Brain

The study is the first to identify distinct subgroups of psychological flexibility

Psychological flexibility is a core element of Acceptance and Commitment Therapy

The findings will help clinicians to better tailor therapies to the needs of their clients

Tailored therapies are more likely to result in sustainable benefits - to the client and to public health in general

According to figures from NHS England, some 1.4 million people were referred for NHS mental health therapy during 2017. This does not take into account people who accessed mental health therapy from private sources.

Increasing numbers of people of all ages experiencing some form of psychological distress are well-documented and reported in the media. A key therapeutic resource for clinicians and their clients is Acceptance and Commitment Therapy (ACT), where difficult feelings are not eliminated but rather accepted by clients so that they can commit to move towards behaviour and goals in line with their chosen values.

A core element of ACT is psychological flexibility, which helps people get unstuck, deal with stress, improve wellbeing, but also build more meaningful lives around what it is they really value. To date, clinicians have had little scientific understanding of how the different component elements of psychological flexibility worked together to help cope with psychological distress. It appeared to be a 'one size fits all' construct, thereby limiting a clinician's ability to tailor ACT to the individual needs of their clients.

New research from the University of Chichester, published in Behavior Modification, has for the first time analysed degrees of psychological flexibility and identified three distinct classes. It is thought that a knowledge of these classes among clinicians will help them to better tailor the ACT offered to their clients - with benefits not just for the client but for public health in general.

The research team found three classes of psychological flexibility: high, moderate and low. Those in the low psychological flexibility subgroup reported the highest levels of psychological distress, compared to the lowest levels of psychological distress reported by those in the high psychological flexibility subgroup. Clearly, the therapeutic requirements for those with high levels of psychological distress are very different to those at the other end of the spectrum - by providing information on classes of psychological flexibility, the research team have presented clinicians with invaluable diagnostic tools upon which to create more individual therapeutic solutions.

It is hoped that their findings will stimulate further, much-needed research on the subject.

The study was led by Dr Ian Tyndall and Dr Antonina Pereira from the Department of Psychology at the University of Chichester. Dr Tyndall commented: "Our study provides a clearer view to clinicians of the wider spectrum of psychological flexibility, which we hope will help them to facilitate greater change in their clients, in a way which is better tailored to their needs. With more and more people presenting with psychological distress, and seeking professional assistance with their conditions, it is important that the concept of psychological flexibility provides the necessary nuance to underpin successful therapy. Our study is an important addition to the literature, and we are looking forward to initiating further research in this area."

The research team at the University of Chichester worked with colleagues from Coventry University, the University of Milano-Biccoca, Italy, Trinity College Dublin and Maynooth University, Ireland.

A team of researchers at the Disparities Research Unit at Massachusetts General Hospital (MGH) - in collaboration with two teams in Spain and collaborators in the U.S. and Puerto Rico - has tested a novel preventive intervention designed to provide tailored treatment for Latino immigrants with both mental health and substance misuse symptoms. Their report is being published online in JAMA Network Open.

"We know that Latino patients benefit when treatments are culturally tailored, evidence based and accessible," says Margarita Alegria, PhD, chief of the Disparities Research Unit and a professor in the Departments of Medicine and Psychiatry at Harvard Medical School. "We sought to provide a customized treatment to Latino immigrants in different contexts - in the U.S. and Spain - to see how best to serve this growing and important demographic population in our communities."

The authors note that immigrants face enormous barriers to access appropriate behavioral health treatments. A variety of structural and institutional barriers mean that Latinos who need mental health and substance use services may be less likely to receive evidenced-based care and have worse outcomes than non-immigrant Latino adults. Therefore, the study team conducted outreach to people not seeking care, inviting them to be screened for elevated co-occurring mental health and substance use symptoms. If the screenings revealed mild to severe symptoms, they were invited to participate.

The study team developed the Integrated Intervention for Dual Problems and Early Action (IIDEA) program to provide culturally tailored care that incorporates evidence-based practices - including cognitive restructuring and mindfulness-based therapy along with substance-craving reduction and coping strategies. The intervention was offered in both the Greater Boston area and in Madrid and Barcelona, Spain, to Latino adults aged 18 to 70 who screened positive for co-occurring symptoms. IIDEA is an integrated therapy that involves 10 to 12 weekly sessions that include motivational interviewing, cultural formulation, assessment of barriers to care, psychoeducation, cognitive behavioral therapy, mindfulness exercises, communication skills and reduction of risk behaviors.

Bilingual/bicultural staff across sites identified individuals in primary care and emergency departments, as well as non-clinical settings such as Latino-serving community-based organizations. A total of 341 participants were randomized to receive either the IIDEA intervention or take part in an enhanced usual care group with regular telephone check-ins to assure safety. Participants were assessed on enrollment and 2, 4, 6, and 12 months after enrollment.

Results showed that the intervention reduced mental health symptoms but did not show an effect on alcohol and drug outcomes for participants overall, a large proportion of whom had mild symptoms upon enrollment. However, secondary analyses indicated that IIDEA was effective in reducing both substance use and mental health symptoms for participants who initially screened with moderate to severe symptoms. Those participating in four or more sessions also saw decreasing drug use and mental health symptoms.

Lead author Alegria notes, "These results point to the potential for an adequate dose of tailored therapy, even as few as four sessions, to improve outcomes for those with moderate to severe symptoms." More than half of participants completed the full course of treatment, supporting previous findings showing that premature termination of treatment may be reduced by the use of culturally adapted interventions and by matching patients with therapists who share their culture or language. Study authors also point to the importance of maintaining the effects of the therapy over time and hope to continue to address this in future work.

The Disparities Research Unit (DRU) in the MGH Department of Medicine has a goal of generating innovative health services research that helps shape policy, practice and service delivery to reduce disparities and improve the well-being of multicultural populations. Utilizing collaborative approaches with researchers, clinicians and community agencies, the DRU supports an array of research activities as well as nurtures a core of junior researchers. The DRU has a strong focus on community-based and applied interventions to improve service delivery for multicultural populations.

Repeatedly missing general practice (GP) appointments may be a risk marker for all-cause mortality, particularly in patients with mental health conditions, new research published in the open access journal BMC Medicine suggests. Although further research is needed to better understand the relationship between missed appointments and mortality, the authors suggest that general practices and other services within the UK National Health Service (NHS) may need to consider how to best engage with patients who repeatedly miss appointments.

Researchers at the Universities of Glasgow, Aberdeen and Lancaster found that the more long-term conditions (LTC) a person had, the more likely they were to miss appointments. Of the 824,374 patients whose data were examined in this study, 59% had one or more LTC, while 13.3% had four or more. Patients with no LTCs were less likely to miss GP appointments than patients with LTCs. Out of the 439, 592 patients who did not miss any GP appointments over a three-year period 51.5% had no LTCs, whereas 41.6% had one to three LTCs and 7% had four LTCs. Out of 59, 340 patients who missed three or more appointments per year over the same three-year period, 40.1% had four or more LTCs, 50.1% had one to three LTCs, and 9.8% had no LTCs.

Mental-health-based LTCs were found to be associated with a higher risk of missing appointments than physical LTCs. One to three mental health comorbidities were associated with a 30% higher risk of missing appointments compared to those who had no LTCs, and patients with four or more mental health LTCs were twice as likely to miss appointments. Patients with one to three physical morbidities were 16% more likely to miss appointments than those with no LTCs, whereas those with four or more physical LTCs were at 38% higher risk of missing appointments.

Dr Ross McQueenie, the corresponding author of the study, said: "Patients with a higher number of missed appointments were also at greater risk of death within the following year. Those with long-term physical conditions who missed two or more appointments per year had a threefold increase in all-cause mortality compared with those who missed no appointments. Patients with only mental health conditions who missed more than two appointments per year had an eightfold increase in all-cause mortality compared with those who missed no appointments. Patients diagnosed with long-term mental health problems, who died during the follow-up period, were more likely to die prematurely, often as a result of external factors such as suicide, rather than of natural causes."

The authors used a large Scottish primary healthcare appointment dataset, collected from 136 general practices from 11 Scottish health boards between 2013 and 2016, resulting in a cohort of 11.5 million appointments from 824,374 patients. The authors linked that data to the Scottish death registry to examine the association between missed appointments and mortality.

The observational nature of this study does not allow for conclusions about cause and effect. The authors note that it is unlikely that the relationship between missed appointments and mortality is directly causal; one possible mechanism mediating that relationship involves conditions associated with cognitive impairment, such as dementia or problem alcohol and drug use. These conditions are also associated with an increased risk of missing appointments, as well as with increased mortality.

Bad decision-making is a trait oftentimes associated with drug addicts and pathological gamblers, but what about people who excessively use social media? New research from Michigan State University shows a connection between social media use and impaired risky decision-making, which is commonly deficient in substance addiction.

"Around one-third of humans on the planet are using social media, and some of these people are displaying maladaptive, excessive use of these sites," said Dar Meshi, lead author and assistant professor at MSU. "Our findings will hopefully motivate the field to take social media overuse seriously."

The findings, published in the Journal of Behavior Addictions, are the first to examine the relationship between social media use and risky decision-making capabilities.

"Decision making is oftentimes compromised in individuals with substance use disorders. They sometimes fail to learn from their mistakes and continue down a path of negative outcomes," Meshi said. "But no one previously looked at this behavior as it relates to excessive social media users, so we investigated this possible parallel between excessive social media users and substance abusers. While we didn't test for the cause of poor decision-making, we tested for its correlation with problematic social media use."

Meshi and his co-authors had 71 participants take a survey that measured their psychological dependence on Facebook, similar to addiction. Questions on the survey asked about users' preoccupation with the platform, their feelings when unable to use it, attempts to quit and the impact that Facebook has had on their job or studies.

The researchers then had the participants do the Iowa Gambling Task, a common exercise used by psychologists to measure decision-making. To successfully complete the task, users identify outcome patterns in decks of cards to choose the best possible deck.

Meshi and his colleagues found that by the end of the gambling task, the worse people performed by choosing from bad decks, the more excessive their social media use. The better they did in the task, the less their social media use. This result is complementary to results with substance abusers. People who abuse opioids, cocaine, methamphetamine, among others - have similar outcomes on the Iowa Gambling Task, thus showing the same deficiency in decision-making.

"With so many people around the world using social media, it's critical for us to understand its use," Meshi said. "I believe that social media has tremendous benefits for individuals, but there's also a dark side when people can't pull themselves away. We need to better understand this drive so we can determine if excessive social media use should be considered an addiction."

Missing GP appointments is associated with early death, and those with long-term mental health conditions are at particular risk.

Dr Ross McQueenie led the study from the University of Glasgow along with colleagues from Lancaster University and the University of Aberdeen.

In the largest study of its kind, the team examined over 500,000 patients' appointment histories in Scotland, tracked for 3 years between 2013 and 2016.

All data were provided on condition of patient and practice anonymity. Appointment information was then linked to patient medical histories and death records.

The researchers found that:

Patients with a greater number of long-term health conditions had an increased risk of missing general practice appointments. These same patients were also at substantially greater risk of death within the following year.

Patients with long term physical conditions who missed two or more appointments per year had a threefold increase in all-cause mortality compared with those who missed no appointments.

Patients with mental-health conditions only who missed more than two appointments per year had an eight times greater risk of death during the follow-up period compared with those who missed no appointments.

These results emerged even after researchers controlled for a variety of other factors already known to affect attendance.
Dr McQueenie said "Patients diagnosed with long-term mental health problems, who did die during the follow-up period, died prematurely, often from non-natural external factors such as suicide.

Dr Ellis added "These results align with clinicians own observations. Specifically, patients with long-term mental health conditions are more likely to miss multiple appointments."

The researchers are now exploring how new interventions might improve attendance however, their research raises important questions when it comes to ensuring that mental health services remain easy to access and are readily available across the UK.

Professor Wilson concluded "These findings are crucially important for GPs wishing to identify patients at high risk of premature death. For people with physical conditions missed appointments are a strong independent risk factor for dying in the near future. Among those without long-term physical conditions, the absolute risk is lower, but missing appointments is an even stronger risk marker for premature death from non-natural causes."

Researchers have used artificial intelligence to support the instant diagnosis of one of the top causes of blindness, diabetes-related eye disease, in its earliest stages.

Diabetic retinopathy is the leading cause of vision loss in adults* and its impact is growing worldwide, with 191 million people set to be affected by 2030**.

There are no early-stage symptoms and the disease may already be advanced by the time people start losing their sight. Early diagnosis and treatment can make a dramatic difference to how much vision a patient retains.

Now a team of Australian-Brazilian researchers led by RMIT University have developed an image-processing algorithm that can automatically detect one of the key signs of the disease, fluid on the retina, with an accuracy rate of 98%.

Lead investigator Professor Dinesh Kant Kumar, RMIT, said the method was instantaneous and cost-effective.

"We know that only half of those with diabetes have regular eye exams and one-third have never been checked," Kumar said.

"But the gold standard methods of diagnosing diabetic retinopathy are invasive or expensive, and often unavailable in remote or developing parts of the world.

"Our AI-driven approach delivers results that are just as accurate as clinical scans but relies on retinal images that can be generated with ordinary optometry equipment.

"Making it quicker and cheaper to detect this incurable disease could be life changing for the millions of people who are currently undiagnosed and risk losing their sight."

Fluorescein angiography and optical coherence tomography scans are currently the most accurate clinical methods for diagnosing diabetic retinopathy.

An alternative and cheaper method is analysing images of the retina that can be taken with relatively inexpensive equipment called fundus cameras, but the process is manual, time-consuming and less reliable.

To automate the analysis of fundus images, researchers in the Biosignals Laboratory in the School of Engineering at RMIT, together with collaborators in Brazil, used deep learning and artificial intelligence techniques.

The algorithm they developed can accurately and reliably spot the presence of fluid from damaged blood vessels, or exudate, inside the retina.

The researchers hope their method could eventually be used for widespread screening of at-risk populations.

"Undiagnosed diabetes is a massive health problem here and around the globe," Kumar said.

"For every single person in Australia who knows they have diabetes, another is living with diabetes but isn't diagnosed. In developing countries, the ratio is one diagnosed to four undiagnosed.

"This results in millions of people developing preventable and treatable complications from diabetes-related diseases.

"With further development, our technology has the potential to reduce that burden."

The researchers are in discussions with manufacturers of fundus cameras about potential collaborations to advance the technology.

As many as one in four women attending sexual and reproductive healthcare services say they are not allowed to take control of their own reproductive lives, reveals a review of the available evidence, published today in BMJ Sexual & Reproductive Health.

As well as not being able to actively choose whether to use contraceptives, or start or continue with a pregnancy, this 'reproductive control' also takes the form of 'contraceptive sabotage', which includes covert removal of a condom during sex, so invalidating consent, the research shows.

The concept of reproductive coercion-control over women's reproductive autonomy by others-was first described in 2010.

The study authors wanted to update the available evidence to 2017, and to widen the spectrum of activities involved, to include family pressure and criminal behaviour, such as sex trafficking and exploitation.

They therefore searched relevant databases of medical and social sciences research, looking at women's experiences of interference with their reproductive autonomy.

They found that the practice is common, with as many as one in four women attending sexual and reproductive healthcare clinics reporting coercion over their reproductive lives.

Younger women, and in the US, black and racial minority women, seem to be particularly vulnerable, the research indicates.

And in some cultures, the wider family, and older female relatives in particular, may have control over reproductive decision-making that is endorsed by society.

Reproductive control covers a wide range of behaviours, from persuasion through emotional blackmail, to threatened or actual infidelity and physical violence. It is predominantly perpetrated by male partners, but also by the wider family and criminal gangs, the evidence shows.

It includes not being allowed to make decisions about becoming pregnant and continuing or terminating a pregnancy, and contraceptive sabotage. This last interacts and overlaps with sexual coercion and violence, and effectively invalidates consent, say the study authors.

Examples of contraceptive sabotage include a male partner lying about having had 'the snip' (vasectomy); refusal to permit the use of contraceptives; forceful removal of contraceptive devices; failure to practise withdrawal during sex; piercing condoms or other barrier methods; and throwing away/hiding contraceptive pills.

And it includes 'stealthing,' whereby a condom is covertly removed during sex, and at the other end of the spectrum, spiking food and drink with agents known to induce abortion.

The negative consequences are many: undermining responsibility for contraceptive use; unintended or unwanted pregnancy; a higher risk of abortion; higher rates of testing for sexually transmitted infections and pregnancy and requests for emergency contraception.

Women may themselves respond by lying about their use of contraception, pregnancy testing, etc, and risk harm if they try to negotiate contraceptive use in a violent relationship.

But they may not always be aware that they are being subjected to reproductive control, especially if this isn't accompanied by physical or sexual violence, say the study authors.

"The degree of control that a male partner can have will vary from mild to extreme. Milder amounts of control may not be perceived by the victim as unhealthy or abusive. Women in a long term relationship may become inured to significant levels of reproductive control," they write.

Healthcare professionals have a key role in picking up and preventing this form of abusive behaviour, they say, and call for more international research to help guide this.

"In particular, more research is needed on the non-physical elements of abusive relationships and how coercive control can be resisted," they suggest.

A study from the University of Notre Dame has found that the properties of a material commonly used to create conductive or protective films and encapsulate drug compounds - and the conditions in which this material will disassemble to release that medication - may be different than initially thought.

Published in the Journal of the American Chemical Society, the study aimed to identify the conditions under which polyelectrolyte complexes, or PECs, would assemble and stay assembled. The researchers found new, important differences between strong and weak PECs. 

"The mechanism of weak PECs is completely different than that of strong PECs," said Jonathan Whitmer, assistant professor in the Department of Chemical and Biomolecular Engineering and principal investigator for the study. "During our research, we found that when each of the weak polyelectrolytes came together in a solution, the presence of an oppositely charged polymer resulted in a strong pKa shift, enabling both polyelectrolytes to become highly charged and to stay stable. On the contrary, pH has relatively little influence on the charge and assembly of strong PECs, whose strong binding to salt ions determines most of their assembly."

Weak PECs have been studied for many uses, including as a material to create capsules that hold medications. Weak PECs have a unique ability to bond and release in certain environments, but Whitmer's team found that pH affected the overall assembly of weak PECs, as well as the conditions in which these materials may release.

"This study completely changes our perspective on the formation of weak PECs and how this material can be used," said Whitmer, an affiliated member of NDnano. "Not only does this study point out physical mechanisms that will enable us to engineer better PECs, but it also has the potential to improve how this material can be utilized in industry, including the 'smart' encapsulation and delivery of medications, thin conductive materials and protective coatings." 

In conducting the study, Whitmer and his team also developed a novel simulation algorithm. This algorithm allowed the researchers to analyze certain aspects of weak PECs that were not possible before, including the proper replication of solution conditions. 

BEER-SHEVA, Israel...January 4, 2019 - Ben-Gurion University researchers have developed a new satellite imaging system that could revolutionize the economics and imagery available from space-based cameras and even earth-based telescopes.

"This is an invention that completely changes the costs of space exploration, astronomy, aerial photography, and more," says Angika Bulbul, a BGU Ph.D. candidate under the supervision of Prof. Joseph Rosen in the BGU Department of Electrical and Computer Engineering.

In a paper published in the December issue of Optica, the researchers demonstrate that nanosatellites the size of milk cartons arranged in a spherical (annular) configuration were able to capture images that match the resolution of the full-frame, lens-based or concave mirror systems used on today's telescopes.

"Several previous assumptions about long-range photography were incorrect," Bulbul says. "We found that you only need a small part of a telescope lens to obtain quality images. Even by using the perimeter aperture of a lens, as low as 0.43 percent, we managed to obtain similar image resolution compared to the full aperture area of mirror/lens-based imaging systems. Consequently, we can slash the huge cost, time and material needed for gigantic traditional optical space telescopes with large curved mirrors."

To demonstrate the synthetic marginal aperture with revolving telescopes (SMART) system capabilities, the research team built a miniature laboratory model with a circular array of sub-apertures to study the image resolution and compare them with full lens imagery.

Every time we look at a face, we take in a flood of information effortlessly: age, gender, race, expression, the direction of our subject's gaze, perhaps even their mood. Faces draw us in and help us navigate relationships and the world around us.

How the brain does this is a mystery. Understanding how facial recognition works has great value--perhaps particularly for those whose brains process information in ways that make eye contact challenging, including people with autism. Helping people tap into this flow of social cues could be transformational.

A new study of facial "fixation" led by Nicolas Davidenko, an assistant professor of psychology at the University of California, Santa Cruz, boosts our insights considerably.

"Looking at the eyes allows you to gather much more information," said Davidenko. "It's a real advantage."

By contrast, the inability to make eye contact has causal effects. "It impairs your facial processing abilities and puts you at a real social disadvantage," he said. People who are reluctant to make eye contact may also be misperceived as disinterested, distracted, or aloof, he noted.

Scientists have known for decades that when we look at a face, we tend to focus on the left side of the face we're viewing, from the viewer's perspective. Called the "left-gaze bias," this phenomenon is thought to be rooted in the brain, the right hemisphere of which dominates the face-processing task.

Researchers also know that we have a terrible time "reading" a face that's upside down. It's as if our neural circuits become scrambled, and we are challenged to grasp the most basic information. Much less is known about the middle ground, how we take in faces that are rotated or slightly tilted¬.

"We take in faces holistically, all at once--not feature by feature," said Davidenko. "But no one had studied where we look on rotated faces."

Davidenko used eye-tracking technology to get the answers, and what he found surprised him: The left-gaze bias completely vanished and an "upper eye bias" emerged, even with a tilt as minor as 11 degrees off center.

"People tend to look first at whichever eye is higher," he said. "A slight tilt kills the left-gaze bias that has been known for so long. That's what's so interesting. I was surprised how strong it was."

Perhaps more importantly for people with autism, Davidenko found that the tilt leads people to look more at the eyes, perhaps because it makes them more approachable and less threatening. "Across species, direct eye contact can be threatening," he said. "When the head is tilted, we look at the upper eye more than either or both eyes when the head is upright. I think this finding could be used therapeutically."

Davidenko is eager to explore two aspects of these findings: whether people with autism are more comfortable engaging with images of rotated faces, and whether tilts help facilitate comprehension during conversation.

The findings may also be of value for people with amblyopia, or "lazy eye," which can be disconcerting to others. "In conversation, they may want to tilt their head so their dominant eye is up," he said. "That taps into our natural tendency to fix our gaze on that eye."

The effect is strongest when the rotation is 45 degrees. The upper-eye bias is much weaker at a 90-degree rotation. "Ninety degrees is too weird," said Davidenko. "People don't know where to look, and it changes their behavior totally."

Davidenko's findings appear in the latest edition of the journal Perception, in an article titled "The Upper Eye Bias: Rotated Faces Draw Fixations to the Upper." His coauthors are Hema Kopalle, a graduate student in the Department of Neurosciences at UC San Diego who was an undergraduate researcher on the project, and the late Bruce Bridgeman, professor emeritus of psychology at UCSC.

Two Veterans Affairs researchers have explored how memory is tied to the hippocampus, with findings that will expand scientists' understanding of how memory works.

Drs. Christine N. Smith and Larry R. Squire, both with the VA San Diego Healthcare System and the University of California, San Diego, found that declarative memory--recalling facts and events--depends on conscious knowledge of what has been learned. The finding helps explain how the hippocampus controls the process of memory. They also showed that conscious knowledge is compromised in patients with damage to the hippocampus.

Smith sums up the findings by saying, "Our study shows that awareness is a key feature of declarative memory."

The results appeared in the Nov. 20, 2018, issue of the Proceedings of the National Academy of Sciences.

Past research has shown that damage to the medial temporal lobe (MTL), the brain region that contains the hippocampus, can cause problems with declarative memory. This type of memory, the ability to remember information about past facts and events, has been linked to the hippocampus. It is expressed through direct recollection. Another type of memory--nondeclarative--refers to skill and habit learning, as well as and other types of learning, that are based on performance rather than recollection. Nondeclarative memory does not seem to be affected by MTL damage. For example, a person with MTL damage may still remember how to ride a bike, but might not remember what he or she did yesterday.

While scientists know that the hippocampus is involved in declarative but not nondeclarative memory, how exactly the hippocampus operates during memory acquisition is not well-understood.

According to Squire: "A central issue for understanding memory and memory disorders is the matter of classification. What kinds of memory are there, what are the characteristics of each kind, and what brain systems are important for each kind?"

One theory is that declarative memory is linked to conscious knowledge, or awareness of what has been learned. Another theory suggests that memory is dependent on how the brain processes information, rather than on conscious knowledge. For example, the second theory suggests that the MTL is needed when learning associations of relationships between items, regardless of whether the person is aware of what he or she has learned.

To test these two competing theories, Smith and Squire recruited five memory-impaired patients with MTL lesions. The patients, with an average age of 63, had amnesia from different causes. Two became amnesic after a drug overdose and associated respiratory failure, one suffered ischemia (lack of blood to the brain) because of kidney failure and toxic shock syndrome, one had viral encephalitis, and one became amnesic with no known cause. Brain scans showed that these patients had smaller-than-normal hippocampus volume. The researchers also recruited six healthy people to serve as controls.

They assessed participants' memories using something called the manipulation effect. Participants are shown a picture they are familiar with that has either been altered in some way or remains the same. According to the manipulation effect, people will spend more time looking at the section of a picture that has been changed than at the same section of an unaltered picture. But research has shown that the manipulation effect occurs only when participants know that a picture has been altered.

For the experiment, participants were shown 24 scenes for five seconds each. After a short break, they were shown the scenes again. After another break, they were shown the same 24 scenes, except that 12 had been changed and 12 remained the same. Changes were either an item being added to the scene or an item being removed. For example, in a scene of a moving truck in front of a building, the first picture showed a worker with a cart while in the second picture the worker had been removed.

The process was repeated with 24 different scenes in a second session. A computer tracked eye movements to record where in the pictures participants were looking.

During the third round, participants were told to look for possible changes. They were then asked to state whether each scene was the same or changed, and to rank their confidence in that answer. Finally, participants were shown the changed scenes again and asked to describe what was changed and identify where in the picture the change occurred.

The results showed that patients with MTL lesions were "markedly impaired" at telling which scenes were changed. Specifically, control participants correctly identified an average of 16.5 out of 24 of the changed scenes, and 20.5 of the unchanged scenes. Patients identified only 8.4 changes and 18.4 repeated scenes. Controls were also more confident in their answers when they were correct than when they were incorrect, while patients showed the same level of confidence in correct and incorrect answers.

Patients were able to correctly identify a scene as changed, describe the change, and locate the section of the image that changed for only10.8 percent of the altered images. Controls did this for 60.4 percent of the images. Getting all three aspects of the change right was termed "robust knowledge."

Both controls and patients directed their eyes toward the change only when they had robust knowledge of the change. This showed that the manipulation effect is a function of conscious memory, according to Smith and Squire. This eye movement effect suggests that conscious knowledge is an important aspect of declarative memory, and that the hippocampus supports the acquisition of this type of memory.

Smith explains the eye-movement data in this way: "When memory-impaired patients occasionally succeed at remembering a past event (measured in their eye movements), they also consciously remember the event. When the patients failed to remember (and eye movements showed no recognition), they were unaware of the past event. Our findings suggest that awareness of the past is a crucial and consistent feature of the kind of memory that depends on the hippocampus"

According to Squire, adding to the understanding of how memory works could help improve how doctors diagnose and treat memory problems. "Scientists often say that we want to fix the car but it will help to know how the car works. As we learn more about memory, we move closer to being able to detect, prevent, and treat diseases and disorders that affect memory," he explains.

As a non-noble metal, copper oxidizes more easily to positive valence (Cu+ or Cu2+) than same-family elements Au or Ag. In general, this chemical property is mainly determined by electron structure. Can we change the chemical properties of an element by regulating its electron structure? Can Cu act as a noble metal in catalytic reactions?

A team led by Dr. SUN Jian of the Dalian Institute of Chemical Physics (DICP) of the Chinese Academy of Sciences (CAS) gives a positive answer. The team's recently published paper in Science Advances shows that the electron structure of Cu can be changed, assisted by high energy plasma, making Cu exhibit significantly different catalytic behaviors than normal Cu in selective hydrogenation reactions.

The dimethyl oxalate (DMO) hydrogenation reaction, a typical multistep catalytic reaction producing methyl glycolate (MG), ethylene glycol or ethanol, was selected as a probe reaction for copper. In this reaction, the common product over supported Cu/SiO2 catalysts is one of the latter two owing to the inevitable co-existence of Cu+ and Cu0 for deep hydrogenation.

The sputtered (SP) Cu, which is bombarded by high energy argon plasma, can be "frozen" at zero valence when exposed to oxidation or reaction atmosphere at a very wide range of temperature, presenting noble-metal-like behaviors (see figure below).

In DMO hydrogenation, a high selectivity (87%) towards the preliminary hydrogenation product, MG, a high-value chemical, was observed. The molecule level free energy surface in various reaction pathways by DFT calculation also verifies that "frozen" Cu0 is crucial for preliminary hydrogenation.

SEATTLE - Globally, one in four people over age 25 is at risk for stroke during their lifetime, according to a new scientific study.

Researchers found a nearly five-fold difference in lifetime stroke risk worldwide, with the highest risk in East Asia and Central and Eastern Europe, and lowest in sub-Saharan Africa. The lifetime stroke risk for 25-year-olds in 2016 ranged from 8% to 39%, depending on where they live; people in China have the highest risk.

"Our findings are startling," said Dr. Gregory Roth, Assistant Professor of Health Metrics Sciences at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, and senior author on the study. "It is imperative that physicians warn their patients about preventing strokes and other vascular diseases at earlier points in patients' lives. We found extremely high lifetime risk for stroke, and based on other research we evaluated, it is clear that younger adults need to think about long-term health risks. They can make a real difference by eating healthier diets, exercising regularly, and avoiding tobacco and alcohol." The studies and additional information are available at http://www.healthdata.org.

The study, "Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990-2016," was published today in The New England Journal of Medicine.

Using estimates from the Global Burden of Disease study (GBD), researchers developed a new summary measure that combines one's risk of having a stroke and surviving, with suffering a stroke and dying. For the first time, the study estimates lifetime stroke risk starting at age 25, whereas previous studies begin at age 45.

The authors analyzed the lifetime risk of first-ever stroke, categorized by subtype - ischemic and hemorrhagic stroke. They did not assess the lifetime risk of recurring stroke, pediatric stroke, or transient ischemic attack (TIA), commonly known as "mini-stroke," which does not result in permanent brain damage. Findings cover 1990 to 2016 in 195 countries and territories by age and sex.

The findings expose large geographic variations. In 2016, the three regions with the highest estimated lifetime risk of stroke were East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%); the region with the lowest risk was eastern sub-Saharan Africa (11.8%).

"The lower risk of lifetime stroke in sub-Saharan Africa does not necessarily represent a lower incidence of stroke or more effective prevention and treatment strategies," said Roth. "On the contrary, people there are merely at higher risk of dying of another cause first."

The burden of stroke among adults is largely dependent on modifiable risk factors and the characteristics of health systems. Therefore, the study's findings may be useful for long-term planning, especially in terms of prevention and public education.

Nations' ministers of health and other policymakers need to develop programs encouraging young adults to eat healthier diets with more fruit, vegetables, and whole grains, as well as avoid tobacco and alcohol, and increase physical activity and maintain a healthy weight, Roth said. They also should advocate for lower prices of medications that control high blood pressure and cholesterol.

"This important paper provides reliable data on current lifetime risks across the world for different types of stroke, as well as providing countries with valuable insights into the burden of stroke," said Dr. Peter Rothwell, Head of the Centre for the Prevention of Stroke and Dementia and Professor of Clinical Neurology at the University of Oxford. "These data and insights can be used to prioritize and target strategies for prevention. I hope this important work will be continued so that these trends can be mapped in future decades."

Additional findings include:

The estimated global lifetime risk of stroke - an average of widely varying rates around the world - from age 25 onward was 24.9% in 2016.
Broken out by stroke subtype, the global lifetime risk of ischemic stroke was 18.3% and the risk of hemorrhagic stroke 8.2%. Ischemic stroke occurs when an obstruction within a blood vessel prevents blood supply to the brain, whereas hemorrhagic stroke occurs when a weakened blood vessel ruptures.

The greatest increases in lifetime stroke risk between 1990 and 2016 were found in East Asia, South Asia, Southeast Asia, eastern sub-Saharan Africa, Central Europe, western sub-Saharan Africa, and North Africa and the Middle East.
Conversely, the risk in Central Asia, southern and tropical Latin America, high-income Asia-Pacific, and southern sub-Saharan Africa decreased substantially over the same time period.

Despite no significant difference in global risk of lifetime stroke between men and women in 2016, the findings revealed substantial regional and country-level variation by sex.

Among 21 regions, the highest lifetime risk among men was in East Asia (40.6%), whereas the highest lifetime risks among women were in Eastern Europe (36.5%) and East Asia (36.3%).

The greatest risk among men, at 41.1%, was in China; the greatest risk among women, at 41.7%, was in Latvia.

Countries with highest lifetime stroke risk for individuals beginning at age 25:

1. China: 39.3%
2. Latvia: 37.0%
3. Romania: 36.2%
4. Montenegro: 36.0%
5. Bosnia and Herzegovina: 35.7%
6. Macedonia: 35.2%
7. Serbia: 33.8%
8. Bulgaria: 33.4%
9. Albania: 33.4%
10. Croatia: 33.0%