"All the lonely people": The impact of loneliness in old age on life and health expectancy

DUKE-NUS MEDICAL SCHOOL

Research News

Singapore, 7 July 2021 - In 1966, The Beatles cemented the plight of lonely older people in the popular imagination with the iconic 'Eleanor Rigby', a song that turned pop music on its head when it stayed at number one on the British charts for four weeks. Today, the impact of loneliness in old age on life and health expectancy has been categorically quantified for the first time in a study by scientists at Duke-NUS Medical School (Singapore), Nihon University (Tokyo, Japan) and their collaborators, published in the Journal of the American Geriatrics Society.

"We found that lonely older adults can expect to live a shorter life than their peers who don't perceive themselves as lonely," summarised the study's lead author, Assistant Professor Rahul Malhotra, Head of Research at Duke-NUS' Centre for Ageing Research and Education (CARE). "Furthermore, they pay a penalty for their shorter life by forfeiting potential years of good health."

Associate Professor Angelique Chan, Executive Director of CARE and a senior author of the study, noted, "Besides being the year associated with the coronavirus disease, 2019 was also when the number of adults aged over 30 made up half the total global population for the first time in recorded history, marking the start of an increasingly ageing world. In consequence, loneliness among seniors has become an issue of social and public health concern."

Research Project Professor Yasuhiko Saito, from the College of Economics, Nihon University, a senior co-author of the study, added, "This study is timely because stay-at-home and physical distancing measures instituted since the start of the COVID-19 pandemic have only intensified concern for the mental and physical well-being of older persons."

Key findings: Loneliness has real, physical consequences

The study findings show that people aged 60, who perceive themselves to be sometimes lonely or mostly lonely, can expect to live three to five years less, on average, compared to peers who perceive themselves as never lonely. Similarly, at ages 70 and 80, lonely older persons can, on average, expect to live three to four and two to three years less, respectively, compared to non-lonely peers.

Using the same dataset, the researchers found that the perception of loneliness has a similar impact on two types of health expectancy--remaining years of life lived in a self-rated state of good health as well as remaining years of life lived without being limited when going about 'activities of daily living'. Such activities include routines like bathing and dressing, rising from or settling into a bed or chair, and preparing meals.

At age 60, sometimes lonely or mostly lonely seniors can expect to spend three to five fewer years of their remaining life, on average, without limitations in daily living activities, compared to never-lonely peers. At age 70, their active life expectancy goes down to two to four fewer years, on average. At age 80, it is at one to three fewer years, on average.

How common is loneliness among older adults in Singapore?

Singapore is a particularly relevant setting for studying how loneliness impacts older adults because the country has a rapidly ageing population, and a 'collectivistic' culture, in which relationships and the interconnectedness between people are central--in contrast to an 'individualistic' culture, where each individual's needs and desires are considered to be more important. Previous studies found levels of loneliness to be higher in collectivistic societies, suggesting loneliness may have a more detrimental impact in Singaporean society.

In 2016 and 2017, CARE researchers conducted a study--known as the Transitions in Health, Employment, Social Engagement, and Intergenerational Transfers in Singapore (THE SIGNS) study--to look into factors influencing health, well-being, and activity and productivity levels in older Singaporeans. Nationally representative data, collected from more than 2,000 older Singapore citizens and permanent residents, showed that a third (34 per cent) perceived themselves to be lonely. This proportion increased with age, from 32 per cent among those aged 60-69 years, to 40 per cent among those aged 80 and above.

More males (37 per cent) were lonely, relative to females (31 per cent). Across education levels, the proportion of lonely older Singaporeans was lowest (33 per cent) among those with no formal education, and highest (38 per cent) among those with higher-than-tertiary education. This proportion was nearly 10 per cent higher among seniors who lived alone (43 per cent) compared to those who did not live alone (33 per cent).

"Building on THE SIGNS study, our recent findings highlight the population health impact of loneliness, and the importance of identifying and managing it among older adults," said Asst Prof Malhotra. "This is part of a series of studies to assess the impact of important health and social constructs, like loneliness, sensory impairments, obesity, gender and education, on life and health expectancy among older adults."

"With older persons at potentially greater risk of loneliness as a result of pandemic control measures, there has been increasing policy interest in loneliness around the world," said Assoc Prof Chan. "In 2018, the UK launched a national strategy for tackling loneliness and, in 2021, Japan appointed a 'Minister of Loneliness'. We hope this study helps galvanise more policies to tackle loneliness among older persons."

More and more older people suffer a traumatic brain injury due to falls

RUHR-UNIVERSITY BOCHUM

Research News

 

The study is the first on epidemiology and causes of traumatic brain injury in over 20 years. The research team reports in the journal BMJ Open of 4 June 2021.

Falling and cycling without a helmet are common causes

From a minor fall on a bicycle to a serious road traffic accident: The causes of a traumatic brain injury are manifold. About 90 percent of the approximately 270,000 cases per year are classified as mild, ten percent as moderate or severe. Current findings show that traumatic brain injury is increasing in the age group of over-65s. The research team at BG Kliniken in Bochum, Hamburg, Berlin, Halle, Frankfurt, Ludwigshafen and Murnau found that there has been a shift in the age group most frequently affected and that there is a discernible correlation between the severity of a traumatic brain injury, age and cause.

The study shows that the most frequent causes of traumatic brain injury are falls and no longer road traffic accidents. There has also been a shift with regard to road traffic accidents: The largest group here is no longer car occupants, but cyclists without helmets.

"We are registering a clear shift in the majority of the affected age group towards the older generation. This phenomenon can be observed in almost all industrialised countries," explains Professor Peter Schwenkreis, senior physician at the Neurological Clinic at Bergmannsheil. A link with the age of those affected is also discernible. Falls are the most common cause, especially among older women and men. "Older people are significantly more prone to falls and thus suffer a traumatic brain injury more quickly than other age groups. In addition, the severity of the injury is higher in these patients", Schwenkreis specifies. "This also explains why we are seeing an increase in deaths caused by such an injury in this age group."

Study with over 3,500 participants

For the study, a neuroscientific research group of the BG Kliniken observed and evaluated the development, treatment and impact for patients with traumatic brain injury. A total of 3,514 patients were included in the study. All of them were treated at one of the participating BG Kliniken between 1 October 2014 and 30 September 2015. The prerequisite was that the medical care had taken place within the first 24 hours after suffering the traumatic brain injury.

The results were collected using two different methods: Evaluation of documentation forms from initial care to rehabilitation on the one hand, and standardised telephone interviews with the affected persons three and twelve months after they suffered the trauma on the other hand. A study of this magnitude on the epidemiology of traumatic brain injury has not been published in Germany since 2000/2001.

Simple measures can have a big impact

As moderate to severe traumatic brain injuries occur more frequently in older people, the research group identifies a specific need for more prevention work here. "Training measures for safe walking, training in the use of walking aids or redesigning the home by removing tripping hazards are conceivable. As simple as these measures sound, they can prevent serious injuries", says Peter Schwenkreis. "The advances in passenger protection in cars have had a clearly demonstrable effect", he explains further. "Now it is important to implement the protection of pedestrians and cyclists as part of the emerging shift in mobility."

Traumatic brain injury

A traumatic brain injury is any injury to the skull, with or without fracture, that involves damage to the brain. Just like the causes, the symptoms can also be very diverse. They range from headaches, dizziness and lightheadedness to amnesia or impaired consciousness. However, even minor injuries to the skull can cause bleeding or swelling the brain, which is why a traumatic brain injury should be assessed immediately after an accident.

###

Muscles retain positional memory from fetal life

New perspectives on the pathological mechanisms of muscle diseases and regenerative medicine development

KUMAMOTO UNIVERSITY

Research News

 

IMAGE: MUSCLE STEM CELLS PROLIFERATE TO PRODUCE NEW MYOFIBERS. view more 

CREDIT: ASSOCIATE PROFESSOR YUSUKE ONO

A research collaboration based in Kumamoto University, Japan has discovered that muscles and the resident stem cells (satellite cells) responsible for muscle regeneration retain memory of their location in the body. This positional memory was found to be based on the expression pattern of the homeobox (Hox) gene cluster, which is responsible for shaping the body during fetal life. These findings are expected to provide clues to elucidate the pathogenesis of muscle diseases such as muscular dystrophy, in which the position of muscle vulnerability varies depending on the type of muscle, and to help develop regenerative medicine based on positional memory.

There are various types of the intractable muscle disease muscular dystrophy and each type has a different symptom location. Similarly, age-related muscle fragility (sarcopenia) does not occur evenly throughout the body. The physical location of the symptoms of these diseases cannot be explained by differences in muscle fiber types or physical activity patterns alone, and requires a new perspective to elucidate their respective pathogeneses.

The developmental origin of cells that form muscles differ in the fetal stage. For example, most of the craniofacial muscles originate from the cranial mesoderm, while the limb muscles originate from the body segments. Development of limb and craniofacial muscles in the fetal period involves specific molecular mechanisms that depends on their origin. However, differences in the properties of mature skeletal muscle depending on body position after birth have not been fully discussed. Thus, a research collaboration worked to visualize the body's positional information by studying the epigenomic state and gene expression patterns of skeletal muscle and the muscle stem cells responsible for regeneration.

Using skeletal muscle and associated muscle stem cells isolated from the heads and hind limbs of adult mice, researchers investigated positional specificity at the epigenomic level using DNA methylome analysis. They found characteristic differences in the DNA methylation status at the homeobox (Hox) loci. Among four regions, A to D, the Hox-A locus in particular had an overall DNA hypermethylation state in hindlimb skeletal muscle and muscle stem cells compared to the head. Additionally, both skeletal muscle and muscle stem cells in the hind limbs showed high expression of the Hox-A gene. Many of these Hox-A genes reflected expression patterns in the fetal period. These findings suggest that skeletal muscle and muscle stem cells remember positional information during fetal life, and that epigenomic regulation by DNA methylation may be involved in positional memory.

The researchers then focused on the Hoxa10 gene, which was highly expressed only in the limb muscles. When hindlimb-derived muscle stem cells expressing Hoxa10 were isolated and transplanted into craniofacial muscles that do not express Hoxa10, Hoxa10 gene expression became detectable in the craniofacial muscles. In other words, hindlimb-derived muscle stem cells were able to innervate the craniofacial muscle with strong retention of positional memory even after ectopic transplantation.

They then created mice lacking the Hoxa10 gene in muscle stem cells to analyze its function. A Hoxa10 deficiency severely impaired the regeneration of hindlimb muscles but had no effect on craniofacial muscle regeneration. A detailed investigation of the mechanism behind the hindlimb muscle regeneration disorder revealed that it is caused by genomic instability due to abnormal chromosome distribution during muscle stem cell division. Furthermore, analysis of human head and leg muscle stem cells also showed that only leg muscle cells expressed the HOX-A gene and that its inhibition resulted in abnormal cell division, confirming that muscle cell positional memory is retained in humans and mice.

This research suggest that the positional memory of muscle stem cells based on the position-specific distribution of Hox gene expression may determine the position-specific properties of skeletal muscle, rather than merely persisting from fetal life.

"In the future, we expect that the functional aspects of muscle stem cell positional memory will lead to the clarification of the mechanisms that lead to location-specificity of symptoms that are observed in various muscle diseases like muscular dystrophy," said Associate Professor Yusuke Ono, who led the study. "In addition, ectopic transplantation experiments, in which muscle stem cells are transplanted to a location different from where they were harvested, have shown that they maintain positional memory and regenerate. From a different perspective, skeletal muscles regenerated from xenotransplantation may not possess their original positional information which may impair their normal function. There has been rapid progress recently in the differentiation of iPS cells into various progenitor cells and the development of mass culture techniques, but the location of induced progenitor cells has not been considered. In the future, our group will attempt to develop regenerative therapy applications for muscle diseases by artificially controlling the positional memory of cells and by utilizing the properties of cells with positional memory in the right places."

CAPTION

Muscle stem cells isolated from the hindlimb and ectopically transplanted into the head cause the craniofacial muscles to acquire the positional memory of the hindlimb.

CREDIT

Associate Professor Yusuke Ono

CAPTION

Regenerated muscle after 2 weeks of transient muscle injury: Hoxa10-deficient mice show reduced regeneration and muscle atrophy in the hind limbs, but no effect in the craniofacial muscles.

CREDIT

This research was posted online in Science Advances on 9 June 2021.

Source:

Yoshioka, K., Nagahisa, H., Miura, F., Araki, H., Kamei, Y., Kitajima, Y., ... Ono, Y. (2021). Hoxa10 mediates positional memory to govern stem cell function in adult skeletal muscle. Science Advances, 7(24), eabd7924. doi:10.1126/sciadv.abd7924

 

Study reveals source of remarkable memory of "superagers"

For the first time, researchers have used fMRI to understand how some older adults can learn and remember new information as well as a 25-year-old.

MASSACHUSETTS GENERAL HOSPITAL

Research News

BOSTON -- As we age, our brains typically undergo a slow process of atrophy, causing less robust communication between various brain regions, which leads to declining memory and other cognitive functions. But a rare group of older individuals called "superagers" have been shown to learn and recall novel information as well as a 25-year-old. Investigators from Massachusetts General Hospital (MGH) have now identified the brain activity that underlies superagers' superior memory. "This is the first time we have images of the function of superagers' brains as they actively learn and remember new information," says Alexandra Touroutoglou, PhD, director of Imaging Operations at MGH's Frontotemporal Disorders Unit and senior author of the paper published in Cerebral Cortex.

In 2016, Touroutoglou and her fellow researchers identified a group of adults older than 65 with remarkable performance on memory tests. The superagers are participants in an ongoing longitudinal study of aging at MGH led by Bradford Dickerson, MD, director of the Frontotemporal Disorders Unit at MGH, and Lisa Feldman Barrett, PhD, a research scientist in Psychiatry at MGH. "Using MRI, we found that the structure of superagers' brains and the connectivity of their neural networks more closely resemble the brains of young adults; superagers had avoided the brain atrophy typically seen in older adults," says Touroutoglou.

In the new study, the investigators gave 40 adults with a mean age of 67 a very challenging memory test while their brains were imaged using functional magnetic resonance imaging (fMRI), which, unlike typical MRI, shows the activity of different brain areas during tasks. Forty-one young adults (mean age of 25) also took the same memory test while their brains were imaged. The participants first viewed 80 pictures of faces or scenes that were each paired with an adjective, such as a cityscape paired with the word "industrial" or a male face paired with the word "average." Their first task was to determine whether the word matched the image, a process called encoding. After 10 minutes, participants were presented with the 80 image-word pairs they had just learned, an additional 40 pairs of new words and images, and 40 rearranged pairs consisting of words and images they had previously seen. Their second task was to recall whether they had previously seen each specific word-picture pair, or whether they were looking at a new or rearranged pair.

While the participants were in the scanner, the researchers paid close attention to the visual cortex, which is the area of the brain that processes what you see and is particularly sensitive to aging. "In the visual cortex, there are populations of neurons that are selectively involved in processing different categories of images, such as faces, houses or scenes," says lead author Yuta Katsumi, PhD, a postdoctoral fellow in Psychiatry at MGH. "This selective function of each group of neurons makes them more efficient at processing what you see and creating a distinct memory of those images, which can then easily be retrieved."

During aging, this selectivity, called neural differentiation, diminishes and the group of neurons that once responded primarily to faces now activates for other images. The brain now has difficulty creating unique neural activation patterns for different types of images, which means it is making less distinctive mental representations of what the person is seeing. That's one reason older individuals have trouble remembering when they may have seen a television show, read an article, or eaten a specific meal.

But in the fMRI study, the superagers' memory performance was indistinguishable from the 25-year-olds', and their brains' visual cortex maintained youthful activity patterns. "The superagers had maintained the same high level of neural differentiation, or selectivity, as a young adult," says Katsumi. "Their brains enabled them to create distinct representations of the different categories of visual information so that they could accurately remember the image-word pairs."

An important question that researchers still must answer is whether "superagers' brains were always more efficient than their peers, or whether, over time, they developed mechanisms to compensate for the decline of the aging brain," says Touroutoglou.

Previous studies have shown that training can increase the selectivity of brain regions, which may be a potential intervention to delay or prevent the decline in neural differentiation in normal aging adults and make their brains more like those of superagers. Currently the researchers are conducting a clinical trial to evaluate whether noninvasive electromagnetic stimulation, which delivers an electrical current to targeted areas of the brain, can improve memory in older adults. The researchers also plan to study different brain regions to further understand how superagers learn and remember, and they will examine lifestyle and other factors that might contribute to superagers' amazing memory.

###

Major funding for this study was provided by the National Institute on Aging.

Touroutoglou is an assistant professor of Neurology at Harvard Medical School (HMS). Dickerson is professor of Neurology at HMS. Barrett is distinguished professor of Psychology at Northeastern University. The other co-author is Joseph Andreano, PhD, an investigator in the Department of Psychiatry at MGH and an instructor of Psychiatry at HMS.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2020, Mass General was named #6 in the U.S. News & World Report list of "America's Best Hospitals."

 

Work like a dream: new anticholinergic drug keeps PTSD flashbacks and nightmares away

Researchers find that central anticholinergic drug trihexyphenidyl can potentially keep away post-traumatic stress disorder-related flashbacks and nightmares

CACTUS COMMUNICATIONS

Research News

 

Post-traumatic stress disorder (PTSD) rings a bell for many, due to its rampant references in pop culture, and more, importantly, its prevalence in today's society. It is only probable that this disorder, which develops after shocking or dangerous events, would unfortunately affect the lives of many people. Medical researchers have been hard at work trying to come up with solutions to combat this condition and its manifestations effectively. Unfortunately, the neurological mechanisms of PTSD aren't clear, and without knowing this exactly, trying to find a cure is a shot in the dark.

Fortunately, a group of Japanese researchers from the Sogo PTSD Institute, Medical Corporation Sogokai, Japan led by Dr. Masanobu Sogo appear to have made a breakthrough in PTSD treatment! They have identified a drug called trihexyphenidyl, that can significantly reduce the flashbacks and nightmares experienced by patients with PTSD, according to a study published in Brain and Behavior, a sister open access journal to ACTA J.

Trihexyphenidyl is a central anticholinergic drug used to manage disorders like parkinsonism, and alleviate several side-effects induced by drugs acting on the central nervous system (CNS). It acts by blocking the activity of a neurotransmitter, acetylcholine, in the CNS. Interestingly, it has been available for therapeutic use for around 66 years.

So, what inspired the researchers to pick up this drug? In 2009, they encountered a patient who suffered severe PTSD-related flashbacks and nightmares for 9 years, was diagnosed with bacterial diarrhea at another hospital, and administered a drip infusion containing antibiotics and scopolamine butyl bromide (SB), which is a peripheral anticholinergic that doesn't cross the blood-brain barrier (BBB, penetration rate 0.01%). Twenty minutes after the infusion, the patient's flashbacks completely disappeared!

Since SB is a "peripheral" anticholinergic agent, it shouldn't be able to cross the BBB, but it is probable that the patient's brain was in a state of severe brain excitement due to PTSD. There are eight acetylcholine basal ganglia in the brain, of which the largest, the Meynert nucleus, is closely associated with BBB permeability. The researchers hypothesized that due to abnormal excitement of the Meynert basal ganglia, SB enters the brain and activates anticholinergic action to suppress abnormal acetylcholine secretion of acetylcholine-memory-related circuits centered on the Meynert basal ganglia, eliminating the flashbacks.

From this valuable clinical experience, they figured that PTSD is generated through an acetylcholine-memory-related-circuit centered on Meynert. Based on this, Dr. Sogo and his team considered the use of a central anticholinergic agent: trihexyphenidyl.

Excited at the discovery, the researchers went on to devise an exploratory study, to check if trihexyphenidyl is effective against similar symptoms in other patients with PTSD. They administered trihexyphenidyl in 34 patients with PTSD, who had previously received psychiatric treatment for several years without therapeutic benefits, and determined its effect through interviews.

A significant 88% of the analyzed patients reported mild to no PTSD-related nightmares. Similarly, 79% of the analyzed patients reported similar responses for PTSD-related flashbacks. Notably, the researchers found that trihexyphenidyl has efficacy and a rapid onset (1-2 days) in the treatment of PTSD-related nightmares and flashbacks. Clearly, trihexyphenidyl is the elusive silver bullet against PTSD!

Dr. Sogo states, "To the best of our knowledge, this is the first pharmacological report describing the novel use of trihexyphenidyl for PTSD-related nightmares, which doesn't respond to conventional psychiatric treatment." While further studies are needed to prove the mechanism of PTSD, repurposing trihexyphenidyl to treat PTSD would be a promising turn of events, since the drug is inexpensive, and has no adverse effects. Here's to hope for patients suffering from PTSD, with the discovery of trihexyphenidyl!

###

Reference

Authors: Katsumasa Sogo, Masanobu Sogo, Yoshie Okawa

Title of original paper: Centrally acting anticholinergic drug trihexyphenidyl is highly effective in reducing nightmares associated with post-traumatic stress disorder

Journal: Brain and Behavior

DOI: https://doi.org/10.1002/brb3.2147

Affiliations: Sogo PTSD Institute, Medical Corporation, Sogokai, Hiroshima-city, Japan

About Dr. Masanobu Sogo

Dr. Masanobu Sogo is a researcher affiliated to Sogo Clinic, Hiroshima City, Japan. His primary research interests involve post-traumatic stress disorder and its treatment.

Novel study of high-potency cannabis shows some memory effects

WASHINGTON STATE UNIVERSITY

Research News

 

PULLMAN, Wash. - Even before the pandemic made Zoom ubiquitous, Washington State University researchers were using the video conferencing app to research a type of cannabis that is understudied: the kind people actually use.

For the study, published in Scientific Reports, researchers observed cannabis users over Zoom as they smoked high-potency cannabis flower or vaped concentrates they purchased themselves from cannabis dispensaries in Washington state, where recreational cannabis use is legal. They then gave the subjects a series of cognitive tests.

The researchers found no impact on the users' performance on decision-making tests in comparison to a sober control group but did find some memory impairments related to free recall, source memory and false memories.

While the findings are in line with previous research on low-potency cannabis, this study is one of the few to investigate cannabis that contains much more than 10% tetrahydrocannabinol (THC), the plant's main psychoactive ingredient. This is only the second known study to examine the effect of cannabis concentrates.

"Because of federal restrictions to researchers, it was just not possible to study the acute effects of these high-potency products," said Carrie Cuttler, WSU psychologist and lead researcher on the study. "The general population in states where cannabis is legal has very easy access to a wide array of high- potency cannabis products, including extremely high-potency cannabis concentrates which can exceed 90% THC, and we've been limited to studying the whole plant with under 10% THC."

While 19 states and Washington D.C. have legalized cannabis for recreational use, the U.S. federal government still classifies it as a Schedule 1 drug, implying it has a high potential for abuse and no medicinal benefits. Until recently, researchers interested in studying cannabis were limited to using low-potency plants of around 6% THC supplied by the National Institute of Drug Abuse. In June, the U.S. Drug Enforcement Administration indicated it may allow some companies to start growing cannabis for research purposes.

For this study, which began in 2018, Cuttler and her colleagues found a way to study the effects of high-potency cannabis while still complying with federal guidelines. The study participants bought their own products and used them in their own homes. They were never in a laboratory on federal property, and the researchers never handled the cannabis themselves. Participants were not reimbursed for their purchase. Instead they were compensated for their time with Amazon gift cards. All participants were over 21 and experienced cannabis users who reported no past negative reactions to cannabis like panic attacks. The study's method was cleared by WSU Division of the Office of the Attorney General and the university's research ethics board.

The 80 participants were divided into four groups: two groups used cannabis flower with more than 20% THC but one containing cannabidiol (CBD), a non-psychoactive component of cannabis, and the other without CBD. Another group vaped cannabis concentrates with more than 60% THC that included CBD. A fourth group remained sober.

For all cannabis using groups, the researchers found no effect on a range of decision-making tests including risk perception and confidence in knowledge. On a few memory tests there were also no significant differences between the cannabis-using and sober groups, including prospective memory, the ability to remember to do things at a later time, such as attend an appointment. The cannabis-using participants also did well on temporal order memory, the ability to remember the sequence of previous events.

However, the groups that smoked cannabis flower with CBD did worse on verbal free recall trials- they were unable to recall as many words or pictures that were shown to them compared to the sober group. This finding was contrary to a small number of previous studies indicating CBD might have a protective effect on memory. The groups that used cannabis without CBD and the group that used concentrates, performed worse on a measure of source memory which means being able to distinguish the way previously learned information was presented.

Finally, all three cannabis-using groups did poorly on a false memory test - when given a new word and asked if it had been presented before, they were more likely to say it had when it had not.

There was also an unexpected finding: people who vaped the high-potency concentrates with more than 60% THC performed comparably to those who smoked cannabis flower. This may have been because they tended to self-titrate - using less of the drug to achieve a similar level of intoxication and impairment as the people who smoked the less-potent cannabis flower.

Cuttler said this was cause for cautious optimism on the little-studied but widely available concentrates.

"There's been a lot of speculation that these really high-potency cannabis concentrates might magnify detrimental consequences, but there's been almost zero research on cannabis concentrates which are freely available for people to use," said Cuttler. "I want to see way more research before we come to any general conclusion, but it is encouraging to see that the concentrates didn't increase harms."

###

Faulty memories of our past whereabouts: The fallacy of an airtight alibi

ASSOCIATION FOR PSYCHOLOGICAL SCIENCE

Research News

 

When someone is suspected of criminal activity, one of the most important questions they are asked is if they have a credible alibi. Playing back past events in our minds, however, is not like playing back a video recording. Recollections of locations, dates, and companions can become muddled with the passage of time. If a suspect's memories are out of line with documented events, a once-plausible alibi can crumble and may be seen as evidence of guilt.

To put people's memories of past whereabouts to the test, a team of researchers tracked the locations of 51 volunteers for one month and found that their recollections were wrong approximately 36% of the time.

"This is the first study to examine memory for where an event happened," said Simon J. Dennis, director of the Complex Human Data Hub at the University of Melbourne's School of Psychological Sciences and lead author of the study, which was published in the journal Psychological Science. "We were able to use experience-sampling methods to actually examine people's memories and analyze what is affecting memory error in their everyday life."

In the study, an app on the participants' smartphones continuously (and securely) recorded their locations and surroundings via GPS. The app also made sound recordings of the environment every 10 minutes. Participants had the freedom to turn off the app or to delete events--a mechanism designed to protect privacy.

At the end of the month, the participants received a memory test in which they were given a time and date and then asked to select one of four markers on Google Maps to show where they had been at that moment.

The results revealed that participants tended to confuse days across weeks. They also often confused weeks in general and hours across days. The participants had the poorest recall when memories of one event become entwined with memories of a similar experience, such as filling up a car with gas at a different location of the same gas-station chain.

Additionally, the researchers found that people tended to confuse places they had visited at similar times or locations, such as multiple bars visited in one evening. People also made mistakes--although less frequently--when events involved similar sounds or movement patterns, such as when they had walked through town on different days while listening to their favorite music.

"This has implications for alibi generation, as jurors tend to assume that a suspect who is wrong is lying," said Dennis. "These results can alert investigators to the questions they should ask in order to catch the memory errors that suspects are likely to make."

###

Reference: Laliberete, E., Yim, H., Stone, B., & Dennis, S. (2021). The fallacy of an airtight alibi: Understanding human memory for "where" using experience sampling. Psychological Science, 23(6), 944-951https://doi.org/10.1177/0956797620980752

Additional research can be found in the APS Research Topic on Memory.

 

CAMH releases updated national clinical guidelines for treatment of opioid use disorder

Harmonization of guidelines across Canada will improve consistency and quality of care amid worsening opioid epidemic

CENTRE FOR ADDICTION AND MENTAL HEALTH

Research News

As more evidence emerges that opioid overdose deaths have increased dramatically since the onset of COVID-19, the Centre for Addiction and Mental Health (CAMH), in collaboration with subject matter experts and medical regulatory authorities across Canada, have now released updated national clinical guidelines for the treatment of opioid use disorder. Opioid Agonist Therapy: A Synthesis of Canadian Guidelines for Treating Opioid Use Disorder, harmonizes existing provincial and national guidelines, evidence-based practices, and expert opinions into one document aimed at providing consistent and high-quality care to people with opioid use disorder.

First-line treatment for those with opioid use disorder is opioid agonist therapy (OAT). This includes providing a medication that keeps the person out of withdrawal, reduces their cravings and prevents overdose deaths should they relapse. These medications are the most effective treatment option for opioid use disorder, and are scientifically proven to save lives, even when people use fentanyl. When combined with counselling and addressing the social causes and consequences of addiction, the person can make a full recovery and get back to living their lives. OAT is a long-term treatment and it can take some people a few tries before they get better completely.

"COVID has drastically changed the situation on the ground across Canada in regards to the opioid crisis and these need to be living guidelines that can be updated as circumstances change and new evidence evolves," said Dr. Peter Selby, Clinician Scientist, Addictions Division, and CAMH lead for this initiative. "For example, we wanted to change some of the old rules that were making it hard to provide person-centred care and help people stay in treatment. That is key because the longer people are in treatment the better they recover and the less likely they are to die from an opioid overdose."

The new guidelines are updated with the most up-to-date information and clinically-proven strategies to help patients overcome opioid addiction. These include updated medication delivery options, such as offering injectables, and expanding the list of medications for those who don't respond to traditional treatments. The guidelines also feature less regulatory restriction and new strategies to combat stigma to make treatment adherence easier.

"OAT, like any other substance use treatment, needs to meet every patient's individualized needs and goals," added Dr. Narges Beyraghi, CAMH Addictions Psychiatrist. "The recovery journey is different for every individual and they may connect to different components of care during this process. This updated guideline has tried to be inclusive to a patient's gender, age and other physical and mental health problems that could be a barrier to access to care or equitable care."

A CAMH study released in April found that a large number of people who were regular opioid users when the pandemic began reported heightened fears of dying from an overdose, in large part because of disruptions in the supply of street drugs that made drugs more expensive, harder to get and of unknown origin or potency. Lockdown measures across the country also increased the risk that people would use alone without anyone to help them in the event of an overdose. This risk was compounded by reduced access to harm reduction services like safe injection centres. All of these factors led experts to fear that the COVID pandemic would make the opioid crisis more deadly, and new numbers recently released by Ontario Public Heath confirmed those fears, with a 60 per cent increase in opioid deaths reported.

Dr. Marina Reinecke, Medical Consultant, Prescribing Practices Program, The College of Physicians & Surgeons of Manitoba, said: "Opioid use disorder affects a large and diverse group of Canadians. In Manitoba, our patients live in urban, rural and remote locations and have diverse care needs. These needs often collide with inequitable access to health care services. This compounds the tragedy associated with this very treatable disease. These guidelines provide evidence-based guidance and practical information for frontline clinicians in every care setting, empowering them to bring hope and health to Canadians where they live."

"However, guidelines alone don't change practice," added Dr. Beyraghi. "What does change practice is a combination of policy changes to address structural and societal stigma and education. We have several courses at CAMH that help providers acquire and improve their skills in treating people with opioid use disorder in a humane and respectful manner. We also have great resources for people who use opioids and their loved ones to make a science-based informed choice about treatment."

###

Visit the CAMH website to learn more about the updated opioid use disorder guidelines, as well as additional resources regarding OAT.

 

Study: Hospitals not adequately prepared for next pandemic

Use of new preparedness tool can help hospitals determine their ability to respond to unexpected surges due to mass shootings, terrorist attacks, or future pandemics 

UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE

Research News

 

As the COVID-19 pandemic wanes in the U.S., a new study from the University of Maryland School of Medicine (UMSOM) and University of Maryland Medical Center (UMMC) finds that hospitals nationwide may not be adequately prepared for the next pandemic. A 10-year analysis of hospitals' preparedness for pandemics and other mass casualty events found only marginal improvements in a measurement to assess preparedness during the years leading up to the COVID-19 pandemic. The study was published last month in the Journal of Healthcare Management.

"Our work links objective healthcare data to a hospital score that assesses the ability to save lives in a disaster," said study lead author David Marcozzi, MD, Professor of Emergency Medicine at UMSOM and Chief Clinical Officer/Senior Vice President at UMMC. "It attempts to fill a glaring gap in the national conversation on the need for improved assessments of and the opportunity for better hospital planning to assure readiness."

To conduct the research, Dr. Marcozzi, who is also the COVID-19 Incident Commander for the University of Maryland Medical System, and his colleagues first developed and published a surge index tool that linked standard reported hospital information to healthcare preparedness elements.  The tool, called the Hospital Medical Surge Preparedness Index (HMSPI), used data from 2005 to 2014 to produce a score designed to predict how well a hospital can handle a sudden influx in patients due to a mass shooting or infectious disease outbreak.  Such data included the size of the medical staff, the number of hospital beds, and the amount of equipment and supplies.

Medical surge capacity is an important measure to assess a hospital's ability to expand quickly beyond normal services to meet an increased demand for healthcare. The Las Vegas mass shooting in 2017, for example, sent more than 500 concertgoers to local hospitals. During the early weeks of the COVID-19 pandemic, New York City hospitals were under siege with 4,000 patients hospitalized. To calculate the HMSPI, researchers input data from four important metrics.

Staff: Doctors, nurses, pharmacists, respiratory technicians and others

Supplies: Personal protective equipment, cardiac monitors, sterile bandages, and ventilators

Space: Total beds and number of beds that current staff can handle

Systems: Framework for enabling electronic sharing of files and information between departments and multiple hospitals

In the new study, Dr. Marcozzi and his colleagues used data from the American Hospital Association's annual surveys of more than 6,200 hospitals nationwide that were collected from 2005 to 2014. They also employed data from the U.S. Census Bureau to determine population estimates in cities and the Dartmouth Atlas Project to establish the geographic service area of each hospital. They combined the hospital metrics gleaned from the AHA's annual surveys with the geographic data to calculate HMSPI composite scores for hospitals in each state.

Their evaluation found varying levels of increases in HMSPI scores from 2005 to 2014 in every state, which could indicate that states are becoming better prepared to handle a medical surge. The scores also indicated that ideal readiness had not yet been achieved in any state before the COVID-19 pandemic.

"This is just the starting point. We need to better understand the ability of our nation's hospitals to save lives in times of crisis," said Dr. Marcozzi.  This information, and follow-up studies building from this work, will be key to better matching states' healthcare resources to their population to assure optimal care is delivered.  Dr. Marcozzi described one follow-up study that would be impactful would be to use data from the COVID-19 pandemic to see whether the index was predictive to indicate which hospitals were most prepared for the pandemic surge based on their patient outcomes.

"This pioneering work is a needed advancement that could allow for a transparent assessment of a hospital's ability to save lives in a large-scale emergency," Dr. Marcozzi said. "The COVID-19 pandemic demonstrated that there is still plenty of room for improvement in the ability of our nation's healthcare system to triage and manage multiple patients in a crisis and that translates into lives lost, unnecessarily. Our research is dedicated to those who lost their lives in this tragedy and other mass casualty events. We can do better."

National health leadership organizations, such as the U.S. Centers for Medicare and Medicaid Services, the Assistant Secretary for Preparedness and Response, the Joint Commission, and the American Medical Association, as well as state and local emergency planners, could all potentially benefit from the use of HMSPI scores, according to Dr. Marcozzi. The tool could be used to support data-driven policy development and resource allocation to close gaps and assure that individuals get the care they need, when then need it, during a crisis.

Ricardo Pietrobon, MD, PhD, MBA, Adjunct Associate Professor of Emergency Medicine at UMSOM, Nicole Baehr, Manager of Operations at UMMC, and Brian J. Browne, MD, Professor and Chair of the Department of Emergency Medicine, were co-authors on this study. Researchers from the University of Nebraska Medical Center, University of Miami, and the U.S. Department of Veterans Affairs also participated in this research. The study was funded by the Bipartisan Commission on Biodefense.

"The COVID-19 pandemic taught us that we need to be better prepared for the unexpected crisis," said E. Albert Reece, MD, PhD, MBA, Executive Vice President for Medical Affairs, UM Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine. "Having an important metric like the HMSPI could be a game changer that ultimately saves lives during a surge by helping hospitals identify and fix their vulnerabilities.

###

JUL 7, 2021

 

Wolff Responds: Surfside Condo Collapse & Socialism

In this Wolff Responds, In this Wolff Responds, Prof. Wolff comments on the recent condominium building collapse in Miami. Housing, he argues, is a social responsibility and therefore decisions like construction, structural improvements and maintenance of residential buildings should be made by the society at large, instead of a small minority, like a coop board, as was the case with the Surfside condo.

Wolff Responds is a @Democracy At Work  production. We provide these videos free of ads. Please consider supporting our work. Visit our website democracyatwork.info/donate or join our growing Patreon community and support Global Capitalism Live Economic Update with Richard D. Wolff at https://www.patreon.com/gcleu.

 

Experimental Investigation on Performance and Exhaust Emissions of a Diesel Engine Fueled With Palm Oil Shea Butter Oil Blends Biodiesels

International Journal of Trend in Scientific Research and Development - IJTSRD

2021, International Journal of Trend in Scientific Research and Development

1 View7 Pages

1 File ▾

Biodiesel,

Engine Performance,

Transesterification

In this study, experimental investigations on the performance and exhaust emissions of a diesel engine was carried out using Palm oil Shea butter oil biodiesel as fuel. The two vegetable oils, Shea butter SB and Palm oil PO were blended in the proportion 25 75 , 50 50 , and 75 25 v v. The transesterification of the blended oils were carried out using ethanol, with potassium hydroxide as catalyst. The chemo physical properties of the biodiesels produced were determined experimentally and compared with that of petroleum diesel. Engine performance and emission test were conducted using the engine test bed with the instrumentation unit, emission gas analyzer, and the produced biodiesels as fuel. From the results, it was observed that, the petroleum diesel recorded the highest torque, while biodiesels recorded reduced values of torque at all the loads with the 100 SB and 75 SB 25 PO biodiesels both recorded the same values of torque at all the loads. The 100 SB biodiesel recorded the highest exhaust temperature, while the petroleum diesel recorded the lowest exhaust temperature at all the loads. Exhaust gas temperature increase as the load increases. Biodiesels showed reduced brake power as compared to petroleum diesel, but the 100 SB and 75 SB 25 PO both recorded the highest brake power among the biodiesels at all the loads. Biodiesels recorded higher values of BSFC as compared to petroleum diesel, with the 25 SB 75 PO biodiesel having the highest BSFC at all the loads. The brake thermal efficiency BTE of the petroleum diesel was highest as compared to biodiesels at all the loads. The 25 SB 75 PO and 100 PO biodiesels both recorded the least carbon monoxide CO emissions, and CO emissions decreases with increase in loads. The petroleum diesel recorded the highest CO emissions for all the three loads. The carbon dioxide CO2 emissions increases with increase in loads, with the petroleum diesel recording the least CO2 emissions at all the loads. The petroleum diesel showed increased hydrocarbon HC emissions for all the loads, while the 25 SB 75 PO and 100 PO biodiesels recorded the least HC emission. The 100 SB biodiesel recorded the highest NOx emissions, while the petroleum diesel recorded the least NOx emissions at all the loads. Thus, the 25 SB 75 PO and 75 SB 25 PO with improved engine performance and reduced emissions is suitable for use in diesel engine without engine modification. Abdul Musa | L. T. Tuleun | J. S. Ib … View full abstract

https://www.academia.edu/49594985/Experimental_Investigation_on_Performance_and_Exhaust_Emissions_of_a_Diesel_Engine_Fueled_With_Palm_Oil_Shea_Butter_Oil_Blends_Biodiesels?email_work_card=view-paper