bone structure, and this is one of the areas where 3D printing, in our experience, has been very positive. The devices are much lighter than those traditionally manufactured,” said Myers, a Ph.D. candidate in RIT’s Kate Gleason College of Engineering. She also teaches courses in the engineering college and participates in interdisciplinary projects taking place at the LiveAbility Lab, an initiative based in the university’s Partnership for Effective Access Technology Research and Development.

There are several types of prosthetic sockets designed to interface with residual limbs. A more recent style developed is called a compression-release-stabilized (CRS) socket. Compression on either side of the humerus bone, for example, helps stabilize the prosthesis, and release areas ensure the soft tissue has a place to emerge.

“That is where this lattice structure comes in,” she said. “There are better ways to precisely control compression by changing the density of the lattice structure.”

Picking up items with a prosthesis means weight is added causing uneven pressure, or weight-load, concentrated on the far end of the bone. Adjusting pressure along the length of the bone and device can increase utility and range of motion, plus ease pain on the compressed tissue.

Inspiration for her new socket design came from running shoes.

“I knew they were using lattice structures at Adidas for running shoes to adjust pressure in different areas of the foot based on sensor readings,” she said. “Where individuals were putting the most pressure on their feet, that is where they put the dense lattice to make it firmer. I thought, why can’t we do that with prosthetic sockets?”

Myers re-worked the idea to form a padded socket with varied areas of density in RIT’s AMPrint Center, a campus laboratory and research facility focusing on additive manufacturing and 3D print advances. After compression, pressure, fatigue, and new materials testing, she will begin prototyping 3D printed models.

“We want it to have both form and function,” she said.

When Myers first began work in prosthetics, she was part of a nonprofit health organization associated with RIT and was instrumental in helping clinicians in Haiti understand how 3D-printed prostheses could be added to their practice.

While there, she met Danie, a young woman who lost her arm during the earthquake in 2010. Myers was touched by her plight, but also saw her as someone with a will to live despite hardships and socio-cultural stigma encountered in her community because of her amputation.

“Danie inspired me. In Haiti it is very hard for a person to not only afford a prosthesis, but to get to a clinic. Some people are spending the night outside of the clinic waiting for them to create this device that takes several days for them to make,” said Myers. “Being able to manufacture the devices faster is one of the things we want to do. We want to be able to provide things people can afford, and that work well for them. The faster it happens, the sooner people like Danie can have the opportunity to wear these. It not only impacts them—it can have a ripple effect on families and their opportunities, too. It gives me greater drive, practically a desperation to do better faster because I have had the opportunity to see with my own eyes what a real difference it has potential to make for people. I can never imagine doing anything else with my life.”

Myers and Danie have remained in contact since meeting, now co-designing devices together. The two have become good friends, and Myers has visited Haiti on several occasions seeing her friend re-building her life. Myers expects to graduate with her doctoral degree in 2023.

Awareness, not mandatory GMO labels, shifts consumer preference

Peer-Reviewed Publication

CORNELL UNIVERSITY

ITHACA, N.Y. – Six years ago, the state of Vermont passed what turned out to be a short-lived law mandating disclosure of genetically modified organisms, or GMOs, on all food products. That law’s effect? A collective shrug of the shoulders.

That doesn’t mean people don’t care about whether GMO ingredients are in their food, according to new Cornell research. Although the mandatory labeling law didn’t change consumer purchasing patterns, the researchers found that the increased consumer awareness caused by the legislation, coupled with existing non-GMO labeling, actually did shift preferences.

“For the consumers who care about this non-GMO attribute, they already have a relevant information signal available in the form of the non-GMO label,” said Jura Liaukonyte, the Dake Family Associate Professor in the Charles H. Dyson School of Applied Economics and Management.

“That’s when the switching happens,” Liaukonyte said, “and this switching is triggered by a heightened awareness through these legislative conversations.”

GMO and non-GMO Labeling Effects: Evidence From a Quasi-Natural Experiment,” published Aug. 29 in Marketing Science. Liaukonyte’s co-authors were Aaron Adalja, assistant professor of food and beverage management in the Cornell Peter and Stephanie Nolan School of Hotel Administration; Emily Wang of the University of Massachusetts, Amherst; and Xinrong Zhu, of Imperial College Business School. Both Dyson and the Nolan School are in the Cornell SC Johnson College of Business.

The group’s key finding: An increase in consumer awareness around GMO-related topics – even in states that didn’t ultimately pass GMO labeling laws – is linked to an increase in demand for non-GMO products. And that difference can be quantified: They found that 36% of new non-GMO product adoption can be explained by differences in consumer awareness tied to legislative activity.

“What’s really interesting is the way legislative activity essentially generates consumer awareness,” Adalja said. “In the paper, we differentiate between this ‘indirect awareness effect’ and the direct effect of labeling, and we show that indirect awareness – in this case, the labeling legislation being discussed in the media – is really the primary mechanism by which we find consumer preferences are shifting.”

Over the last three decades, GMO labeling has become an increasingly important topic of public and political debate. The paper cites a 2016 National Academy of Sciences report finding no scientific evidence that GMO foods are less healthy or safe than non-GMO products; however, on Jan. 1, 2022, the United States mandated disclosure labels on all foods that contain GMOs.

The controversy over GMOs sparked several state-level labeling initiatives over the years, but Vermont was the only state to successfully pass and implement a labeling law. The law took effect July 1, 2016, but was quickly preempted by the National Bioengineered Food Disclosure Standard, signed into law by President Barack Obama on July 29, 2016.

For their study, the researchers analyzed GMO labeling in three steps. They first examined the relationship between the adoption rate of newly introduced non-GMO products and consumer awareness at the time of introduction. These products are identified by the “Non-GMO Project Verified” label, a certification from the third-party nonprofit Non-GMO Project, which has been used since 2010.

Then they analyzed the natural experiment condition created in the run-up to Vermont adopting its GMO labeling law in 2016, to gauge the relationship between product demand and the information available via on-the-ground efforts related to the legislation. The increase in demand tied to increased awareness was significant, the authors found.

And finally, the authors looked into whether actual adoption of the Vermont law – GMO labels appearing on store shelves – resulted in any additional demand for non-GMO or GMO products. It did not.

Previous studies, conducted via questionnaires or in laboratory settings, indicated that GMO labeling would result in big swings in consumer preference, but the Cornell researchers’ study in the field found a more subtle change.

“It’s difficult to approximate in the lab the complexity of the actual marketplace with its many co-existing information signals,” Liaukonyte said.

Adalja said the role of legislative discussion around GMO labeling – even in states that didn’t ultimately adopt labeling laws – was compelling.

“That has some important implications,” he said. “It’s another mechanism lawmakers need to consider when designing and debating policies that aim to change preferences of consumers.”

They also suggest that voluntary non-GMO labels – increasingly common over the last dozen years – may have provided a sufficient disclosure mechanism even without mandatory GMO labeling.

For additional information, see this Cornell Chronicle story.

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POLYMORPHOSLY PERVERSE POLYANDRY

Dolphins form largest alliance network outside humans, study finds

Peer-Reviewed Publication

UNIVERSITY OF BRISTOL

Image 1 

IMAGE: FOUR MALE ALLIES AND A FEMALE view more 

CREDIT: SIMON ALLEN

Male bottlenose dolphins form the largest known multi-level alliance network outside humans, an international team led by researchers at the University of Bristol have shown. These cooperative relationships between groups increase male access to a contested resource.

The scientists, with colleagues from the University of Zurich and University of Massachusetts, analysed association and consortship data to model the structure of alliances between 121 adult male Indo-Pacific bottlenose dolphins at Shark Bay in Western Australia. Their findings have been published today in The Proceedings of the National Academy of Sciences (PNAS).

Male dolphins in Shark Bay form first-order alliances of two-three males to cooperatively pursue consortships with individual females. Second-order alliances of four-14 unrelated males compete with other alliances over access to female dolphins and third-order alliances occur between cooperating second-order alliances.

Co-lead author Dr Stephanie King, Associate Professor from Bristol’s School of Biological Sciences explained: “Cooperation between allies is widespread in human societies and one of the hallmarks of our success. Our capacity to build strategic, cooperative relationships at multiple social levels, such as trade or military alliances both nationally and internationally, was once thought unique to our species.

“Not only have we shown that male bottlenose dolphins form the largest known multilevel alliance network outside humans, but that cooperative relationships between groups, rather than simply alliance size, allows males to spend more time with females, thereby increasing their reproductive success.”

Dr Simon Allen, Senior Lecturer at Bristol’s School of Biological Sciences, who contributed to the study, said “We show that the duration over which these teams of male dolphins consort females is dependent upon being well-connected with third-order allies, that is, social ties between alliances leads to long-term benefits for these males.”

Intergroup cooperation in humans was thought to be unique and dependent upon two other features that distinguish humans from our common ancestor with chimpanzees, the evolution of pair bonds and parental care by males. “However, our results show that intergroup alliances can emerge without these features, from a social and mating system that is more chimpanzee like” noted Richard Connor, Professor Emeritus at the University of Massachusetts and now affiliated with Florida International University, who co-led the study with Dr King.

The publication of the importance of third level or intergroup alliances in dolphins in 2022 holds special significance as the team celebrate the 40th anniversary of the start of Shark Bay dolphin research in 1982 and the 30th anniversary of the publication in 1992 of their discovery of two levels of male alliance formation, also published in The Proceedings of the National Academy of Sciences.

Professor Dr. Michael Krützen, an author on the study and Head of the Anthropology Institute at the University of Zurich, added; “It is rare for non-primate research to be conducted from an anthropology department, but our study shows that important insights about the evolution of characteristics previously thought to be uniquely human can be gained by examining other highly social, large-brained taxa”.

Dr King concluded: “Our work highlights that dolphin societies, as well as those of nonhuman primates, are valuable model systems for understanding human social and cognitive evolution.”

Paper

‘Strategic intergroup alliances increase access to a contested resource in male bottlenose dolphins’ Stephanie L. King, Richard C. Connor, Michael Krützen, Simon J. Allen and William B. Sherwin in The Proceedings of the National Academy of Sciences.

Image 2 

CAPTION

Six allied males and female consort

CREDIT

Simon Allen


CAPTION

Male trio with female

CREDIT

Simon Allen

Contact

Stephanie King stephanie.king@bristol.ac.uk

Simon Allen simon.allen@bristol.ac.uk

Richard Connor rconnor@umassd.edu

Inside the head of one of Australia’s smallest fossil crocs

Peer-Reviewed Publication

UNIVERSITY OF QUEENSLAND

Size comparison 

IMAGE: CREDIT: JORGO RISTEVSKI view more 

CREDIT: JORGO RISTEVSKI

Approximately 13.5 million years ago, north-west Queensland was home to an unusual and particularly tiny species of crocodile and now scientists are unlocking its secrets.

University of Queensland researchers have used state-of-the-art technology to reveal previously unknown details about the prehistoric Trilophosuchus rackhami’s anatomy.

Faculty of Science PhD candidate, Jorgo Ristevski said it is the most detailed examination ever undertaken of the skull anatomy of an extinct croc from Australia.

“By micro-CT scanning the beautifully preserved skull, we were able to digitally separate each bone,” Mr Ristevski said.

“We estimated that at adulthood, Trilophosuchus rackhami would have been between 70 and 90 centimetres long and weigh one to two kilograms, which was very small compared to most present-day crocs.

“This was a truly unique looking croc, with a short snout and three distinct ridges on the top of its skull.”

Trilophosuchus rackhami means Rackham’s three-crested croc, which was named in 1993 in honour of Alan Rackham, who now manages the Riversleigh Fossil Discovery Centre at Mt Isa.

Mr Ristevski said palaeoneurology, a field that studies the brain and nervous system of fossil species, can provide crucial insights into the animal’s evolution, morphology and even behaviour.

“For one of the studies, I digitally reconstructed the brain cavity of Trilophosuchus rackhami and found that it resembles that of some distantly related and potentially terrestrial extinct crocs from Africa and South America,” Mr Ristevski said.

“We were quite surprised to find this because evolutionarily speaking, Trilophosuchus rackhami is more closely related to today’s crocs.

“This may indicate that Trilophosuchus rackhami spent more time on land than most living crocs.”

Mr Ristevski said the findings would be useful in interpreting the evolutionary relationships of extinct crocs, something that will be researched in the future.

Associate Professor Steve Salisbury said up until very recently, Australia had an amazing diversity of prehistoric crocs.

Trilophosuchus rackhami was certainly one of the cutest,” he said.

“If we could travel back in time to north Queensland 13 million years ago, not only would you need to watch out for crocodiles at the water’s edge, but you’d also have to make sure you didn’t step on them in the forest.”

The research was published in The Anatomical Record and The Journal of Anatomy.

CAPTION

Part fossil of Trilophosuchus rackhami skull.

CREDIT

Jorgo Ristevski

CAPTION

Digital reconstruction using the part fossil sample of the Trilophosuchus rackhami skull.

CREDIT

Jorgo Ristevski

CAPTION

Trilophosuchus rackhami skull.

CREDIT

Jorgo Ristevski

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Trilophosuchus rackhami croc.

CREDIT

Jorgo Ristevski



CAPTION

Lead author on the research, Jorgo Ristevski.

CREDIT

Jorgo Ristevski