Tuesday 25 November 2014

Vitamin D Deficiency Predicts Cognitive Decline

Megan Brooks
November 20, 2014
A new study supports a link between low levels of vitamin D and increased risk for cognitive decline, prompting calls for clinical trials to test whether vitamin D supplementation may delay or prevent dementia.

In a group of cognitively intact older adults, serum 25-hydroxyvitamin D (25OHD) levels below 75 nmol/L at the outset predicted cognitive decline over roughly the next 4 years, independent of other factors.

"[N]eurologists and geriatricians should be aware of the possibility that in elderly individuals, vitamin D supplementation might be a potential cost-effective strategy for preventing neurodegenerative diseases," Elena D. Toffanello, MD, from University of Padova, Italy, and colleagues say.

Their study was published online November 5 in Neurology.

For this analysis, the researchers looked at data on 1927 community-dwelling elderly individuals (mean age, 73.9 years) participating in the Italian population-based cohort study, Progetto Veneto Anziani (Pro.V.A.).

At baseline, participants had a mean serum 25OHD level of 84.1 nmol/L. Roughly 28% of the cohort had 25OHD deficiency (<50 nmol/L), and it was severe (<25 nmol/L) in 6.5%.

Participants with 25OHD deficiency or insufficiency (50 to 75 nmol/L) were more likely to have declining Mini-Mental State Examination (MMSE) scores over 4.4 years of follow-up than their peers with sufficient 25OHD levels (75 nmol/L or greater).

Among participants with intact cognitive function at baseline (MMSE score of at least 24), 25OHD insufficiency was strongly and independently associated with a higher risk for onset of cognitive decline over 4 years compared with those with normal 25OHD levels, the researchers say.

Table. Risk for Cognitive Decline by Vitamin D Level
Serum 25OHD Level Adjusted Relative Risk (95% Confidence Interval) P Value
50 to <75 nmol/L 1.29 (1.00 - 1.76) .03 
<50 nmol/L 1.36 (1.04 - 1.80) .02

In individuals already cognitively impaired at baseline, vitamin D deficiency was also associated with a higher risk for decline in cognitive function, but the association became nonsignificant after adjustment for other medication conditions.

It's possible, say the researchers, that the role of vitamin D on further cognitive decline may be less obvious because of the presence of other comorbidities and disabilities that might accelerate cognitive decline regardless of the starting levels of vitamin D.

Supplementation Trials Warranted
 
Dr Toffanello and colleagues say studies are needed to evaluate whether vitamin D supplementation might help to delay the cognitive decline, especially in patients who already have cognitive impairment.

David J. Llewellyn, PhD, from the University of Exeter Medical School in the United Kingdom, who has studied vitamin D and cognitive function but wasn't involved in this study, agrees.

He told Medscape Medical News that this new study "effectively replicates" a 2010 study by his group showing a link between low vitamin D levels and an increased risk for cognitive decline.

He said the Pro.V.A . study results are also consistent with a study his group published just this year in Neurology. That study suggested older patients with vitamin D levels below 50 nmol/L have about a 122% increased risk for dementia compared with those with higher levels.

"Taken together, this rapidly evolving body of evidence suggests clinical trials are warranted to investigate whether vitamin D supplementation helps to delay or prevent dementia in elderly adults," Dr Llewellyn concluded.

The study had no commercial funding, and the authors have disclosed no relevant financial relationships.
Neurology. Published online November 5, 2014. Abstract

 

Saturday 8 November 2014

To Schill or Not To Schill, Should That Be The Question?

Editorializing?  or The SoapBox of Self Reflection

I Love the ever evolving site Boing Boing they have brought me knowledge and encouraged all who view it's content to be wary of The Free Deal, to make Your own Personal Investment, To read a Book, basically engage in life long learning.

Some times they grant opportunities to friends. That happened this day, profiling a site called Iodine. Iodine offers to make medical Jargon simpler for free.
It's a Google Chrome App that.......



Iodine doesn't provide medical advice, diagnosis, treatment, or prescriptions. Read our terms of use for more info.

Boing Boing has also told us about  





and real grass roots books  like  Where there is no Doctor

http://en.wikipedia.org/wiki/Where_There_Is_No_Doctor

http://www.shamba.worldpossible.org/hesperian/en_wtnd_2011_full.pdf

just to name a small few.

I have have read them all.

So Compare and Beware

Your health is important, but it's your health.

Friday 31 October 2014

Grieving and Growth To Be Truly Alive and With Emotion







How We Grieve: Meghan O’Rourke on the Messiness of Mourning and Learning to Live with Loss

by
“The people we most love do become a physical part of us, ingrained in our synapses, in the pathways where memories are created.”
John Updike wrote in his memoir, “Each day, we wake slightly altered, and the person we were yesterday is dead. So why, one could say, be afraid of death, when death comes all the time?” And yet even if we were to somehow make peace with our own mortality, a primal and soul-shattering fear rips through whenever we think about losing those we love most dearly — a fear that metastasizes into all-consuming grief when loss does come. In The Long Goodbye (public library), her magnificent memoir of grieving her mother’s death, Meghan O’Rourke crafts a masterwork of remembrance and reflection woven of extraordinary emotional intelligence. A poet, essayist, literary critic, and one of the youngest editors the New Yorker has ever had, she tells a story that is deeply personal in its details yet richly resonant in its larger humanity, making tangible the messy and often ineffable complexities that anyone who has ever lost a loved one knows all too intimately, all too anguishingly. What makes her writing — her mind, really — particularly enchanting is that she brings to this paralyzingly difficult subject a poet’s emotional precision, an essayist’s intellectual expansiveness, and a voracious reader’s gift for apt, exquisitely placed allusions to such luminaries of language and life as Whitman, Longfellow, Tennyson, Swift, and Dickinson (“the supreme poet of grief”).

O’Rourke writes:
When we are learning the world, we know things we cannot say how we know. When we are relearning the world in the aftermath of a loss, we feel things we had almost forgotten, old things, beneath the seat of reason.
[…]
Nothing prepared me for the loss of my mother. Even knowing that she would die did not prepare me. A mother, after all, is your entry into the world. She is the shell in which you divide and become a life. Waking up in a world without her is like waking up in a world without sky: unimaginable.
[…]
When we talk about love, we go back to the start, to pinpoint the moment of free fall. But this story is the story of an ending, of death, and it has no beginning. A mother is beyond any notion of a beginning. That’s what makes her a mother: you cannot start the story.

In the days following her mother’s death, as O’Rourke faces the loneliness she anticipated and the sense of being lost that engulfed her unawares, she contemplates the paradoxes of loss: Ours is a culture that treats grief — a process of profound emotional upheaval — with a grotesquely mismatched rational prescription. On the one hand, society seems to operate by a set of unspoken shoulds for how we ought to feel and behave in the face of sorrow; on the other, she observes, “we have so few rituals for observing and externalizing loss.” Without a coping strategy, she finds herself shutting down emotionally and going “dead inside” — a feeling psychologists call “numbing out” — and describes the disconnect between her intellectual awareness of sadness and its inaccessible emotional manifestation:
It was like when you stay in cold water too long. You know something is off but don’t start shivering for ten minutes.
But at least as harrowing as the aftermath of loss is the anticipatory bereavement in the months and weeks and days leading up to the inevitable — a particularly cruel reality of terminal cancer. O’Rourke writes:
So much of dealing with a disease is waiting. Waiting for appointments, for tests, for “procedures.” And waiting, more broadly, for it—for the thing itself, for the other shoe to drop.
The hallmark of this anticipatory loss seems to be a tapestry of inner contradictions. O’Rourke notes with exquisite self-awareness her resentment for the mundanity of it all — there is her mother, sipping soda in front of the TV on one of those final days — coupled with weighty, crushing compassion for the sacred humanity of death:
Time doesn’t obey our commands. You cannot make it holy just because it is disappearing.
Then there was the question of the body — the object of so much social and personal anxiety in real life, suddenly stripped of control in the surreal experience of impending death. Reflecting on the initially disorienting experience of helping her mother on and off the toilet and how quickly it became normalized, O’Rourke writes:
It was what she had done for us, back before we became private and civilized about our bodies. In some ways I liked it. A level of anxiety about the body had been stripped away, and we were left with the simple reality: Here it was.
I heard a lot about the idea of dying “with dignity” while my mother was sick. It was only near her very end that I gave much thought to what this idea meant. I didn’t actually feel it was undignified for my mother’s body to fail — that was the human condition. Having to help my mother on and off the toilet was difficult, but it was natural. The real indignity, it seemed, was dying where no one cared for you the way your family did, dying where it was hard for your whole family to be with you and where excessive measures might be taken to keep you alive past a moment that called for letting go. I didn’t want that for my mother. I wanted her to be able to go home. I didn’t want to pretend she wasn’t going to die.
Among the most painful realities of witnessing death — one particularly exasperating for type-A personalities — is how swiftly it severs the direct correlation between effort and outcome around which we build our lives. Though the notion might seem rational on the surface — especially in a culture that fetishizes work ethic and “grit” as the key to success — an underbelly of magical thinking lurks beneath, which comes to light as we behold the helplessness and injustice of premature death. Noting that “the mourner’s mind is superstitious, looking for signs and wonders,” O’Rourke captures this paradox:
One of the ideas I’ve clung to most of my life is that if I just try hard enough it will work out. If I work hard, I will be spared, and I will get what I desire, finding the cave opening over and over again, thieving life from the abyss. This sturdy belief system has a sidecar in which superstition rides. Until recently, I half believed that if a certain song came on the radio just as I thought of it, it meant that all would be well. What did I mean? I preferred not to answer that question. To look too closely was to prick the balloon of possibility.
But our very capacity for the irrational — for the magic of magical thinking — also turns out to be essential for our spiritual survival. Without the capacity to discern from life’s senseless sound a meaningful melody, we would be consumed by the noise. In fact, one of O’Rourke’s most poetic passages recounts her struggle to find a transcendent meaning on an average day, amid the average hospital noises:
I could hear the coughing man whose family talked about sports and sitcoms every time they visited, sitting politely around his bed as if you couldn’t see the death knobs that were his knees poking through the blanket, but as they left they would hug him and say, We love you, and We’ll be back soon, and in their voices and in mine and in the nurse who was so gentle with my mother, tucking cool white sheets over her with a twist of her wrist, I could hear love, love that sounded like a rope, and I began to see a flickering electric current everywhere I looked as I went up and down the halls, flagging nurses, little flecks of light dotting the air in sinewy lines, and I leaned on these lines like guy ropes when I was so tired I couldn’t walk anymore and a voice in my head said: Do you see this love? And do you still not believe?
I couldn’t deny the voice.
Now I think: That was exhaustion.
But at the time the love, the love, it was like ropes around me, cables that could carry us up into the higher floors away from our predicament and out onto the roof and across the empty spaces above the hospital to the sky where we could gaze down upon all the people driving, eating, having sex, watching TV, angry people, tired people, happy people, all doing, all being –
In the weeks following her mother’s death, melancholy — “the black sorrow, bilious, angry, a slick in my chest” — comes coupled with another intense emotion, a parallel longing for a different branch of that-which-no-longer-is:
I experienced an acute nostalgia. This longing for a lost time was so intense I thought it might split me in two, like a tree hit by lightning. I was — as the expression goes — flooded by memories. It was a submersion in the past that threatened to overwhelm any “rational” experience of the present, water coming up around my branches, rising higher. I did not care much about work I had to do. I was consumed by memories of seemingly trivial things.
But the embodied presence of the loss is far from trivial. O’Rourke, citing a psychiatrist whose words had stayed with her, captures it with harrowing precision:
The people we most love do become a physical part of us, ingrained in our synapses, in the pathways where memories are created.
In another breathtaking passage, O’Rourke conveys the largeness of grief as it emanates out of our pores and into the world that surrounds us:
In February, there was a two-day snowstorm in New York. For hours I lay on my couch, reading, watching the snow drift down through the large elm outside … the sky going gray, then eerie violet, the night breaking around us, snow like flakes of ash. A white mantle covered trees, cars, lintels, and windows. It was like one of grief’s moods: melancholic; estranged from the normal; in touch with the longing that reminds us that we are being-toward-death, as Heidegger puts it. Loss is our atmosphere; we, like the snow, are always falling toward the ground, and most of the time we forget it.

Because grief seeps into the external world as the inner experience bleeds into the outer, it’s understandable — it’s hopelessly human — that we’d also project the very object of our grief onto the external world. One of the most common experiences, O’Rourke notes, is for the grieving to try to bring back the dead — not literally, but by seeing, seeking, signs of them in the landscape of life, symbolism in the everyday. The mind, after all, is a pattern-recognition machine and when the mind’s eye is as heavily clouded with a particular object as it is when we grieve a loved one, we begin to manufacture patterns. Recounting a day when she found inside a library book handwriting that seemed to be her mother’s, O’Rourke writes:
The idea that the dead might not be utterly gone has an irresistible magnetism. I’d read something that described what I had been experiencing. Many people go through what psychologists call a period of “animism,” in which you see the dead person in objects and animals around you, and you construct your false reality, the reality where she is just hiding, or absent. This was the mourner’s secret position, it seemed to me: I have to say this person is dead, but I don’t have to believe it.
[…]
Acceptance isn’t necessarily something you can choose off a menu, like eggs instead of French toast. Instead, researchers now think that some people are inherently primed to accept their own death with “integrity” (their word, not mine), while others are primed for “despair.” Most of us, though, are somewhere in the middle, and one question researchers are now focusing on is: How might more of those in the middle learn to accept their deaths? The answer has real consequences for both the dying and the bereaved.
O’Rourke considers the psychology and physiology of grief:
When you lose someone you were close to, you have to reassess your picture of the world and your place in it. The more your identity is wrapped up with the deceased, the more difficult the mental work.
The first systematic survey of grief, I read, was conducted by Erich Lindemann. Having studied 101 people, many of them related to the victims of the Cocoanut Grove fire of 1942, he defined grief as “sensations of somatic distress occurring in waves lasting from twenty minutes to an hour at a time, a feeling of tightness in the throat, choking with shortness of breath, need for sighing, and an empty feeling in the abdomen, lack of muscular power, and an intensive subjective distress described as tension or mental pain.”
Tracing the history of studying grief, including Elisabeth Kübler-Ross’s famous and often criticized 1969 “stage theory” outlining a simple sequence of Denial, Anger, Bargaining, Depression, and Acceptance, O’Rourke notes that most people experience grief not as sequential stages but as ebbing and flowing states that recur at various points throughout the process. She writes:
Researchers now believe there are two kinds of grief: “normal grief” and “complicated grief” (also called “prolonged grief”). “Normal grief” is a term for what most bereaved people experience. It peaks within the first six months and then begins to dissipate. “Complicated grief” does not, and often requires medication or therapy. But even “normal grief” … is hardly gentle. Its symptoms include insomnia or other sleep disorders, difficulty breathing, auditory or visual hallucinations, appetite problems, and dryness of mouth.
One of the most persistent psychiatric ideas about grief, O’Rourke notes, is the notion that one ought to “let go” in order to “move on” — a proposition plentiful even in the casual advice of her friends in the weeks following her mother’s death. And yet it isn’t necessarily the right coping strategy for everyone, let alone the only one, as our culture seems to suggest. Unwilling to “let go,” O’Rourke finds solace in anthropological alternatives:
Studies have shown that some mourners hold on to a relationship with the deceased with no notable ill effects. In China, for instance, mourners regularly speak to dead ancestors, and one study demonstrated that the bereaved there “recovered more quickly from loss” than bereaved Americans do.
I wasn’t living in China, though, and in those weeks after my mother’s death, I felt that the world expected me to absorb the loss and move forward, like some kind of emotional warrior. One night I heard a character on 24—the president of the United States—announce that grief was a “luxury” she couldn’t “afford right now.” This model represents an old American ethic of muscling through pain by throwing yourself into work; embedded in it is a desire to avoid looking at death. We’ve adopted a sort of “Ask, don’t tell” policy. The question “How are you?” is an expression of concern, but as my dad had said, the mourner quickly figures out that it shouldn’t always be taken for an actual inquiry… A mourner’s experience of time isn’t like everyone else’s. Grief that lasts longer than a few weeks may look like self-indulgence to those around you. But if you’re in mourning, three months seems like nothing — [according to some] research, three months might well find you approaching the height of sorrow.

Another Western hegemony in the culture of grief, O’Rourke notes, is its privatization — the unspoken rule that mourning is something we do in the privacy of our inner lives, alone, away from the public eye. Though for centuries private grief was externalized as public mourning, modernity has left us bereft of rituals to help us deal with our grief:
The disappearance of mourning rituals affects everyone, not just the mourner. One of the reasons many people are unsure about how to act around a loss is that they lack rules or meaningful conventions, and they fear making a mistake. Rituals used to help the community by giving everyone a sense of what to do or say. Now, we’re at sea.
[…]
Such rituals … aren’t just about the individual; they are about the community.
Craving “a formalization of grief, one that might externalize it,” O’Rourke plunges into the existing literature:
The British anthropologist Geoffrey Gorer, the author of Death, Grief, and Mourning, argues that, at least in Britain, the First World War played a huge role in changing the way people mourned. Communities were so overwhelmed by the sheer number of dead that the practice of ritualized mourning for the individual eroded. Other changes were less obvious but no less important. More people, including women, began working outside the home; in the absence of caretakers, death increasingly took place in the quarantining swaddle of the hospital. The rise of psychoanalysis shifted attention from the communal to the individual experience. In 1917, only two years after Émile Durkheim wrote about mourning as an essential social process, Freud’s “Mourning and Melancholia” defined it as something essentially private and individual, internalizing the work of mourning. Within a few generations, I read, the experience of grief had fundamentally changed. Death and mourning had been largely removed from the public realm. By the 1960s, Gorer could write that many people believed that “sensible, rational men and women can keep their mourning under complete control by strength of will and character, so that it need be given no public expression, and indulged, if at all, in private, as furtively as . . . masturbation.” Today, our only public mourning takes the form of watching the funerals of celebrities and statesmen. It’s common to mock such grief as false or voyeuristic (“crocodile tears,” one commentator called mourners’ distress at Princess Diana’s funeral), and yet it serves an important social function. It’s a more mediated version, Leader suggests, of a practice that goes all the way back to soldiers in The Iliad mourning with Achilles for the fallen Patroclus.
I found myself nodding in recognition at Gorer’s conclusions. “If mourning is denied outlet, the result will be suffering,” Gorer wrote. “At the moment our society is signally failing to give this support and assistance. . . . The cost of this failure in misery, loneliness, despair and maladaptive behavior is very high.” Maybe it’s not a coincidence that in Western countries with fewer mourning rituals, the bereaved report more physical ailments in the year following a death.

Illustration from 'The Iliad and the Odyssey: A Giant Golden Book' by Alice and Martin Provensen. Click image for details.
Finding solace in Marilynne Robinson’s beautiful meditation on our humanity, O’Rourke returns to her own journey:
The otherworldliness of loss was so intense that at times I had to believe it was a singular passage, a privilege of some kind, even if all it left me with was a clearer grasp of our human predicament. It was why I kept finding myself drawn to the remote desert: I wanted to be reminded of how the numinous impinges on ordinary life.
Reflecting on her struggle to accept her mother’s loss — her absence, “an absence that becomes a presence” — O’Rourke writes:
If children learn through exposure to new experiences, mourners unlearn through exposure to absence in new contexts. Grief requires acquainting yourself with the world again and again; each “first” causes a break that must be reset… And so you always feel suspense, a queer dread—you never know what occasion will break the loss freshly open.
She later adds:
After a loss, you have to learn to believe the dead one is dead. It doesn’t come naturally.

Among the most chilling effects of grief is how it reorients us toward ourselves as it surfaces our mortality paradox and the dawning awareness of our own impermanence. O’Rourke’s words ring with the profound discomfort of our shared existential bind:
The dread of death is so primal, it overtakes me on a molecular level. In the lowest moments, it produces nihilism. If I am going to die, why not get it over with? Why live in this agony of anticipation?
[…]
I was unable to push these questions aside: What are we to do with the knowledge that we die? What bargain do you make in your mind so as not to go crazy with fear of the predicament, a predicament none of us knowingly chose to enter? You can believe in God and heaven, if you have the capacity for faith. Or, if you don’t, you can do what a stoic like Seneca did, and push away the awfulness by noting that if death is indeed extinction, it won’t hurt, for we won’t experience it. “It would be dreadful could it remain with you; but of necessity either it does not arrive or else it departs,” he wrote.
If this logic fails to comfort, you can decide, as Plato and Jonathan Swift did, that since death is natural, and the gods must exist, it cannot be a bad thing. As Swift said, “It is impossible that anything so natural, so necessary, and so universal as death, should ever have been designed by Providence as an evil to mankind.” And Socrates: “I am quite ready to admit … that I ought to be grieved at death, if I were not persuaded in the first place that I am going to other gods who are wise and good.” But this is poor comfort to those of us who have no gods to turn to. If you love this world, how can you look forward to departing it? Rousseau wrote, “He who pretends to look on death without fear lies. All men are afraid of dying, this is the great law of sentient beings, without which the entire human species would soon be destroyed.”
And yet, O’Rourke arrives at the same conclusion that Alan Lightman did in his sublime meditation on our longing for permanence as she writes:
Without death our lives would lose their shape: “Death is the mother of beauty,” Wallace Stevens wrote. Or as a character in Don DeLillo’s White Noise says, “I think it’s a mistake to lose one’s sense of death, even one’s fear of death. Isn’t death the boundary we need?” It’s not clear that DeLillo means us to agree, but I think I do. I love the world more because it is transient.
[…]
One would think that living so proximately to the provisional would ruin life, and at times it did make it hard. But at other times I experienced the world with less fear and more clarity. It didn’t matter if I was in line for an extra two minutes. I could take in the sensations of color, sound, life. How strange that we should live on this planet and make cereal boxes, and shopping carts, and gum! That we should renovate stately old banks and replace them with Trader Joe’s! We were ants in a sugar bowl, and one day the bowl would empty.

A Perseid meteor over Joshua Tree National Park (Image: Joe Westerberg / NASA)
This awareness of our transience, our minuteness, and the paradoxical enlargement of our aliveness that it produces seems to be the sole solace from grief’s grip, though we all arrive at it differently. O’Rourke’s father approached it from another angle. Recounting a conversation with him one autumn night — one can’t help but notice the beautiful, if inadvertent, echo of Carl Sagan’s memorable words — O’Rourke writes:
“The Perseid meteor showers are here,” he told me. “And I’ve been eating dinner outside and then lying in the lounge chairs watching the stars like your mother and I used to” — at some point he stopped calling her Mom — “and that helps. It might sound strange, but I was sitting there, looking up at the sky, and I thought, ‘You are but a mote of dust. And your troubles and travails are just a mote of a mote of dust.’ And it helped me. I have allowed myself to think about things I had been scared to think about and feel. And it allowed me to be there — to be present. Whatever my life is, whatever my loss is, it’s small in the face of all that existence… The meteor shower changed something. I was looking the other way through a telescope before: I was just looking at what was not there. Now I look at what is there.”
O’Rourke goes on to reflect on this ground-shifting quality of loss:
It’s not a question of getting over it or healing. No; it’s a question of learning to live with this transformation. For the loss is transformative, in good ways and bad, a tangle of change that cannot be threaded into the usual narrative spools. It is too central for that. It’s not an emergence from the cocoon, but a tree growing around an obstruction.
In one of the most beautiful passages in the book, O’Rourke captures the spiritual sensemaking of death in an anecdote that calls to mind Alan Lightman’s account of a “transcendent experience” and Alan Watt’s consolation in the oneness of the universe. She writes:
Before we scattered the ashes, I had an eerie experience. I went for a short run. I hate running in the cold, but after so much time indoors in the dead of winter I was filled with exuberance. I ran lightly through the stripped, bare woods, past my favorite house, poised on a high hill, and turned back, flying up the road, turning left. In the last stretch I picked up the pace, the air crisp, and I felt myself float up off the ground. The world became greenish. The brightness of the snow and the trees intensified. I was almost giddy. Behind the bright flat horizon of the treescape, I understood, were worlds beyond our everyday perceptions. My mother was out there, inaccessible to me, but indelible. The blood moved along my veins and the snow and trees shimmered in greenish light. Suffused with joy, I stopped stock-still in the road, feeling like a player in a drama I didn’t understand and didn’t need to. Then I sprinted up the driveway and opened the door and as the heat rushed out the clarity dropped away.
I’d had an intuition like this once before, as a child in Vermont. I was walking from the house to open the gate to the driveway. It was fall. As I put my hand on the gate, the world went ablaze, as bright as the autumn leaves, and I lifted out of myself and understood that I was part of a magnificent book. What I knew as “life” was a thin version of something larger, the pages of which had all been written. What I would do, how I would live — it was already known. I stood there with a kind of peace humming in my blood.

A non-believer who had prayed for the first time in her life when her mother died, O’Rourke quotes Virginia Woolf’s luminous meditation on the spirit and writes:
This is the closest description I have ever come across to what I feel to be my experience. I suspect a pattern behind the wool, even the wool of grief; the pattern may not lead to heaven or the survival of my consciousness — frankly I don’t think it does — but that it is there somehow in our neurons and synapses is evident to me. We are not transparent to ourselves. Our longings are like thick curtains stirring in the wind. We give them names. What I do not know is this: Does that otherness — that sense of an impossibly real universe larger than our ability to understand it — mean that there is meaning around us?
[…]
I have learned a lot about how humans think about death. But it hasn’t necessarily taught me more about my dead, where she is, what she is. When I held her body in my hands and it was just black ash, I felt no connection to it, but I tell myself perhaps it is enough to still be matter, to go into the ground and be “remixed” into some new part of the living culture, a new organic matter. Perhaps there is some solace in this continued existence.
[…]
I think about my mother every day, but not as concertedly as I used to. She crosses my mind like a spring cardinal that flies past the edge of your eye: startling, luminous, lovely, gone.
The Long Goodbye is a remarkable read in its entirety — the kind that speaks with gentle crispness to the parts of us we protect most fiercely yet long to awaken most desperately. Complement it with Alan Lightman in finding solace in our impermanence and Tolstoy on finding meaning in a meaningless world.
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Thursday 30 October 2014


Rapid Recent Rise in Modafinil Use

Pauline Anderson
March 22, 2013

Prescriptions for the narcolepsy drug modafinil have rapidly increased in recent years, and most of this increase is due to off-label use, according to a new study.


Many drugs are used off label, but the expansion of modafinil within a relatively short period of time is "striking," said Dr. Claman.

The study appeared in a Research Letter published online March 18 in JAMA Internal Medicine
 

15-Fold Increase

Using the National Ambulatory Medical Care Survey, a representative sample of ambulatory visits, researchers examined modafinil use from January 1, 2002, to December 31, 2009.

During that period, the number of patients receiving modafinil increased almost 10-fold, from 57,768 to 555,691. 
On-label use increased by less than 3-fold, but off-label use (where there was no on-label diagnosis) increased more than 15-fold.

Across all years, 89% of patients prescribed modafinil did not have an on-label diagnosis. 

Patients with depression accounted for 18% of all modafinil prescriptions, and those with multiple sclerosis, 12%.

The study found an association between modafinil use and several off-label indications, including MS (odds ratio [OR], 84.6, 95% confidence interval [CI], 50.0 - 143.0), Parkinson's disease (OR, 19.4; 95% CI, 6.7 - 56.1), chronic fatigue syndrome (OR, 23.4; 95% CI, 4.6 - 118.0), depression (OR, 10.8; 95% CI, 6.0 – 19.5), and attention deficit/hyperactivity disorder (ADHD) (OR, 5.4; 95% CI, 2.3 - 12.6) relative to the absence of a given diagnosis.

According to the authors, the association between modafinil and depression and MS is especially noteworthy given that the trials on which the US Food and Drug Administration (FDA) approved the drug excluded patients with these diseases.

Patients treated by psychiatrists (OR, 21.1) and neurologists (OR, 19.7) had higher odds of receiving modafinil relative to primary care physicians and other specialists, the study found.

Altogether, 45% of patients receiving modafinil were also receiving an antidepressant, whereas 15% were also receiving a benzodiazepine and 6% an amphetamine.

The authors noted that the clinical trials of modafinil excluded antidepressant and benzodiazepine use.

The authors noted that the company that markets modafinil, Cephalon Inc, was sued by several US states for promoting modafinil for off-label indications and agreed to a settlement in 2008. 
That marketing might explain some of the increase in off-label use, but there was still a substantial increase in use after the case was settled.

Dr. Claman speculated that drug companies are now "better at staying within FDA-approved guidelines" for marketing.

Although the paper raises the concern about the increased off-label use of modafinil, it doesn't determine whether this is a "big concern" because of drug interactions and adverse effects or a "small concern" in that it seems to be well tolerated, said Dr. Claman.

To help address that question, Dr. Claman advocates what he calls a "post drug release registry" of patients taking modafinil for nonapproved indications that could be administered by the FDA, pharmacies, or the drug company itself. 
Such a registry, he said, would provide better information about adverse-effect risk profiles in the "real world" that were unavailable with the more restricted and limited FDA studies.

Increase Not Surprising

For sleep expert Merrill S. Wise, MD, Methodist Health Care Sleep Disorders Center, Memphis, Tennessee, who is on the board of the American Academy of Sleep Medicine, the rapid increase in prescriptions for modafinil is not surprising.

"While I confine my clinical use of modafinil almost exclusively to FDA 'on-label' indications, I see patients with some regularity who come to me already receiving modafinil or the newer form, armodafinil, for sleepiness in association with depression, multiple sclerosis, chronic fatigue syndrome, and several other conditions."

Clinical trials that include patients with depression and MS taking modafinil or armodafinil for sleepiness would be helpful, said Dr. Wise.

"Patients and healthcare providers would benefit from additional data regarding adverse side effects and reactions to modafinil in these patient groups. In particular, we would benefit from having a clearer understanding of which individuals are at increased risk for allergic/hypersensitivity reactions to modafinil."

Reports indicate that the FDA did not approve modafinil in children partly because of rare reports of a serious skin rash.

Dr. Wise noted that the research letter does not address the presence or extent of "drug diversion" or selling modafinil to nonpatients. "

Although this is theoretically a contributor to the increase in off-label use, there isn't much evidence of modafinil being a popular drug of abuse, and laboratory animal studies don't suggest much tendency for addiction."

It could be argued, though, that modafinil is a safer than traditional stimulants and certainly a lot safer than abusing illicit substances such as cocaine, he said.

Another sleep specialist, Marc Raphaelson, MD, medical director, SleepMed, Washington, DC region, is also not surprised at the increasing off-label use of modafinil. Much of this can be attributed, he said, to the fact that there is no approved treatment for the "enormous" number of people with idiopathic sleepiness or hypersomnolence.

"There are a lot of people who are sleepy but don't meet the strict diagnostic criteria for narcolepsy, so anything you treat them with is going to be off-label," said Dr. Raphaelson.

"It's not that doctors are throwing drugs at people who don't need them; it's that we have people with real, severe sleepiness, we can't get an exact diagnosis, there's no on-label therapy, and we're not just going to send them home to have car crashes," he said.
Dr. Raphaelson also noted that some patients develop tolerance to stimulants typically used for ADHD.

The study was supported by a grant from the National Institutes of Health/National Heart, Lung, and Blood Institute. Dr. Claman, Dr. Wise, and Dr. Raphaelson have disclosed no relevant financial relationships.
JAMA Intern Med. Published online March 18, 2013. Abstract



Sepsis Spleen machine vs antibiotics New develpoment


An extracorporeal blood-cleansing device for sepsis therapy

Nature Medicine
doi:10.1038/nm.3640
Received
Accepted
Published online

Abstract


Here we describe a blood-cleansing device for sepsis therapy inspired by the spleen, which can continuously remove pathogens and toxins from blood without first identifying the infectious agent.

Blood flowing from an infected individual is mixed with magnetic nanobeads coated with an engineered human opsonin—mannose-binding lectin (MBL)—that captures a broad range of pathogens and toxins without activating complement factors or coagulation.

Magnets pull the opsonin-bound pathogens and toxins from the blood; the cleansed blood is then returned back to the individual. 

The biospleen efficiently removes multiple Gram-negative and Gram-positive bacteria, fungi and endotoxins from whole human blood flowing through a single biospleen unit at up to 1.25 liters per h in vitro

In rats infected with Staphylococcus aureus or Escherichia coli, the biospleen cleared >90% of bacteria from blood, reduced pathogen and immune cell infiltration in multiple organs and decreased inflammatory cytokine levels. 

In a model of endotoxemic shock, the biospleen increased survival rates after a 5-h treatment.

At a glance

Figures

left
  1. Magnetic opsonin and biospleen device.
    Figure 1
  2. Magnetic capture efficiency of the biospleen device in vitro.
    Figure 2
  3. In vivo blood cleansing using the biospleen blood-cleansing device in a rat bacteremia model.
    Figure 3
  4. In vivo blood cleansing using the biospleen device in a rat acute endotoxic shock model.
    Figure 4
right

Read the full article

Supplementary Information links

Video

  1. Video 1: The fabrication and the magnetic separation principle of the biospleen: (2.6 MB, Download)
    Schematic drawing and microscopic video showing how the biospleen device is fabricated and how the magnetically opsonized pathogens are separated from the blood channel under flow. 
    Because it is difficult to observe the cell movement across the blood channel in the biospleen device, we demonstrated this in a microfluidic device fabricated from optically clear poly(dimethylsiloxane) (PDMS). 
    To mimic pathogens captured by the magnetic opsonins, fluorescent magnetic particles (8 μm, 1.1g ml–1, UMC4F, Bang Laboratories, Inc., IN, USA) were spiked into human banked blood (1ml) and flowed at 10 μl min–1.

    PDF files

  2. Supplementary Text and Figures (8,828 KB)
    Supplementary Figures 1–5, Supplementary Table 1

 

 

 

Thursday 17 July 2014

Light Up Your Life- Sleep / Wake Tips For Better Sleep Hygiene. It could save your life

LIGHT UP YOUR LIFE

12 tips for a better day’s light and a better night’s sleep

- Get up and go to bed at the same time every day, even at weekends
- Open your curtains each morning and embrace the day, not your privacy
- Spend time outside by day and take the whole family with you, young and old
- Don’t draw the blind
- Try to work by a windowa room with a view isn’t just a good novel
- Play video games by day, not at night
- Buy an extra desk lamp
- Have a romantic dinner with the lights dimmed
- Don’t use your computer or tablet for two hours before bedtime
- Install f.lux software on your computer. It’s a free program that cuts blue glare later in the day
- Make your bedroom dark or sleep in a face mask
- Turn off the light half an hour earlier. 

It could save your life
Rosie Blau is an associate editor of Intelligent Life


THE LIGHT THERAPEUTIC

Research suggests that light looms as large in our well-being as sleep. Rosie Blau consults experts in California and Japan
From INTELLIGENT LIFE magazine, May/June 2014

Every summer when he was a boy, Satchin Panda would stay on his grandparents’ farm near Chandipur on the east coast of India. He lazed in a hammock, caught fish in the lake and climbed trees to pick mangoes. His grandfather spent most of his 91 years there, working on his 20-acre plot. He produced almost everything his wife and eight children needed. They cooked whatever he grew; they bought salt and sold a little rice. “He did that for his entire life,” says Panda. “He travelled more than 100km from his home perhaps eight or nine times.”

Panda’s home now is thousands of miles awaya four-bedroom house on the edge of a canyon near San Diego, California. He lives off his mind rather than his muscles and regularly jets around the world for work. “If I’m within a five-hour flight of India,” he says, “I go and see my Mum and my sister.” But the shift is more profound than one of geography. Panda commutes by car, works in a basement and spends most of his leisure time between four walls too. Within two generations, he and his family have moved inside out of the daylight, from rising with the sun to being woken by an alarm, from ending their day near dusk to choosing how lateand how bright—to make their night.

For most of human history we have marked time by the solar cycle. We evolved to spend hours outside every day; bedtime came soon after sunset and the night was black. Now most of us pass our waking hours inside offices, factories, schools, shops, hospitals and nurseries, in cosy but often dim rooms with sealed windows and little natural light. Then, as day starts to fade, we flick a switch and bring it back. Compared with the past, our working hours are gloomy and our nights dazzling. 

We have been slow to recognize the positive link between light and health. Over the past 40 years the sun has been the enemy: the medical establishment has warned us off the ultraviolet rays that contribute to skin cancer. But now scientists have a new worrythat getting too little daylight may also do long-term damage to our health.
Satchin Panda (right) is one of these scientists. A professor of molecular biology, he works at the Salk Institute for Biological Studies in La Jolla, California, where he does research on the body clock that every living being has inside them. “My grandpa was almost religious about taking an hour’s nap by day,” says Panda. “He slept nine to ten hours a night.” Such habits would be inconceivable for Panda himself. But he is far from complacent about the contrast between their lives: he fears that when we override the light-dark cycle of the natural world, we are disrupting the internal workings of the human body. By robbing ourselves of daylight we may be losing something more fundamental.



Moving off the land and lighting up the night have been integral to the narrative of human progress. When people first domesticated fire they changed their lives for ever: day did not end at sundown. They enlivened dark caves, and later lit homes with candles and oil lamps. After the incandescent bulb was commercialized in the 1880s, some feared electricity as a silent, god-like force that might bend the laws of nature. Others clamoured for the bright, white, steady filaments that burned reliably even when the fickle sun did not. Less than a century and a half on from Edison’s eureka moment, we live in a 24-hour society unimaginable without such brilliance.

The illumination of the world has brightened our lives in more ways than the simply physical. Now we can watch the news, work on our laptops, make a Facebook friend, play video games, eat pancakes, buy shoes or download a novel at any hour of the day or night. We are undaunted by the rising or setting of the sun. Now we are all masters of the light.

One consequence is that we sleep less and less. A few hundred years ago, we probably conked out for up to ten hours a night, depending on the season. When researchers give people the opportunity to rest as much as they want over a few months, most young adults eventually stabilize around 8.5 hours, older people a little lower. On average Americans sleep about 20% less than a century ago, according to the National Sleep Foundation, and a third have six hours or fewer. These trends are repeated across the developed world.
This matters. If we don’t sleep, we die. Literally. Rats kept from sleeping drop dead within weeks. Being tired makes us less productive, more forgetful and apt to make mistakeshuman error in the wee small hours contributed to the Exxon Valdez oil spill, and the Chernobyl and Three Mile Island nuclear accidents. Sleep affects the body’s internal workings too. It enhances our immune system, so that, when deprived of it, we are not only liable to catch a cold, but also more susceptible to some types of cancerand if we already have cancer it will probably grow faster. We are more likely to have heart attacks or become depressed. We over-eat when tired, and because our metabolism alters too, we are far more prone to obesity and diabetes.
We also inflict these ills on our children: worldwide they sleep for an estimated hour and 15 minutes less each school night than a century ago; in America only a third of high-school students get at least eight hours on a week-night. But whereas tired adults are sluggish and lethargic, kids become hyperactive and distractiblewhich may be one reason that more than one in ten children in America are now diagnosed with attention deficit hyperactivity disorder, the symptoms of which are remarkably similar to sleep deprivation. What would be the effect if, rather than popping pills, we sent them outside to play each morning and put them to bed earlier?

The medical benefits of sleep are well established but the science of light is much newer. We have only recently started to notice the benefits of boosting our light exposure by day and asked why they occur. Some consequences are fairly predictable: in brighter environments we are more alert, complete visual tasks better and make fewer mistakesa study of call-centre workers in Sacramento found that those with a good window view from their workstation processed calls 6-12% faster than those without. Other responses are more surprising. In 1999 consultants studied an unidentified retail chain in America with 108 similarly laid out stores in a single region and found that people spent 40% more in the shops with skylights than in those lit only by electricity.

What is most startling is the way our bodies respond to light.
Gloomy winter days are known to trigger a form of depressionseasonal affective disorderwhich can be reversed if the sufferer sits by a large lightbox every morning. 
But light eases other forms of depression too: an Italian study found that bipolar patients in east-facing hospital rooms stayed nearly four days fewer than those in west-facing ones.
Even physical conditions respond to doses of daylight: people recuperating from spinal and cervical surgery in bright rooms took fewer painkillers every hour; in sunny Alberta in Canada female heart-attack patients treated in an intensive-care unit recovered faster if they were exposed to lots of natural light.
Mortality in both sexes is consistently higher in dull rooms. 
But why is it a matter of light or death?
 


“You don’t hear a psychiatrist asking how much light you get,” Satchin Panda tells me, sitting beneath cluttered bookshelves in his lab office at Salk. Crazily for a man who works on such things, his laboratory is two storeys below street level. But this is California, and on bright days like today rays pour in through a lightwell large enough to fit a ping-pong table (“we don’t really use it,” he says).
Light is such a new field of study that its medical contribution is still very much in question. But Panda is convinced. “It affects so much of our psychology, physiology and mood. But we take it for granted,” he says, dark eyes gleaming behind heavy glasses as he starts to range over how the science of light applies to all our lives.

We “need” light, he argues, because it affects our body clock. Animals kept in the dark all day, humans included, will wake and sleep at precise intervals over a 24-hour period. 
This indicates that an internal clock controls the sleep-wake cycle. (That’s why we get jetlagthe body remembers the time.)
Crucially, though, this circadian pacemaker also responds to the environment, especially light and dark.

Panda laughs at me as I fire off queries: how much light do we need; does it matter if it is natural or electric; does getting lots of light on one day compensate for less on another; what could be the long-term effects of spending our days in drab rooms?
“These are very interesting questions,” he says, shifting about on his chair. But we simply do not know the exact answer to most of them. 
“It’s an area of research that falls between the cracks.”

Partly thanks to Panda, though, we at least know quite a lot about how light affects our body clock. When it comes to the internal clock, some types of light are more equal than others.

The eye perceives three main colours in light: red, green and blue, each vibrating at a different wavelength.
In the morning, high concentrations of blue occur naturally; by dusk we are left mostly with green and red.
The blue light has the greatest impact on our circadian system, telling the brain that it’s morning and time to be alert, and setting our clock for the day. That is important because we sleep soundly, and our brain and body function better, when the internal signals of the body clock are in sync with external cues of day and night.

The problem is that artificial light does not replicate the colours of the natural world. Much electric light has high intensities of blue, so it deceives our brains into thinking that it’s daytime even when it isn’t. Just ten minutes of regular electric light can make some changes to our internal clock. “We evolved to be blue-sensitive, we need it,” says Panda.
But many of us get an awful lot of it, particularly in the evening: when we get home we spotlight the kitchen so we can make the dinner, and then plug into our laptops, tablets or smartphones, which beam blue light into our eyes at close range.
So we bombard our internal clock with mixed messages: our gloomy morning sends a weak signal to be alert; our over-bright evening shouts at our brain to rise and shine. We also lessen the contrast between light and dark that our circadian system relies on to work well. All of which makes us more prone to insomnia or disturbed sleep in some way.

Panda has assembled these ideas into strict rules for himself. 
  •  He rarely watches television and never checks his e-mail after 9pm (“it’s always bad news and deadlines”);
  •  he eats three small meals a day, and takes a photo of everything he consumes (food helps synchronise our clock too);
  •  the layout of his home is “close to ideal for circadian health”. He knows this because he monitors his surroundings all the timehe points to a small black disc on his wrist that at first glance looks like a plastic watch: it is a sensor, which has been recording how much light he gets every 30 seconds for the past 18 months. He wears it day and night, except in the shower: “It says it’s waterproof, but I don’t trust it,” he says, laughing.
His biggest contribution as a scientist has been to discover that a particular receptor senses blue light and tells our brain when to nod off and when to sharpen up.

The likelihood of such a photoreceptor was suggested in 1923, when an American geneticist, Clyde Keeler, noticed that even the pupils of blind mice contract in response to light.
They could not see it, but it had some kind of non-visual effect. Scientists had since identified seven or eight different receptors that might be responding to light in some way, but no one had pinpointed the exact one.

It took Panda a year to construct an artificial segment of DNA with the embryonic stem cells that blocked one of these receptors, melanopsin. He handed it over to a lab technician just before he returned to India to get married in 2001. It took another year to breed a single blind mouse that lacked the specific receptor, and then he really got going. “It was the middle of the night and we had our experiment. And there it was: mouse number 1626 did not entrain [respond] to light.”

All the other blind mice changed their waking times when exposed to a different light-dark cycle, but Panda’s single melanopsin-free mouse did not. His voice lifts. “I knew that this was going to change something,” he says. “I had this cocky feeling that I am the only one in the world that knows this. If you get that kick three or four times in your life, that’s enough.”

He later repeated the experiment with more mice. He even left the bedside of his wife and sleeping newborn daughter when she was hours old, because he had “messed up” the timing and needed to switch on the lab lights over the mice. (“I didn’t tell my wife about that for some years.”) And he was right about the receptor: every animal has melanopsin“even the blind catfish”which registers blue light and helps to reset and synchronise the biological clock on a daily basis.

“We closed a 75-year-old mystery.”

Last summer an international group of scientists (including Panda), doctors, ophthalmologists, architects and engineers gathered in Tokyo, all animated by the same question: how light affects health. That first meeting of the Blue Light Society was convened by Kazuo Tsubota, professor of ophthalmology at Keio University School of Medicine in Japan.
After years of research, he had concluded that only if different disciplines collaborate can we adjust the way we live to the needs of the circadian system.

“Some people don’t like this idea. It is like big tobacco,” Tsubota tells me. “They ask you to prove that there is a health hazard. The tobacco industry has been fighting that proof for years, and I can see the same with this.” We have to learn how to live with blue light, for good and for ill, he says.
In contrast to cigarettes, “blue light is not the bad guy. But you shouldn’t have it all the time.”

Tsubota’s ambition as an ophthalmologist is “to protect the eye for this long-lived society”. We all know that our eyesight fades with agewhat he calls “the eye as a camera”but “the eye as a clock” does too. As we get older, our lens yellows, so less light reaches the receptor at the back of the eye to tell our brains what time it isand we need more daytime rays to reset our body clock. “At 58 years, my lens is a third as good at receiving blue light as the 20-year-old lens,” says Tsubota, who talks with a wide smile and waving hands.

“In order to have a proper amount of light, I have to play outside three times as much as a 20-year-old boy,” he says and laughs. “That gives me a good excuse to ski, go swimming, jogging.”

Tsubota says he is motivated by gokigen, meaning a life filled with happiness.

This is not idle chat, he insists.
Happiness is one of three things that help to stave off the depredations of age, along with diet and exercise.

His remedy is not to sing and laugh, or even to get rich or get married, but to sleep: “It has almost the same beneficial effect on health as smoking has a bad one.” And getting a good night depends on having the right amount of light at the right time of day.

Much of his research focuses on his own cataract patients.
After a cataract operation, people usually have fewer falls, their mood lifts and they think more sharply. Tsubota also found that his patients’ sleep “dramatically improved”. 
He believes many of the other benefits of the operation flow from this: “The surgery replaces the opaque lens and suddenly 90% of the blue light is received, you are like a five-year-old. 
So cataract is a treatment for the clock as well as the camera.”

While lack of light can be a problem for some, for others the headache is that we get too much by night, says Tsubota, particularly blue light. 
This is particularly so for those of us interminably glued to radiant, luminous screens only a foot or so from our eyes. For tech junkieswhich is most of us these daysTsubota has helped to develop “PC glasses” that cut 30-50% of the blue light reaching the wearer’s eyes.
“The idea is that we can wear these for protection, not just for myopiajust as we wear shoes to protect our feet.” The glasses are slimline, slight on the nose and come in 15 frames and 16 colours, with a faint yellow tinge to the lens. They are marketed as cool accessories: one advert for them features manga characters wearing the shades, another shows a young courting couple. 
Since 2011 Jins, a regular spectacle-maker, has sold more than 3m pairs of them at ¥3,990-5,990 (£23-35) a piece.
Tsubota’s team is now working on the next creation: light-protecting contact lenses.
 

Teenagers the world over should be cheering on the work of Mariana Figueiro (below), an expert on light and health at Rensselaer Polytechnic Institute in upstate New York.
In 2012 she found that when a group of young adults used an iPad for two hours before bedtime, they suppressed their production of melatonin, a sleep-promoting hormone. 
The media focused on the obvious conclusion: that using such backlit devices ruins our sleep. But Figueiro draws another inference too. 
Because they blast us with blue light, these same backlit items could act as light therapy by day to help invigorate us and reset our clock. 

She may be the first person to prescribe an hour playing “Angry Birds” each morning as a solution to our ills.

Figueiro is an unlikely hero for the American teen.
Born in Belo Horizonte, one of Brazil’s largest cities, she trained as an architect“I thought it seemed charming”and in 1996 moved to Troy, New York, because her husband wanted to do an MBA. To fill her time she embarked on a master’s at Rensselaer; for her thesis her supervisor suggested she look at how shift workers in the local neo-natal unit functioned in different light levels. It was a serendipitous choice. “It got me busy, and it got me started,” she tells me. “And I became infatuated with research.” At the end of the year Figueiro’s husband returned to Brazil. She stayed in Troy.

We are bad at judging how much light we get, says Figueiro, relaxing as she moves from talking about herself back to her research. “Our visual system fools us a lot.” There is plenty of daylight even on an overcast, grey day. “But we think a television is a lot of light because it is from a single sourceand we often work in offices that seem bright but give us too little light.”

We need more light to synchronize the circadian system than we do to see.
The upside of this is that you can turn on a lamp to go to the bathroom at night and not immediately crash your biological clock.
The downside is that most of us have no idea how our light exposure varies between home and outdoors. A study of a group of Colorado campers found that they got four times as much light on a summer holiday in a mountainous desert as they did at home, and their melatonin levels rose two hours earlier.

Daylight is not intrinsically better for us than electric light, Figueiro says. It’s just that getting artificial light to do the same job “is more expensive, uses more energy and is more difficult to get right”. But getting it right is exactly what she’s aiming to do. 

Sleep disturbances magnify as we age: anything from 40% to 70% of people over 65 have serious problems dropping off, wake up often at night or struggle to keep their eyes open by day. 
Disrupted sleep often accompanies a general decline in our physical condition and immunity, as well as depression and other ills. 
Most of us assume this is just part of getting old.
Not Figueiro. 
She reckons more exposure to bright light by day could help keep the doctor away.

She has created a lighting system specially for residential homes.
If elderly people get two hours of morning sun every day for two weeks, their sleep improves; some research shows benefits even sooner.
Yet most people see a fraction of that: one study found that middle-aged adults get about an hour of bright light a day, older adults in assisted-living facilities about half that, and those in nursing homes only two minutes. 
So Figueiro has experimented with adding bright lamps to TV screens, wheelchairs or sofas in the morning. Alzheimer’s patients can be hard to treat, she says, because they don’t reliably stay in one placebut everyone eats, so you can make a dining table a lightbox. 
Residents slept better when she tested this lighting scheme at an assisted-living facility in Troy. Other old-people’s homes are introducing similar ones.

Figueiro is now working with the American navy on how much light submariners need to be sharp, productive and healthy at the bottom of the sea.
Blue light might be used to help drivers and pilots stay awake at the wheel, she says. And as for the backlit gadgets that wreak such havoc with our night, she argues these should be made more circadian-friendly. Like many working in this field, Figueiro says she doesn’t “do electronic devices before bed”. But such products could be programmed to our daily schedules so they radiate less blue light later in the day. “It’s possible,” she says. “Why not?”

There are plenty of technical answers.
But her best advice for a good day’s lightand a good night’s sleepinvolves no machines. “Wake up and go for a walk in the morning,” she says. “Every morning.”

In America, the advisory committee that sets the light standard for architects focuses on having just enough illumination to perform a task, says Frederick Marks, a Los Angeles architect: “People do not think about health.” He is a founding member of the Academy of Neuroscience for Architecture, a group of scientists and architects looking at how buildings affect our behaviour and well-being.

This question is becoming urgent, Marks tells me, speaking slowly, deliberately, as if lecturing a class of students. 
As urbanization continues apace, ever more of us will live in high-rises, where “the opportunity for natural light is often not that good”. Even where light is abundant, many of us draw our blinds to stop people peeking in or to avoid glare. Thermostats are now fitted as standard in homes. A light sensor costs less than a carbon-monoxide monitor, says Marks, “but no one has them”.

Measuring light is only one part of the solution. The other is making better use of what we’ve got. Marks is keen on a new kind of glass“electrochromic glazing”which can be transparent or translucent depending on the brightness of the sun. So far people have used it to save on air conditioning and deflect blinding rays, he says, but you could equally apply large plates of it to enjoy more natural light.

Artificial lighting can also be manipulated. The lights we dazzle ourselves with by night have got brighter in the past ten years, as we replace incandescent bulbs with more intense light-emitting diodes (LEDs). At the moment these leds have all three types of light within them: red, green and blue. 
These can be programmed, as a visit to any nightclub will confirm. So our homes could mirror the natural world, with shining blue in the morning, and gentler reds and greens later. You can already set your sprinklers or security systems from your phone. Why not your lights?

In addition to light and dark, the body clock also responds to the direction of rays and movement in a scene (which is why glittering, windowless casinos are so disorientating). Within 20 years, Marks reckons many of us will have a digital, programmable wall in our homes or workplaces. Depending on our taste, our mood or the time of day, we might choose to project a Thai beach with towering palm trees, a vista over sunny mountain peaks or a taverna under a twinkling sky. “You interact with what you see and what you see interacts with you,” says Marks. The lighting is on the wall.

Consider the whole span of human life on Earth as a single day and the light switch was flipped on less than a second ago. Piccadilly Circus, Times Square and Shibuya have only just started to shimmer; the iPad has been glowing for well under a nanosecond.

Work-hard, play-hard cultures both prize the hours stolen from the night. The question is how we manage our health in a 24-hour society. If we know how much light we need and make sure we get it, we may live better, longer and more happily. “Getting the light wrong isn’t something that produces an acute or immediate problem,” says Satchin Panda, “It’s not like flunking an exam.” 
But in the long run we may gradually realize that it’s too late to correct something that has been going wrong for years. “It’s like a chronic disease.” Returning to the savannahor even his grandfather’s farmis no solution, he says.

“But what if you can change a light bulb and change your life?”


LIGHT UP YOUR LIFE

12 tips for a better day’s light and a better night’s sleep

- Get up and go to bed at the same time every day, even at weekends
- Open your curtains each morning and embrace the day, not your privacy
- Spend time outside by day and take the whole family with you, young and old
- Don’t draw the blind
- Try to work by a windowa room with a view isn’t just a good novel
- Play video games by day, not at night
- Buy an extra desk lamp
- Have a romantic dinner with the lights dimmed
- Don’t use your computer or tablet for two hours before bedtime
- Install f.lux software on your computer. It’s a free program that cuts blue glare later in the day
- Make your bedroom dark or sleep in a face mask
- Turn off the light half an hour earlier. It could save your life



Rosie Blau is an associate editor of Intelligent Life
Illustrations Andy Gilmore