How Can I Tell if She’s Lying? Sarcasm, white lies and teasing can be difficult to identify for those with certain disorders – new video inventory developed at McGill may help

Newswise, December 1, 2015— When she says she loves my new haircut is she telling the truth or being sarcastic? The answer isn’t always obvious.

Especially for men.

Or for those who suffer from diseases like Alzheimer’s or Parkinson’s, or neurodevelopmental conditions such as Autism spectrum disorder. For people with these problems, any form of non-literal speech such as sarcasm, teasing or ‘white lies’ can be very confusing. 

A new video inventory of examples of these forms of indirect speech developed at McGill should help in the diagnosis and clinical testing of those with disorders of this kind.

A ‘truth bias’ underlies much social interaction

“We tend to believe that people tell the truth most of the time,” says Kathrin Rothermich, from McGill’s School of Communication Disorders, who has recently published a paper about the research in PLoS ONE. 

“So sarcasm and white lies seem to go against a basic understanding of what ‘should’ be happening in conversation. This may be part of what makes them so difficult to recognize for some.”

Rothermich has spent the past two years creating and testing the Relational Inference and Social Communication (RISC) video inventory that she and her colleague Marc Pell developed. 

These 926 videos feature short, scripted scenes with four actors interacting in different relationships (as romantic partners, as friends, as colleagues, or as boss/employee).

In each exchange, the actors were asked to convey one specific intention through their speech and actions: to be sincere, to tell ‘white lies’, to tease, or to be sarcastic. 

Rothermich then tested the videos on a group of healthy participants to see whether they were able to identify the speakers’ intentions, and to get feedback about which vocal and facial cues had helped them identify what was going on.

Sarcasm is especially hard to recognize

Participants were generally well able to identify the speakers’ intention either when one of the actors was teasing someone else or when they were telling the truth. 

What proved to be more difficult, and particularly so for men, was identifying when someone was being sarcastic. It was only when sarcasm was used in relationships between friends that participants were better able to recognize it.

“We discovered that the actors found it hardest to perform the scripts where they were being asked to tease one another,” says Rothermich. 

“This may be because teasing doesn’t always fit easily or logically into a conversation. One of the things that some actors did was to speak with exaggerated or fake accents when they were teasing, which is something that other researchers have also reported.”

The researchers believe that this video inventory will provide a useful tool for future research on social cognition, inter-personal communication and the interpretation of a speaker’s intentions in both healthy adult and clinical populations.

Nurses Help Tracheostomy Patients Regain Speech

Article in Critical Care Nurse describes nursing assessments and interventions to help patients regain the ability to speak after a tracheostomy

Newswise, December 1, 2015— Tracheostomies are among the most common procedures performed in critically ill patients, and various methods are available to help patients with tracheostomies regain the ability to speak, according to an article in the December issue of Critical Care Nurse (CCN).

The article, “Restoring Speech to Tracheostomy Patients,” provides an overview of nursing assessments and interventions to help patients regain the ability to speak after a tracheostomy.

Critical care nurses work as part of an interdisciplinary team that includes respiratory therapists, speech pathologists, advanced practice nurses and physicians to coordinate care and develop a patient-specific communication plan, which is essential to the goal of voice restoration.

Lead author Linda L. Morris, PhD, APN, CCNS, FCCM, is a tracheostomy specialist/consultant and associate professor of clinical anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago. 

The co-editor/author of the 2010 edition of “Tracheostomies: The Complete Guide,” she also serves on the board of directors for the Global Tracheostomy Collaborative.

“Losing the ability to speak after a tracheostomy adds to the stress, fear and frustration of being critically ill,” she said. “Restoring speech to a patient after a tracheostomy allows them to more fully and effectively express their needs and wishes, participate in their plan of care and converse with their loved ones and caregivers.”

Speaking after a tracheostomy depends on having an adequate supply of air reach the vocal cords with a minimum of resistance, and the tracheostomy tube itself is an important factor related to phonation, or the ability to make sound with one’s vocal cords. 

Changing the type of tube, as well as its diameter or length, can help avoid complications and lead to greater success in phonation.

The article summarizes different approaches to restore phonation in patients with a tracheostomy, including special considerations related to nursing interventions. 

The methods vary, depending on whether the patient is spontaneously breathing, being treated with intermittent mechanical ventilation or is fully ventilator dependent.

“An essential component of successfully helping a patient regain the ability to speak is to determine which option or options are most appropriate, and nurses need to be aware of all the options available,” Morris said.

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for high acuity, progressive and critical care nurses, CCN is a trusted source for information related to the bedside care of critically and acutely ill patients.

Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org/.

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in high acuity, progressive and critical care settings. CCN enjoys a circulation of more than 105,000 and can be accessed at http://ccn.aacnjournals.org/.

About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN represents the interests of more than 500,000 acute and critical care nurses and includes more than 225 chapters worldwide. 

The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. www.aacn.org; www.facebook.com/aacnface; www.twitter.com/aacnme

Senior Patients Treated in Van Equipped as Dentist’s Office

Newswise, December 1, 2015 — Students and faculty at Case Western Reserve University’s School of Dental Medicine are treating seniors in a dentist’s office on wheels—a 38-foot van, in fact, renovated to provide full-service oral care.

“There’s almost no difference between our van and a traditional dentist’s office,” said Nicole Harris, a visiting assistant professor in the dental school’s Department of Community Dentistry.

Dental students, under supervision of faculty, provide, oral exams, digital X-rays, cleanings, fillings, dentures, extractions and cancer screenings on the van for many patients who haven’t visited a dentist in years.

The "Lifelong Smiles" van is driven and parked outside nursing homes and assisted-living facilities for residents to come aboard. In addition, two portable dental chairs are set up in facilities for those patients who cannot get on the van.

“There’s a perception it’s more difficult to treat seniors, which has kept many dentists in their comfort zones, avoiding these patients,” said James Lalumandier, chair and professor in the dental school’s Department of Community Dentistry. “We want to reverse that—and need to—given our current and future dental needs.”

The van is the centerpiece of a new dental school initiative known as the Geriatric Dental Program, which was created, in part, as a response to changing demographics nationally, said Lalumandier.

The nation’s senior population—ages 65 and older—is expected to surpass 72 million by 2030—more than double the number from 2000, according to the U.S. Department of Health and Human Services.

“Often, underserved elderly populations cannot go out and get care on their own. So we’re building a model where we go to them,” said Suparna A. Mahalaha, a visiting assistant professor in the Department of Community Dentistry and co-director of its new Geriatric Dental Program, along with Harris.

“At the same time, by providing students experience with older patients, we’re planting a seed in them to serve seniors during their careers.”

Soon, medical, nursing and social work students at Case Western Reserve also will accompany dental students in assessing patients in facilities where the van is parked, as part of an emphasis on increasing interdisciplinary training in the health sciences.

“It used to be people just lost their teeth. In today’s world, seniors are retaining a good portion of their teeth and need specialized care that’s in fitting with their overall medical histories,” said Lalumandier.

“Across the health sciences, students are opening their eyes to the idea that oral health is key to a patient’s complete wellbeing.”

The Ohio Department of Health donated the vehicle to the university after reviewing competing proposals from across the state. Funds for the van’s overhaul were provided by the McGregor Foundation, the Dental Trade Alliance Foundation and others

Study Offers Insights to How Ovarian Cancer Grows – and Potential to Stop It

Findings support cancer stem cell model, with exceptions

Study offers insights to how ovarian cancer grows – and potential to stop it...

Findings support cancer stem cell model, with exception

Newswise, December 1, 2015 — Can any cancer cell form another tumor, or is it only select cancer stem cells that give rise to new cancer cells? The answer, a new study finds, is both.

Researchers at the University of Michigan Comprehensive Cancer Center looked at human ovarian cancer cells and found that for the most part the cancer cells generate offspring in a predictable and organized fashion: mother cancer cells produced daughter cells and the daughter cells produced granddaughter cells. The grandmother cells are the rare cancer stem cells that can initiate cancer recurrence and the granddaughter cells are the bulk tumor cells.

But in rare exceptions, the daughter cells gave rise to the stem-like grandmother cells.

The question of whether cancer cells divide in a patterned fashion or randomly has been hotly debated.

“Like any nature/nurture question, the answer is always both. In general we observed that cancer cells do not divide randomly. Just like in normal biology, we saw the pattern of stem cells giving rise to daughter cells. But within that hierarchy, we saw rare exceptions that went against the hierarchy,” says senior study author Ronald J. Buckanovich, M.D., Ph.D., associate professor of internal medicine at the University of Michigan Medical School.

“This is very significant for how you design cancer therapies. These stem-like cells are the really critical therapeutic targets, but the non-stem cells need to be addressed as well,” he adds.

The researchers also found that a protein called BMP2 increased the growth of the cancer stem cells and decreased the growth of the granddaughter cells, or the bulk tumor cells. 

It’s like a conversation between the two types of cells: When there are too many granddaughter cells, they trigger BMP2 to increase the number of stem cells. The non-stem cells are helping to support the growth of the stem cells to maintain an equilibrium within the tumor.

“BMP2 tells the cancer to make more grandmothers and stop making granddaughters. So there are fewer bulk cells. But there are more of the aggressive, chemotherapy-resistant cells that have the ability to create new tumors,” Buckanovich says.

When the researcher blocked BMP2, it reduced the ability of the cancer cells to make new stem cells. But blocking BMP2 promotes the growth of the granddaughter bulk cells. 

The challenge is to target the BMP2 inhibitor to the cancer stem cells only. This type of treatment is not currently available to patients. Researchers are examining ways to deliver an inhibitor only to the stem cells.

The study, which is published in PNAS, is unique because it looked at human tissue, rather than mouse models. The cancer researchers tapped into a microfluidic device designed by Euisik Yoon’s group at the University of Michigan College of Engineering. 

The device enabled the cells to be separated and studied individually over time in a manner that would not be possible with traditional methods.

“We could watch cancer cells divide in real time, actually track and watch who’s the mother and who’s the daughter,” Buckanovich says. “This device allowed us to study human cells instead of mouse models. We believe it is the first instance to define a cancer hierarchy using cells from patients.”

Additional authors: Yunjung Choi, Patrick Neal Ingram, Kun Yang, Lan Coffman, Mangala Iyengar, Shoumei Bai, Dafydd Thomas, Euisik Yoon

Funding: Ovarian Cancer Research Fund, National Institutes of Health grants DP200440377 and P30 CA046592

Disclosure: None

Lewy Body Dementia: Unfamiliar With This Common Disorder?

International conference Dec. 1 – 4 brings together experts, patients and caregivers

Newswise, December 1, 2015— Lewy body dementia is the second most common type of dementia after Alzheimer’s disease. 

But if you’re not familiar with it, you’re not alone. “Lewy body dementia is the most common disorder you’ve never heard of,” says Bradley Boeve, M.D., a Mayo Clinic neurologist who will speak at the International Dementia with Lewy Bodies Conference Dec. 1-4 in Fort Lauderdale, Florida.

Lewy body dementia shares similar symptoms of memory issues like Alzheimer’s and slow, stiff movements like Parkinson’s disease. But people with Lewy body dementia may act out their dreams while asleep, or they may have visual hallucinations that can lead to unusual behavior, such as having conversations with deceased loved ones.

Getting an accurate diagnosis is the key to improving patients’ lives, says Dr. Boeve, co-investigator of the Mayo Clinic Dorothy and Harry T. Mangurian Jr. Lewy Body Dementia Program. 

“We want to help patients stop the diagnostic odyssey of seeing many different clinicians, undergoing many different tests over an extended period of time with no clear answers and all of the frustration that goes with this,” Dr. Boeve says.

While there’s no cure today for Lewy body dementia, an accurate diagnosis can help patients receive the right medications. Some medications that don’t work for Alzheimer’s may help improve Lewy body dementia symptoms.

Dr. Boeve explains it this way: In Lewy body dementia, protein deposits – named after Frederick Lewy who discovered them — develop in brain cells. While some brain cells die, others are just not working properly. 

Certain medications, called cholinesterase inhibitors, help trigger nerve impulses from one brain cell to the next — sometimes improving symptoms.

Lewy body dementia symptoms include:

* Visual hallucinations: Seeing colors, shapes, animals or people that aren’t there.
* Movement disorders: Slowed movement, rigid muscles, tremors or shuffling walk.
* Poor regulations of body function: Dizziness, falls and bowel issues.
* Cognitive problems: Confusion, reduced attention span and memory loss.
* Sleep difficulties: Physically acting out dreams while asleep.
* Fluctuating attention: Drowsiness, staring into space, daytime naps and disorganized speech.
* Depression: Persistent sadness and loss of interest.

While the cause of Lewy body dementia is unclear, risk factors include being older than 60, being male and having a family member with Lewy body dementia.

After diagnosis, doctors, patients and caregivers work together to monitor medications and find nondrug approaches.

“Education and empowerment of patients and families are critical,” Dr. Boeve says. 

“For example, if visual hallucinations are present, learning techniques to manage them can help avoid Emergency Department visits or hospitalizations, so it’s cost saving and lessens patients’ and families’ frustration. The education and support by the Lewy Body Dementia Association are also critical.”

The International Dementia with Lewy Bodies Conference includes sessions for health care providers, patients and caregivers. Dr. Boeve and his colleagues in Mayo Clinic’s Lewy Body Dementia Research Program are the hosts, working in conjunction with the staff of the Lewy Body Dementia Association.

Critically Ill Patients at Long-term Risk for Bone Fracture

Newswise, December 1, 2015--One year after being hospitalized in intensive care, patients have reduced bone mass that puts them at greater risk for fractures, according to a new study published online ahead of print in the American Journal of Respiratory and Critical Care Medicine.

Neil R. Orford, MBBS, director of the ICU at the University Hospital Geelong in Australia, and colleagues found that patients who spent at least 24 hours on a breathing machine in an intensive care unit had 1.59 percent less bone mineral density (BMD) in their lower spines and 1.2 percent less BMD in their thigh bone than expected one year after being hospitalized. 

The bone losses were statistically significant in the overall study population and in just women. In men, only the BMD decline in the thigh bone was significant.

The loss of bone density, along with other clinical risk factors assessed by a World Health Organization algorithm, increased their chances of suffering a fragility fracture according to the researchers.

The researchers also looked at the biochemical changes occurring in the patients that might affect bone density. 

Specifically, they looked at two molecular “bone turnover markers”: type 1 N-terminal procollagen, which helps bone form, and collagen type 1 cross-linked c-telopeptide, which helps bone break down.

Their study suggests that critical illness accelerates bone resorption, the process by which the body breaks down bone and releases calcium and other minerals into the bloodstream. 

A year later, the researchers found that resorption had normalized, but patients were left with a bone-mass deficit.

“Our study demonstrates a need to investigate the role anti-resorptive therapies to prevent bone loss in critically ill patients during their time in the hospital and afterwards during recovery,” Dr. Orford said.

The authors wrote that follow-up studies should investigate drugs already being used to treat osteoporosis and other treatments, including physical therapy, to see if bone loss can be prevented in critically ill patients.

The Geelong study included 66 patients, average age 68.8 years, who underwent BMD testing after leaving the ICU and then again a year later. The authors believe theirs in the first study to look at the long-term effect of ICU treatment on bone density.

The patients were matched and compared to patients from the Geelong Osteoporosis Study, a large random population-based sample used to determine normal ranges of BMD over time.

The authors said the relatively small number of participants limits the generalizability of the findings to other ICU patients and prevents them from identifying additional bone-loss risk factors. 

Because the study only looked at ICU patients, the authors said they cannot rule out the possibility that other hospitalized patients would experience similar bone losses.

“The impact of accelerated bone loss observed in the year after critical illness is dependent on previous bone health and likely to be of more significance in post-menopausal women,” Orford said. 

“Investigations of anti-resorptive drugs in larger, multi-center trials, however, are needed before treatment recommendations can be made.”

The Right Shoes for the Season: Preventing Winter Falls for Seniors

Newswise, December 1, 2015– Many parts of Canada saw their first snow fall and with it comes an increased risk of falls on snow and ice. The issue is most serious for those over the age of 65, 20 to 30 per cent of whom experience a fall each year according to a report by the Government of Canada.

Researchers at the Toronto Rehabilitation Institute (Toronto Rehab) are examining how these falls can be prevented in people’s homes, and out in the community while also encouraging safe activity.

“Falls are an underappreciated, preventable health risk,” explains Tilak Dutta, scientist at Toronto Rehab. “The fear of falling itself can have devastating effects on health. Keeping active is important to maintain health yet most older adults become sedentary in the winter.”

To raise awareness about falls and measures people can take to prevent falls in their homes and in the community, Dutta and his team are hosting a number of events and talks for the public for in November.

Events include testing winter boots in a simulator called WinterLab. Members of the public are invited to walk up and down the icy slopes of WinterLab while in a safety harness. The lab is tilted to progressively greater inclines from zero to 22 degrees until participants start to slip.

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“Our testing has shown that it isn’t possible to determine performance by simply looking at your footwear. Some footwear that looks sophisticated will only climb a two-degree slope covered in wet ice while others maintain their grip even at a 15 or 20-degree angle.”

Dutta and his team plan to publish a website soon with the results of their tests so the public will have the information they need to buy the best winter footwear.

The team also has an ongoing series of short talks each day at 12:30 p.m. which are streamed live on YouTube and archived for viewing later. Topics range from ways of making stairs and bathroom safer to suggestions on exercises for improving balance.

“Falls prevention is so far-reaching,” Dutta explains. “We will all either become at risk of falling at some point in our lives, or care for someone who is at risk.”
For more information on the activities and talks, please see trihomeandcommunity.com/falls/.