Electric ‘thinking cap’ controls learning speed

Caffeine-fueled cram sessions are routine occurrences on any college campus. But what if there was a better, safer way to learn new or difficult material more quickly? What if “thinking caps” were real? Scientists have now shown that it is possible to selectively manipulate our ability to learn through the application of a mild electrical current to the brain, and that this effect can be enhanced or depressed depending on the direction of the current.

Robert Reinhart applies the electrical stimulus to subject Laura McClenahan. After 20 minutes the headband is removed and the EEG cap will capture readings of her brain as she executes the learning task.

Caffeine-fueled cram sessions are routine occurrences on any college campus. But what if there was a better, safer way to learn new or difficult material more quickly? What if “thinking caps” were real?

In a new study published in the Journal of Neuroscience, Vanderbilt psychologists Robert Reinhart, a Ph.D. candidate, and Geoffrey Woodman, assistant professor of psychology, show that it is possible to selectively manipulate our ability to learn through the application of a mild electrical current to the brain, and that this effect can be enhanced or depressed depending on the direction of the current.

The medial-frontal cortex is believed to be the part of the brain responsible for the instinctive “Oops!” response we have when we make a mistake. Previous studies have shown that a spike of negative voltage originates from this area of the brain milliseconds after a person makes a mistake, but not why. Reinhart and Woodman wanted to test the idea that this activity influences learning because it allows the brain to learn from our mistakes. “And that’s what we set out to test: What is the actual function of these brainwaves?” Reinhart said. “We wanted to reach into your brain and causally control your inner critic.”

Reinhart and Woodman set out to test several hypotheses: One, they wanted to establish that it is possible to control the brain’s electrophysiological response to mistakes, and two, that its effect could be intentionally regulated up or down depending on the direction of an electrical current applied to it. This bi-directionality had been observed before in animal studies, but not in humans. Additionally, the researchers set out to see how long the effect lasted and whether the results could be generalized to other tasks.

Stimulating the brain

Using an elastic headband that secured two electrodes conducted by saline-soaked sponges to the cheek and the crown of the head, the researchers applied 20 minutes of transcranial direct current stimulation (tDCS) to each subject. In tDCS, a very mild direct current travels from the anodal electrode, through the skin, muscle, bones and brain, and out through the corresponding cathodal electrode to complete the circuit. “It’s one of the safest ways to noninvasively stimulate the brain,” Reinhart said. The current is so gentle that subjects reported only a few seconds of tingling or itching at the beginning of each stimulation session.

In each of three sessions, subjects were randomly given either an anodal (current traveling from the electrode on the crown of the head to the one on the cheek), cathodal (current traveling from cheek to crown) or a sham condition that replicated the physical tingling sensation under the electrodes without affecting the brain. The subjects were unable to tell the difference between the three conditions.

The learning task

After 20 minutes of stimulation, subjects were given a learning task that involved figuring out by trial and error which buttons on a game controller corresponded to specific colors displayed on a monitor. The task was made more complicated by occasionally displaying a signal for the subject not to respond — sort of like a reverse “Simon Says.” For even more difficulty, they had less than a second to respond correctly, providing many opportunities to make errors — and, therefore, many opportunities for the medial-frontal cortex to fire.

The researchers measured the electrical brain activity of each participant. This allowed them to watch as the brain changed at the very moment participants were making mistakes, and most importantly, allowed them to determine how these brain activities changed under the influence of electrical stimulation.

Controlling the inner critic

So when we up-regulate that process, we can make you more cautious, less error-prone, more adaptable to new or changing situations — which is pretty extraordinary,” Reinhart said. When anodal current was applied, the spike was almost twice as large on average and was significantly higher in a majority of the individuals tested (about 75 percent of all subjects across four experiments). This was reflected in their behavior; they made fewer errors and learned from their mistakes more quickly than they did after the sham stimulus. When cathodal current was applied, the researchers observed the opposite result: The spike was significantly smaller, and the subjects made more errors and took longer to learn the task. “So when we up-regulate that process, we can make you more cautious, less error-prone, more adaptable to new or changing situations — which is pretty extraordinary,” Reinhart said.

The effect was not noticeable to the subjects — their error rates only varied about 4 percent either way, and the behavioral adjustments adjusted by a matter of only 20 milliseconds — but they were plain to see on the EEG. “This success rate is far better than that observed in studies of pharmaceuticals or other types of psychological therapy,” said Woodman.

The researchers found that the effects of a 20-minute stimulation did transfer to other tasks and lasted about five hours.

The implications of the findings extend beyond the potential to improve learning. It may also have clinical benefits in the treatment of conditions like schizophrenia and ADHD, which are associated with performance-monitoring deficits.

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Story Source:

The above story is based on materials provided by Vanderbilt University. The original article was written by Liz Entman. Note: Materials may be edited for content and length.

Really old school: Archaeologists unearth ancient example of human cancer

 

 

 

 Researchers at the British Museum and Durham University in the U.K. have located a skeleton more than 3,000 years old that they say represents the oldest complete example of a human being with metastatic cancer.

The remains were found in modern day Sudan, and bone lesions were identified using radiography and a scanning electron microscope.

For more on the big find and what it could mean for our understanding of cancer, click the link below:

Archaeologists Find 3,200-Year-Old Human Skeleton With Cancer

 

MedPAC: Short-term drop in imaging offset by long-term growth

By Kate Madden Yee, AuntMinnie.com staff writer

March 21, 2014 — Imaging volume per Medicare beneficiary decreased by 3.2% from 2011 to 2012, but the use of imaging services has remained much higher than it was a decade ago, according to the Medicare Payment Advisory Commission’s (MedPAC) annual report to Congress.

The agency recognized the decline in Medicare imaging volume in a report it released on March 14, but it focused on the fact that overall cumulative growth in imaging volume from 2000 to 2009 totaled 85%, compared with a cumulative decrease in imaging volume since then of about 7%.

“Despite decreases after 2009, use of imaging services has remained much higher than it was a decade ago,” MedPAC wrote in its 2014 “Report to the Congress: Medicare Payment Policy.”

“The growth in imaging volume from 2000 to 2009 was exceeded only by the 86% growth in the use of tests — such as allergy tests — during those years,” according to the agency.

Changes in Medicare imaging volume

Average annual change in units of service per beneficiary, 2007-2011 0.6%
Change in units of service per beneficiary, 2011-2012 -1.9%
Average change in volume per beneficiary, 2007-2011 0.2%
Change in volume per beneficiary, 2011-2012 -3.2%
Percent of 2012 allowed charges 11.9%
Source: MedPAC analysis of claims data for 100% of Medicare beneficiaries.
The decrease in imaging volume is due in part to the shift in billing for cardiovascular imaging from physician offices to hospital outpatient departments, MedPAC found. In 2012 compared with 2011, the number of echocardiograms per beneficiary provided in hospital outpatient departments went up by 13.5%, but the number provided in professional offices decreased by 9%.

In addition, from 2011 to 2012, the number of cardiac nuclear medicine studies per beneficiary provided in hospital outpatient departments increased by 9.4%, while the number provided in professional offices decreased by 15.9%. These changes in billing patterns are consistent with reports of an increase in hospital-owned cardiologist practices, the agency wrote.

“Some of the 3.2% decrease in the volume of imaging services results from decreases in units of service for nuclear medicine and echocardiography,” MedPAC wrote. “However, the most important factor is the movement of these services from the nonfacility setting to the facility setting. If these two types of services are excluded from the calculations, the volume of all other imaging services from 2011 through 2012 would show a decrease of 1.9% instead of 3.2%.”

SGR repeal is of highest priority

In its report, MedPAC reiterated its long-standing recommendation to repeal the sustainable growth rate (SGR) formula. After a decade of year-end legislative overrides, the policy is causing uncertainty for physician and other clinician practices and has the potential to create instability for beneficiaries.

“MedPAC’s highest policy priority with respect to Medicare’s payments to physicians and other health professionals is repeal of the SGR,” the commission wrote.

MedPAC suggested that Congress take the following four actions:

•Repeal the SGR and replace it with 10 years of legislated updates. Updated percentages would differ for clinicians who deliver primary care and those who deliver other services: Fees for nonprimary care services would be reduced by less than 3% in each of the first three years, followed by a freeze, while fees for primary care would be frozen for 10 years. This way, physicians would shoulder about one-third of the cost of repealing the SGR, according to MedPAC.

•Collect data to improve the relative valuation of services. The commission is recommending that the Secretary of the Department of Health and Human Services regularly collect data — including service volume and work time — to establish more accurate work and practice expense values.

•Identify overpriced services and rebalance payments.

•Encourage accountable care organizations (ACOs) by creating greater opportunities for shared savings. Physicians who join or lead two-sided risk ACOs should be afforded a greater opportunity for shared savings than those in bonus-only ACOs and those who do not join any ACO, according to MedPAC.

“Repeal of the SGR should be done in a fiscally responsible way,” MedPAC wrote. “The commission’s recommendations to the Congress aim to preserve or enhance beneficiary access to quality care, while minimizing the financial burden on beneficiaries and taxpayers.”

Ultrasound can identify pregnant woman with preeclampsia at risk for respiratory failure

Ultrasound can identify pregnant woman with preeclampsia at risk for respiratory failure
Posted on March 20, 2014 Updated on March 20, 2014

Ultrasound of the lungs could help doctors quickly determine if a pregnant woman with preeclampsia is at risk for respiratory failure, suggests preliminary research published in the April issue of Anesthesiology.About 60,000 women worldwide die as a result of preeclampsia, which causes severely high blood pressure. Potential complications include stroke, bleeding and excess fluid in the lungs – called pulmonary edema – which can lead to respiratory failure. The study suggests a lung ultrasound can help doctors easily learn whether a woman with preeclampsia is suffering from pulmonary edema and ensure she receives the correct treatment.

“Lung Ultrasound is fast, safe, noninvasive and easy to use,” said Marc Leone, M.D., Ph.D., lead author of the study and vice chair of the department of anesthesiology and critical care medicine, Hopital Nord, Marseille, France. “We found it allowed us to quickly assess whether a woman with preeclampsia had pulmonary edema and confirm the severity of the condition.”

Doctors often measure urine output to determine if a woman needs fluid administration, but the results are wrong about half of the time. “Lung ultrasound enables the medical team to identify which women really need the fluid treatment,” noted Dr. Zieleskiewicz, the study’s first author.

Pulmonary edema is typically caused by heart failure, but also can be caused by lung inflammation. Researchers analyzed the use of lung ultrasounds, which can assess lung edema, are easier to use than cardiac ultrasound and can be performed with devices commonly found in maternity wards. Lung ultrasound highlights white lines mimicking comet tails, irradiating from the border of the lungs. These lines are the reflection of water in the lungs. The detection of three or more lines strongly suggests the diagnosis of pulmonary edema.

Researchers performed both cardiac and lung ultrasounds before and after delivery in 20 women with severe preeclampsia. Five of the 20 women (25 percent) had pulmonary edema prior to delivery according to lung ultrasound, while four (20 percent) had the condition according to the cardiac ultrasound. The lung ultrasound identified a patient with non-cardiac pulmonary edema, which the cardiac ultrasound did not detect.

The test results could help ensure that pregnant women with pulmonary edema not be given intravenous or excess fluids, which worsens the condition and can lead to respiratory failure. Typically, women with pulmonary edema are treated with oxygen and medication to lower the blood pressure or rid the body of excess fluid. In real time, lung ultrasound also serves to observe improvement or worsening of pulmonary edema.

Join the conversation: Maria Shriver answers your questions about Alzheimer’s

Join the conversation: Maria Shriver answers your questions about Alzheimer’s

More than 5 million Americans are living with Alzheimer’s disease and that number is expected to jump to 13 million in next 35 years. Nearly every one of us has been touched by this disease in some way.

To kick off the series, Maria Shriver hosted a live Google+ hangout on the politics of Alzheimer’s, activism and what can be learned from AIDS activists and more. Other guests included actors Seth Rogen and wife Lauren Miller, Dr. Maria Carrillo and along with Trish and George Vradenburg (founders of US Against Alzheimer’s). Watch it here.

On Wednesday, she answered viewer questions about the disease via Twitter. Find a transcript here.

Share your stories with us and each other on Twitter, Facebook, and Google+ by using the hashtag #AgeofAlz. You can also comment directly here.

For more of Maria’s reporting, connect with her on Facebook and Twitter.

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http://www.nytimes.com/video/multimedia/1248069388474/portraits-of-the-mind.html

Jonathon Niese has Favorable MRI, Cleared to Resume Throwing

By Danny Abriano – Mar 17th, 2014 at 11:53 am

UPDATE, 12:18 PM:

According to Adam Rubin of ESPN New York, citing multiple sources, Jonathon Niese’s MRI Monday morning in New York revealed no structural damage.

Niese was given a cortisone shot in the back of his elbow, and was cleared to resume throwing, which Rubin believes he’ll do on Wednesday.

Still, it’s likely that Niese opens the season on the disabled list, though he can return as early as April 6th if the Mets backdate his DL stint.

ORIGINAL ARTICLE:

Although the Mets have yet to receive the results from the MRI Jonathon Niese was scheduled to undergo on Monday in New York, it’s highly likely the left-hander will open the season on the disabled list. Writes Adam Rubin:

The Mets do not need a fifth starter until April 6, against the Cincinnati Reds at Citi Field. And that would be the day Niese would be eligible to be activated from the disabled list.

As Rubin explains, the Mets would be able to backdate a potential Niese disabled list stint nine days (the end of spring training).

After departing Sunday’s start early, Niese explained to reporters that he had been dealing with a hyperextended elbow, and that he was taking anti-inflammatories for it.

Sep 29, 2013; New York, NY, USA; New York Mets starting pitcher Jonathon Niese (49) reacts after giving up two runs to the Milwaukee Brewers during the fourth inning of a game at Citi Field. Mandatory Credit: Brad Penner-USA TODAY Sports

He went on to note that he wanted to remain in the game, and that the pain he feels is not in the area usually associated with ligament damage (which could lead to Tommy John surgery).

Thoughts:

Even if Jonathon Niese’s MRI comes back clean, there is absolutely no reason to rush him back in time for his Opening Day start.

Instead, the club should allow him to proceed deliberately, building up the innings that he hasn’t yet had the chance to throw due to his multiple setbacks.

Manager Terry Collins has indicated that he’ll likely start either Bartolo Colon or Dillon Gee in Niese’s stead on Opening Day, but it would certainly be interesting if he reversed course and instead handed the ball to Zack Wheeler.

FBI agents raid Zwanger-Pesiri Radiology over accusations of health care fraud

Published: March 11, 2014 6:11 PM
LINDENHURST – Federal agents raided an office of a well-known radiology company in Suffolk Tuesday.

FBI agents collected dozens of boxes of medical records from Zwanger-Pesiri Radiology in Lindenhurst as part of an investigation into health care fraud.

Sources at Newsday say the raid stems from an investigation into allegations that the company engaged in a multimillion-dollar fraud by overbilling the federal Medicare program for services, including X-rays, MRIs and CT scans.

Officials did not comment about how long the radiology giant was being investigated or how many people may have been affected.

They say a second location in Lindenhurst at Sunrise Plaza of Wellwood Avenue was also raided Tuesday. Agents on the scene said the small, seemingly vacant office space was involved in the investigation.

Kris Medlen to have second opinion

Updated: March 12, 2014, 12:31 PM ET

ESPN.com news services

Atlanta Braves right-hander Kris Medlen underwent an MRI exam Monday that revealed an “injury to the ligament” in his pitching elbow, according to general manager Frank Wren.

Wren said Medlen will seek a second opinion. According to The Associated Press, he is expected to meet this week with Dr. James Andrews, who performed Tommy John surgery on the pitcher in 2010.

[+] Enlarge

Brad Barr/USA TODAY SportsAn MRI on Kris Medlen’s elbow revealed an “injury to the ligament,” the Braves said. The team will seek a second opinion for its slated Opening Day starter.

 “His MRI showed injury to the ligament, but we don’t yet know the extent,” Wren said in a statement. “A diagnosis would be premature at this point. He will undergo further tests until we seek a second opinion. An MRI can sometimes be inconclusive when a player has had a previous Tommy John surgery.”

Medlen, though, seemed resigned to the fact that he would need a second Tommy John surgery.

“Mentally preparing myself,” Medlen told reporters Wednesday, according to the Atlanta Journal-Constitution. “It’s something that I’ve felt before. I think I had all the answers to anybody’s questions in my head when I was walking off the mound. I never do that. When I did it before in 2010, the same thing kind of happened.”

The Braves tweeted their support Wednesday:

Medlen was injured during Sunday’s game against the Mets, grabbing his elbow after throwing the first pitch to Matt Clark with two outs in the bottom of the fourth inning. He quickly left the field with a trainer.

“I talked to him 30 seconds after he came inside, after I made the pitching change,” Braves manager Fredi Gonzalez said. “He wasn’t in good spirits then. He was really, really worried. But after he got settled down and the trainers looked at him and Mets doctors looked at him, I think he was in better spirits. I did not talk to him after those conversations he had with the doctors and trainers, but our people told me that he was in little better spirits.

“Keep our fingers crossed. But I feel a lot better after talking to our medical people. We might be OK.”

Medlen, 28, who had Tommy John surgery in 2010 and missed most of the 2011 season, was 15-12 with a 3.11 ERA last year. He is slated to be Atlanta’s Opening Day starter.

Before leaving with the injury, Medlen had allowed one run on three hits, striking out two.

Fellow right-hander Brandon Beachy also left a start early, exiting a 8-1 win over the Phillies on Monday because of tightness around his pitching elbow. Beachy, 27, has been limited to 18 starts the past two seasons while battling elbow ailments. There is no plan for him to get an MRI.

Left-hander Mike Minor, who underwent urinary tract surgery Dec. 31, is struggling with shoulder soreness. He hopes to pitch within the next week but could open the season on the disabled list.

Atlanta could start the season without the trio, and Wren described the latest events as “worrisome.”

Julio Teheran hasn’t allowed a run all spring training after pitching four shutout innings against Philadelphia on Tuesday and is likely to be joined in the starting rotation by Alex Wood, who pitches Wednesday against Washington in a split-squad game. Rookie David Hale was impressive during a call-up to the Braves in September, but he has struggled a bit this spring training.

ESPNNewYork.com’s Adam Rubin and The Associated Press contributed to this report.

President’s 2015 budget proposal: Political, not practical

March 5, 2014 — The Obama administration has released its 2015 budget plan, which largely reflects proposals that were included in the 2014 budget and will most likely not affect medical imaging — for better or for worse, according to the American College of Radiology (ACR).

“The likelihood of this budget going anywhere is nil,” Cynthia Moran, ACR’s assistant executive director for government relations, told AuntMinnie.com. “It’s a political document that sets out, in broad terms, the White House’s policy priorities. It will be used more for campaign purposes in the upcoming midterm elections, since it leans heavily left to shore up the candidacies of the progressive side of the party.”

The budget does address two areas of concern for medical imaging: prior authorization and the exclusion of certain services from the Stark law’s in-office ancillary services exception.

The U.S. Centers for Medicare and Medicaid Services has authority to require prior authorization for Medicare durable medical equipment service items. This budget would extend that authority to all Medicare fee-for-service items, particularly those at the highest risk for improper payment — as well as in two service areas: power mobility devices and advanced imaging — for an estimated savings of $90 million over 10 years.

“The fact that diagnostic imaging services are lumped together with scooters underscores how ridiculous this proposal is,” Moran said.

As for in-office ancillary services, the budget proposal would amend the in-office ancillary services exception (IOASE) to prohibit certain referrals for radiation therapy, therapy services, advanced imaging, and anatomic pathology services, for an estimated savings of $6 billion over 10 years, ACR said.

“Most of the Medicare proposals in this budget would require legislation to implement, and in this political environment anything controversial — like self-referral reform — won’t be considered on the hill,” Moran told AuntMinnie.com.

The document also lauds bipartisan sustainable growth rate (SGR) reform efforts in Congress and proposes strengthening the Independent Payment Advisory Board, a 15-member panel established as part of the Patient Protection and Affordable Care Act that can make changes to Medicare programs without the approval of Congress, according to ACR.

Professional groups’ reactions to the budget proposal were mixed.

The Medical Imaging and Technology Alliance (MITA) said in a statement that the budget would threaten patient access to imaging services and hinder innovation by instituting the prior authorization system.

“The president’s budget directly counteracts the administration’s efforts to reduce healthcare costs and encourage advanced manufacturing in communities across our country by instituting a burdensome prior authorization system,” said MITA Executive Director Gail Rodriguez. “Inserting a bureaucratic middleman between physicians and patients will limit seniors’ access to diagnostic services, while resulting in wasteful healthcare spending and fewer investments in research and development.”

Other professional groups such as the Large Urology Group Practice Association (LUGPA) criticized the budget’s self-referral language.

“Excluding certain services from the IOASE will not have any meaningful impact on utilization or cost reduction and will only jeopardize patient access to comprehensive, cost-effective treatment at the healthcare site of their own choosing,” said Dr. Deepak Kapoor, LUGPA’s chairman of health policy.

But the Alliance for Integrity in Medicare (AIM) — a coalition of medical specialty, laboratory, radiation oncology, and medical imaging groups committed to ending the practice of inappropriate physician self-referral — praised the budget’s self-referral language.

“AIM has long supported additional limitations on physician self-referral, and we applaud the administration for including IOASE reform for a second year, and also for adding anatomic pathology services to the proposed list of excluded services,” the organization said.