Psilocybin-assisted group therapy in patients with cancer diagnosed with a major depressive disorder.

BACKGROUND: Depression is common in patients with cancer and is associated with lower treatment adherence and reduced quality of life. Antidepressants and psychotherapy have limited success in improving depression among patients with cancer. This study explored the safety, feasibility, and efficacy of psilocybin-assisted therapy in patients with cancer and major depressive disorder. METHODS: This phase 2, open-label trial enrolled patients with curable and noncurable cancer and major depressive disorder at a single community oncology practice site. A single 25-mg dose of psilocybin was administered simultaneously to cohorts of three to four participants with individual (4.25 hours in 1:1 therapist-to-patient ratio) and group therapeutic support (3.75 hours) before, during, and after psilocybin administration. Outcomes included depression severity, anxiety, pain, demoralization, and disability. RESULTS: Thirty participants completed the study. No psilocybin-related serious adverse events occurred; treatment-related adverse events (e.g., nausea, headache) were generally mild and expected. There were no laboratory or electrocardiogram abnormalities. No suicidality was reported. Efficacy was suggested with a robust reduction in depression severity scores from baseline to posttreatment of 19.1 points (95% CI, 22.3 to -16.0; p < .0001) by week 8. Eighty percent of participants demonstrated a sustained response to psilocybin treatment; 50% showed full remission of depressive symptoms at week 1, which was sustained for 8 weeks. CONCLUSIONS: Psilocybin-assisted therapy in group cohort administration was safe and feasible in patients with cancer and depression. Efficacy was suggested based on clinically meaningful reductions in depressive symptoms. The novel, group-oriented format, compact delivery time, community cancer center setting, and one-to-one therapist-to-patient ratio could also add to therapeutic gains and efficiency of administration. TRIAL REGISTRATION: NCT04593563. PLAIN LANGUAGE SUMMARY: Depression is common in patients with cancer and associated with lower treatment adherence, reduced quality of life, and limited response to antidepressants and psychotherapy. We conducted a phase 2 trial to study a single dose of psilocybin administered in a group therapy setting with one-to-one therapist-to-participant psychological support to patients with curable and noncurable cancer and major depressive disorder. Findings of the study showed safety (no treatment-related serious adverse events or suicidality) with psilocybin and suggested efficacy, with a significant reduction in depression severity scores from baseline to posttreatment. Further investigation is warranted.

Assessment of Psilocybin Therapy for Patients With Cancer and Major Depression Disorder.

This nonrandomized controlled trial used a 1-to-1 therapist-to-patient ratio to administer psilocybin to groups of patients with cancer who were diagnosed with major depression disorder to create a scalable, rapidly effective depression treatment.

Top Ten Tips Palliative Care Clinicians Should Know About Psychedelic-Assisted Therapy in the Context of Serious Illness.

Psychedelic-assisted therapy (PAT) is a burgeoning treatment with growing interest across a variety of settings and disciplines. Empirical evidence supports PAT as a novel therapeutic approach that provides safe and effective treatment for people suffering from a variety of diagnoses, including treatment-resistant depression, substance use disorder, and post-traumatic stress disorder. Within the palliative care (PC) field, one-time PAT dosing may lead to sustained reductions in anxiety, depression, and demoralization-symptoms that diminish the quality of life in both seriously ill patients and those at end of life. Despite a well-noted psychedelic renaissance in scholarship and a renewed public interest in the utilization of these medicines, serious illness-specific content to guide PAT applications in hospice and PC clinical settings has been limited. This article offers 10 evidence-informed tips for PC clinicians synthesized through consultation with interdisciplinary and international leading experts in the field with aims to: (1) familiarize PC clinicians and teams with PAT; (2) identify the unique challenges pertaining to this intervention given the current legalities and logistical barriers; (3) discuss therapeutic competencies and considerations for current and future PAT use in PC; and (4) highlight critical approaches to optimize the safety and potential benefits of PAT among patients with serious illness and their caregivers.

Development and Evaluation of a Therapist Training Program for Psilocybin Therapy for Treatment-Resistant Depression in Clinical Research.

Introduction: Psychological support throughout psilocybin therapy is mandated by regulators as an essential part of ensuring participants' physical and psychological safety. There is an increased need for specially trained therapists who can provide high-quality care to participants in clinical studies. This paper describes the development and practical implementation of a therapist training program of psychological support within a current phase IIb international, multicenter, randomized controlled study of psilocybin therapy for people experiencing treatment-resistant depression. Description of Training Program: This new and manualized approach, based on current evidence-based psychotherapeutic approaches, was developed in partnership with different mental health researchers, practitioners, and experts; and has been approved by the FDA. Training consists of four components: an online learning platform; in-person training; applied clinical training; and ongoing individual mentoring and participation in webinars.This paper provides a brief overview of the method of support, the rationale and methodology of the training program, and describes each stage of training. The design and implementation of fidelity procedures are also outlined. Lessons Learned: As part of the phase IIb study of psilocybin therapy for treatment-resistant depression, 65 health care professionals have been fully trained as therapists and assisting therapists, across the US, Canada and Europe. Therapists provided informal feedback on the training program. Feedback indicates that the didactic and experiential interactive learning, delivered through a combination of online and in-person teaching, helped therapists build conceptual understanding and skill development in the therapeutic approach. Clinical training and engagement in participant care, under the guidance of experienced therapists, were considered the most beneficial and challenging aspects of the training. Conclusions: Clinical training for therapists is essential for ensuring consistently high-quality psilocybin therapy. Development of a rigorous, effective and scalable training methodology has been possible through a process of early, active and ongoing collaborations between mental health experts. To maximize impact and meet phase III and post-approval need, enhanced online learning and establishing pathways for clinical training are identified as critical points for quality assurance. This will require close public, academic and industry collaboration.

Detection of glyphosate residues in companion animal feeds.

The widespread adoption of genetically modified, glyphosate-tolerant corn and soybean varieties in US crop production has led to a dramatic increase in glyphosate usage. Though present at or below regulatory limits currently set for human foodstuffs, the concentration of glyphosate in companion animal feed is currently unknown. In the present study, 18 commercial companion animal feeds from eight manufacturers were analyzed for glyphosate residues using ELISA. Every product contained detectable glyphosate residues in the range of 7.83 × 101-2.14 × 103 µg kg-1 dry weight, with the average and medians being 3.57 × 102 and 1.98 × 102 µg kg-1 respectively. Three products were tested for within-bag variation and six were tested for lot to lot variation. Little within-bag variation was found, but the concentration of glyphosate varied by lot in half of the products tested. Glyphosate concentration was significantly correlated with crude fiber content, but not crude fat or crude protein. Average daily intakes by animals consuming feeds containing the median glyphosate concentration are estimated to result in exposures that are 0.68-2.5% of the Allowable Daily Intake (ADI) for humans in the US and EU, which are 1750 and 500 µg kg-1 respectively. Consumption of the most contaminated feed, however, would result in exposure to 7.3% and 25% of the above ADIs, though the relevance of such an exposure to companion animals is currently unknown. Companion animal feeds contained 7.83 × 101-2.14 × 103 µg kg-1 glyphosate which is likely to result in pet exposure that is 4-12 times higher than that of humans on a per Kg basis.

Psilocybin-occasioned mystical-type experience in combination with meditation and other spiritual practices produces enduring positive changes in psychological functioning and in trait measures of prosocial attitudes and behaviors.

Psilocybin can occasion mystical-type experiences with participant-attributed increases in well-being. However, little research has examined enduring changes in traits. This study administered psilocybin to participants who undertook a program of meditation/spiritual practices. Healthy participants were randomized to three groups (25 each): (1) very low-dose (1 mg/70 kg on sessions 1 and 2) with moderate-level ("standard") support for spiritual-practice (LD-SS); (2) high-dose (20 and 30 mg/70 kg on sessions 1 and 2, respectively) with standard support (HD-SS); and (3) high-dose (20 and 30 mg/70kg on sessions 1 and 2, respectively) with high support for spiritual practice (HD-HS). Psilocybin was administered double-blind and instructions to participants/staff minimized expectancy confounds. Psilocybin was administered 1 and 2 months after spiritual-practice initiation. Outcomes at 6 months included rates of spiritual practice and persisting effects of psilocybin. Compared with low-dose, high-dose psilocybin produced greater acute and persisting effects. At 6 months, compared with LD-SS, both high-dose groups showed large significant positive changes on longitudinal measures of interpersonal closeness, gratitude, life meaning/purpose, forgiveness, death transcendence, daily spiritual experiences, religious faith and coping, and community observer ratings. Determinants of enduring effects were psilocybin-occasioned mystical-type experience and rates of meditation/spiritual practices. Psilocybin can occasion enduring trait-level increases in prosocial attitudes/behaviors and in healthy psychological functioning. Trial Registration ClinicalTrials.gov Identifier NCT00802282.

Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial.

Cancer patients often develop chronic, clinically significant symptoms of depression and anxiety. Previous studies suggest that psilocybin may decrease depression and anxiety in cancer patients. The effects of psilocybin were studied in 51 cancer patients with life-threatening diagnoses and symptoms of depression and/or anxiety. This randomized, double-blind, cross-over trial investigated the effects of a very low (placebo-like) dose (1 or 3 mg/70 kg) vs. a high dose (22 or 30 mg/70 kg) of psilocybin administered in counterbalanced sequence with 5 weeks between sessions and a 6-month follow-up. Instructions to participants and staff minimized expectancy effects. Participants, staff, and community observers rated participant moods, attitudes, and behaviors throughout the study. High-dose psilocybin produced large decreases in clinician- and self-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism, and decreases in death anxiety. At 6-month follow-up, these changes were sustained, with about 80% of participants continuing to show clinically significant decreases in depressed mood and anxiety. Participants attributed improvements in attitudes about life/self, mood, relationships, and spirituality to the high-dose experience, with >80% endorsing moderately or greater increased well-being/life satisfaction. Community observer ratings showed corresponding changes. Mystical-type psilocybin experience on session day mediated the effect of psilocybin dose on therapeutic outcomes. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00465595.

Ablation of the locally advanced pancreatic cancer: An introduction and brief summary of techniques.

Pancreatic ductal adenocarcinoma is a lethal and late presenting malignancy with dismal survival rates. An estimated total of 330,000 people died from this malignancy in 2012. Although there have been improvements in diagnostic and treatment methods, the survival of late stage pancreatic cancer has not shown significant improvement in the past 4 decades. Multiple treatment approaches are available including chemotherapy, radiotherapy, and immunotherapy, but to this day surgical resection remains the only curative treatment option. Ablative techniques use various forms of energy to cause local tissue destruction through necrosis or apoptosis. They are relevant in pancreatic ductal adenocarcinoma as they are a treatment option in non-resectable tumors where their use ranges from symptom control to reducing tumor size for resection. In this narrative review we have grouped and outlined the various ablative methods, classifying them into thermal (Radiofrequency ablation, Microwave ablation, High Intensity Focused Ultrasound ablation, Cryoablation), and non-thermal ablative methods (Irreversible Electroporation (NanoKnife®), Photodynamic Therapy). This is followed by a description and review of the available evidence on survival and complications for each of these ablative methods. According to the literature, thermal ablative methods appear to be more accessible but are implicated with more complications than non thermal ablative methods which show the most promise.

Does load uncertainty affect adaptation to catch training?

Catching relies on anticipatory and compensatory control processes. Load uncertainty increases anticipatory and compensatory neuromotor effort in catching. This experiment tested the effect of load uncertainty in plyometric catch/throw training on elbow flexion reaction time (RT), movement time (MT) and peak torque, as well as the distribution of anticipatory and compensatory neuromotor effort in catching. We expected load uncertainty training to be superior to traditional training for improving elbow flexion MT and peak torque, as well as for reallocating neuromotor effort from compensatory to anticipatory control in catching. Three groups of men (mean age = 21), load knowledge training (K) (n = 14), load uncertainty training (U) (n = 13) and control (C) (n = 14), participated. Groups K and U trained three times/week for 6 weeks using single-arm catch/throw exercises with 0.45-4.08 kg balls. Sets involved 16 repetitions of four different ball masses presented randomly. Group K had knowledge of ball mass on every repetition, whereas group U never did. Change scores were analyzed using Kruskal-Wallis tests and follow-up Wilcoxon rank-sum tests. Group K improved both RT and MT (by 6.2 and 12 %, respectively), whereas group U did not. Both groups K and U improved peak eccentric elbow flexion torque. Group K reallocated neuromotor effort from compensatory to anticipatory processes in the biceps, triceps and the all muscle average, whereas group U did so in the triceps only. In sum, plyometric catch/throw training caused a reallocation of neuromotor effort from compensatory to anticipatory control in catching. However, load uncertainty training did not amplify this effect and in fact appeared to inhibit the reallocation of neuromotor effort from compensatory to anticipatory control.

Opioid substitution therapy: Lowering the treatment thresholds.

BACKGROUND: Opioid substitution therapy (OST) has been established as the gold standard in treating opioid use disorders. Nevertheless, there is still a debate regarding the qualitative characteristics that define the optimal OST intervention, namely the treatment threshold. The aim of this review is twofold: first, to provide a summary and definition of "treatment thresholds", and second, to outline these thresholds and describe how they related to low and high threshold treatment characteristics and outcomes. METHOD: We searched the main databases of Medline, PubMed, PsycInfo, EMBASE, CINAHL and the Cochrane Library. Original published research papers, reviews, and meta-analyses, containing the eligible keywords: "opioid substitution", "OST", "low threshold", "high threshold" were searched alone and in combination, up to June, 2015. RESULTS: Treatment thresholds were defined as barriers a patient may face prior to and during treatment. The variables of these barriers were classified into treatment accessibility barriers and treatment design barriers. There are increasing numbers of studies implementing low threshold designs with an increasing body of evidence suggesting better treatment outcomes compared to high threshold designs. CONCLUSION: Clinical characteristics of low threshold treatments that were identified to increase the effectiveness of OST intervention include increasing accessibility so as to avoid waiting lists, using personalized treatment options regarding medication choice and dose titration, flexible treatment duration, a treatment design that focuses on maintenance and harm reduction with emphasis on the retention of low adherence patients.

A Case of Pneumococcal Peritonitis after Caesarean Section in a Healthy Woman.

Pneumococcal peritonitis is prevalent in children and adults with comorbidities but extremely rare in healthy adults. Here we describe a case of pneumococcal peritonitis in a previously healthy woman with no known risk factors who presented with constipation, abdominal pain, and distention. Her only past medical history was an uncomplicated C-section two months prior to presentation. A laparotomy revealed a pneumococcal peritonitis without visible source of infection. The patient remained hospitalized until completion of antibiotic regimen with Ceftriaxone and resolution of symptoms. This report adds to the small body of evidence showing possible pneumococcal peritonitis in healthy young adults.

Long-Term Recency in Anterograde Amnesia.

Amnesia is usually described as an impairment of a long-term memory (LTM) despite an intact short-term memory (STM). The intact recency effect in amnesia had supported this view. Although dual-store models of memory have been challenged by single-store models based on interference theory, this had relatively little influence on our understanding and treatment of amnesia, perhaps because the debate has centred on experiments in the neurologically intact population. Here we tested a key prediction of single-store models for free recall in amnesia: that people with amnesia will exhibit a memory advantage for the most recent items even when all items are stored in and retrieved from LTM, an effect called long-term recency. People with amnesia and matched controls studied, and then free-recalled, word lists with a distractor task following each word, including the last (continual distractor task, CDFR). This condition was compared to an Immediate Free Recall (IFR, no distractors) and a Delayed Free Recall (DFR, end-of-list distractor only) condition. People with amnesia demonstrated the full long-term recency pattern: the recency effect was attenuated in DFR and returned in CDFR. The advantage of recency over midlist items in CDFR was comparable to that of controls, confirming a key prediction of single-store models. Memory deficits appeared only after the first word recalled in each list, suggesting the impairment in amnesia may emerge only as the participant's recall sequence develops, perhaps due to increased susceptibility to output interference. Our findings suggest that interference mechanisms are preserved in amnesia despite the overall impairment to LTM, and challenge strict dual-store models of memory and their dominance in explaining amnesia. We discuss the implication of our findings for rehabilitation.

Long-term maintenance of smartphone and PDA use in individuals with moderate to severe memory impairment.

In an earlier paper we described a structured, theory-driven training programme which was administered to 10 individuals with moderate-to-severe memory impairment. All individuals received an errorless-fading-of-cues protocol in the use of personal digital assistants (PDAs) or smartphones (Svoboda, Richards, Leach, & Mertens, 2012) and demonstrated generalisation of acquired skills to day-to-day memory challenges. Maintenance of intervention gains over the long-term is another indicator of successful generalisation. Here we present the maintenance of device use in the same group of individuals 12 to 19 months after programme completion. A within-subject, ABABB multi-case experimental design was used to evaluate the impact of PDA or smartphone use on day-to-day memory functioning at baseline, immediately post-intervention, at return to baseline, and at short-term and long-term follow-up. Results presented here focus predominantly on long-term follow-up. All 10 individuals showed maintenance of gains in day-to-day functioning as quantified across several ecologically valid questionnaire and task-based measures. This was corroborated by family members with whom six of the participants resided. This study further demonstrates the programme's clinical effectiveness in enabling individuals with moderate-to-severe memory impairment to function more independently and with greater confidence up to 19 months following programme completion.

Functional models for colloid retention in porous media at the triple line.

Spectral confocal microscope visualizations of microsphere movement in unsaturated porous media showed that attachment at the Air Water Solid (AWS) interface was an important retention mechanism. These visualizations can aid in resolving the functional form of retention rates of colloids at the AWS interface. In this study, soil adsorption isotherm equations were adapted by replacing the chemical concentration in the water as independent variable by the cumulative colloids passing by. In order of increasing number of fitted parameters, the functions tested were the Langmuir adsorption isotherm, the Logistic distribution, and the Weibull distribution. The functions were fitted against colloid concentrations obtained from time series of images acquired with a spectral confocal microscope for three experiments performed where either plain or carboxylated polystyrene latex microspheres were pulsed in a small flow chamber filled with cleaned quartz sand. Both moving and retained colloids were quantified over time. In fitting the models to the data, the agreement improved with increasing number of model parameters. The Weibull distribution gave overall the best fit. The logistic distribution did not fit the initial retention of microspheres well but otherwise the fit was good. The Langmuir isotherm only fitted the longest time series well. The results can be explained that initially when colloids are first introduced the rate of retention is low. Once colloids are at the AWS interface they act as anchor point for other colloids to attach and thereby increasing the retention rate as clusters form. Once the available attachment sites diminish, the retention rate decreases.

Biofilm eradication with biodegradable modified-release antibiotic pellets: a potential treatment for glue ear.

OBJECTIVE: To develop a biodegradable, modified-release antibiotic pellet capable of eradicating biofilms as a potential novel treatment for biofilm infections. DESIGN: Pellets containing poly(DL-lactic-co-glycolic acid) microparticles, rifampin and clindamycin hydrochloride (3.5%, 7%, or 28% antibiotic by weight), and carrier gel (carboxymethylcellulose or poloxamer 407) were tested in vitro. Drug release was assessed using serial plate transfer testing and high-performance liquid chromatography, and pellets were tested against biofilms in an in vitro model of Staphylococcus aureus biofilm grown on silicone. RESULTS: Serial plate transfer testing demonstrated continuing bacterial inhibition for up to 21 days for all pellets studied. High-performance liquid chromatography showed high levels of drug release for 2 to 4 days, with greatly reduced levels subsequently; continued measurable clindamycin (but not rifampin) release for up to 21 days was achieved. Pellets made with poloxamer released higher drug levels for a longer period. Irrespective of the carrier gel used, pellets containing 7% and 28% (but not 3.5%) antibiotic eradicated biofilms successfully. CONCLUSIONS: Antibiotic pellets can release antibiotics for up to 21 days and are able to eradicate biofilms in an in vitro model. Use of modified-release antibiotic formulations in the middle ear as a treatment for biofilms appears to be a potentially promising new therapy for otitis media with effusion.

Characterization of individuals seeking treatment for caffeine dependence.

Previous investigations have identified individuals who meet criteria for Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) substance dependence as applied to caffeine, but there is little research on treatments for caffeine dependence. This study aimed to thoroughly characterize individuals who are seeking treatment for problematic caffeine use. Ninety-four individuals who identified as being psychologically or physically dependent on caffeine, or who had tried unsuccessfully to modify caffeine consumption participated in a face-to-face diagnostic clinical interview. They also completed measures concerning caffeine use and quitting history, reasons for seeking treatment, and standardized self-report measures of psychological functioning. Caffeine treatment seekers (mean age 41 years, 55% women) consumed an average of 548 mg caffeine per day. The primary source of caffeine was coffee for 50% of the sample and soft drinks for 37%. Eighty-eight percent reported prior serious attempts to modify caffeine use (mean 2.7 prior attempts), and 43% reported being advised by a medical professional to reduce or eliminate caffeine. Ninety-three percent met criteria for caffeine dependence when generic DSM-IV-TR substance dependence criteria were applied to caffeine use. The most commonly endorsed criteria were withdrawal (96%), persistent desire or unsuccessful efforts to control use (89%), and use despite knowledge of physical or psychological problems caused by caffeine (87%). The most common reasons for wanting to modify caffeine use were health-related (59%) and not wanting to be dependent on caffeine (35%). This investigation reveals that there are individuals with problematic caffeine use who are seeking treatment and suggests that there is a need for effective caffeine dependence treatments.

PDA and smartphone use by individuals with moderate-to-severe memory impairment: application of a theory-driven training programme.

We describe a structured, theory-driven training programme for individuals with moderate-to-severe memory impairment in the use of emerging commercial technology. We demonstrate its application to 10 individuals with memory impairment from a variety of aetiologies. A within-subject, ABAB multi-case experimental design was used to evaluate the impact of personal digital assistant or smartphone use on day-to-day memory functioning at baseline, immediately post-intervention, at return to baseline, and at short-term follow-up (range = 3-8 months). An errorless fading-of-cues protocol enabled all participants to acquire the skill set necessary to operate their PDA or smartphone independently. All 10 individuals showed robust improvement in day-to-day functioning post-intervention as quantified across a number of ecologically valid questionnaire and task-based measures. This was further corroborated by family members with whom six of the participants resided. These findings demonstrate that individuals with moderate-to-severe memory impairment can acquire the skills necessary to independently, flexibly and broadly apply commercial technology to support their everyday memory functioning. Moreover the findings confirm that the gap between individuals with memory impairment and potent emerging technology can be closed by the application of a systematic theory-driven training programme.

Psilocybin occasioned mystical-type experiences: immediate and persisting dose-related effects.

RATIONALE: This dose-effect study extends previous observations showing that psilocybin can occasion mystical-type experiences having persisting positive effects on attitudes, mood, and behavior. OBJECTIVES: This double-blind study evaluated psilocybin (0, 5, 10, 20, 30 mg/70 kg, p.o.) administered under supportive conditions. METHODS: Participants were 18 adults (17 hallucinogen-naïve). Five 8-h sessions were conducted individually for each participant at 1-month intervals. Participants were randomized to receive the four active doses in either ascending or descending order (nine participants each). Placebo was scheduled quasi-randomly. During sessions, volunteers used eyeshades and were instructed to direct their attention inward. Volunteers completed questionnaires assessing effects immediately after and 1 month after each session, and at 14 months follow-up. RESULTS: Psilocybin produced acute perceptual and subjective effects including, at 20 and/or 30 mg/70 kg, extreme anxiety/fear (39% of volunteers) and/or mystical-type experience (72% of volunteers). One month after sessions at the two highest doses, volunteers rated the psilocybin experience as having substantial personal and spiritual significance, and attributed to the experience sustained positive changes in attitudes, mood, and behavior, with the ascending dose sequence showing greater positive effects. At 14 months, ratings were undiminished and were consistent with changes rated by community observers. Both the acute and persisting effects of psilocybin were generally a monotonically increasing function of dose, with the lowest dose showing significant effects. CONCLUSIONS: Under supportive conditions, 20 and 30 mg/70 kg psilocybin occasioned mystical-type experiences having persisting positive effects on attitudes, mood, and behavior. Implications for therapeutic trials are discussed.

A theory-driven training programme in the use of emerging commercial technology: Application to an adolescent with severe memory impairment.

We describe a theory-driven memory intervention programme for training individuals with moderate to severe memory impairment in the use of emerging commercial technology. Here we demonstrate the application of the programme to training MK, an 18-year-old woman with severe memory impairment following treatment for a suprasellar germinoma, to autonomously use a smartphone to support her day-to-day memory. A within-subject A(1)B(1)A(2)B(2) single-case experimental design was used to evaluate the impact of smartphone use on MK's real-life functioning. Following intervention MK showed increased confidence in dealing with memory-demanding situations and generalised smartphone use across all aspects of her life as quantified by several and varied ecologically valid measures including a phone call schedule, behaviour memory observations and questionnaires. Moreover the intervention also benefited her family as indicated by a sustained reduction in caregiver strain and an increase in reported quality of life. These findings suggest that individuals with severe memory impairment, particularly young adults with potentially life-long dependence on their families, are able to capitalise on emerging commercial technology to function more autonomously. The findings also suggest that the gap between individuals with severe memory impairment and potent emerging technology can be closed by provision of a theory-driven structured training programme.

Recollection and familiarity for public events in neurologically intact older adults and two brain-damaged patients.

Despite extensive investigations of the role of recollection and familiarity on laboratory-acquired memories, there is a dearth of such research on memories formed in real life settings. We used the Remember/Know paradigm to investigate the relative contribution of recollection and familiarity processes to memory of public historical events reported in the media across the life span of two groups of neurologically intact older adults (old-old: 74-85, young-old: 58-69) and on two patients with brain damage. First, in neurologically intact participants, recollection rates decreased as a function of time elapsed since the event occurred, at a significantly higher rate than the corresponding decrease in familiarity or global memory. Second, consistent with the hypothesis that memories become increasingly semantic as they age, and that recollection is selectively impaired in older adults, across decades, old-old participants exhibited lower recollection, but not familiarity, relative to young-old participants. Finally, as a demonstration of how this procedure may be applied to studies of clinical populations, we tested two patients, one with medial temporal lesions and another with relative sparing of the medial temporal lobes, but with anterior temporal damage. We found that recollection was disproportionately impaired relative to familiarity across most of the life span in the patient with medial temporal lesions severely while recollection was relatively intact in the patient with anterior lateral temporal damage. We discuss the present results in the context of neuroanatomical and process-oriented theories of how memories age.