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COVID-19: Life in the fast lane

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A few months ago, my brother excitedly told us he was planning a trip to Holland with his friends because he thought a few days away would be a welcome break from the stresses of work.

However, my sister did not share his excitement and her immediate response was to tell him not to go.

When she failed to dissuade him, she told him to at least pack a face mask. This kind of response is not surprising at a time when the world has been brought to the edge of mania.  There is a name for this phenomenon- ‘moral panic’.

Moral panic is a concept in sociology that refers to the phenomenon of a mass of people becoming distressed about a perceived threat or social issue.

This threat, however, is often catastrophised, or over-exaggerated, in the media, leading to a collective stray from the reality of the problem.

The current turmoil around Covid-19 is nothing new; we saw similar reactions during the swine flu pandemic, the SARS outbreak and Ebola.

Yet the global response to the new coronavirus signals a new and unfamiliar level of threat that is unprecedented, and far surpasses that of previous pandemics.

The world has seen a host of negative repercussions from the spread of Covid-19.

FTSE stocks falling dramatically, schools closing down and sporting events and festivals being cancelled to name a few.

However, there have also been equally negative consequences from the spread of moral panic, including Chinese students being victims of hate crimes and supermarkets being emptied in record time.

While the former are sanctions placed by governments based on scientific advice, the latter are unwarranted and harmful.

So how do emotions like panic and anxiety influence us? What effect does fear have on our ability to make rational decisions?

When it comes to emotion in the brain, research suggests that there are two ‘paths’ emotion can take: the slow route or the fast route.

This illustration shows the slow route on the left, with the relevant frontal areas highlighted. In contrast, the diagram on the right shows the fast route which bypasses the frontal brain areas.

The slow route involves information from our senses travelling through the frontal lobes and hippocampus, areas of the brain which are involved in reasoning, memory and learning.

The information then travels to the amygdala, a brain area well-known for its role in processing fear and automatic responses to emotion.

Thanks to the frontal lobes and hippocampus, this route means that we can assess the situation logically and weigh up our options, before choosing the best emotional response.

However, the fast route to emotional experience means that information travels straight to the amygdala (the fear processing centre) and bypasses those ‘logical’ areas. This results in an immediate reaction.

For example, imagine going on a walk and suddenly coming face to face with a wild bear. You would probably be terrified and experience a boost of adrenaline whilst running away as fast as you could.

In a situation where you have to react quickly, the fast route is beneficial. But not all situations call for this type of instant response; in other situations, it can do more harm than good.

Most people can relate to the feeling of being so overwhelmed by an emotion that you can’t think straight. The slow route to emotion gives us that space to pause and think rationally before acting on how we feel.

People with brain damage to those crucial frontal lobe areas can become quick to anger over the smallest of stressors. For instance, they may become incredibly irritated if someone arrives a few minutes late to a meeting.

This shows the importance of the frontal lobe in the slow route to emotion. As the saying goes, don’t make decisions when you’re angry and don’t make promises when you’re happy- you might do something you regret later.

The same idea applies to feelings of anxiety, as when we feel anxious, we have a tendency to focus too much on anything that is remotely negative or scary.

Researchers from Cambridge investigated individuals who were highly anxious compared to those who were low on anxiety, to see how they responded to fearful faces.

They found increased amygdala activation in the individuals who were high in anxiety, even when their attention was focused on another image. These findings suggest that there is a link between high levels of anxiety and activity in the amygdala.

As mentioned earlier, the amygdala is widely linked to fear processing. When we feel anxious, we become hypervigilant of anything that could pose a threat, even if it’s practically harmless.

Interestingly, the researchers also found relatively decreased activation of regions in the frontal lobes. This reduced activity in those ‘logical’ frontal areas is reflected by an impaired ability to make rational decisions.

The recent panic-buying situation is a perfect illustration of anxiety clouding rational thought and judgement. Hand-sanitising gel ran out almost everywhere as people rushed in blind panic to protect themselves and buy more than they needed.

Although hand gel is a good preventative measure, it is unlikely that people will use all 50 of those bottles in a week. Moreover, this also leaves the most vulnerable population and key workers without these essential resources. Research investigating the effect of anxiety on decision-making sheds some light on why this may be happening.

Two psychologists from Italy, Bensi and Giusberti, proposed that extremely anxious people would be more likely to jump to conclusions when it came to making a decision.

Just as they predicted, studies have shown that anxious individuals ask for less evidence before making a decision on experimental tasks and they collect less data before answering a hypothetical question.

In a state of anxiety, our priority becomes to get rid of that feeling, so we are less likely to spend a lot of time thinking before making a decision.

We just want to stop feeling anxious as quickly as possible. So when it comes to moral panic, it is easy to understand how people can become overwhelmed by strong feelings of fear and anxiety, which can then lead them to make bad decisions (like emptying all supermarkets, corner stores and petrol stations of bread).

One psychologist says that a reason for this type of mass behaviour is because these emotions spread rapidly across individuals and at a time of moral panic, facts are replaced by opinions about facts.

In an age of alternative truths and widespread misinformation, a pandemic such as Covid-19 is bound to become embroiled in myths and lies. The research discussed above shows that when people become highly anxious, they seek out less information before making a decision and they do not care about whether the information is correct.

Therefore, even though we are constantly being bombarded with daunting updates on the new coronavirus, it is more crucial than ever to remain calm, rational and well-informed.

Before you rush to that supermarket and frantically buy 40 loaves of bread and 30 packs of toilet roll, think about the elderly lady who has taken the risk to leave home only to find the aisles completely barren.

Before you swipe to share that online article, do a quick search to find out the facts and confirm if it’s really true or just a poor attempt at fearmongering.

The unfamiliar is scary, but do not let your emotions get the better of you. Choose the slow route.

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Insight

Astrocytes identified as master ‘conductors’ of the brain

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In the orchestra of the brain, the firing of each neuron is controlled by two notes – excitatory and inhibitory – that come from two distinct forms of a cellular structure called synapses.

Synapses are essentially the connections between neurons, transmitting information from one cell to the other. The synaptic harmonies come together to create the most exquisite music–at least most of the time.

When the music becomes discordant and a person is diagnosed with a brain disease, scientists typically look to the synapses between neurons to determine what went wrong. But a new study from Duke University neuroscientists suggests that it would be more useful to look at the white-gloved conductor of the orchestra – the astrocyte.

Astrocytes are star-shaped cells that form the glue-like framework of the brain. They are one kind of cell called glia, which is Greek for “glue.” Previously found to be involved in controlling excitatory synapses, a team of Duke scientists also found that astrocytes are involved in regulating inhibitory synapses by binding to neurons through an adhesion molecule called NrCAM. The astrocytes reach out thin, fine tentacles to the inhibitory synapse, and when they touch, the adhesion is formed by NrCAM. Their findings were published in Nature on November 11.

“We really discovered that the astrocytes are the conductors that orchestrate the notes that make up the music of the brain,” said Scott Soderling, PhD, chair of the Department of Cell Biology in the School of Medicine and senior author on the paper.

Excitatory synapses — the brain’s accelerator — and inhibitory synapses — the brain’s brakes — were previously thought to be the most important instruments in the brain. Too much excitation can lead to epilepsy, too much inhibition can lead to schizophrenia, and an imbalance either way can lead to autism.

However, this study shows that astrocytes are running the show in overall brain function, and could be important targets for brain therapies, said co-senior author Cagla Eroglu, PhD, associate professor of cell biology and neurobiology in the School of Medicine. Eroglu is a world expert in astrocytes and her lab discovered how astrocytes send their tentacles and connect to synapses in 2017.

“A lot of the time, studies that investigate molecular aspects of brain development and disease study gene function or molecular function in neurons, or they only consider neurons to be the primary cells that are affected,” said Eroglu. “However, here we were able to show that by simply changing the interaction between astrocytes and neurons — specifically by manipulating the astrocytes — we were able to dramatically alter the wiring of the neurons as well.”

Soderling and Eroglu collaborate often scientifically, and they hashed out the plan for the project over coffee and pastries. The plan was to apply a proteomic method developed in Soderling’s lab that was further developed by his postdoctoral associate Tetsuya Takano, who is the paper’s lead author.

Takano designed a new method that allowed scientists to use a virus to insert an enzyme into the brain of a mouse that labeled the proteins connecting astrocytes and neurons. Once tagged with this label, the scientists could pluck the tagged proteins from the brain tissue and use Duke’s mass spectrometry facility to identify the adhesion molecule NrCAM.

Then, Takano teamed up with Katie Baldwin, a postdoctoral associate in Eroglu’s lab, to run assays to determine how the adhesion molecule NrCAM plays a role in the connection between astrocyte and inhibitory synapses. Together the labs discovered NrCAM was a missing link that controlled how astrocytes influence inhibitory synapses, demonstrating they influence all of the ‘notes’ of the brain.

“We were very lucky that we had really cooperative team members,” said Eroglu. “They worked very hard and they were open to crazy ideas. I would call this a crazy idea.”

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Insight

Carers at risk of being forgotten

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A study has found that 68% of people believe they should ‘reach out’ to carers more often – with 60% of respondents only asking carers how they are ‘now and again’, ‘rarely’ or ‘almost never’; leaving carers at risk of feeling forgotten.

Furthermore, 72% of respondents worried that carers struggled with ‘loneliness’ thanks to the full-on nature of care leaving them little time for socialising.

Throughout the pandemic, caregivers have been at the forefront of the fight, looking after the most vulnerable in society and putting their own lives on the line to do so. In light of this, a campaign called #ReachOutAndHelpOut has been launched to encourage support for carers as they continue to deliver essential care to those in need – amidst fears that carers’ wellbeing is often overlooked.

Spearheaded by Sentai, a British technology start-up focused on helping the elderly live more independently in their own homes, the campaign looks to highlight the vital role that carers play.

Respondents, mindful of the associated health impact of winter, believe the biggest fears to be faced by carers in coming months is another ‘national lockdown’ (60%), while 53% of respondents saw ‘excessive workload’ as a primary worry. 50% also believed ‘difficulty visiting family and friends due to their care commitments’ was a central concern, while ‘juggling different responsibilities’ was a key issue according to 46%.

Other concerns included ‘lack of time’ (32.9%) and carers ‘feeling they’re not doing enough’ (25%).

Professor Ray Jones, professor of health informatics at Plymouth University and director of eHealth Productivity and Innovation in Cornwall and the Isles of Scilly (EPIC), which focuses on the provision of internet based healthcare services (eHealth) voiced his support for the campaign, highlighting the difficulties carers face.

He said: “The impact of the coronavirus crisis has been profound on almost all aspects of society. For carers though, this impact has been magnified to a far higher degree. The physical and psychological toll of caring during a pandemic is huge. We must be mindful of the burden placed on carers and do what we can to help. The service they provide is essential, and we’re all indebted to their hard work. The very least we can do then is simply ask them how they’re doing and offer whatever assistance we’re able to give.”

These sentiments were echoed by Philip Marshman, founder of Sentai and orchestrator of #ReachOutAndHelpOut, who said: “The role of a carer is often overlooked. It’s all too easy to ask how the recipient of care is without extending that concern beyond to take into account the person looking after them. Carers are people, not robots, and now, more than ever we must do what we can to consider and support their wellbeing and mental health.”

Sentai has launched a Kickstarter campaign to raise funds for the next stage of its smart device development, the success of which will see its pioneering technology brought to mass market – allowing those in need to benefit from its advanced offering.

Philip said: “The experience of looking after my own father led me to create Sentai, and it’s been developed to help both the care recipient and the caregiver. Through revolutionary voice technology it initiates intelligent conversations, helping to alleviate boredom and loneliness, while also providing helpful reminders. It’s safety properties also allow the caregiver to monitor the care recipient remotely and unobtrusively, providing reassurance that the care recipient is OK and acting as normal, thereby helping to ease stress and worry for the caregiver.”

He added: “We have everything in place to deliver a successful solution – we want to get Sentai into people’s homes as quickly as possible – whether that’s someone’s own home, or a care home. Raising funds in this way means we can stay true to our mission which is helping people live more independently, for longer.”

Further details of the Kickstarter campaign can be found via https://www.kickstarter.com/projects/sentai/sentai.

To find out more about the #ReachOutAndHelpOut campaign and the different ways to get involved, including the chance to win a well-deserved break away, please visit sentai.ai/ReachOut.

Others in the care industry who have expressed support for the #ReachOutAndHelpOut campaign, include Dr Stephen Ladyman, founder of Oak Retirement and former Minister of Health responsible for Social Care, and Shaleeza Hasham, founder of the Adopt a Grandparent scheme and head of hospitality at care home and home care provider, CHD Living.

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PhysioFunction setting the trend for telerehab

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Having been an early adopter of telerehab, PhysioFunction was perhaps less daunted than most at the prospect of responding to the COVID-19 lockdown and ensuring their clients’ needs were met.

The specialist neuro physiotherapy practice has, for the past year, used video calls to enable its clients to receive one-to-one sessions in addition to those provided in person, with its staff supporting them to install and use the technology remotely.

It is also an early adopter of the MindMotion GO, a first-of-its-kind mobile neurorehabilitation therapy system which uses gaming to support the recovery of brain injury and neuro patients.

PhysioFunction has reported strong levels of engagement and progress among clients as a result of its telerehab programme, which has increased in its use during the past few months amidst the pandemic.

From its specialist outpatient rehabilitation unit in Northampton, PhysioFunction supports patients from a 100-mile radius, which was a key driver in the adoption of virtual means of delivering therapy.

Claire Everett, clinical operations manager at PhysioFunction and a senior neurological physiotherapist, said: “For some time now, we have tried to embrace the use of online means for therapy, and it has really helped many of our clients. By doing sessions in their own homes, we see them taking ownership of their rehabilitation and it delivers benefits to them in their own settings.

“For example, we might be doing a session by video with a client on how to cope in the kitchen – but because it’s their own kitchen they’re in, that makes it even more relatable.

“It is a very useful way for some clients who perhaps struggle to get to us once a week, but cope much better with two half-hour weekly sessions by telerehab. We do carry out home visits, and will combine the remote sessions with hands-on therapy wherever we can, but some clients live quite a distance away or maybe it isn’t easy for them to get out of the house.

“By holding sessions by video, it doesn’t matter where they live, whether it’s round the corner or two hours away, and we’ve had a great response to our telerehab work. It’s changed our practice in some really positive ways.”

When lockdown came, while for many organisations a swift and seismic move to the adoption of remote communication was needed, PhysioFunction were in the enviable position of being able to build on what they had already created.

“With us already being established with many clients, we didn’t have to start from scratch, and we could look at how to build on what we had already done. By extending our telerehab programme, we could continue to support our clients effectively,” says Claire.

“The team were able to take our classes online from a very early stage, with Taher Dhuliawala and Keiran Cox very much holding the fort during lockdown. The classes followed the same format as in person, with small numbers of participants so we can easily spot if someone needs help, but we were able to increase the frequency of them. Being able to do these kinds of sessions in your own living room was really welcomed.

“With clients who were already able to use video, we also were able to introduce the MindMotion GO, which is fantastic as we can interact with the technology and, for example, increase the intensity as required. But at the start of the pandemic, we still had some clients who didn’t use video, and the fact we have supported them to use it meant they had an extra channel of communication with their family during lockdown, and that was a lovely extra benefit.

“Even aside from COVID, with the flu and winter weather coming, we are expecting further demand for our telerehab sessions. We’re currently running a blended approach of online and in-person sessions, although a few people are still choosing not to come in at all, but they have found our telerehab so effective that they’re still progressing with their therapy.”

While remote working was a ‘needs must’ for many practices during lockdown, and to help mitigate ongoing restrictions, PhysioFunction intend to continue to build telerehab as a core function.

“We are very into innovation and technology here and our team have worked really hard to do what we’ve done, I’m really proud of what we’ve achieved,” adds Claire.

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