How the brain selectively remembers new places

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Neuroscientists identify a circuit that helps the brain record memories of new locations.

MIT News release – Source: How the brain selectively remembers new places

When you enter a room, your brain is bombarded with sensory information. If the room is a place you know well, most of this information is already stored in long-term memory. However, if the room is unfamiliar to you, your brain creates a new memory of it almost immediately.

MIT neuroscientists have now discovered how this occurs. A small region of the brainstem, known as the locus coeruleus, is activated in response to novel sensory stimuli, and this activity triggers the release of a flood of dopamine into a certain region of the hippocampus to store a memory of the new location.

“We have the remarkable ability to memorize some specific features of an experience in an entirely new environment, and such ability is crucial for our adaptation to the constantly changing world,” says Susumu Tonegawa, the Picower Professor of Biology and Neuroscience and director of the RIKEN-MIT Center for Neural Circuit Genetics at the Picower Institute for Learning and Memory.

“This study opens an exciting avenue of research into the circuit mechanism by which behaviorally relevant stimuli are specifically encoded into long-term memory, ensuring that important stimuli are stored preferentially over incidental ones,” adds Tonegawa, the senior author of the study.

Akiko Wagatsuma, a former MIT research scientist, is the lead author of the study, which appears in the Proceedings of the National Academy of Sciences the week of Dec. 25.

New places

In a study published about 15 years ago, Tonegawa’s lab found that a part of the hippocampus called the CA3 is responsible for forming memories of novel environments. They hypothesized that the CA3 receives a signal from another part of the brain when a novel place is encountered, stimulating memory formation.

They believed this signal to be carried by chemicals known as neuromodulators, which influence neuronal activity. The CA3 receives neuromodulators from both the locus coeruleus (LC) and a region called the ventral tegmental area (VTA), which is a key part of the brain’s reward circuitry. The researchers decided to focus on the LC because it has been shown to project to the CA3 extensively and to respond to novelty, among many other functions.

The LC responds to an array of sensory input, including visual information as well as sound and odor, then sends information on to other brain areas, including the CA3. To uncover the role of LC-CA3 communication, the researchers genetically engineered mice so that they could block the neuronal activity between those regions by shining light on neurons that form the connection.

To test the mice’s ability to form new memories, the researchers placed the mice in a large open space that they had never seen before. The next day, they placed them in the same space again. Mice whose LC-CA3 connections were not disrupted spent much less time exploring the space on the second day, because the environment was already familiar to them. However, when the researchers interfered with the LC-CA3 connection during the first exposure to the space, the mice explored the area on the second day just as much as they had on the first. This suggests that they were unable to form a memory of the new environment.

The LC appears to exert this effect by releasing the neuromodulator dopamine into the CA3 region, which was surprising because the LC is known to be a major source of norepinephrine to the hippocampus. The researchers believe that this influx of dopamine helps to boost CA3’s ability to strengthen synapses and form a memory of the new location.

They found that this mechanism was not required for other types of memory, such as memories of fearful events, but appears to be specific to memory of new environments. The connections between the LC and CA3 are necessary for long-term spatial memories to form in CA3.

“The selectivity of successful memory formation has long been a puzzle,” says Richard Morris, a professor of neuroscience at the University of Edinburgh, who was not involved in the research. “This study goes a long way toward identifying the brain mechanisms of this process. Activity in the pathway between the locus coeruleus and CA3 occurs most strongly during novelty, and it seems that activity fixes the representations of everyday experience, helping to register and retain what’s been happening and where we’ve been.”

Choosing to remember

This mechanism likely evolved as a way to help animals survive, allowing them to remember new environments without wasting brainpower on recording places that are already familiar, the researchers say.

“When we are exposed to sensory information, we unconsciously choose what to memorize. For an animal’s survival, certain things are necessary to be remembered, and other things, familiar things, probably can be forgotten,” Wagatsuma says.

Still unknown is how the LC recognizes that an environment is new. The researchers hypothesize that some part of the brain is able to compare new environments with stored memories or with expectations of the environment, but more studies are needed to explore how this might happen.

“That’s the next big question,” Tonegawa says. “Hopefully new technology will help to resolve that.”

The research was funded by the RIKEN Brain Science Institute, the Howard Hughes Medical Institute, and the JPB Foundation.

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Dementia: number of people affected to triple in next 30 years

WHO News release – Source: Dementia: number of people affected to triple in next 30 years 

News release

 As the global population ages, the number of people living with dementia is expected to triple from 50 million to 152 million by 2050.

“Nearly 10 million people develop dementia each year, 6 million of them in low- and middle-income countries,” says Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “The suffering that results is enormous. This is an alarm call: we must pay greater attention to this growing challenge and ensure that all people living with dementia, wherever they live, get the care that they need.”

The estimated annual global cost of dementia is US$ 818 billion, equivalent to more than 1% of global gross domestic product. The total cost includes direct medical costs, social care and informal care (loss of income of carers). By 2030, the cost is expected to have more than doubled, to US$ 2 trillion, a cost that could undermine social and economic development and overwhelm health and social services, including long-term care systems.

First global monitoring system launched

The Global Dementia Observatory, a web-based platform launched by WHO today, will track progress on the provision of services for people with dementia and for those who care for them, both within countries and globally. It will monitor the presence of national policy and plans, risk reduction measures and infrastructure for providing care and treatment. Information on surveillance systems and disease burden data is also included.

“This is the first global monitoring system for dementia that includes such a comprehensive range of data,” said Dr Tarun Dua, of WHO’s Department of Mental Health and Substance Abuse. “The system will not only enable us to track progress, but just as importantly, to identify areas where future efforts are most needed.”

Encouraging results in planning for dementia and support for carers

To date, WHO has collected data from 21 countries (1) of all income levels. By the end of 2018, it is expected that 50 countries will be contributing data.

Initial results indicate that a high proportion of countries submitting data are already taking action in areas such as planning, dementia awareness and dementia-friendliness (such as facilitating participation in community activities and tackling the stigmatization of people living with dementia) and provision of support and training for carers, who are very often family members.

Of the countries reporting data so far:

  • 81% have carried out a dementia awareness or risk reduction campaign
  • 71% have a plan for dementia
  • 71% provide support and training for carers
  • 66% have a dementia-friendly initiative.

All of these activities are recommended by WHO in the Global action plan on the public health response to dementia 2017-2025. The Plan provides a comprehensive blueprint for action, in areas including: dementia awareness and dementia-friendliness; reducing the risk of dementia; diagnosis, treatment and care; research and innovation; and support for dementia carers. It suggests concrete actions that can be taken by policy-makers, health- and social-care providers, civil society organizations and people with dementia and their careers. The Plan has been developed with attention to the importance of respecting the human rights of people with dementia and engaging them in planning for their care. Targets against which progress can be measured are included.

Diagnosis and research require significant effort

Just 14% of countries reporting data could indicate the number of people being diagnosed with dementia. Previous studies suggest that as many as 90% of people with dementia in low- and middle-income countries are unaware of their status.

The data also highlight the need for rapid scale-up of research. There have been some encouraging signs in funding available for investment in research for a cure for dementia in recent years, but much more needs to be done. The number of articles in peer-reviewed journals on dementia in 2016 was close to 7000. This compares with more than 15 000 for diabetes, and more than 99 000 for cancer during the same year. Research is needed not only to find a cure for dementia, but also in the areas of prevention, risk reduction, diagnosis, treatment and care.

The Observatory will provide a knowledge bank where health and social care authorities, medical professionals, researchers and civil society organizations will be able to find country and regional dementia profiles, global reports, policy guidance, guidelines and toolkits on dementia prevention and care.

Dementia

Dementia is an umbrella term for several diseases that are mostly progressive, affecting memory, other cognitive abilities and behaviour and interfering significantly with a person’s ability to maintain the activities of daily living. Women are more often affected than men. Alzheimer’s disease is the most common type of dementia and accounts for 60–70% of cases. The other common types are vascular dementia and mixed forms.

Editor’s note

WHO’s work on the Global Dementia Observatory is supported by the governments of Canada, Germany, Japan, the Netherlands, Switzerland and the United Kingdom of Great Britain and Northern Ireland and the European Commission.

For more information, please contact:

Alison Brunier
Communications Officer
World Health Organization
Tel: +41 22 791 4468
Mobile: +41 79 701 9480
E-mail: bruniera@who.int

Fadela Chaib
Communications Officer
World Health Organization
Tel: +41 22 791 3228
Mobile: +41 79 475 5556
E-mail: chaibf@who.int


(1) Australia, Bangladesh, Chile, Costa Rica, Dominican Republic, Fiji, France, Hungary, Italy, Japan, Jordan, Maldives, Mauritius, Myanmar, Netherlands, Qatar, Swaziland, Sweden, Switzerland, Togo, Tunisia

 

Does colour really affect our mind and body? A professor of colour science explains

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Bathing in pure colour can have effects on the body and mind.
Author provided

Stephen Westland, University of Leeds

Red makes the heart beat faster. You will frequently find this and other claims made for the effects of different colours on the human mind and body. But is there any scientific evidence and data to support such claims? The physiological mechanisms that underpin human colour vision have been understood for the best part of a century, but it is only in the last couple of decades that we have discovered and begun to understand a separate pathway for the non-visual effects of colour.

Like the ear, which also provides us with our sense of balance, we now know that the eye performs two functions. Light sensitive cells known as cones in the retina at the back of the eye send electrochemical signals primarily to an area of the brain known as the visual cortex, where the visual images we see are formed. However, we now know that some retinal ganglion cells respond to light by sending signals mainly to a central brain region called the hypothalamus which plays no part in forming visual images.

Light but not vision

The hypothalamus is a key part of the brain responsible for the secretion of a number of hormones which control many aspects of the body’s self-regulation, including temperature, sleep, hunger and circadian rhythms. Exposure to light in the morning, and blue/green light in particular, prompts the release of the hormone cortisol which stimulates and wakes us, and inhibits the release of melatonin. In the late evening as the amount of blue light in sunlight is reduced, melatonin is released into the bloodstream and we become drowsy.

The retinal cells that form the non-image-forming visual pathway between eye and hypothalamus are selectively sensitive to the short wavelengths (blue and green) of the visible spectrum. What this means is that there is clearly an established physiological mechanism through which colour and light can affect mood, heart rate, alertness, and impulsivity, to name but a few.

For example, this non-image-forming visual pathway to the hypothalmus is believed to be involved in seasonal affective disorder, a mood disorder that affects some people during the darker winter months that can be successfully treated by exposure to light in the morning.

Similarly, there is published data that show that exposure to bright, short-wavelength light a couple of hours prior to normal bedtime can increase alertness and subsequently affect sleep quality. Poor quality sleep is becoming increasingly prevalent in modern society and is linked with increased risk factors for obesity, diabetes and heart disease. There is some concern that the excessive use of smartphones and tablets in the late evening can affect sleep quality, because they emit substantial amounts of blue/green light at the wavelengths that inhibit the release of melatonin, and so prevent us from becoming drowsy.

That’s one effect of blue/green light, but there is much more research to be done in order to back the many claims made for other colours.

Experiencing colour

I lead the Experience Design research group at the University of Leeds where we have a lighting laboratory especially designed to evaluate the effect of light on human behaviour and psychology. The lighting system is unique in the UK in that it can flood a room with coloured light of any specific wavelengths (other coloured lighting usually uses a crude mixture of red, green and blue light).

Recent research by the group has found a small effect of coloured light on heart rate and blood pressure: red light does seem to raise heart rate, while blue light lowers it. The effect is small but has been corroborated in a 2015 paper by a group in Australia.

Blue light has been claimed to reduce suicides on train stations.
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In 2009 blue lights were installed at the end of platforms on Tokyo’s Yamanote railway line to reduce the incidence of suicide. As a result of the success of these lights (suicides fell by 74% at stations where the blue lights were installed), similar coloured lighting has been installed at Gatwick Airport train platforms. These steps were taken based on the claim that blue light could make people less impulsive and more calm, but there is little scientific evidence yet to support these claims: a three-year study (forthcoming) by Nicholas Ciccone, a PhD researcher in our group, found inconclusive evidence for the effect of coloured lighting on impulsivity. Similar studies are underway in our laboratories to explore the effect of colour on creativity, student learning in the classroom, and sleep quality.

The ConversationIt is clear that light, and colour specifically, can affect us in ways that go far beyond regular colour vision. The discovery of the non-image-forming visual pathway has given a new impetus to research that explores how we respond, both physiologically and psychologically, to colour around us. The increasing availability and use of coloured lighting that has resulted from advances in LED technology has added to the need to carry out rigorous research in this field, but it is becoming increasingly difficult to separate claims for the effects of colour that are supported by data, from those that are based on intuition or tradition.

Stephen Westland, Professor, Chair of Colour Science and Technology, University of Leeds

This article was originally published on The Conversation. Read the original article.

 

Architecture And Design Help the Brain to Recover

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How does the hospital environment affect our rehabilitation? New research from the University of Gothenburg, Sweden, into how the space around us affects the brain reveals that well-planned architecture, design and sensory stimulation increase patients’ ability to recover both physically and mentally. Digital textiles and multisensory spaces can make rehabilitation more effective and reduce the amount of time spent in care.

In an interdisciplinary research project, Kristina Sahlqvist has used research into the recovery of the brain to examine how hospitals can create better environments for rehabilitation.

“We want to help patients to get involved in their rehabilitation, a side effect of which can be an improvement in self-confidence,” says Sahlqvist, interior architect and researcher at the University of Gothenburg’s School of Design and Crafts (HDK).

The project drew on all the expertise used on a ward, with input from neurologists, rehabilitation doctors, nurses, psychologists, occupational therapists and physiotherapists. The result is a conceptual solution for an optimal rehabilitation ward.

“Our concept gives the ward a spatial heart, for example, where patients and their families can prepare food and eat together, which allows for a more normal way of spending time together in a hospital environment,” says Sahlqvist.

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In tandem with her research work, she has teamed up with a designer and researcher at the Swedish School of Textiles in Borås on an artistic development project where they redesigned furniture, developed easy-grip cups and cutlery and used smart textiles, in other words textiles with technology embedded in them. The concept includes a table and chairs, a rug and a muff with integral heating, a cardigan with speakers and a soft bracelet that is also a remote control.

In order to measure and test the research theories Sahlgrenska University Hospital will be developing an intensive care room featuring multimodal stimulation, where all the senses are affected. The work involves an architect, doctors, hospital staff, musicians, a designer, an acoustician and a cognition specialist. In a bid to see what kind of results the environment can produce in practice, the researchers will take account of the entire social situation of patients, family and staff.

There are other interesting tricks in the field of neuroarchitecture, where it is possible, for example, to use spatial expressions to improve learning. Although these are currently used predominantly in schools, they could also have potential for the elderly.

“It’s worth wondering why there are so many educational models for preschool children but so few for the elderly. Many old people need a far more stimulating environment than they have at the moment,” says Sahlqvist.

Date: November 3, 2011
Source: University of Gothenburg
Release from University of Gothenburg

建筑和设计帮助大脑恢复

发布日期:2011年11月2日。
哥德堡大学发布 

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医院环境如何影响我们的康复? 瑞典哥德堡大学的最新研究发现,我们周围的空间如何影响大脑,显示出精心策划的建筑,设计和感官刺激可以提高患者身心恢复的能力。 数字纺织品和多感官空间可以使康复更有效,并减少花费在护理上的时间。

在一个跨学科研究项目中,Kristina Sahlqvist利用大脑恢复研究来研究医院如何创造更好的康复环境。

哥德堡大学设计与工艺学院(HDK)室内设计师兼研究员Sahlqvist说:“我们希望帮助患者参与康复治疗,其副作用可以提高自信心。

该项目利用了病房的所有专业知识,由神经科医生,康复医生,护士,心理学家,职业治疗师和物理治疗师提供投入。 结果是最佳康复病房的概念性解决方案。

Sahlqvist说:“我们的理念给病房提供了一个空间的心脏,例如,病人和他们的家人可以一起准备食物和一起吃饭,这样可以在医院环境中更加正常地花时间在一起。

在她的研究工作的同时,她与布罗斯的瑞典纺织学院的一位设计师和研究员合作开展了一个艺术发展项目,重新设计了家具,开发了易握杯子和餐具,并使用了智能纺织品,换句话说纺织品其中嵌入了技术。 这个概念包括一张桌子和椅子,一个地毯和一个带有整体加热装置的手套,一个带扬声器的开襟衫和一个也是遥控器的软手镯。

为了衡量和测试研究理论,萨尔格林斯卡大学医院将开发一个以多模式刺激为特征的重症监护室,所有感官都受到影响。 这项工作涉及建筑师,医生,医院工作人员,音乐家,设计师,声学家和认知专家。 为了研究环境在实践中能产生怎样的结果,研究人员将考虑患者,家属和工作人员的整个社会状况。

在神经体系结构领域还有其他一些有趣的技巧,例如使用空间表达来改善学习。 虽然这些目前主要用于学校,但也可能对老年人有潜力。

Sahlqvist表示:“值得一提的是,为什么学龄前儿童的教育模式如此之多,而老年人的教育模式却很少。许多老年人需要的环境比现在更为刺激。

High-intensity exercise delays Parkinson’s progression

 

 

High-intensity exercise three times a week is safe for individuals with early-stage Parkinson’s disease and decreases worsening of motor symptoms, according to a new phase 2, multi-site trial led by Northwestern Medicine and University of Colorado School of Medicine scientists.

This is the first time scientists have tested the effects of high-intensity exercise on patients with Parkinson’s disease, the second most common neurodegenerative disorder and the most common movement disorder, affecting more than a million people in the United States.

It previously had been thought high-intensity exercise was too physically stressful for individuals with Parkinson’s disease.

The paper will be published in JAMA Neurology Dec. 11, 2017.

Parkinson’s symptoms include progressive loss of muscle control, trembling, stiffness, slowness and impaired balance. As the disease progresses, it may become difficult to walk, talk and complete simple tasks. Most people who develop Parkinson’s are 60 and older.

“If you have Parkinson’s disease and you want to delay the progression of your symptoms, you should exercise three times a week with your heart rate between 80 to 85 percent maximum. It is that simple,” said co-lead author Daniel Corcos, professor of physical therapy and human movement sciences at Northwestern University Feinberg School of Medicine.

Because medications for Parkinson’s have adverse side effects and reduced effectiveness over time, new treatments are needed.

The randomized clinical trial included 128 participants ages 40 to 80 years old from Northwestern University, Rush University Medical Center, the University of Colorado and the University of Pittsburgh.

Participants enrolled in the Study in Parkinson Disease of Exercise (SPARX) were at an early stage of the disease and not taking Parkinson’s medication, ensuring the results of the study were related to the exercise and not affected by medication.

“The earlier in the disease you intervene, the more likely it is you can prevent the progression of the disease,” Corcos said. “We delayed worsening of symptoms for six months; whether we can prevent progression any longer than six months will require further study.”

Scientists examined the safety and effects of exercise three times weekly for six months at high intensity, 80 to 85 percent of maximum heart rate, and moderate intensity, 60 to 65 percent of maximum heart rate. They compared the results to a control group who did not exercise.

After six months, participants were rated by clinicians on a Parkinson’s disease scale ranging from 0 to 108. The higher the number, the more severe the symptoms.

Participants in the study had a score of about 20 before exercise. Those in the high intensity group stayed at 20. The group with moderate exercise got worse by 1.5 points. The group that did not exercise worsened by three points. Three points out of a score of 20 points is a 15 percent change in the primary signs of the disease and considered clinically important to patients. It makes a difference in their quality of life.

“We are stopping people from getting worse, which is significant, particularly if we catch them early in the disease,” Corcos said.

What sets this study apart from others is the high number of participants, and that they exercised for a relatively long period of time. Most exercise studies are 12 weeks, Corcos said.

“We gave them a proper workout,” Corcos said. “This is not mild stretching. This is high intensity. It’s part of the idea that exercise is medicine.”

Corcos and colleagues confirmed it was safe for the participants to do high-intensity exercise by giving them a cardiologist-supervised graded exercise test to evaluate the heart’s response to exercise.

Previous studies in humans suggest high-intensity exercise improves motor symptoms, but the evidence wasn’t sufficient to determine whether exercise intensity modifies symptoms or disease progression. In addition, most studies have not precisely measured or controlled exercise intensity and none have been conducted at 80 to 85 percent maximum heart rate.

“Several lines of evidence point to a beneficial effect of exercise in Parkinson’s disease,” said Dr. Codrin Lungu, program director at the National Institute of Neurological Disorders and Stroke. “Nevertheless, it’s not clear which kind of exercise is most effective. The SPARX trial tries to rigorously address this issue. The results are interesting and warrant further exploration of the optimal exercise regimes for Parkinson’s.”

Published: December 11, 2017

Source: Northwestern Now

高强度运动延迟帕金森氏症的进展

发布日期:2017年12月11日
西北大学发布 

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芝加哥 – 根据由西北医学院和科罗拉多大学分校领导的新的第二阶段多点试验,每周三次高强度运动对于早期帕金森病患者是安全的,并且减少了运动症状的恶化。医学科学家。

这是科学家第一次测试高强度运动对帕金森病患者的影响,帕金森病是第二种最常见的神经退行性疾病和最常见的运动障碍,影响了美国超过一百万人。

以前曾认为高强度运动对帕金森病患者来说过于紧张。

该论文将于2017年12月11日在JAMA Neurology上发表。

帕金森症状包括肌肉控制进行性减退,发抖,僵硬,缓慢和平衡受损。 随着疾病的进展,走路,谈话和完成简单任务可能变得困难。 大多数帕金森病患者年龄在60岁以上。

“如果你患有帕金森病,而且你想延缓症状的进展,那么你应该每周锻炼三次,心率在80%到85%之间,这是很简单的,”联合主编丹尼尔·科科斯(Daniel Corcos)教授说。西北大学费因伯格医学院的物理治疗和人体运动科学。

由于帕金森药物有不良的副作用,随着时间的推移有效性降低,需要新的治疗方法。

随机临床试验纳入了来自西北大学,拉什大学医学中心,科罗拉多大学和匹兹堡大学的128名40至80岁的参与者。

参加帕金森病运动研究(SPARX)的参与者处于疾病的早期阶段,不服用帕金森药物,确保研究结果与运动有关,并且不受药物影响。

Corcos说:“你介入的疾病越早,你就越可能预防疾病的进展。 “我们推迟了六个月的症状恶化,是否可以阻止进展超过六个月,需要进一步研究。”

科学家每周三次检查运动的安全性和效果,持续六个月,高强度,最高心率的80%到85%,中等强度,最高心率的60%到65%。 他们将结果与没有运动的对照组进行比较。

六个月后,参与者由帕金森病评分范围为0至108的临床医师评价。数目越高,症状越严重。

研究参与者在运动前有20分左右的成绩。 高强度组为20人。中度运动组为1.5分。 没有运动的组恶化了三分。 得分为20分的三分之一是这种疾病的主要体征有15%的变化,并且认为临床上对于患者是重要的。 这对他们的生活质量有所影响。

Corcos说:“我们正在阻止人们变得更糟,这很重要,特别是如果我们在疾病早期发现他们。

这项研究与其他研究不同之处在于参与者人数众多,而且他们行使了相当长的一段时间。 Corcos说,大多数运动研究是12周。

“我们给了他们适当的锻炼,”Corcos说。 “这不是轻度的拉伸,这是高强度的,这是锻炼是药物的一部分。”

Corcos及其同事证实,参与者通过给予心脏科医师监督的分级运动试验来评估心脏对运动的反应,从而进行高强度运动是安全的。

以前对人类的研究表明高强度运动可改善运动症状,但证据不足以确定运动强度是否改变症状或疾病进展。 此外,大多数研究没有精确测量或控制运动强度,没有进行过最高心率的80%到85%。

美国国立神经疾病与卒中研究所(National Institute of Neurological Disorders and Stroke)的项目主任Codrin Lungu博士说:“有几条证据表明,帕金森病的运动是有益的。” “然而,目前还不清楚哪一种运动最有效,SPARX试验试图严格解决这个问题,结果是有趣的,并且需要进一步探索帕金森氏症的最佳运动机制。

Alarming amounts of noise demand ways to silence noisy hospital environments

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Spending a night in the hospital is not only stressful, but also loud. The constant beeps, whirrs and alarms ascend to a cacophony that produces anything but a relaxing, restful environment. Researchers will summarize the limited number of studies available on hospital noise and discuss the different approaches health care facilities are taking to bring restful repose to patients across the country during the 174th ASA Meeting, Dec. 4-8, 2017, in New Orleans, La.

Source: Alarming amounts of noise demand ways to silence noisy hospital environments

Hospital noise is a growing concern for patients, family and staff, but many facilities are looking for new approaches to reduce the din and bring peace back to their environment.

Public Release: ACOUSTICAL SOCIETY OF AMERICA

WASHINGTON, D.C. December 6, 2017– Spending a night in the hospital is not only stressful, but also loud. The constant beeps, whirrs and alarms ascend to a cacophony that produces anything but a relaxing, restful environment. Ilene Busch-Vishniac, of BeoGrin Consulting in Baltimore, Maryland, will summarize the limited number of studies available on hospital noise and discuss the different approaches health care facilities are taking to bring restful repose to patients across the country.

According to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, noise is the top complaint of patients, staff and visitors. “Nearly everyone has a stay in a hospital at some point,” Busch-Vishniac said. “Noise is a universal problem in hospitals around the world.”

Busch-Vishniac will explore these concepts during the 174th Meeting of the Acoustical Society of America, being held Dec. 4-8, 2017, in New Orleans, Louisiana. Noises emanate from a variety of sources at the bedside. Airflow and the noisy machines controlling it are kept on high to prevent pathogens from lingering near patients, and overhead pages alert staff of needs or announcements. Equipment alarms are the most egregious source, and although they are designed to alert staff of changes in the patient’s medical condition, many also sound when medication needs to be changed or when battery conditions are low.

“Alarms in hospitals are being horribly abused,” Busch-Vishniac said. “Most of the time, they don’t in fact indicate urgent situations.”

Previous studies showed that alarms at a patient’s bedside sound an average 133 times per day. With so many alarms, staff often face alarm fatigue as well.

“Most alarms are being responded to eventually, but not all in a timely fashion,” said Busch-Vishniac. “Staff also may not respond quickly because they recognize that the sound is not critical and the situation will right itself.”

Besides the obvious barrier to rest, high noise levels have been associated with changes in the patient’s heart rate, respiration and blood pressure. These changes increase stress levels and may impair healing. The noise can also impair communication between patients and staff.

With noise levels on the rise, the Centers for Medicare and Medicaid Services (CMS) initiated the HCAHPS survey in 2008 to assess consumer perception of health care providers and systems. Today, more than 5,500 hospitals contribute to the report, which consists of patients’ responses on seven composite measures, including questions focused on room cleanliness and quietness.

The survey has teeth. Hospital value-based purchasing links up to 30 percent of CMS payments to hospitals across the country to the results of the survey.

“Faced with a loss of money, many hospitals are looking for ways to address noise levels in a way that patients can see as an improvement,” said Busch-Vishniac.

Hospitals have been developing and implementing noise control programs that can be broken into two categories: engineering and administrative interventions.

Engineering interventions aim to find ways to quiet the room. The solutions can be as simple as closing the door to a patient’s room or as complex as installing acoustical absorption materials along the walls and ceiling to dampen the noise level. Administrative interventions focus on changing behaviors. Many hospitals have instituted quiet hours when doors are closed and voices are kept low.

One of the big changes during the past 10 years has shifted alarms from solely sounding at the patient’s bedside to also alerting a central monitor at the nursing station. This approach improves the ability of staff to identify and respond to alarms set at a reduced volume.

According to Busch-Vishniac, it may be possible in the future to remove alarms from the bedside. A quiet hospital may not be a pipedream for much longer.

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Presentation 3pIDa: “Hospital noise: how bad is it?” by Ilene Busch-Vishniac is at 1:45-2:05 p.m. CST, Wednesday, Dec. 6, 2017, in Salon E in the New Orleans Marriott. https://asa2017fall.abstractcentral.com/s/u/M8hKSrQu66E

From ‘demented’ to ‘person with dementia’: how and why the language of disability changed

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The initial aim of political correctness, to establish non-hateful language was, and still is, admirable.
Nathan Anderson/Unsplash

Roland Sussex, The University of Queensland

In the second half of the 20th century, we came to accept that in certain cases we should avoid deliberately hurtful language. While many deride political correctness for going too far, its initial aim to establish non-hateful language was, and still is, admirable.

In the early 20th century, “moron” was a medical term for someone with a mental age of between eight and 12. “Mongol” was a person with Down syndrome, and also was indirectly a slur on people from Mongolia, some of whose features were supposed to resemble those with Down syndrome. “Retarded” described someone mentally, socially or physically less advanced than their chronological age.

We know these terms now primarily as pejoratives. “Mongol”, following the Australian tendency to form diminutives, has even given us “mong”, meaning someone who is stupid or behaves as such. Yet there is also a consensus such language is unacceptable. How did we get here?

The path to dignified language

In December 1948, the United Nations passed the Universal Declaration of Human Rights. Affirming the dignity of all humans, Article 1 of this landmark document states:

All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.

Article 2 goes on to specify this should apply

without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.

The declaration, prompted by the dehumanising events of the second world war, soon led to concerted initiatives to avoid hurtful and denigrating language.

Race and ethnicity was the first area to be addressed in Australia, where the philosophy of respect was enshrined in the Racial Discrimination Act of 1975. This included the currently controversial section 18C, which made it an offence to offend, insult, humiliate or intimidate someone else on the basis of race or nationality.


Read more – What is Section 18C and why do some politicians want it changed?


In the 1980s the scope was expanded in Australia to include gender and sexuality, with the legitimisation of terms like “queer”, and an increasing range of different kinds of sexuality now evident in the LGBTQI designations.

Words like ‘deaf’ and ‘blind’ are commonly used in negative ways.
from shutterstock.com

The third big change involved the language for people with disabilities, whether cognitive or physical. Here the English vocabulary was full of terms that mixed description with pejorative overtones.

People first

Words like “deaf”, “blind”, “dumb” and “lame” are not only descriptions of physical ability and disability, but are commonly used in negative ways. For instance, “deaf as a post”, “blind Freddie”.

We have now moved away from such language. Especially unacceptable are nouns like “retard” or adjectives like “demented”. In their place we have the principle of people first. The person and the disability are separated.

Instead of a phrase like “demented person” we have “person with dementia” or “person living with dementia”. The New South Wales Department of Ageing, Disability and Home Care has a list of such terms.

We should avoid terms that suggest deficit in a negative way, such as “disabled”, “invalid”, “retarded”, “handicap”, “spastic” and “cripple”. We should also avoid terms that explicitly specify limitation like “confined” (say, to a wheelchair). “Suffering from” is to be eschewed for the same reason, since it suggests the person is passive and incapable.


Read more – Redefining the (able) body: disabled performers make their presence felt at the Fringe


A number of paraphrases allow us to avoid sensitive terms. Instead of “blind” we have “visually impaired”. People are not “disabled” but “differently abled”.

Some of these terms can go too far and are effectively euphemisms because they sound overdone and excessively delicate, like “intellectually challenged”.

It is preferable to use language that doesn’t exclude people with these conditions from society. A good example of such inclusive language is “ambulant toilet”, often found in airports and public places, which simply indicates the toilet is suitable for anyone able to walk.

The Disability Discrimination Act 1992 consolidated these issues in Australian legislation, which now forms part of an expanding suite of anti-discrimination legislation both here and overseas.

Ambulant toilet is a good use of inclusive language.
shutterstock.com

Talking to someone with a disability

A general guideline for talking to someone with a certain condition is to ask that person how they wish to be described. In some cases, words like “deaf” have been reclaimed by bodies like the National Association of the Deaf in the US. The presence of the capital letter legitimises the term’s use, so long as it is done respectfully. In a similar way, various gender groups have reclaimed the word “queer”, and the fact they use it licenses others to do so too.

The requirement for respectful and considerate speech is not just a matter of good manners; it has teeth. Governments, education systems, companies, societies and other bodies often have guidelines for language use for people with disabilities.


Read more – Political correctness: its origins and the backlash against it


The US National Institutes of Health recommends “intellectually and developmentally disabled” or “IDD” for people with Down syndrome. Bodies like Dementia Australia have language recommendations.

Institutions and governments can apply a variety of sanctions to people who violate this principle in a persistent and hurtful way. These principles are now common in the English-speaking world and countries of the European Union, especially as enshrined in its Charter of Fundamental Rights.

The ConversationIn little more than a generation and half, we have become a more caring and inclusive society, and one much more aware of the importance of avoiding hurtful language. We don’t always get the expression right. But we are getting better at seeing the effect of what we say and write from the point of view of others.

Roland Sussex, Professor Emeritus, The University of Queensland

This article was originally published on The Conversation. Read the original article.