Amplified cortical neural responses as animals learn to use novel activity patterns.

Cerebral cortex supports representations of the world in patterns of neural activity, used by the brain to make decisions and guide behavior. Past work has found diverse, or limited, changes in the primary sensory cortex in response to learning, suggesting that the key computations might occur in downstream regions. Alternatively, sensory cortical changes may be central to learning. We studied cortical learning by using controlled inputs we insert: we trained mice to recognize entirely novel, non-sensory patterns of cortical activity in the primary visual cortex (V1) created by optogenetic stimulation. As animals learned to use these novel patterns, we found that their detection abilities improved by an order of magnitude or more. The behavioral change was accompanied by large increases in V1 neural responses to fixed optogenetic input. Neural response amplification to novel optogenetic inputs had little effect on existing visual sensory responses. A recurrent cortical model shows that this amplification can be achieved by a small mean shift in recurrent network synaptic strength. Amplification would seem to be desirable to improve decision-making in a detection task; therefore, these results suggest that adult recurrent cortical plasticity plays a significant role in improving behavioral performance during learning.

We Orient Residents to Surgical Life: Why Not Their Families Too?

Surgical education requires more than time and commitment; it is a period of a professional development that relies on one's resilience and fortitude. While training programs makes substantial efforts to onboard learners and prepare them for the experiences to come, most are likely underutilizing one of the greatest resources available to learners: their personal communities. Every intern who enters residency brings with them the emotional bonds and benefits of family, friends, and/or other community members who may or may not understand the nature of surgical training and the professional journey ahead. In an effort to support our own learners and increase the awareness of resources available to them, we hosted an orientation for interns' friends and families. The programming allowed for residents and their personal supports to better understand residency culture, meet educational leadership, and discuss the experiences of more senior residents, faculty and their families over time. Additionally, some education was provided regarding the signs and symptoms of burnout and depression; our aim was to help residents' communities feel better able to recognize and respond to such symptoms. The preliminary feedback regarding the program is strong, encouraging its continued implementation.

Reducing hospital readmission through team-based primary care: A 7-week pilot study integrating behavioral health and pharmacy.

INTRODUCTION: A team-based service delivery model was applied to provide patients with biopsychosocial care following hospital discharge to reduce hospital readmission. Most previous interventions focused on transitions of care occurred in the inpatient setting with attention to predischarge strategies. These interventions have not considered psychosocial stressors, and few have explored management in primary care settings. METHOD: A 7-week team-based service delivery model was implemented in a family medicine practice emphasizing a biopsychosocial approach. A physician, psychologist, pharmacist, care managers, and interdisciplinary trainees worked with 17 patients following hospital discharge. This comprehensive evaluation assessed patients' mood, cognitive abilities, and self-management of health behaviors. Modifications were made to improve ease of access to outpatient care and to improve patient understanding of the therapeutic plan. This pilot study was conducted to determine the utility of the model. RESULTS: Of 17 patients, 15 individuals avoided readmission at 30- and 90-day intervals. Other substantial benefits were noted, including reduced polypharmacy, engagement in specialty care, and reduction of environmental stressors to improve access to care. The clinic in which this was implemented is currently making efforts to maintain this model of care based on observed success. DISCUSSION: Although this work only represents a small sample, results are encouraging. This model can be replicated in other primary care settings with specialty clinicians on site. Specifically, approaches that promote a team-based delivery in a primary care setting may support improved patient outcomes and reduced overall systems' costs. Recommendations for research in a clinical setting are also offered. (PsycINFO Database Record

Extracellular Mitochondria and Mitochondrial Components Act as Damage-Associated Molecular Pattern Molecules in the Mouse Brain.

Mitochondria and mitochondrial debris are found in the brain's extracellular space, and extracellular mitochondrial components can act as damage associated molecular pattern (DAMP) molecules. To characterize the effects of potential mitochondrial DAMP molecules on neuroinflammation, we injected either isolated mitochondria or mitochondrial DNA (mtDNA) into hippocampi of C57BL/6 mice and seven days later measured markers of inflammation. Brains injected with whole mitochondria showed increased Tnfα and decreased Trem2 mRNA, increased GFAP protein, and increased NFκB phosphorylation. Some of these effects were also observed in brains injected with mtDNA (decreased Trem2 mRNA, increased GFAP protein, and increased NFκB phosphorylation), and mtDNA injection also caused several unique changes including increased CSF1R protein and AKT phosphorylation. To further establish the potential relevance of this response to Alzheimer's disease (AD), a brain disorder characterized by neurodegeneration, mitochondrial dysfunction, and neuroinflammation we also measured App mRNA, APP protein, and Aß1-42 levels. We found mitochondria (but not mtDNA) injections increased these parameters. Our data show that in the mouse brain extracellular mitochondria and its components can induce neuroinflammation, extracellular mtDNA or mtDNA-associated proteins can contribute to this effect, and mitochondria derived-DAMP molecules can influence AD-associated biomarkers.

Dementia spousal caregivers and past transgressions: Measuring and understanding forgiveness experiences.

The transition from "wife" to "caregiver" for a cognitively impaired husband can be an overwhelming experience. Communication patterns change and small conflicts can grow, at times bringing angry feelings and new burdens. Engagement with forgiveness processes may benefit wives by lowering resentment over past tensions, restoring trust, and enhancing the overall caregiving experience. This study examined the utility of the Enright Forgiveness Inventory (EFI) within a sample of caregiving wives. Our intent was to better understand this population's experience with forgiveness when other contextual factors were likely to influence this process. Forgiveness scores on the EFI were positively related to the cognitive status of the care recipient, a particularly important finding for clinical intervention, and inversely related to marital distress and state anxiety.

Simulation-based learning: From theory to practice.

Comments on the article, ""Stimulating Reflective Practice Using Collaborative Reflective Training in Breaking Bad News Simulations," by Kim, Hernandez, Lavery, and Denmark (see record 2016-18380-001). Kim et al. are applauded for engaging and supporting the development of simulation-based education, and for their efforts to create an interprofessional learning environment. However, we hope further work on alternate methods of debriefing leverage the already inherent activation of learners that builds on previous experience, fosters reflection and builds skills. What is needed is the transference of learning theories into our educational research efforts that measure the effectiveness, validation, and reliability of behavior based performance change. The majority of breaking bad news (BBN) curricula limit program evaluations to reports of learner satisfaction, confidence and self-efficacy, rather than determining the successful translation of effective and humanistic interpersonal skills into long-term clinical practice (Rosenbaum et al., 2004). Research is needed to investigate how educational programs affect provider-patient-family interaction, and ultimately patient and family understanding, to better inform our teaching BBN skills. (PsycINFO Database Record

Hospital to home: a geriatric educational program on effective discharge planning.

There has been increased attention on the needs of the burgeoning older adult population, with focus on the limited education and training experiences available in geriatric care. Older adults transitioning between levels of care often require increased attention, and the American Geriatrics Society (AGS) Task Force on the Future of Geriatric Medicine has encouraged greater training opportunities be provided to better understand the needs of this population. The Hospital to Home Program is one model of geriatric training emphasizing many of the AGS recommendations. Through qualitative analyses of 51 internal medicine residents' reflections, the authors report how this educational program is meeting the above need and share how Hospital to Home is enhancing residents' skills in creating a safe discharge for geriatric patients and their families.