Tuesday, September 11, 2012

Nigeria: Brain Drain - Kano Loses 100 Doctors in Six Months

The Nigerian Medical Association (NMA) Kano state chapter has urged the state Government to declare state of emergency in the health sector to halt brain drain in existing government hospitals that have witnessed the dis- engagement of over 100 medical doctors in the last six months.

Kano State Chairman of the Nigeria medical Association, Dr Shehi Ali Abubakar stated that the mass exodus of medical doctors to federal institutions and neighbouring states was brought about by what he described as "systemic decay in the available facilities".

Addressing reporters on Monday in Kano, Dr. Shehi said sequel to the collapse of infrastructures, the Paediatrics' ward at Murtala Muhammad Hospital has been closed down due to lack of manpower.
He stressed that at present only 65 doctors attend to patients in a facility adjudged to be one of the busiest government hospitals in the state.

"Murtala Muhammad Hospital, the largest and busiest government hospital in the state has less than 65 doctors working there and it is estimated that at the current exodus rate, less than 40 doctors will be working in this facility by the end of the year."

The Chairman noted that there is general lack of morale among doctors under the employment of the state government, adding that Kano State remain the only state in the North West region yet to implement CONMESS despite several agreements and undertaking with the medical practitioners.

Dr Abubakar pointed out that the precarious situation in the existing state government health facilities had piled pressure on the Aminu Kano Teaching Hospital, originally designated a tertiary institution intended to be a research base facility now handles patients from primary facilities.

Dr Abubakar while assuring the general of public their readiness to carry on with services to humanity was however quick to call on Governor Rabiu Musa Kwankwaso-led administration as a matter of urgency fix the infrastructure decay and as well commence full implementation of CONMESS to health workers.

When reporters contacted the state Commissioner for Health, Dr Abubakar Labaran Yusuf explained that "I am attending a meeting now and do not want to say anything concerning the position of the NMA."

This Is Your Brain on the Internet (Maybe)

Headlines like “Is Google Making Us Stupid?” or “Is the Internet Making Us Dumber?” quite clearly show that people are concerned about what the Internet is doing to our cognition. Some have speculated that the Internet has become a kind of external hard drive for our brains, eliminating our need to really learn or process information. Others point to the obvious advantages of having more information available to more people than at any other time in history. As our lives become increasingly wired, we are now stepping back to see just how deep down the connections go.

In the late 1980s, communication researchers began shifting to a view of human communication that was more cognitively based. Out of this shift came a few now very successful theories that sought to describe how we seek and process information. One of the most widely applicable theories to come out of this “cognitive revolution,” developed by researchers Alice Eagly and Shelly Chaiken, was dubbed the “Heuristic Systematic Model” (or HSM). Like the highly popularized theory of “System 1” and “System 2” thinking advanced by Nobel laureate Daniel Kahneman, the HSM separates our information processing strategies into two distinct modes. Our heuristic thinking is characterized as a rough and ready approximator relying on basic cues. Being that this style of thought is cognitively less costly, it is our default, applying stereotypes, models, and gut-reactions to the processing of information. Conversely, our systematic thinking is an in-depth look at the evidence where we internalize information and connect it to other ideas. The organizing concept of the HSM is that people are cognitive misers. It takes real mental effort to process information deeply, and as such we rarely do so, or only do so when properly motivated.

The trigger to transition between styles in this dual-process cognition is partially dependent on the sufficiency principle. Generally, when making a decision, we weigh how much we know against how much we need to know to make a confident judgment about a topic. If this gap between what we know and what we need to know is small, heuristic-style thinking is more likely. Conversely, if there is a large gap, we need to expend more mental resources to close it, thus encouraging systematic thinking. This Scrooge-like mental calculus determines how much we process the information we are inundated with everyday. And we readily recognize this game of cognitive economy, especially when browsing the web. For example, going through a stuffed RSS feed can be a fairly disengaged experience, with only the topics that are interesting, confusing, or contentious garnering real attention. This “surf or stay” mentality is easily grafted onto the HSM.

Where I think many of the “the Internet is making us stupid” claims get it wrong is that these detractions also apply to other mediums. The Internet is young and revolutionary, to be sure, but the brains we explore it with are the same that peruse the sports section or catch up on the Colbert Report. It should stand to reason that our theories of information processing, like the HSM, should then apply to this new medium. Rather than call a change in processing strategies a “dumbing down” of the populous, we should be just as willing to first understand without judgment how we think on the Internet as we do with newspapers and television.

So what is the Internet doing to our thinking? It is hard to say. Current research has a hard time keeping up with the break-neck pace of online culture, and only the more conventional mediums like television and newspapers have been evaluated in any rigorous sense. Applying successful models of human information processing to the Internet could be a real boon for science. Are there certain aspects of websites that encourage critical thinking? How do people determine if something is credible on the Internet? Could we craft websites with an understanding of cognition to better promote in-depth thought? These are questions that are hard to answer in specific ways without a general foundation of research, which is lacking. Ever the intrepid graduate student, I believe this deficiency needs remedying.

Faced with an open chasm separating ignorance from less ignorance, I have been trying to apply the HSM to the Internet. Of course I would like to pair down this vague goal, perhaps looking at how people evaluate scientific information on the web, but with a grand canyon of research before me, I had to start general. I reasoned that if people are to apply a certain style of thought to information, the information must first go through the requisite credibility checks. An accuracy motivation, one of three motivations outlined in the HSM (the others being defense and impression management), would then be a good place to begin. Everyone has had the experience of trying to find good information on the Internet, and examining the cognitive pursuit of this goal could inform how people glean information from it. If I could instill an accuracy motivation in participants and then ask them what factors of websites indicate credible information, I would be one step closer to learning how these factors modulate thinking styles.

I should state up front that the following discussion is the result of a small pilot study that I completed during my graduate work. What I have made of the results is largely speculative, but then again, given the state of the literature, I have to be.
After delving into the communication literature on what factors indicate credibility (there have been some studies looking at this in an online context), I crafted a questionnaire. It first asked participants to imagine that they needed to find information on the Internet about a scientific topic and then asked what website characteristics would steer them towards a credible site. Based on the results, I found a grouping of five factors that informed the credibility of a website:

1.       Heuristics: This factor is comprised of the appearance of a “like button,” attractive graphics, and professional design. Because these are superficial characteristics of a website and are linked to the presence of accurate information, it was decided that this factor measures a heuristic judgment.

2.       Need for Outside Verification: This factor is comprised of the appearance of scientific references and links to other websites. The items in this factor were interpreted to represent a value in outside verification for accurate information. For example, a website that has scientific references to back up the information on that website has externally validated information. Similarly, a website that has links to other websites that a person recognizes may indicate that the website is as credible as the other websites that the person knows or trusts.

3.       Authority: This factor is comprised of valuing an organization’s website over an individual’s (e.g. NASA versus a lone person) and valuing an authority-run website. This factor is similar to the Heuristic factor, as an appeal to authority is a cognitive heuristic, but is separate because authority is not a superficial characteristic like attractive graphics is, for example. This factor represents a value in the authority of the website for an indication of accurate information.

4.       Skeptics: This factor is comprised of the appearance of advertisements, impressive author credentials, and available author contact information. This factor is interpreted as a skeptical mindset because it represents respondents who think advertisements on a website make the website less credible, who do not trust high author credentials, and who value author contact information. This factor rejects some superficial characteristics of credibility and values the ability to contact the author of the information on a website directly.
5.       Domain: This factor is only comprised of a website’s domain (.gov or .edu versus .com). Interestingly, this item does not fit into any other superficial characteristics. This may indicate that an official domain is the bar to pass when searching for a credible website.
These factors capture much of what I think people look for in assessing the credibility of a website. But how does this inform how we think within digital confines? The next step would be to vary these factors experimentally. Perhaps the more authoritative the website, the more heuristically people will process the information found there. Maybe a website with a “.com” domain triggers more systematic processing to verify the information (given a strong motivation). But the work on this still needs to be done.

When the data is laid bare, finding the triggers of heuristic and systematic thinking could inform science communication and scientific literacy. If we know what cues give that superficial gleam of accuracy, we can better inform the public on how to sort the sites that only look good from the ones that actually are good and encourage more systematic processing. Science educators could craft websites that hit all the right switches, separating the science wheat from the pseudoscience chaff. Furthermore, it could be the case that the uniqueness of the Internet is actually affecting the way we think. Perhaps persistent “surfing” has fundamentally changed the size of our perceived information sufficiency gap; heuristics may rule the day. Of course, without the necessary cognitive resources or motivations, it is hard to get us to think critically about anything. In this way, promoting scientific literacy and effective science communication is still critically important.

Research into how we process information on the Internet is in its infancy, simultaneously announcing a grand ignorance and inspiring novel ideas. The meticulous plod of science in the Internet age is reminiscent of the tortoise and the hare, yet there seems to be no better way to win the race than to look at digital culture with our emerging tools which investigate cognition. I’d speculate more about how the Internet has changed our information processing strategies, but I have 500+ RSS items to get through…

“Information overload” image courtesy of Science Photo Library, diagram by author.

Study hints at brain chemistry of cocaine withdrawal pain

The results may offer a clue for researchers looking to mitigate the symptoms and keep the user from relapsing.
bags of cocaine
When a person is high on cocaine, "it speeds everything up, pushing you to a highly rewarding emotional state," said lead author, Bradley Winters.
U.S. researchers have uncovered part of what's happening, on a cellular level, to make cocaine addicts going cold turkey feel so bloody awful, according to a study published Monday.
The results provide a better understanding of what's creating that crashing low of withdrawal — and may offer a clue for researchers looking to mitigate the symptoms and keep the user from relapsing.
Studying genetically-engineered mice, the researchers focused on a molecule — called cannabinoid receptor 1, or CB1 — that slows communication between nerve cells.
The molecule is particularly important in what is called the nucleus accumbens region of the brain, which governs emotion and motivation.
It was already well-known that cocaine produces strong effects on that part of the brain. But this is the first study of cocaine's impact on CR1 production, and what that means for the nucleus accumbens during and after a cocaine high.
When a person is high on cocaine, "it speeds everything up, pushing you to a highly rewarding emotional state," said lead author, Bradley Winters.
The cocaine caused the mice to produce an excess of CB1, effectively slamming the brakes on the brain's hyper-activity in the nucleus accumbens.
"It is kind of like going down a steep hill so you have to start riding that brake really hard," Winters explained in a statement.
The problem is that the brain doesn't seem to know to let up on the brakes, after the cocaine high wears off.
"You're still riding that brake just as hard. Now you're going down a regular, low-grade hill but you're going two miles per hour because your foot is still jammed on the brake," he said.
"The state is like, 'I feel terrible and I don't want to do anything," he continued, adding that's "what brings you back to the drug because you want to feel better and the drug is the only thing you feel motivation for."

Scientists Scan Children’s Brains for Answers to Mental Illness

A girl lies inside a simulator of a brain scanner at The Child Mind Institute, to practice for the real thing. Courtesy of Tobias Everke.

kid practices getting her brain scanned
In a room tucked next to the reception desk in a colorful lobby of a Park Avenue office tower, kids slide into the core of a white cylinder and practice something kids typically find quite difficult: staying still. Inside the tunnel, a child lies on her back and looks up at a television screen, watching a cartoon. If her head moves, the screen goes blank, motivating her to remain motionless.

This dress rehearsal, performed at The Child Mind Institute, prepares children emotionally and physically to enter a real magnet for a scan of their brain. The scan is not part of the child’s treatment; it is his or her contribution to science. What scientists learn from hundreds to thousands of brain scans from children who are ill, as well as those who are not, is likely to be of enormous benefit to children in the future.

The Child Mind Institute is a one-of-a-kind facility dedicated to the mental health of children. Its clinicians offer state-of-the-art treatments for children with psychiatric disorders. (For more on its clinical services see my previous post, “Minding Our Children’s Minds.”) In addition to spotting and treating mental illness, The Child Mind Institute is dedicated to improving both through science. Its researchers are helping build a repository of brain scans to better understand both ordinary brain development and how mental illness might warp that process.

Tracking the developmental trajectory of mental illness is a critical, overlooked enterprise. Almost three quarters of psychiatric disorders start before age 24 and psychological problems in childhood often portend bona fide, or more severe, diagnoses in adults. If scientists can pinpoint changes that forecast a mental disorder, they might be able to diagnose an incipient disease, when it might be preventable, and possibly target the troublesome circuits through therapy. Certain brain signatures might also provide information about disease risk and prognosis, and about what types of treatments might work best for an individual.

Timeline for the Brain
The first step in this process is obtaining a reliable snapshot of ordinary brain development, one based on lots of brains. The ability to recognize signs of a sick brain (or one at risk of becoming sick), after all, requires knowing what a healthy brain looks like. Toward this end, 1,000 residents of Rockland county, ages six to 85 will, in the next few years, travel to the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York, 27 miles north of New York City, to take part in a landmark study to have their brains speed-read using state-of-the-art functional magnetic resonance imaging (fMRI) machines.

sculpture of the brainEach scan divulges the so-called “functional architecture” of the brain by gauging levels of neural activity in different regions. (fMRI devices don’t measure such activity directly, but track blood flow, under the assumption that more active neurons use more blood.) From these activity levels, software can infer how strongly two regions are connected, says Cameron Craddock, director of imaging at the Center for the Developing Brain at the Child Mind Institute, which, along with the Nathan S. Kline Institute and the National Institutes of Mental Health is supporting this unique endeavor. If two regions are abuzz at the same time, researchers assume they are connected and form part of a common network. By scanning large numbers of individuals of various ages, researchers can determine how the functional connectivity of the brain changes over time.

The resulting images will be made publicly available through the International Neuroimaging Data-Sharing Initiative, the first large-scale attempt to collect and share a large number of brain images. On December 11, 2009, the scientists behind this effort, previously dubbed the 1,000 Functional Connectomes Project, publicly released over 1,200 sets of fMRI images of the brain at rest created at 33 different sites around the world. Since then, investigators have downloaded and used this data to sketch a core architecture behind human brain function along with variations between individuals of different ages and genders—findings outlined in more than 40 publications so far.

Images of Illness
In a second project, The Child Mind Institute will explore brain development patterns in its young patients. Children who volunteer for the project will travel to Orangeburg for a brain scan. The images, stripped of identifying details, will comprise a future Child Mind Institute Biobank. As with the repository of brains from healthy individuals, Biobank curators will pair these scans with carefully collected psychological and clinical data from the same individuals to understand the significance of what they are seeing in the scans.

The hope is to find functional brain signatures of mental illness and learning disorders in children and teens. “We plan to integrate the research and the clinical,” to determine the developmental origins of ailments such as autism, depression and psychosis, says Ronald Steingard, a psychopharmacologist at The Child Mind Institute. Scientists hope such information might one day be used to develop objective medical tests for these problems and to see a patient’s response to treatment as a change in his or her brain.

This effort parallels other recent undertakings conducted with the support of the International Neuroimaging Data-Sharing Initiative. In one of these, the Autism Brain Imaging Data Exchange, investigators from 16 scattered labs have divulged brain scans, along with behavioral data, from 539 individuals with an autism spectrum disorder and 573 counterparts without autism. A separate research consortium has released brain images, along with basic clinical information, from 285 children and adolescents with attention-deficit hyperactivity disorder and 491 without the deficit for comparison.

just a really cute baby
In addition to more accurate diagnosis, a close look at the brain regions altered by illness could help doctors tailor treatment more precisely to a patient’s problem. Strategies such as electroconvulsive therapy and deep-brain stimulation (DBS) that work by revving up or shutting down neural activity can be aimed at particular brain regions or nerve fiber tracts. In some cases, medication is known to act largely on particular brain areas as well.

Focused treatment could also take the form of biofeedback, in which the patient tries to deliberately alter brain activity through conscious processes. The hubbub in a brain area or circuit could drive a visual output—say, a needle on a “brainometer.” Patients might try to move that needle one way or the other by directing their thoughts to particular topics, sensations or remembrances. (Often, patients try several strategies by trial-and-error before landing on one that works.) Craddock is now actively investigating biofeedback as a possible treatment for depression.

In addition, shedding light on the neural circuits involved in specific brain disorders might inspire the development of new therapies aimed at those circuits. Like the collaborative effort to decipher the human genome, a large-scale endeavor to uncover the vast array of connections in the human brain, their meaning, and how they change over time, is likely to yield myriad benefits, many of which we cannot yet predict.

Heavy drinkers may risk brain bleed at a young age: study

(Reuters) - People who drink heavily - at least four drinks a day - may be at risk of suffering a brain hemorrhage at a relatively early age, according to a French study.

Researchers whose findings were published in the journal Neurology focused on drinking habits among people who had suffered an intracerebral hemorrhage, a type of stroke where ruptured blood vessels leak blood into the brain.

Among the 540 patients they followed, one-quarter were heavy drinkers before the stroke. Their brain hemorrhage typically struck at the age of 60, versus age 74 among patients who were not heavy drinkers.
"Chronic heavy alcohol intake increases the risk of bleeding at a very young age," said senior researcher Charlotte Cordonnier, at the University of Lille Nord de France.

Heavy drinkers were not only younger when they had their stroke, but they were also relatively healthy and less likely to have any history of heart disease, stroke or "mini-stroke" symptoms compared to patients who were not heavy drinkers.

Besides suffering brain hemorrhages at a younger age, some of the big drinkers in the study also had a worse prognosis.

When the stroke occurred in a deep part of the brain, heavy drinkers younger than 60 were more likely to die within two years - more than half, as opposed to one third of those who did not drink heavily.
Larry Goldstein, a neurologist not involved in the study, said the findings cannot prove that heavy drinking itself caused strokes at an earlier age.

"There may be other things these individuals were doing that would affect their risk," said Goldstein, director of the Duke Stroke Center in Durham, North Carolina, and a spokesperson for the American Heart Association/American Stroke Association.

He pointed out that the heavy drinkers were often smokers as well, with 42 percent smoking compared to 12 percent of the other patients. There may have been additional, unmeasured factors as well.
Still, heavy drinking has long been considered a risk factor for strokes, and Goldstein said there are reasons to believe that heavy drinking itself is the problem.

Heavy drinking can feed high blood pressure and may also affect the blood's ability to clot, which could raise the odds of a hemorrhagic-type stroke.

In this study, heavy drinkers had lower levels of certain substances that allow blood to clot, though those levels were still within normal range.

Even when the researchers accounted for factors such as smoking habits, the heavy drinkers were twice as likely to die.

The bottom line, according to Goldstein, is that moderation is the way to go.

"Excessive alcohol consumption is bad for your brain, in a number of ways," he said.

Artificial short-term memories stored directly in brain

Artificial short-term memories stored directly in brain Artificial short-term memories stored directly in brain

Case Western Reserve researchers have discovered how to store diverse forms of artificial short-term memories in isolated brain tissue.

Ben W. Strowbridge, PhD, Professor of Neurosciences and Physiology/Biophysics, and Robert A. Hyde, a fourth year MD/PhD student in the neurosciences graduate program at Case Western Reserve University School of Medicine made the discovery.

"This is the first time anyone has found a way to store information over seconds about both temporal sequences and stimulus patterns directly in brain tissue," said Dr. Strowbridge.

"This paves the way for future research to identify the specific brain circuits that allow us to form short-term memories," he noted.

Memories are often grouped into two categories: declarative memory, the short and long-term storage of facts like names, places and events; and implicit memory, the type of memory used to learn a skill like playing the piano.

In their study, the researchers sought to better understand the mechanisms underlying short-term declarative memories such as remembering a phone number or email address someone has just shared.

Using isolated pieces of rodent brain tissue, the researchers demonstrated that they could form a memory of which one of four input pathways was activated.

The neural circuits contained within small isolated sections of the brain region called the hippocampus maintained the memory of stimulated input for more than 10 seconds. The information about which pathway was stimulated was evident by the changes in the ongoing activity of brain cells.

"The type of activity we triggered in isolated brain sections was similar to what other researchers have demonstrated in monkeys taught to perform short-term memory tasks. Both types of memory-related activity changes typically lasted for 5-10 seconds," according to Hyde.

The researchers also demonstrated that they could generate memories for specific contexts, such as whether a particular pathway was activated alone or as part of a sequence of stimuli to different inputs. Changes in ongoing activity of hippocampal neurons accurately distinguished between two temporal sequences, akin to humans recognizing the difference between two different song melodies.

The artificial memories Dr. Strowbridge's group created in the hippocampus continued to recognize each sequence even when the interval between stimuli was changed.

The new research expands upon a previous study, also published in Nature Neuroscience in 2010, in which Dr. Strowbridge's group found that isolated pieces of the hippocampus could store which one of two inputs was stimulated. That study also found that a relatively rare type of brain cell, originally described in the 1800's by the famous Spanish anatomist Santiago Ramon y Cajal, but ignored in modern times, played a critical role in the memory effect.

By demonstrating that the same neural circuits also can store information about context, the new study will likely increase the focus on these potential "memory cells" in the hippocampus, called semilunar granule cells, said Dr. Strowbridge.

Understanding normal memory function also lays the groundwork for understanding how neurodegenerative diseases, such as Alzheimer's or Parkinson's disease, affect memory and for developing new, more effective treatments for memory impairments associated with aging.

Their study is slated for publication in the October issue of Nature Neuroscience, and is currently available online.

Alzheimer drug may stabilize brain plaque: Studies

An experimental drug that failed to stop mental decline in Alzheimer's patients in the US and Canada also showed some potential benefit in slowing brain plaque, fuller results of two major studies show.

Some patients on the drug had stable levels of brain plaque and less evidence of nerve damage compared to others who were given a dummy treatment, researchers reported Tuesday in Sweden.

About 35 million people worldwide have dementia, and Alzheimer's is the most common type. Current medicines such as Aricept and Namenda just temporarily ease symptoms. There is no known cure.

The drug, called bapineuzumab, is made by Pfizer Inc. and Johnson & Johnson. The new results suggest it might work if given earlier in the course of the disease, before so much damage and memory loss have occurred that it might not be possible to reverse, experts say.

"We're very disappointed that we were not able to come up with a treatment to provide to our dementia patients in the near term," said Dr. Reisa Sperling, director of the Alzheimer's center at Brigham and Women's Hospital in Boston and leader of one of the studies.

But brain imaging and spinal fluid tests are "very encouraging" and suggest "that we were doing something to the biology of the disease" by giving the drug, she said.

"We've got a path forward" now to test it in people with mild mental impairment or those who show plaque on brain imaging but have not yet developed symptoms of dementia, Sperling said.

Of people with mild cognitive impairment, about 15 to 20 per cent a year will develop Alzheimer's disease.

Bapineuzumab is designed to attach to and help clear amyloid, the stuff that makes up the sticky plaque that clogs patients' brains, harming nerve cells and impairing memory and thought. Doctors don't know whether amyloid is a cause or just a symptom of Alzheimer's, but many companies are testing drugs to try to remove it.

Two studies of more than 1,000 patients each in the United States and Canada tested bapineuzumab in people with mild to moderate Alzheimer's. Sperling's study involved people with a gene that raises the risk of developing the disease. Dr. Stephen Salloway, a neurologist at Brown Medical School, led the other study of people without the gene.

Both researchers have consulted for the companies that make the drug and presented results Tuesday at a neurology conference in Sweden.

The companies previously announced that the 18-month studies failed to meet their main goal of slowing mental decline or improving activities of daily living.

However, brain imaging on a subset of patients in Sperling's study found 9 per cent less amyloid in those on bapineuzumab compared to those on a dummy treatment. The drug group had stable levels while the others developed more plaque. Spinal fluid tests on some participants also showed the drug group had less of another substance that is released when nerve cells are damaged.

"I found that very encouraging, that we were doing something to the biology of the disease. We're having an impact on nerve cell injury," Sperling said.

There were potential safety concerns. There were 15 deaths among the 673 in bapineuzumab group versus only five among the 448 in the placebo group. Six of the deaths in the drug group were from various forms of cancer. But a wider review of thousands of patients in multiple studies of bapineuzumab found that cancer was not more common among those on the drug.

The cancer deaths "were wide and varied, and they weren't a specific type of cancer, so that's not raising any red flags," said an independent expert, Dr. Maria Carrillo, a senior scientist at the Alzheimer's Association.

Salloway's study produced less evidence of benefit. Too few participants had brain imaging to make definitive conclusions about amyloid, and there was just a trend toward less of the nerve-damage substance in the group receiving the higher of two doses tested.

Bapineuzumab is given as periodic intravenous infusions, and the companies have said they are stopping development of that form but continuing to test a version that can be given as a shot.

More results on this drug and a similar one, Eli Lilly & Co.'s solanezumab, will be presented at a conference in Boston next month. Lilly recently announced that combined results of two large studies of solanezumab suggested some benefit on cognition.