Nerve stimulation for severe depression changes brain function

May 7, 2013 ? For nearly a decade, doctors have used an implanted electronic stimulator to treat severe depression in people who don't respond to standard antidepressant therapy.

Now, preliminary brain scan studies conducted by researchers at Washington University School of Medicine in St. Louis are beginning to reveal the processes occurring in the brain during stimulation and may provide some clues about how the device improves depression. They found that vagus nerve stimulation brings about changes in brain metabolism weeks or even months before patients begin to feel better.

The findings will appear in an upcoming issue of the journal Brain Stimulation and are now available online.

"Previous studies involving large numbers of people have demonstrated that many with treatment-resistant depression improve with vagus nerve stimulation," says first author Charles R. Conway, MD, associate professor of psychiatry. "But little is known about how this stimulation works to relieve depression. We focused on specific brain regions known to be connected to depression."

Conway's team followed 13 people with treatment-resistant depression. Their symptoms had not improved after many months of treatment with as many as five different antidepressant medications. Most had been depressed for at least two years, but some patients had been clinically depressed for more than 20 years.

All of the participants had surgery to insert a device to electronically stimulate the left vagus nerve, which runs down the side of the body from the brainstem to the abdomen. Once activated, the device delivers a 30-second electronic stimulus to the vagus nerve every five minutes.

To establish the nature of the treatment's effects on brain activity, the researchers performed positron emission tomography (PET) brain imaging prior to the initiation of stimulation, and again three and 12 months after stimulation had begun.

Eventually, nine of the 13 subjects experienced improvements in depression with the treatment. However, in most cases it took several months for improvement to occur.

Remarkably, in those who responded, the scans showed significant changes in brain metabolism following three months of stimulation, which typically preceded improvements in symptoms of depression by several months.

"We saw very large changes in brain metabolism occurring far in advance of any improvement in mood," Conway says. "It's almost as if there's an adaptive process that occurs. First, the brain begins to function differently. Then, the patient's mood begins to improve."

Although the patients remained on antidepressants for several months after their stimulators were implanted, Conway says many of those who responded to the device eventually were able to stop taking medication.

"Sometimes the antidepressant drugs work in concert with the stimulator, but it appears to us that when people get better, it is the vagus nerve stimulator that is doing the heavy lifting," Conway explains. "Stimulation seems to be responsible for most of the improvement we see."

Additionally, the PET scans demonstrated that structures deeper in the brain also begin to change several months after nerve stimulation begins. Many of those structures have high concentrations of brain cells that release dopamine, a neurotransmitter that helps control the brain's reward and pleasure centers and also helps regulate emotional responses.

There is a consensus forming among depression researchers that problems in dopamine pathways may be particularly important in treatment-resistant depression, according to Conway. And he says the finding that vagus nerve stimulators influence those pathways may explain why the therapy can help and why, when it does work, its effects are not transient. Patients who respond to vagus nerve stimulation tend to get better and to stay better.

"We hypothesized that something significant had to be occurring in the brain, and our research seems to back that up," he says.

Funding for this research comes from the National Institute of Mental Health (NIMH) and the National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH). Other funding was provided by a Young Investigator Award to Charles Conway from the National Alliance for Research in Schizophrenia and Affective Disorders (NARSAD) and the Sidney R. Baer Jr. Foundation. Cyberonics, the maker of the vagus nerve stimulation device, donated three cost-free devices to subjects in this trial. NIH grant numbers are 1K08MH078156-01A1, 9K24MH07951006 and P30NS048056.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/mind_brain/mental_health/~3/JkQHh2rceIk/130507134412.htm

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Mario Machado Dies; Scarface Actor Was 78

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Louisiana House votes to phase out solar energy tax credits by 2020 ...

Louisiana is on the path to phase out the state's solar energy tax credit: The state House on Tuesday easily approved a bill to end the incentives by 2020.

"As the production cost of solar is going down, then (solar energy systems are) becoming more affordable and therefore the credits aren't as needed as they once were," bill sponsor Erich Ponti, R-Baton Rouge, told the House on Tuesday.House Bill 705 would reduce income tax credits for the purchase and installation costs of solar electric and thermal systems and would eliminate the tax credit for wind generators, which have not gained much traction in the state because of its relatively flat terrain. Louisianians currently can claim up to 50 percent of the first $25,000 in costs for the purchase and installation of solar energy systems. The bill would split this category in two: solar thermal, which provides heating, and solar electric, which provides power. Solar thermal tax credits would be immediately phased down from the current level to 50 percent of the first $10,000 in costs; after 2017, the level would be lowered to 35 percent. Solar electric credits would be kept at current levels until 2017 and then would be phased down to 35 percent of $25,000 in costs. On Dec. 31, 2020, the credits would be eliminated.The bill, if passed, also would tweak the current law to allow only one solar system per home. Ponti, responding to lawmakers' questions about abuse of the credits, said, "Multi-system installation is very prevalent."October figures released by the state showed the solar energy tax incentives have far exceeded original cost projections. When first approved by lawmakers five years ago, the incentives were not expected to cost state taxpayers more than $500,000 a year in lost tax revenue.

The real price tag amounted to nearly $39?million through 2011. Ponti said Tuesday the state paid $24 million for the credits in 2012.

The bill passed 95-1, with Larose Democrat Jerry "Truck" Gisclair voting against it. It was approved without opposition in committee. It now heads to the Senate for further debate.

To?receive updates?on all Louisiana legislative session news from the Capitol in Baton Rouge,?follow @brnola on Twitter?or?"Like" the NOLA.com | Baton Rouge Facebook page.

Source: http://www.nola.com/politics/index.ssf/2013/05/solar_clean_energy_tax_la.html

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Watch Anthony Pettis show off capoeira skills

Anthony Pettis has shown off his acrobatic ability in fights. The former WEC lightweight champion is still remembered for his kick off the cage that clinched his win over Benson Henderson. Now, imagine what he can do with capoeira training? Pettis has been training in Brazil, and as shown in the video above, has picked up some skills from the Brazilian martial art that mixes acrobatics, dancing and fighting.

He'll fight Jose Aldo in August for the UFC featherweight belt. Do you think we'll see him pull out any of these tricks at UFC 163? Speak up on Facebook or on Twitter.

Thanks, MMA Fighting.

Source: http://sports.yahoo.com/blogs/mma-cagewriter/watch-anthony-pettis-show-off-capoeira-skills-131520511.html

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How Automated License Plate Readers Threaten Our Privacy

Law enforcement agencies are increasingly using sophisticated cameras, called ?automated license plate readers? or ALPR, to scan and record the license plates of millions of cars across the country. These cameras, mounted on top of patrol cars and on city streets, can scan up to 1,800 license plate per minute, day or night, allowing one squad car to record more than 14,000 plates during the course of a single shift.

Read more...

Source: http://feeds.gawker.com/~r/gizmodo/full/~3/4DaM_inPIXA/how-automated-license-plate-readers-threaten-our-privac-493400783

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Bangladesh police, Islamic activists clash; 20 die

DHAKA, Bangladesh (AP) ? Police banned all rallies in Bangladesh's capital for the rest of the day Monday after at least 20 people died in clashes between police and large numbers of Islamic hardliners demanding that the government enact an anti-blasphemy law, officials said.

A police official, speaking on customary condition of anonymity, said 13 people, including two police and a paramilitary soldier, were killed in clashes in Kanchpur just outside Dhaka. He said seven others died in Motijheel, a commercial area of the capital.

The protesters blocked roads with burning tires and logs during more than five hours of clashes. They also attacked a police station and set fire to at least 30 vehicles, including police trucks, private Ekattar TV reported.

The private United News of Bangladesh reported that the violence erupted after security forces fired tear gas and rubber bullets at protesters in the central commercial district.

Dhaka Metropolitan Police said in a statement that all rallies and protests had been banned in the city until midnight Monday for fear of more clashes.

The Islamic activists have been holding protests to demand that the government implement an anti-blasphemy law. The government of the Muslim-majority nation has rejected the demand, insisting that Bangladesh is governed by secular law.

On Sunday, police fired rubber bullets to disperse stone-throwing activists who were among thousands who rallied around Dhaka. Officials said at least one person died and 45 others were injured.

The ruling Awami League and an opposition alliance had both planned rallies later Monday in response to Sunday's violence but postponed their plans.

Bangladesh, an impoverished nation of 160 million people, has a history of political violence.

The opposition has sponsored a series of recent general strikes demanding that the next general election due in early 2014 be supervised by a neutral caretaker administration.

Source: http://news.yahoo.com/bangladesh-police-islamic-activists-clash-20-die-131753725.html

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Millions pass up free health subsidy

May 6, 2013 ? Millions of seniors are turning down free money.

The Low Income Subsidy for Medicare Part D is a rare beast in economics research. The subsidy provides prescription drug coverage essentially free for low-income adults. That means it is what economists call a dominant option. For those who are eligible, there is no rational reason not to choose it. And yet, a new study shows that many eligible seniors do not take advantage of the program, despite outreach efforts by the Social Security Administration.

"We examined the role of seniors' cognitive abilities in explaining this puzzle," said J. Michael McWilliams assistant professor of health care policy and medicine at Harvard Medical School and Brigham and Women's Hospital and senior author of the paper. "If impaired abilities to access and process information are a root cause, simply providing seniors with more information is unlikely to help them make better choices."

McWilliams and his team analyzed data from the nationally representative Health and Retirement Study on seniors who were likely eligible for the Low Income Subsidy and found that seniors with lower cognition and lower basic math abilities were less likely to enroll in Medicare Part D, and less likely to apply for the subsidy if they did enroll in Part D. The study results will be published in JAMA Internal Medicine on May 6.

Can competition drive value?

In addition to raising important questions about how to best extend important benefits to a vulnerable population, the study raises questions about the extent to which consumer choices can be relied upon to reward value and drive competition in Medicare in general, the researchers said.

Medicare Part D provides seniors with a variety of plans to choose from for prescription drug benefits. The low-income subsidy reduces the cost of premiums and co-pays, and for the lowest income group the cost of benefits is entirely covered.

Those who qualify for Medicaid and are also in Medicare are automatically enrolled and get the subsidy without needing to take any action on their own. Other low-income adults must apply for the benefit, and estimates suggest that more than 2 million people who would qualify for a benefit fail to apply, according to a report from the Kaiser Family Foundation. The Harvard researchers focused on those who qualify but must apply for the subsidy.

"For those who are already enrolled in Medicare Part D plans and eligible for fully covered prescription drugs, this is not 'Here's thirty plans, pick the best one.' This is, 'Here's free money, do you want it?'" said lead author Ifedayo Kuye, a student at Harvard Medical School and Harvard Business School.

Even such a simple decision requires a high level of cognition, the researchers said. In order to meet the needs of this population, which includes many people with high medical needs, including chronic conditions, the design of the program probably needs to be changed, they said. One possible remedy the researchers suggest would be to make the subsidy an opt-out program for those who are eligible, so they would not need to take any extra steps to benefit from the program.

These findings have broader implications about how much reformers should rely on choice and competition in Medicare to drive down costs, the researchers said, because competition only works if consumers are choosing wisely and rewarding value in the marketplace.

The power of competition to drive value is an important component in many health care reform initiatives, including the proposal to transfer Medicare to a voucher system, and the health insurance exchanges that are being set up as part of the Affordable Care Act.

Seniors may need more help

"We may need the government or other agencies to do more on behalf of seniors and other health care consumers, both for their own well-being and if we want competition to be a force for driving up value in health care," Kuye said.

"Choice is generally a good thing, but options in health care can be very complex and consumers can have great difficulty identifying the best one," McWilliams said. "To improve decisions and enhance competition, the government and exchanges may need to play more active roles. Expecting the availability of choices and information for consumers alone to cure our health care system is unrealistic."

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/top_news/top_health/~3/IQlTykwunX4/130506181715.htm

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