Removal of waste, including soluble amyloid β (Aβ), from the brain may be most efficient in the lateral vs. the prone position, according to an experimental study published in the August 5 issue of the Journal of Neuroscience.

Hedok Lee, PhD, from Stony Brook University in New York, and colleagues examined whether body posture impacts cerebrospinal fluid (CSF)-interstitial fluid (ISF) exchange efficiency. They quantified CSF-ISF exchange rates using dynamic-contrast-enhanced magnetic resonance imaging (MRI) and kinetic modeling in the brains of rodents in supine, prone, or lateral positions. Fluorescence microscopy and radioactive tracers were used to validate the MRI data and assess the influence of body posture on clearance of Aβ.

The researchers found that glymphatic transport was most efficient in the lateral vs. the supine or prone positions. Transport was characterized by “retention” of the tracer, slower clearance, and more CSF efflux along larger caliber cervical vessels in the prone position, in which the rat’s head was in the most upright position (mimicking posture during the awake state). Glymphatic transport and Aβ clearance were superior in the lateral and supine positions in optical imaging and radiotracer studies.

“We propose that the most popular sleep posture (lateral) has evolved to optimize waste removal during sleep and that posture must be considered in diagnostic imaging procedures developed in the future to assess CSF-ISF transport in humans,” the authors write.

The frame on the $500 Yerka bicycle forms a steadfast lock around any tree, pole, or bike rack. To steal it, thieves would need to saw through the frame itself, rendering the bike worthless.

One of the last five northern white rhinoceroses in the world has died.

Nabiré, a 31-year-old female northern white rhino, died of a ruptured cyst, authorities at the Dv?r Králové Zoo in the Czech Republic announced today (July 28). Nabiré’s death leaves only three females of this subspecies alive. One male, Sudan, survives on a reserve in Kenya.

Northern white rhinos (Ceratotherium simum cottoni) have been on the brink of extinction for years because of poaching and habitat loss. According to Ol Pejeta Conservancy, home to Sudan and two of the remaining female northern whites, there were only a few dozen of the animals living in the Democratic Republic of the Congo in the early 2000s. The remaining four wild survivors were last seen in 2007 and are presumed dead.

Now, the only northern whites left behind are Sudan, 42, and three females. Najin and Fatu live with Sudan in Kenya but are not capable of carrying babies — Najin because of her age and Fatu because of a uterine condition. The San Diego Zoo is home to Nola, now the only female surviving outside of Africa. She, too, is beyond reproductive age.

Nabiré was born in captivity on Nov. 15, 1983. She was plagued with uterine cysts, making it impossible for her to breed naturally. Conservationists hoped, however, that they could harvest eggs from her healthy left ovary for use in in vitro fertilization (IVF). The goal is to artificially fertilize an egg using sperm from Sudan or frozen white rhino sperm from a long-dead animal. This egg would then be transplanted into a southern white rhinoceros, the closest living relative to the rare northern whites.

But Nabiré’s condition proved fatal.

“The pathological cyst inside the body of Nabiré was huge. There was no way to treat it,” Ji?í Hrubý, a rhino curator at the zoo, said in a statement.

After Nabiré’s death, zoo researchers removed the ovary in hopes of saving some of the rhino’s now-rare genetic material.

Though more female rhinos than males survive, it’s actually eggs that are in short supply, researchers told Live Science in June. Northern white rhinos ovulate only one egg at a time every 30 days or so, which makes collecting mature eggs a slow process. Immature eggs can be harvested from the ovaries, but researchers have to develop techniques to mature those eggs in the lab.

Scientists also have to develop IVF procedures that work on rhinos, which has never been done before.

“Every species requires different culture conditions, and that’s because the actual conditions in the uterus in the animal are different,” said Barbara Durrant, director of reproductive physiology at the San Diego Zoo Institute for Conservation Research.

Durrant and her colleagues around the world are trying to make use of research on horse IVF, as horses are close relatives of rhinoceroses. But IVF is also difficult in horses, Durrant said in June.

The Dv?r Králové Zoo plans to continue its efforts to save the subspecies.

“It is our moral obligation to try to save them,” zoo director P?emysl Rabas said in a statement. “We are the only ones, perhaps with San Diego Zoo, who have enough of collected biological material to do so.”

The loss also struck Nabiré’s keepers on a personal level.

“Nabiré was the kindest rhino ever bred in our zoo,” Rabas said.

http://news.yahoo.com/northern-white-rhino-dies-leaving-only-4-left-123056144.html;_ylt=A0LEVifrd7lVKA0AHKMPxQt.;_ylu=X3oDMTEyNWZlN21nBGNvbG8DYmYxBHBvcwMxBHZ0aWQDQjA3MDBfMQRzZWMDc2M-

By Jethro Mullen

Visitors to Yellowstone Park seem to be having trouble taking in the message that it’s not a good idea to get too close to the wild bison that roam the wilderness.

The latest person to find out the hard way is a 43-year-old Mississippi woman who tried to take a selfie with one of the hairy beasts near a trail on Tuesday.

She and her daughter turned their backs to the bison, which was about 6 yards away, to take a photo with it, according to the National Park Service.

“They heard the bison’s footsteps moving toward them and started to run, but the bison caught the mother on the right side, lifted her up and tossed her with its head,” the park service said in a statement Wednesday.

Her family drove her from the site of the attack, near the Fairy Falls trailhead, to the Old Faithful Clinic in the park for treatment. She was released with minor injuries.

The woman is the fifth person injured after approaching a bison in Yellowstone so far this season — and the third whose dangerous encounter resulted from photo-taking.

Park authorities make an effort to warn people not to get too close to animals.

“The family said they read the warnings in both the park literature and the signage, but saw other people close to the bison, so they thought it would be OK,” said Colleen Rawlings, a ranger in the park’s Old Faithful District. “People need to recognize that Yellowstone wildlife is wild, even though they seem docile. This woman was lucky that her injuries were not more severe.”

A 16-year-old girl from Taiwan was gored by a bison in May while posing for a photo near Old Faithful, Yellowstone’s famous geyser. She suffered serious but not life-threatening injuries from the attack.

And a 62-year-old Australian man was taking pictures within 5 feet of a bison near Old Faithful Lodge on June 2 when the animal charged and tossed him into the air several times, according to park officials. He was taken to a hospital for further medical treatment.

Park authorities instruct visitors not to go within 25 yards of bison and other large animals — and 100 yards away from bears and wolves.

“Bison can sprint three times faster than humans can run and are unpredictable and dangerous,” park officials warn.

On June 23, a 19-year-old Georgia woman was walking with friends to their car after a late-night swim in the Firehole River when they saw a bison lying about 10 feet away. The animal charged the teen and tossed her in the air, leaving her with minor injuries, the park service said.

Just over a week later, a 68-year-old Georgia woman was hospitalized after being attacked by a bison while hiking on Storm Point Trail.

As the woman passed the bison, it charged and gored her. She was taken by helicopter ambulance to a hospital outside the park.

Almost 5,000 bison live in Yellowstone, the only place in the United States where the animals have lived continuously since prehistoric times.

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psych

By Richard A Friedman, a professor of clinical psychiatry at Weill Cornell Medical College

American psychiatry is facing a quandary: Despite a vast investment in basic neuroscience research and its rich intellectual promise, we have little to show for it on the treatment front.

With few exceptions, every major class of current psychotropic drugs — antidepressants, antipsychotics, anti-anxiety medications — basically targets the same receptors and neurotransmitters in the brain as did their precursors, which were developed in the 1950s and 1960s.

Sure, the newer drugs are generally safer and more tolerable than the older ones, but they are no more effective.

Even the new brain stimulatory treatments like repetitive transcranial magnetic stimulation don’t come close to the efficacy of electroconvulsive treatment, developed in the 1940s. (Deep brain stimulation is promising as a treatment for intractable depression, but it is an invasive treatment and little is known about its long-term safety or efficacy.)

At the same time, judging from research funding priorities, it seems that leaders in my field are turning their backs on psychotherapy and psychotherapy research. In 2015, 10 percent of the overall National Institute of Mental Health research funding has been allocated to clinical trials research, of which slightly more than half — a mere 5.4 percent of the whole research allotment — goes to psychotherapy clinical trials research.

As a psychiatrist and psychopharmacologist who loves neuroscience, I find this trend very disturbing. First, psychotherapy has been shown in scores of well-controlled clinical trials to be as effective as psychotropic medication for very common psychiatric illnesses like major depression and anxiety disorders; second, a majority of Americans clearly prefer psychotherapy to taking medication. For example, in a meta-analysis of 34 studies, Dr. R. Kathryn McHugh at McLean Hospital found that patients were three times more likely to want psychotherapy than psychotropic drugs.

Finally, many of our patients have histories of trauma, sexual abuse, the stress of poverty or deprivation. There is obviously no quick biological fix for these complex problems.

Still, there has been a steady decline in the number of Americans receiving psychotherapy along with a concomitant increase in the use of psychotropic medication in those who are treated in the outpatient setting. These trends are most likely driven by many factors, including cost and the limited availability that most Americans have to mental health practitioners. It is clearly cheaper and faster to give a pill than deliver psychotherapy.

The doubling down on basic neuroscience research seems to reflect the premise that if we can unravel the function of the brain, we will have a definitive understanding of the mind and the causes of major psychiatric disorders. Indeed, an editorial in May in one of the most respected journals in our field, JAMA Psychiatry, echoed this view: “The diseases that we treat are diseases of the brain,” the authors wrote.

Even if this premise were true — and many would consider it reductionist and simplistic — an undertaking as ambitious as unraveling the function of the brain would most likely take many years. Moreover, a complete understanding of neurobiology is unlikely to elucidate the complex interactions between genes and the environment that lie at the heart of many mental disorders. Anyone who thinks otherwise should remember the Decade of the Brain, which ended 15 years ago without yielding a significant clue about the underlying causes of psychiatric illnesses.

Sure, we now have astounding new techniques for studying the brain, like optogenetics, in which neurons can be controlled by light, allowing researchers to understand how neurons work alone and in networks. But no one thinks breakthrough biological treatments are just around the corner.

More fundamentally, the fact that all feelings, thoughts and behavior require brain activity to happen does not mean that the only or best way to change — or understand — them is with medicine. We know, for instance, that not all psychiatric disorders can be adequately treated with biological therapy. Personality disorders, like borderline and narcissistic personality disorders, which are common and can cause impairment and suffering comparable to that of severe depression, are generally poorly responsive to psychotropic drugs, but are very treatable with various types of psychotherapy.

There is often no substitute for the self-understanding that comes with therapy. Sure, as a psychiatrist, I can quell a patient’s anxiety, improve mood and clear psychosis with the right medication. But there is no pill — and probably never will be — for any number of painful and disruptive emotional problems we are heir to, like narcissistic rage and paralyzing ambivalence, to name just two.

This requires patients to re-experience the circumstances of their traumatic event, which is meant to desensitize them and teach them that their belief that they are in danger is no longer true.

But we know that many patients with PTSD do not respond to exposure, and many of them find the process emotionally upsetting or intolerable.

Dr. John C. Markowitz, a professor of clinical psychiatry at Columbia University, recently showed for the first time that PTSD is treatable with a psychotherapy that does not involve exposure. Dr. Markowitz and his colleagues randomly assigned a group of patients with PTSD to one of three treatments: prolonged exposure, relaxation therapy and interpersonal psychotherapy, which focuses on patients’ emotional responses to interpersonal relationships and helps them to solve problems and improve these relationships. His federally funded study, published in May’s American Journal of Psychiatry, reported that the response rate to interpersonal therapy (63 percent) was comparable to that of exposure therapy (47 percent).

PTSD is a serious public mental health problem, particularly given the rates of PTSD in our veterans returning from war. This study now gives clinicians a powerful new therapy for this difficult-to-treat disorder. Imagine how many more studies like Dr. Markowitz’s might be possible if the federal funding of psychotherapy research were not so stingy.

The brain is notoriously hard to study and won’t give up its secrets easily. In contrast, psychotherapy research can yield relatively quick and powerful results. Given the critically important value — and popularity — of therapy, psychotherapy research deserves a much larger share of research dollars than it currently receives.

Don’t get me wrong. I’m all for cutting-edge neuroscience research — and lots of it. But we are more than a brain in a jar. Just ask anyone who has benefited from psychotherapy.

http://www.nytimes.com/2015/07/19/opinion/psychiatrys-identity-crisis.html?_r=0

By Allen Frances, MD

There are 3 consistent research findings that should make a world of difference to therapists and to the people they treat.

1. Psychotherapy works at least as well as drugs for most mild to moderate problems and, all things being equal, should be used first

2. A good relationship is much more important in promoting good outcome than the specific psychotherapy techniques that are used

3. There is a very high placebo response rate for all sorts of milder psychiatric and medical problems

This is partly a “time effect”—people come for help at particularly bad times in their lives and are likely to improve with time even if nothing is done. But placebo response also reflects the magical power of hope and expectation. And the effect is not just psychological—the body often actually responds to placebo just as it would respond to active medication.

These 3 findings add up to one crucial conclusion—the major focus of effective therapy should be to establish a powerfully healing relationship and to inspire hope. Specific techniques help when they enhance the primary focus on the relationship; they hurt when they distract from it.

The paradox is that therapists are increasingly schooled in specific techniques to the detriment of learning how to heal. The reason is clear—it is easy to manualize technique, hard to teach great healing.

I have, therefore, asked a great healer, Fanny Marell, a Swedish social worker and licensed psychotherapist, to share some of her secrets. Ms Marell writes:

Many therapists worry so much about assessing symptoms, performing techniques, and filling out forms that they miss the wonderful vibrancy of a strong therapeutic relationship.

Thinking I can help someone just by asking about concerns, troubles, and symptoms is like thinking that I can drive a car solely by looking in the rearview mirror. Dreams, hopes, and abilities are seen out of the front window of the car and help us together to navigate the road ahead. Where are we going? Which roads will you choose and why? It surely will not be the same roads I would take. We are different—we have to find your own best direction.

If we focus only on troubles and diagnosis, we lose the advantage of capitalizing on the person’s strengths and resources. If I am to help someone overcome symptoms, change behaviors, and climb out of difficult situations, I need to emphasize also all the positives he brings to the situation. Therapy without conversations about strengths and hopes is not real therapy.

And often most important: Does the patient have a sense of humor? Laugh together! Be human. No one wants a perfect therapist. It is neither credible nor human.

Symptom checklists and diagnoses play a role but they do not give me an understanding of how this person/patient understands his world and her troubles.

And don’t drown in manuals, missing the person while applying the technique.

People come to me discouraged and overwhelmed—their hopes and dreams abandoned. Early in our time together, I ask many detailed questions about how they would like life to change. What would you do during the day? Where would you live? What would your relationship to your family be like? What would you do in your spare time? What kind of social circle would you have? By getting detailed descriptions, I get concrete goals (eg, I want to go to school, argue less with my parents, spend more time with friends).

Almost always, working with the family is useful; sometimes it is absolutely necessary. What would be a good life for your child? How would it affect you?

Sometimes our dreams are big, perhaps even too extravagant; sometimes they are small and perhaps too cautious. But dreams always become more realistic and realizable when they are expressed. Sharing a dream and making it a treatment goal helps the person make a bigger investment in the treatment, and to take more responsibility for it. He becomes the driver and the therapist may sit in the back seat.

Because my first conversation is not just about symptoms and troubles, we start off on a basis of realistic hope and avoid a negative spiral dominated only by troubles. Problems have to be faced, but from a position of strength, not despair and helplessness.

Having a rounded view of the person’s problems and strengths enriches the therapeutic contact and creates a strong alliance.

Thanks, Ms Marell, for terrific advice. Some of the best natural therapists I have known have been ruined by psychotherapy training—becoming so preoccupied learning and implementing technique that they lost the healing warmth of their personalities.

Therapy should always be an exciting adventure, an intense meeting of hearts and minds. You can’t learn to be an effective therapist by reading a manual and applying it mechanically.

I would tell therapists I supervised never to apply what we discussed to their next session with the patient, lest they would always be a week behind. Therapy should be informed by technique, but not stultified by it.

See more at: http://www.psychiatrictimes.com/blogs/couch-crisis/magical-healing-power-caring-and-hope-psychotherapy?GUID=C523B8FD-3416-4DAC-8E3C-6E28DE36C515&rememberme=1&ts=16072015#sthash.2AOArvAW.dpuf

By Suzanne Allard Levingston

With her hair pulled back and her casual office attire, Ellie is a comforting presence. She’s trained to put patients at ease as she conducts mental health interviews with total confidentiality.

She draws you into conversation: “So how are you doing today?” “When was the last time you felt really happy?” She notices if you look away or fidget or pause, and she follows up with a nod of encouragement or a question: “Can you tell me more about that?”

Not bad for an interviewer who’s not human.

Ellie is a virtual human created by scientists at the University of Southern California to help patients feel comfortable talking about themselves so they’ll be honest with their doctors. She was born of two lines of findings: that anonymity can help people be more truthful and that rapport with a trained caregiver fosters deep disclosure. In some cases, research has shown, the less human involvement, the better. In a 2014 study of 239 people, participants who were told that Ellie was operating automatically as opposed to being controlled by a person nearby, said they felt less fearful about self-disclosure, better able to express sadness and more willing to disclose.

Getting a patient’s full story is crucial in medicine. Many technological tools are being used to help with this quest: virtual humans such as Ellie, electronic health records, secure e-mail, computer databases. Although these technologies often smooth the way, they sometimes create hurdles.

Honesty with doctors is a bedrock of proper care. If we hedge in answering their questions, we’re hampering their ability to help keep us well.

But some people resist divulging their secrets. In a 2009 national opinion survey conducted by GE, the Cleveland Clinic and Ochsner Health System, 28 percent of patients said they “sometimes lie to their health care professional or omit facts about their health.” The survey was conducted by telephone with 2,000 patients.

The Hippocratic Oath imposes a code of confidentiality on doctors: “I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know.”

Nonetheless, patients may not share sensitive, potentially stigmatizing health information on topics such as drug and alcohol abuse, mental health problems and reproductive and sexual history. Patients also might fib about less-fraught issues such as following doctor’s orders or sticking to a diet and exercise plan.

Why patients don’t tell the full truth is complicated. Some want to disclose only information that makes the doctor view them positively. Others fear being judged.

“We never say everything that we’re thinking and everything that we know to another human being, for a lot of different reasons,” says William Tierney, president and chief executive of the Regenstrief Institute, which studies how to improve health-care systems and is associated with the Indiana University School of Medicine.

In his work as an internist at an Indianapolis hospital, Tierney has encountered many situations in which patients aren’t honest. Sometimes they say they took their blood pressure medications even though it’s clear that they haven’t; they may be embarrassed because they can’t pay for the medications or may dislike the medication but don’t want to offend the doctor. Other patients ask for extra pain medicine without admitting that they illegally share or sell the drug.

Incomplete or incorrect information can cause problems. A patient who lies about taking his blood pressure medication, for example, may end up being prescribed a higher dose, which could send the patient into shock, Tierney said.

Leah Wolfe, a primary care physician who trains students, residents and faculty at the Johns Hopkins School of Medicine in Baltimore, said that doctors need to help patients understand why questions are being asked. It helps to normalize sensitive questions by explaining, for example, why all patients are asked about their sexual history.

“I’m a firm believer that 95 percent of diagnosis is history,” she said. “The physician has a lot of responsibility here in helping people understand why they’re asking the questions that they’re asking.”

Technology, which can improve health care, can also have unintended consequences in doctor-patient rapport. In a recent study of 4,700 patients in the Journal of the American Medical Informatics Association, 13 percent of patients said they had kept information from a doctor because of concerns about privacy and security, and this withholding was more likely among patients whose doctors used electronic health records than those who used paper charts.

“It was surprising that it would actually have a negative consequence for that doctor-patient interaction,” said lead author Celeste Campos-Castillo of the University of Wisconsin at Milwaukee. Campos-Castillo suggests that doctors talk to their patients about their computerized-record systems and the security measures that protect those systems.

When given a choice, some patients would use technology to withhold information from providers. Regenstrief Institute researchers gave 105 patients the option to control access to their electronic health records, broken down into who could see the record and what kind of information they chose to share. Nearly half chose to place some limits on access to their health records in a six-month study published in January in the Journal of General Internal Medicine.

While patient control can empower, it can also obstruct. Tierney, who was not involved as a provider in that study, said that if he had a patient who would not allow him full access to health information, he would help the patient find another physician because he would feel unable to provide the best and safest care possible.

“Hamstringing my ability to provide such care is unacceptable to me,” he wrote in a companion article to the study.

Technology can also help patients feel comfortable sharing private information.

A study conducted by the Veterans Health Administration found that some patients used secure e-mail messaging with their providers to address sensitive topics — such as erectile dysfunction and sexually transmitted diseases — a fact that they had not acknowledged in face-to-face interviews with the research team.

“Nobody wants to be judged,” said Jolie Haun, lead author of the 2014 study and a researcher at the Center of Innovation on Disability and Rehabilitation Research at the James A. Haley VA Hospital in Tampa. “We realized that this electronic form of communication created this somewhat removed, confidential, secure, safe space for individuals to bring up these topics with their provider, while avoiding those social issues around shame and embarrassment and discomfort in general.”

USC’s Ellie shows promise as a mental health screening tool. With a microphone, webcam and an infrared camera device that tracks a person’s body posture and movements, Ellie can process such cues as tone of voice or change in gaze and react with a nod, encouragement or question. But the technology can neither understand deeply what the person is saying nor offer therapeutic support.

“Some people make the mistake when they see Ellie — they assume she’s a therapist and that’s absolutely not the case,” says Jonathan Gratch, director for virtual human research at USC’s Institute for Creative Technologies.

The anonymity and rapport created by virtual humans factor into an unpublished USC study of screenings for post-traumatic stress disorder. Members of a National Guard unit were interviewed by a virtual human before and after a year of service in Afghanistan. Talking to the animated character elicited more reports of PTSD symptoms than completing a computerized form did.

One of the challenges for doctors is when a new patient seeks a prescription for a controlled substance. Doctors may be concerned that the drug will be used illegally, a possibility that’s hard to predict.

Here, technology is a powerful lever for honesty. Maryland, like almost all states, keeps a database of prescriptions. When her patients request narcotics, Wolfe explains that it’s her office’s practice to check all such requests against the database that monitors where and when a patient filled a prescription for a controlled substance. This technology-based information helps foster honest give-and-take.

“You’ve created a transparent environment where they are going to be motivated to tell you the truth because they don’t want to get caught in a lie,” she said. “And that totally changes the dynamics.”

It is yet to be seen how technology will evolve to help patients share or withhold their secrets. But what will not change is a doctor’s need for full, open communication with patients.

“It has to be personal,” Tierney says. “I have to get to know that patient deeply if I want to understand what’s the right decision for them.”