Smartphone apps can be memory aids for people with brain injuries, and everyone else

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Calendar apps can be useful to people with and without memory problems.
Darren Grove/Shutterstock

Dana Wong, Monash University

Smartphone apps allow us to outsource remembering appointments or upcoming tasks. It’s a common worry that using technology in this way makes our brain’s memory capacity worse, but the reality is not that simple.

In fact, these platforms can be useful, not only for people with memory impairments, but also the general population.

Over two studies, we set out to explore the potential of smartphones as memory aids by investigating how people with traumatic brain injuries (TBI) or with stroke use them.

We surveyed 29 people with TBI and 33 non-injured people for our TBI study. For the stroke study, we surveyed 29 participants with stroke and 29 with no history of neurological conditions.

We found that memory apps like calendars can be helpful for people with brain injuries. And while it was a small sample, we also found that for participants without brain injury, there was no relationship between memory app use and memory ability.

This finding requires further analysis, but it is not consistent with the idea that memory aids make our brains lazy. Rather, such apps can free our minds to focus on other things, without using up mental resources worrying about what needs to be remembered.

How does brain injury affect memory?

Memory difficulties are common after acquired brain injuries such as a stroke. Everyday problems include forgetting appointments, names and details, losing track of conversations and misplacing personal items.

Research on rehabilitation of memory after brain injury supports the use of compensatory strategies. These include internal or mental strategies such as mentally rehearsing a speech and external strategies, such as calendars, lists, notes, alarms and photos.

Traditionally, external memory aids have been in paper-based formats such as diaries and notes, which are bulky and easily lost. Research shows early technological aids such as pagers and Personal Digital Assistants were helpful in approving improving memory function, but unfamiliar and difficult to learn to use for many people with brain injury.

Smartphones have the potential to address the limitations of earlier devices. They are familiar to most people, at least in the developed world, and are highly portable.

Are smartphones useful memory aids?

In both studies, we found that the majority of people both with and without brain injury used smartphones for three main reasons: for communication, as a memory aid and for internet access.

When asked about the biggest benefit of using a smartphone, users with TBI and stroke most often cited its helpfulness as a memory aid. This contrasted with those with no history of brain injury, who instead listed portability, convenience and access to the internet as the main benefits.

The memory apps used most often by participants with TBI and stroke were calendars, alarms, contacts lists, reminder text messages, notes, cameras, and to-do lists. These apps help the user remember appointments, tasks, details and locations without relying on their internal memory capacity.

A cerebral infarction (ischemic stroke) at the brain’s left hemisphere .
Puwadol Jaturawutthichai/Shutterstock

For people with TBI and those without any neurological conditions, there was no relationship between use of memory apps and performance on objective memory tests requiring recall of a list of words. This suggests that relying on memory aids did not influence intrinsic memory ability.

This result was important in counteracting the fear expressed by some TBI and stroke survivors that using a memory aid may make their memory abilities worse, just like using a wheelchair may make leg muscles weaker.

Our results indicate that this idea does not apply to memory among our sample group – rather, using memory aids is helpful for people who struggle to remember things by supporting their injured brains without causing any further damage.

For stroke survivors, more frequent use of memory apps also seems to be associated with higher productivity, as measured by their engagement in work, study and volunteer activities. This may mean that using smartphone memory apps enabled them to be more productive by supporting them to remember and organise tasks.

What are the barriers to using memory apps?

In both studies, we found that younger participants were more likely to use smartphones, suggesting that older adults may require more support in using them.

TBI and stroke survivors were also more likely to have difficulty learning to use their smartphone, and preferred being directly shown how to use it rather than learning by trial and error. Stroke survivors with motor (physical) symptoms used memory apps less frequently.

To further increase access to the benefits of smartphone memory apps, we now need to work out how to help users with brain injuries who may find them difficult to learn.

The ConversationOur future research will aim to work out the most effective methods for teaching smartphone memory apps to people with memory impairment.

Dana Wong, Senior Lecturer in Clinical Neuropsychology, Monash University

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

Forget cash: geocaching shows there are other ways to create value online

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Geocaching players move treasures all over the world, creating value for themselves and other players.
Martyn Wright 2011, CC BY-ND

Bernardo Figueiredo, RMIT University; Daiane Scaraboto, Universidad Católica de Chile, and Nancy Mills, University of Melbourne

Although we focus on the financial health of online networks, there are other ways to create value in digital spaces.

Take controversial companies like Uber, Airbnb and Airtasker, which are heralded as the poster children of the so-called sharing economy. By focusing on money changing hands, they miss the chance to help users collaboratively share other kinds of value that don’t have a price tag.

On Airbnb, users often undertake actions that don’t create immediate economic benefit: meeting guests, giving gifts, or helping with travel advice. But these actions aren’t captured by the platform beyond the review section.

To better understand how non-economic value creation works, we examined the global treasure-hunting game known as geocaching.

In the game, network members can generate non-financial value from connecting socially or being well regarded by others. They can also gain value from feeling a sense of adventure or acquiring knowledge.

Despite having different locations, culture and social capital, members of such collaborative networks can come together for common goals.

What can geo-caching teach us about value?

Geocaching claims to have millions of players or “geocachers” who hunt for more than 2.8 million treasures (“geocaches”) hidden all over the world.

The game involves creating and exchanging “travel bugs”. These are objects as innocuous as an old whistle or a teddy bear that carry identification tags and are assigned goals by their creators. Geocachers collaborate to help the travel bug move from one cache to another.

We found that individual geocachers are part of a systemic process of value creation.

How does this work? Individual actions, such as a geocacher hiding or finding a geocache, are registered and stored in the form of blog posts, photographs, comments and reviews. When other participants see these registrations (sometimes years later or while living on other continents), they continue yielding value, because others recognise the benefits of these actions to members of the geocaching network.

The key feature of its collaborative network is that the value of one action gets stored with the value of other actions, and becomes redistributed to other participants.

Examples of geocaching homemade video.

For example, when a geocacher reads some posts and learns about the adventures of objects moved from cache to cache by other geocachers, they gain knowledge, a sense of adventure and connection to others in the network. The network stores and redistributes the value outcomes of actions performed by its members.

To an outsider, geocaching might seem like just a hobby, but these activities are extremely valuable to participants. While each action alone means very little, the totality of actions can move a worthless toy across the globe and even to space. What is valuable are the collaborative, often peripheral actions that make this movement happen.

Other platforms, like Couchsurfing, can also store different types of value. Everyday actions performed by users and captured by Couchsurfing include those linked to non-economic value, such as the guests cooking a meal, or hosts giving insights into their home country.

What can other networks learn?

When compared to geocaching, companies like Uber, Airbnb and Airtasker are not fulfilling their potential for creating systemic value.

The platforms don’t completely capture other forms of value creation. These are the collaborative and often peripheral actions that help the system move, like a particularly friendly Uber driver or an Airbnb host who offers useful travel advice.

Although Airbnb has member reviews, it’s up to users whether they mention other forms of value. Airtasker reviews are about services provided, and Uber focuses on ratings.

To capture additional value, these companies should create additional ways for participants to register these other actions. What amazing stories have you discovered from talking to your Uber driver? Have you brought a gift for your Airbnb host? What have you learned from your Airtasker helper?

Questions like these would allow the systemic accumulation of other types of value, which not only enrich the network, but encourage other participants to engage in similar actions.

The ConversationLike geocachers, platforms in the sharing economy will benefit from embracing sharing in its deepest meanings. Only then will users become participants of a true collaborative culture.

Bernardo Figueiredo, Senior Lecturer in Marketing, RMIT University; Daiane Scaraboto, Assistant Professor of Marketing, Universidad Católica de Chile, and Nancy Mills, Postgrad student and freelance writer, University of Melbourne

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

Doing away with the annual performance review? More feedback isn’t necessarily better

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Businesses are considering making the change from a formal review to regular feedback., CC BY-SA

Michelle Brown, University of Melbourne

For many employees the end of the financial year signals performance review time. The dreaded time of the year when they sit down with their supervisor and receive feedback on their performance over the previous 12 months.

In Australia and the US, businesses are reconsidering this traditional approach to managing employee performance. Managers are worried the traditional approach is resource intensive, emphasises employee evaluation over development and tends to be retrospective. Feedback delivered after an event, can leave employees with an inaccurate assessment of their performance.

Employees vary in their views on the frequency of feedback. One survey found that baby boomers prefer less frequent feedback while millennials prefer more. Experienced workers know the job so see no value in feedback. Younger workers feel blindsided by feedback that comes but once a year.

An alternative would be to drop traditional performance reviews and implement regular feedback sessions with employees – maybe twice yearly, quarterly, monthly or even weekly.

One study found that feedback interventions (both positive and negative feedback) resulted in lower performance in over one third of cases examined. Another study suggests that feedback without any consequences won’t be effective. This study reported that when feedback was used alone, it produced consistent improvements in performance in only 28% of the cases examined.

Feedback, maybe just not constantly

The argument for increasing the frequency of feedback is that it will provide more timely information that employees can use to learn and be more effective. This is particularly the case when it’s tied to events in the workplace. One study
found that more frequent feedback improves employee learning and task performance.

A subsequent study also found that increasing the frequency of feedback had a positive effect on learning and performance but only up to a point.

It gets to a point where feedback can be overwhelming for employees, where its too much to process and respond to. This can actually reduce employee learning and performance. The challenge is to find the sweet spot between too much and too little feedback.

The sweet spot

The impact of more frequent feedback will depend partly on its content. Feedback can be positive or negative. Positive feedback makes employees feel pleasant and proud as it is consistent with an employee’s self-image.

Some managers prefer to point out things that need to change in the way their employees work – that’s negative feedback. And it’s pretty risky for managers: researchers report that 98% of managers experienced some form of aggression by employees as a result of providing negative feedback.

So what’s also important in giving feedback is the way it’s delivered. Feedback needs to be clear and relevant. Both supervisors and subordinates need to feel comfortable asking for and giving feedback as part of a relationship of trust between them.

Feedback runs both ways! The quality of the feedback sessions also reflects a manager’s effectiveness. When managers give feedback in a considerate manner, employees are more likely to feel that they are treated fairly by their supervisor.

The delivery

To avoid the unpleasantness of the awkward annual chat, managers could try facilitating feedback electronically. This allows supervisors and employees to compose, edit, and process messages carefully, thereby improving the quality of the communication process. In fact, managers prefer sending negative feedback electronically, as it avoids the discomfort of communicating bad news face to face.

A new market has developed for apps and software that facilitate instant feedback from workplace colleagues. For example, American multinational General Electric is piloting an app called PD@GE to let people post notes of encouragement, advice or criticism under categories like “insight,” “consider” and “continue.”

Making the change to an informal performance management system based on regular feedback is going to be a challenge for Australian organisations. Currently only 36% of managers complete appraisals thoroughly and on time. Companies that have increased the frequency of feedback, do so after upping the training of their managers.

Managers need to develop skills in identifying the causes of performance, distinguishing between systematic versus isolated performance issues, collecting and evaluating data and communicating with employees. It’s a big step up from the traditional ticking of a box agreeing to a statement about an employees’ performance.

The ConversationIncreasing the frequency of performance feedback is not a quick fix to the problems that are associated with performance reviews. Organisations need to think through the implications for training of managers and preferences of employees in order to make a successful change in their approach to performance management.

Michelle Brown, Professor, Human Resource Management, University of Melbourne

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

We know too much sugar is bad for us, but do different sugars have different health effects?

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The type of sugar in popular soft drinks varies from country to country even if the brand name is the same.

Bronwyn Kingwell, Baker Heart and Diabetes Institute; Pia Varsamis, Baker Heart and Diabetes Institute, and Robyn Larsen, Baker Heart and Diabetes Institute

Our recent article published in the Medical Journal of Australia found that Australian and European soft drinks contained higher concentrations of glucose, and less fructose, than soft drinks in the United States. The total glucose concentration of Australian soft drinks was on average 22% higher than in US formulations.

We compared the composition of sugars in four popular, globally marketed brands – Coca-Cola, Fanta, Sprite and Pepsi – using samples from Australia, Europe and the US. While the total sugar concentration did not differ significantly between brands or geographical location, there were differences between countries in the concentrations of particular sugars, even when drinks were marketed under the same trade name.

Sucrose is made up of one glucose molecule and one fructose molecule.

Whether these differences have distinct effects on long-term health is currently unclear. Certainly, over-consumption of either glucose or fructose will contribute to weight gain, which is associated with a host of health conditions such as type 2 diabetes and heart disease. And because the body metabolises glucose and fructose in different ways, their effects may differ.

Sucrose, glucose and fructose

Soft drinks, as they are referred to in Australia, or “sodas” in the US and “fizzy drinks” in the UK, are non-alcoholic, carbonated, sugar-sweetened beverages. Australia ranks seventh out of the top ten countries for soft drink sales per capita.

Sugars are the chief ingredient in soft drinks and include glucose, fructose and sucrose. The source of sugars in popular soft drinks varies between global regions. This is because sugars are sourced from different crops in different areas of the world.

Soft drinks in Australia are primarily sweetened with sucrose from sugar cane. Sucrose, often referred to as “table sugar”, is composed of one glucose molecule and one fructose molecule joined by chemical bonds. This means equal amounts of glucose and fructose are released into the bloodstream when sucrose is digested.

Overseas, soft drinks are sweetened with sucrose-rich sugar beet (Europe) or high-fructose corn syrup (US). High-fructose corn syrup is also made up of glucose and fructose, but contains a higher fructose-to-glucose ratio than sucrose.

Do they have different health impacts?

Fructose over-consumption is known to contribute to fatty liver disease. Fatty liver disease affects about one in ten people in the West. Non-alcoholic fatty liver disease is the leading cause of liver disease.

Some researchers have suggested too much fructose in the diet can harm the liver in a similar fashion to alcohol. However, this concern is related to added fructose in the diet, not natural sources. Natural sources of fructose, such as fruit, honey and some vegetables, are not generally over-consumed and provide other important nutrients, such as dietary fibre and vitamins. So, fruit does not generally pose a risk for fatty liver disease.

Natural sources of fructose, such as fruit, are generally not over-consumed.

High glucose consumption rapidly elevates blood glucose and insulin. This may affect brain function, including mood and fatigue. Because high blood glucose is linked to diabetes, consumption of high-glucose drinks may also raise the risk of diabetes and cardiovascular (heart) disease.

All soft drinks are considered energy-dense, nutrient-poor and bad for health. However, one of the inherent challenges in the field has been an inability to determine the actual dose of glucose or fructose in these drinks.

Studies that follow people over time, and link soft drink consumption to adverse health effects, are complicated by not knowing whether individuals in these studies are simply eating too many energy-rich foods, and whether soft drink consumption coincides with other poor health behaviours. So, further research is required to determine whether soft drinks containing different concentrations of fructose and glucose are associated with differing health risks.

Soft drink policies

There is still much to learn about the differences in composition of sugars and patterns of soft drink intake between countries. A small number of countries, including Mexico and France, have already implemented taxation on soft drinks. It remains to be determined whether these actions reduce the incidence of obesity, diabetes and heart diseases.

Over-consumption of any kind of sugar leads to weight gain.

Australian policymakers are yet to take action to reduce soft drink consumption. A range of intervention strategies have been considered, including banning sugary soft drinks in schools and hospitals, taxation, and regulating beverage marketing.

The ConversationThe New South Wales Health Department has just announced sugary drinks will be phased out of vending machines, cafes and catering services in the state’s health facilities by December. This is a great move. Importantly, we must continue to increase public awareness of the adverse health effects of sugary soft drinks.

Bronwyn Kingwell, Head, Metabolic and Vascular Physiology NHMRC, Senior Principal Research Fellow, Baker Heart and Diabetes Institute; Pia Varsamis, PhD Student, Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute, and Robyn Larsen, Postdoctural Research Fellow in Nutritional Biochemistry, Baker Heart and Diabetes Institute

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

Explainer: what causes alopecia areata and can you treat this type of hair loss?

Rodney Sinclair, University of Melbourne

Alopecia is the medical term for hair loss and comes from the Greek word alōpekía referring to the skin condition, mange, in foxes. Alopecia areata causes a unique form of hair loss different to the more common age-related male and female pattern hair loss.

It’s also the most common autoimmune disease (when the body’s immune system attacks its own tissues), more common than insulin-dependent diabetes, rheumatoid arthritis or thyroiditis (inflammation of the thyroid).


Alopecia areata affects people of all ages including young children. It produces circular patches of hair loss that appear overnight. More patches appear over time and eventually about 5% of people affected lose every hair on their body. This includes eyebrows, eyelashes and even nose hairs. In some people, hair grows back, either in the same place or on a previously unaffected part of the scalp or body.

If alopecia areata is the most common autoimmune disease, why have most people never heard about it?

There are two likely reasons. One is that it’s embarrassing and distressing. Wherever possible, people try to hide it with clever hairstyles and cosmetic camouflage. The other reason is it often comes and goes, and once gone people would rather forget they had it.

So people only tend to see severe cases where people have lost all their hair. Even then people can mistake the condition for the hair loss seen after chemotherapy.

Bouts of alopecia areata generally come and go.
Duncan Creamer/Flickr, CC BY

The distress can be severe, especially in boys whose short hair makes it more difficult to conceal the patches of hair loss. Suicide among young boys affected by alopecia areata is more common than we would expect for a condition that essentially affects appearance, rather than people’s physical health.


Alopecia areata occurs when the body’s immune system mistakes hair follicles as foreign and attacks them. This causes the hairs to fall out. This specific form of autoimmunity is a lifelong tendency that can be inherited from either parent.

It’s what geneticists call a “complex polygenic disease” meaning it arises due to an interaction between multiple genes as opposed to a mutation in a single gene. More than 17 genes have been associated with alopecia areata and scientists expect there are still more genes to be discovered.

While your genes are pretty much fixed from birth, alopecia areata tends to come and go, especially in the early stages. This suggests something in our environment triggers individual episodes.

Doctors, patients and their families have hunted for this elusive trigger hoping its discovery would allow people to avoid relapses. However, no convincing dietary or lifestyle modification has emerged that changes the risk of relapse.

While people regularly blame stress as a trigger, in my experience of treating patients, the condition causes the stress.

Current treatment

For 40 years, there has been little progress in its treatment. Mild cases usually respond to cortisone injections into the bald scalp. Cortisone suppresses inflammation and stops white blood cells from attacking the hair follicles and promotes hair regrowth.

Some patients respond to cortisone tablets or other anti-inflammatory tablets but the results are by no means guaranteed. Some doctors are reluctant to prescribe these medications for fear of side-effects such as weight gain, mood disturbance, diabetes, hypertension and increased risk of infection.

Severe cases, where the scalp is completely bald (called alopecia areata totalis) or where every hair on the body vanishes (called alopeica areata universalis) rarely recover without treatment. These types of hair loss tend to be long lasting or even permanent.

For millions of people worldwide affected by alopecia areata, nothing has helped and for many a wig is the only option.

For many people a wig is the only option.
Lwp Kommunikáció/Flickr, CC BY

Future treatments

Many of the 17 genes associated with alopecia areata are involved in a particular inflammatory pathway called the JAK/STAT pathway. Drugs targeting this pathway, known as JAK inhibitors or JAKs, are already in development or are available, but for other conditions.

Some JAK inhibitors are already available on prescription in Australia, Europe and the USA to treat other diseases such as rheumatoid arthritis and myelofibrosis (a blood disorder). But in Australia and elsewhere they are not yet approved for use to treat alopecia areata.

Clinical trials are taking place to see whether the drugs work in alopecia areata patients, who in particular will benefit the most and to see whether the benefits of treatment outweigh the risks.

The ConversationSide effects of JAK inhibitors identified so far include stomach upset, an increase in chest and skin infections and transaminaitis (an alteration in liver function identified by blood testing). Mild skin and upper respiratory tract infections have been reported in 25% of patients. Very few patients with alopecia areata elect to stop the medication as a result of side effects. Nevertheless patients receiving these medications require close medical supervision.

Rodney Sinclair, Professor of Dermatology, University of Melbourne

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

Explainer: what is traumatic brain injury?

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People with traumatic brain injuries, say after a car accident or an assault, can have behavioural problems long after their physical injuries have healed.

Travis Wearne, UNSW and Emily Trimmer, UNSW

Adam was fortunate to survive a major car accident three years ago. He was in hospital for several months but had no ongoing physical injuries. He looked like he made a full recovery. But he was argumentative, childish, vulgar and his family said he “was not the same person”. Adam had a severe traumatic brain injury.

What is traumatic brain injury?

A traumatic brain injury is when the brain is damaged by an external mechanical force, like the type you may have in a car accident, if you fall, play sport or if you are assaulted.

These injuries are usually in the news when sports players have a concussion; or in relation to drug and alcohol fuelled assaults where a blow to the head results in a damaging, sometimes fatal, fall to the ground (the coward’s punch or king hit).

Mostly, it’s young adults, particularly men, who are affected. But many elderly people may get a traumatic brain injury when they fall.

Australia has a growing population of survivors of traumatic brain injury. This is due to the young age of most victims and decreased death rates due to better treatment. Traumatic brain injury is expected to be a major cause of disability by 2020.

How does it affect people?

Few traumatic brain injuries are the same and the outcomes of two similar injuries can be different in different people. Injuries can affect the way people think, feel, behave and relate to everyday situations.

People with moderate to severe injuries can have problems communicating, paying attention, processing thoughts quickly, learning, remembering, planning, problem-solving, meeting goals, and thinking abstractly or flexibly.

Damage to the part of the brain called the frontal lobes affects people’s ability to regulate their thoughts, emotions and behaviour. It can cause people to be impulsive, irritable, aggressive, have reduced drive, be apathetic, to have excessive emotions or a flattened mood.

Difficulties understanding the emotions and intentions of others (known as social cognition) may cause reduced empathy and socially inappropriate behaviour. Reduced self-awareness can also result in lack of insight into their abilities and the changes others perceive.

Traumatic brain injury can change an individual’s personality to the point where they “may no longer be the same person” that they were before. Given that many of these difficulties can occur without physical problems, they fall under the umbrella of an “invisible disability”.

How does traumatic brain injury affect the brain?

Injuries can be due to the immediate effect of the impact (known as primary injuries) or ones that follow these (secondary complications).

Primary injuries include: lacerations, when the brain tissue is cut or torn; contusions, when the brain is bruised; rupturing of blood vessels; and axonal injury, where neurons are stretched and torn.

These can occur where the object hits the head (a focal injury) or throughout the brain (diffuse injury). Parts of the brain known as the frontal and temporal lobes are most susceptible to both of these types of injuries. This is because of their large size and as they are close to the hard and uneven surfaces of the skull that can cause damage.

The frontal and temporal lobes of the brain, shown here, are particularly susceptible to injury.

Secondary complications include brain lesions (damaged brain tissue); brain swelling, increased intracranial pressure (pressure inside the skull), herniation (movement of brain tissue), tissue death, hypoxia (oxygen deprivation) and infection.

How long someone loses consciousness initially and how long they’re confused for (known as post-traumatic amnesia) are used to classify traumatic brain injury as mild, moderate or severe. Most (about 80%) hospitalisations are for mild injuries.

How is it managed?

People with a traumatic brain injury can be treated while staying in hospital (as an in-patient) or after they’re discharged into the community (as an out-patient).

In-patient rehabilitation focuses on immediate medical and functional issues, with a range of health professionals involved, like physiotherapists, speech pathologists, neuropsychologists (psychologists who specialise in assessing, diagnosing and treating disorders of the brain) and occupational therapists. Typically, a personalised rehabilitation plan is drawn up to help the patient to move back into the community.

Out-patient rehabilitation focuses more on the context of daily living. Here, there is a shift to helping patients establish life roles and successfully complete everyday tasks, like making meals, showering and travelling.

What are the challenges ahead?

Recovery from a traumatic brain injury varies from person to person. Some people can easily resume their lives while others can struggle adjusting to their limitations, new lifestyle and new self. Some can have trouble living independently, fulfilling life goals and finding a meaningful place in society.

Behavioural and emotional difficulties are significant barriers to long-term recovery. These challenges may not become obvious until the person is in the community, discharged from rehabilitation services and completely dependent on their carers and/or families.

Behavioural and personality issues also make traumatic brain injury difficult to manage, placing burden on carers and result in difficulties finding and keeping a job.

Family members and friends can pull away, leading to further social isolation and loneliness, making survivors more susceptible to mental health problems and institutionalisation. Sadly, these problems worsen as years pass, despite improvements made during early recovery.

The ConversationIf you or someone you know is a survivor of traumatic brain injury, contact Brain Injury Australia, Synapse or the Centre for Research Excellence in Brain Recovery for more information and support.

Travis Wearne, Postdoctoral Research Fellow, UNSW and Emily Trimmer, Postdoctoral Research Fellow, UNSW

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

Melanoma: Taming a migratory menace

Richard Neubig, Michigan State University

The deadliest cancer of the skin is cutaneous melanoma. In 2017 over 160,000 Americans are expected to be diagnosed with melanoma, and over half will have invasive disease, or one that has gone beyond the skin and which carries greater risk of recurrence. About 9,700 people are expected to die from melanoma this year.

Unlike most common cancers, such as breast and lung cancer, the incidence of melanoma continues to increase, mainly in young people below the age of 30. There has been a more than 50 percent increase in melanoma in young women since 1980.

The vast majority of melanomas are caused by exposure to UV light from sun or indoor tanning. Reducing these exposures by changing habits or using sun protection – sun screens and clothing coverage – is the best way to avoid melanoma and other skin cancers.

As a researcher who studies what makes melanoma spread, or metastasize, I’m acutely aware of how hard this deadly cancer is to tame. To be sure, advances have been made. Former President Jimmy Carter – probably the most high-profile melanoma survivor in history – benefited from new treatments resulting from immunotherapy, a technique my lab and many others are using to combat cancer.

A challenging cancer

For reasons that aren’t fully understood, even quite small melanomas can spread in the body, or metastasize. Detection very early, when the tumor is less than 1 millimeter thick, allows surgery that provides a near cure.

Survival with the earliest Stage 0 or 1A melanomas, or local disease, is greater than 95 percent at ten years after diagnosis. This fact has prompted the Melanoma Research Foundation to promote its #GETNAKED campaign for monthly skin checks to identify new moles or skin changes that might be an early indication of melanoma. Catching it early is critical because once it spreads, melanoma can become a monster.

Let’s consider the process of cancer metastasis, which involves at least four distinct steps.

First the cancer cells have to leave the vicinity of the primary tumor. They do this by invading through tissue barriers that sustain the normal tissue architecture.

Second, they need to invade through the blood vessel wall to get into the bloodstream.

These two steps are called intravasation, which means “into the blood stream.” Once there, the cancer cells need to survive.

Most cells in normal tissues require cell attachment, or contact with surfaces or other cells, to survive. When normal cells are detached from those contacts, they usually undergo a type of cell suicide called anoikis. This process of cell suicide is lost in many cancers.

The cancer cells then need to leave the bloodstream by invading through the wall of the blood vessel in a process called extravasation. This third step allows the cancer cells to spread to other parts of the body.

Finally, the cancer cells need to adapt and grow in the new environment, such as in the lung or brain.

One unique characteristic of melanoma is that it is not uncommon to have melanoma metastases show up after 10 or more years with no evidence of disease.

These late recurrences may be due to several underlying mechanisms, but one explanation is a process called cellular dormancy. While in this dormant state, cells can not be detected, and it is thought that the patient may have been cured.

Finding a way to prevent dormancy could reduce the chances of a late recurrence of metastatic disease.

Recent advances bring hope

Beyond prevention of the cancer in the first place, which is the best approach, there have been tremendous advances in the treatment of cutaneous melanoma. A critical development was the discovery in 2002 that over half of cutaneous melanomas have a mutation in the BRAF gene.

The mutation of this gene plays a key role in melanoma cell growth and proliferation. The BRAF protein is a member of the protein kinase family which has become a major target class for drug development in the pharmaceutical sector.

In 2010, remarkable results were presented on clinical benefits of a BRAF inhibitor, vemurafenib.

In the same year, a major advance in immune therapy for melanoma was reported where ipilimumab, an antibody that enhances the body’s immune responses, showed a significant survival benefit in patients with diffuse metastatic melanoma. These were the first breakthroughs in melanoma treatment in more than a decade.

In addition to these two early developments, other drugs acting like vemurafenib as well as improved immunotherapies have been developed. These have further improved therapy of cutaneous melanoma. Immune modulation has even resulted in long-term survival in a fraction (10-20 percent) of patients.

Limits to new treatments

Despite these advances, however, there are still key problems with current therapies. Many rapidly lose effectiveness; drugs like vemurafenib that were controlling the tumor stop working through the development of resistant cancer cells, often within less than one year.

Also, the immune therapies only benefit a fraction of patients. When combinations of two immune therapy drugs are used to give a better effect on the cancer, the patients’ immune systems begin attacking normal tissues, which leads to autoimmune side effects.

Consequently, we need new approaches to prevent or treat the progression of melanoma and especially the development of metastases.

Work in our lab and that of others has identified a cellular mechanism similar to the BRAF pathway that appears to play a role in the migration and metastasis of melanoma. A pathway is a series of biological steps that lead to changes in cell function, such as growth or migration.

If we could confirm this new pathway as a possible drug target, we may be able to develop a therapy to prevent metastasis.

A protein to examine

In the BRAF pathway, a small protein called Ras works upstream of BRAF to activate it. Ras is one of the most commonly mutated genes in all of cancer biology. The particular version in melanoma is called NRAS. It is mutated and activated in about 20 percent of melanomas. Combined, mutations in BRAF and NRAS are found in 80-90 percent of melanomas. This is why the BRAF pathway is a prime target for therapy.

The new pathway we have identified starts with something called the Rho protein, which is very closely related to Ras.

When this Rho mechanism is activated, cancer cells move more actively and will invade the tissue that surrounds a tumor.

Along with Rho, a second critical player is a protein called MRTF that turns on gene expression (i.e. the production of RNA and proteins) when it is activated. Rho activates MRTF by driving it into the nucleus of the cell, where it can turn on gene expression.

We found that this Rho/MRTF pathway is activated in some melanoma tumors but not others. When it is turned on, the MRTF protein is in the nucleus and the cells migrate very quickly and form large lung metastases when injected into mice.

Our lab, in collaboration with Dr. Scott Larsen at the University of Michigan, has developed some chemical inhibitors of the Rho/MRTF pathway. In our recent publication, we showed that one of these compounds was able to reduce melanoma cell migration and invasion in lab studies and to reduce metastasis of a human melanoma to the lung in a mouse model. We observed a remarkable decrease in the number and size of lung metastases in this study.

Our current studies are trying to determine whether measurements of Rho/MRTF pathway activity can be used to predict which melanoma tumors will metastasize and which early-stage melanomas are more likely to recur. If so, identification of high activity would trigger the need for very close clinical monitoring after surgery or possible drug treatment with existing drugs, or our compounds if they become available for clinical use.

We are also trying to determine whether we can prevent metastases only before the cancer cells have arrived in the lung, for example. Alternatively, if we prevent dormancy so that the cells die before setting up shop in the distant tissue or prevent the reactivation of the dormant cells in their new environment, the compounds might work even after the earliest stage of tumor spread.

The road from studies in mice to the clinic is long and full of pitfalls. We are continuing efforts to demonstrate that these compounds are safe enough for human studies in a few years. There are still many questions, but this approach could add a new arrow in the quiver of cancer treatment specialists.

The Conversation

Richard Neubig, Professor of Pharmacology and Toxicology, Michigan State University

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

The science is in: gardening is good for you

Chris Williams, University of Melbourne

As the weather warms and days lengthen, your attention may be turning to that forgotten patch of your backyard. This week we’ve asked our experts to share the science behind gardening. So grab a trowel and your green thumbs, and dig in.

“That’s all very well put,” says Candide, in the final line of Voltaire’s novel of the same name, “but we must go and work our garden.”

I studied this text at high school before I became a gardener and professional horticulturist. We were taught that Candide’s gardening imperative was metaphorical not literal; a command for finding an authentic vocation, not a call to take up trowels and secateurs.

In fact, Voltaire himself really believed that active gardening was a great way to stay sane, healthy and free from stress. That was 300 years ago.

As it turns out, the science suggests he was right.

The science of therapeutic horticulture

Gardens and landscapes have long been designed as sanctuaries and retreats from the stresses of life – from great urban green spaces such as Central Park in New York to the humblest suburban backyard. But beyond the passive enjoyment of a garden or of being in nature more generally, researchers have also studied the role of actively caring for plants as a therapeutic and educational tool.

“Therapeutic horticulture” and “horticultural therapy” have become recognised treatments for stress and depression, which have served as a healing aid in settings ranging from prisons and mental health treatment facilities to schools and hospitals.

Gardening and school

Studies of school gardening programs – which usually centre on growing food – show that students who have worked on designing, creating and maintaining gardens develop more positive attitudes about health, nutrition and the consumption of vegetables.

They also score better on science achievement, have better attitudes about school, and improve their interpersonal skills and classroom behaviour.

Research on students confirms that gardening leads to higher levels of self-esteem and responsibility. Research suggests that incorporating gardening into a school setting can boost group cohesiveness.

Gardening and mental health

Tailored gardening programs have been shown to increase quality of life for people with chronic mental illnesses, including anxiety and depression.

Another study on the use of therapeutic horticulture for patients with clinical depression sought to understand why gardening programs were effective in lessening patient experience of depression. They found that structured gardening activities gave patients existential purpose. Put simply, it gave their lives meaning.

In jails and corrective programs, horticultural therapy programs have been used to give inmates positive, purposeful activities that lessen aggression and hostility during and after incarceration.

In one detailed study from a San Francisco program, involvement in therapeutic horticulture was particularly effective in improving psychosocial functioning across prison populations (although the benefits were not necessarily sustained after release.)

Gardening has been shown to help improve the lives of military veterans and homeless people. Various therapeutic horticulture programs have been used to help people with learning difficulties, asylum seekers, refugees and victims of torture.

Gardening and older people

As populations in the West age, hands-on gardening programs have been used for older people in nursing homes and related facilities.

A systematic review of 22 studies of gardening programs for older adults found that gardening was a powerful health-promoting activity across diverse populations.

One study sought to understand if patients recovering from heart attack might benefit from a horticultural therapy program. It concluded:

[Our] findings indicate that horticultural therapy improves mood state, suggesting that it may be a useful tool in reducing stress. Therefore, to the extent that stress contributes to coronary heart disease, these findings support the role of horticultural therapy as an effective component of cardiac rehabilitation.

Horticulturist and nurse Steven Wells talks about his work at Austin Health.

While the literature on the positive effects of gardening, reflecting both qualitative and quantitative studies, is large, most of these studies are from overseas.

Investment in horticultural therapy programs in Australia is piecemeal. That said, there are some standout success stories such as the Stephanie Alexander Kitchen Garden Foundation and the work of nurse Steven Wells at the Royal Talbot Rehabilitation Centre and beyond.

Finally, without professionally trained horticulturists none of these programs – in Australia or internationally – can take place.

The Conversation

Chris Williams, Lecturer in urban horticulture, University of Melbourne

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

Explainer: what is eczema and what can you do about it?

Rodney Sinclair, University of Melbourne

Eczema is a genetic disorder with an environmental trigger, which affects one in three people at some time in their life.

Alila Medical Media/Shutterstock

People with eczema essentially have sensitive skin that is easily irritated. The irritation produces dryness by disrupting the function of the external waterproof skin barrier, allowing water to leave the skin.

The main gene associated with eczema – or atopic dermatitis, as it’s known clinically – is filaggrin. Filaggrin mutations reduce the ability of the skin to withstand environmental insults and to repair itself after injury.

Disruption to the skin barrier allows allergens to enter the deeper layers of the skin and activate the immune system.

How the immune system reacts to these allergens determines the severity of the skin inflammation and the duration of the disruption to the skin barrier function.

What can you do about it?

If you or someone in your family has suffered with severe eczema, you’ve probably tried all sorts of remedies to alleviate the itching. Here are five tips to calm your skin:

1) Avoid things that irritate the skin. No matter how wonderful a hot shower feels on itchy skin, it actually aggravates eczema. Keep showers to five minutes or less and use luke-warm water.

Wash with water alone: no soap, no soap substitute, no soap-free wash and definitely no bubble bath. Just water.

2) Avoid overheating. Heat makes the itch worse, irrespective of the cause. Turn the heating down to 18 to 20 degrees Celsius (64 to 68 degrees Farenheit) and put on an extra layer of clothing.

Take the doona off your bed and sleep under good old-fashioned cotton blankets. Overheating at night leads to scratching in your sleep. If there is blood on your sheets in the morning, that is a sure sign your bed is too hot at night.

Apply moisturiser frequently and liberally.
Kaspars Grinvalds/Shutterstock.

3) Take a bleach bath. This is a simple method to reduce the bacteria on the surface of your skin. For a full tub of water, use half a cup of bleach. Never apply bleach directly to the skin. (More safety tips and instructions are available here.)

If the eczema is weeping, oozing or has honey-coloured crusts, there is almost always golden staph on the skin surface aggravating the eczema. Bleach baths are a good alternative to antibiotics.

4) Use lots and lots of moisturiser. To fix eczema you will also need to restore the skin barrier. That requires frequent and liberal use of moisturiser, including after the eczema appears to have cleared up.

There are lots of moisturisers on the market. Trial and error is the best way to find the right moisturiser for your skin. Keep in mind that if you use a light one, you need to reapply it more often than a heavy one.

While tablets can help stop the inflammation, in general that’s not enough to stop the eczema.

5) Use your topical corticosteroid creams as directed. Additives reduce the skin thinning that can occur with prolonged use of potent topical steroids. Your dermatologist is the best person to advise you on this.

Emerging therapies

Researchers are investigating whether a new class of drugs, called biologics, could help manage severe eczema.

Biologics show promise but they’re still several years away.

Biologics try to block critical steps within certain pathways, which can terminate inflammation.

Biologics are most commonly produced from bacteria or yeast cultures. Specific genes are inserted into bacteria and yeast that have been inactivated so they are no longer dangerous to humans.

Production of biologics in this way is slow, low-volume, high-tech and expensive. Consequently, biologics can cost tens of thousands of dollars per patient per year.

A number of clinical research trials are underway to test these agents. People with severe eczema, which is not adequately controlled with current treatments, may consider enrolling to participate in a research trial.

It will still take three to five years for the results of these trials to be fully assessed and to know whether biologic agents are safe and effective in the management of eczema. If they are, they could revolutionise the management of severe eczema.

The Conversation

Rodney Sinclair, Professor of Dermatology, University of Melbourne

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

Chronic Fatigue Syndrome

So this has been the scourge of my adult life really – Chronic Fatigue Syndrome. I first fell ill with it in late 1989 – early 1990. It is a dreadful illness. The link below is to an article that takes a look at this affliction.

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